Simon Harris destined for failure with inept plan to tackle waiting lists
Analysis in the Irish Independent on 10 August 2016
As record numbers of people – more than half a million – wait for diagnosis and treatment, Health Minister Simon Harris has come up with ‘five specific actions’ to reduce hospital waiting lists.Less than three months in office, the minister took to the airwaves yesterday morning to outline his five-point plan. Harris declined to set a target for overall reduction in the numbers waiting, but his first action is to halve the number of adults waiting more than 18 months for inpatient treatment by the end of the year.
Under Fine Gael stewardship in 2011, the Government set a target that no one would wait more than nine months for inpatient or day treatment by September 2012. When it failed to reach this, new targets were set that no patient would wait more than 15 months.
Harris’s statement yesterday indicates that the 15-month maximum wait time target is now discarded. Halving the number of people waiting more than 18 months is as unambitious a target as could be set.
Next up, Harris promised to make sure waiting lists are accurate, that there would be “a clinical validation of waiting lists”. Validating waiting lists is generally newspeak for getting people off the list. It is set on the premise that there are people on waiting lists who don’t need to be there.
The minister said that from now on, doctors will look at the files of each person on the waiting list and check they need to be there. This fails to recognise that doctors put people on these lists in the first place.
The third action outlined by the minister is to ask the ‘Special Delivery Unit’ to oversee “the implementation of a waiting list improvement plan” for hospital groups. The fourth action is the appointment of an “improvement lead” to tackle waiting lists.
The Special Delivery Unit was set up by James Reilly in 2011 to reduce waiting times for public hospital patients. It had some initial success in reducing wait times but once the political attention was diverted and money dried up, waiting lists crept back up again and are now worse than they were then.
Since 2013, the Special Delivery Unit has been run down by this Government. Now it seems it is being reborn to oversee hospital groups’ plans to improve their waiting times, headed up by an “improvement lead”.
The fifth action is to ask the HSE for specific proposals for this year to reduce waiting lists. We are in the eighth month of the year and the minister asked the HSE, which oversees the growing waiting lists, to come up with waiting list reduction proposals. Let’s see that plan then.
There have been initiatives before to tackle the chronically long wait times in Irish public hospitals. In 1993, under Brendan Howlin, the then coalition government set up the waiting list initiative. In 2001, the PDs usurped Micheál Martin’s health strategy and pushed for the establishment of the National Treatment Purchase Fund. In 2011, James Reilly oversaw the establishment of the Special Delivery Unit to reduce waiting times for public patients. Each failed to deliver, as will Harris’s so-called “specific actions”.
Each of these had some initial successes but like the Special Delivery Unit in 2011, once the political eye is taken off the ball and the purse strings are tightened, they stop producing results. For example, contracting out the care of the longest waiters to private hospitals gets those people treated (and off the waiting lists) but it does not address the underlying causes of long waits in our public hospital system and diverts hundreds of millions in public money to private hospitals.
Repeatedly on yesterday’s ‘Morning Ireland’, Harris said that the HSE’s Service Plan is adequately funded since it got an extra half a billion after the Budget. What the minister omitted was that the HSE Service Plan is inadequate to meet population needs, so waiting lists will continue to grow while demand exceeds supply.
More resources and staff are needed to meet increasing needs. However, making improvements is not just about money. It is often about doing lots of small things differently, making slow, excruciating, much-needed change.
Such change includes having senior clinicians admit and discharge patients; this means making the health system attractive to recruit and retain high-calibre staff.
It requires more and better access to diagnostics and treatment outside of hospitals, often in primary care centres, delivered by GPs and nurses. This involves resourcing primary care.
Currently, the vast majority of hospital care is driven by emergency department admissions, often resulting in cancelled surgery and treatment. Only when these beds are protected from emergency department (ED) admissions will some progress be made in reducing waiting times for elective care.
But the urgent always trumps the important and hospital managers cancel treatment in order to free up space in overcrowded EDs as trolleys remain the political lightning rod.
Harris spoke about how we “clearly need targeted, funded actions”. There was not a clear target nor a funded action in yesterday’s non-announcement. There is €50m for next year – but not a cent for this year.
Harris’s actions broadcast yesterday are pure guff. If he thinks they will reduce the amount of time half a million people are waiting, his honeymoon in health is well and truly over.