Poor hospital administration ‘must be tackled’

Serious maladministration, identified in public hospitals where patients are skipping the queue at the expense of other possibly urgent cases, must be tackled immediately, Social Democrats TD Róisín Shortall has urged.

Ms Shortall, who chaired the all-party Oireachtas committee on the future of healthcare, said it was a matter of “serious concern” the hospital waiting lists could not be trusted and lacked fairness.

The co-leader of the Social Democrats was responding to significant shortcomings identified by a National Treatment Purchase Fund audit of hospital waiting lists.

“When you consider that public patients are already faced with long waits for outpatient appointments any further delay in adding them to a waiting list for treatment is indefensible,” she said yesterday.

“The absurd situation where public hospitals are given targets for maximising their private patient income clearly constitutes a perverse incentive that gives rise to queue jumping.

“In addition, the lack of legal accountability for consultants and hospital managers for their performance leaves the system wide open to abuse.”

The audit, commissioned by Health Minister Simon Harris, looked at a sample of 400 patient cases across five hospitals in Dublin and Cork.

Audits were undertaken in the Mater, Tallaght, Our Lady’s Children’s Hospital, Cork University Hospital — including Cork University Maternity Hospital — and South Infirmary Victoria University Hospital.

Evidence was found of long delays in the listing of patients and also the retrospective placing of patients on waiting lists.

Cases were found in all five hospitals where patients had bypassed the outpatient services and placed on a waiting list by a consultant.

The HSE said it was disappointed with the findings of the NTPF Audit of poor compliances with nationally accepted protocols for waiting list management.

Mr Harris said he had asked the NTPF to examine waiting list management practices in all of the other public hospitals and report back to him. He is committed to ensuring that lessons were learned by the health service.

The audit team found a number of patients across all of the five hospitals examined had bypassed the out-patient service by being placed directly on inpatient or day case waiting lists.

Differences were also found in the management of referrals to ophthalmology services, particularly for cataract surgery.

Some referrals from community ophthalmologists were accepted onto an inpatient and day case waiting list, bypassing the outpatient service, resulting in an inequity of access to treatment.

There was also “direct” listing of some patients in other specialities, including cardiology and orthopaedics.

In most of the hospitals audited, there were patients clinically prioritised as “urgent” who were waiting 12 months and more on the active inpatient and day case waiting list.

The audit team found there was no standard admission or booking form in any of the hospitals audited.

All of the hospitals audited have fully accepted the individual findings and agreed to implement the recommendations.

The HSE said work was already under way to ensure the recommendations were being implemented.

Mater Hospital

  • One in four patients were clinically prioritised as urgent, but three were waiting between 12 and 15 months, one was waiting 15 to 18 months, and six were waiting over 18 months.
  • There were inconsistencies in the management of direct referrals from other hospital consultants onto the inpatient and day-case waiting list with processing delays of more than seven months.
  • Clinical priority was not assigned to seven patients and was incorrectly entered for another two.

Cork University Hospital

  • Cork University Hospital (including Cork University Maternity Hospital) was told to stop restarting a patient’s date added to both the waiting and planned procedure lists.
  • There were 11 patients clinically prioritised as urgent. Six were waiting between 12 and 18 months, and five were waiting for over 18 months. Nine were listed under gynaecology.
  • Of the 31 booking forms reviewed, 23 did not have an indicative treatment date, and there was no evidence that 27 of 40 patients examined had been validated.

South Infirmary, Cork

  • Five of 11 patients referred via the outpatient’s department had no “date received” stamp on their referral letter.
  • Of 40 booking forms reviewed, six were not date- stamped and four patients were only added to the waiting list after the decision to admit was made.
  • A formal validation was only carried out in the last six months for one of 40 patients reviewed.
  • Three patients prioritised as urgent were waiting between 12 and 18 months.

Tallaght Hospital

  • Difficulty in establishing how booking forms for planned procedures were controlled.
  • Of 35 booking forms reviewed, 11 did not include start dates. Treatment year only indicated.
  • An examination of a random sample of 40 patients found no evidence of validation for 28 waiting more than a year on the inpatient and day case waiting list.
  • Twelve out of 40 patients reviewed who were clinically prioritised as urgent were waiting more than a year for treatment, with four waiting more than 18 months.

Crumlin children’s hospital

  • A patient whose clinical priority was revised from “routine” to “urgent” but this change in priority was not reflected in the patient administration system.
  • The patient remained triaged as routine at the time of the audit, which was nine months after the second booking form with the change in priority was completed.
  • The audit team found that 38 out of 39 admission booking forms had no “date stamp received” in the hospital’s waiting list office.


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