Simon Harris’ five-point plan all verbiage, say medics

The health minister’s five-point plan to tackle record waiting lists has been described as “verbiage” and “short-term” at a time when the health service has suffered such reputational damage that doctors and nurses no longer want to work here.

That’s according to consultants, nurses’ representatives, and opposition politicians, who all called for sustained investment in health.

The latest hospital waiting list figures show almost 530,000 patients waiting for treatment or checks at the end of July. More than 430,500 of these patients were waiting to be seen at an out-patient clinic and 77,800 were on the list for in-patient, or day case care. Another 19,700 are waiting for a gastrointestinal check.

Under his plan, minister Simon Harris has pledged to halve the numbers waiting for procedures for more than 18 months by year-end. However, that figure equates to approximately 3,500 patients — a drop in the ocean compared to the overall waiting list figures.

The National Treatment Purchase Fund (NTPF), a Fianna Fáil creation, has been reinstated to help tackle the waiting lists and hospitals have been ordered by the minister to draw up action plans outlining what can be done to reduce waiting times by the end of the year. Clinicians are also being instructed to validate waiting lists and the special delivery unit (SDU) is being tasked with implementing a waiting list improvement plan which individual hospital groups must devise.

While €50m has been being earmarked for waiting list initiatives, that money is not available until 2017.

Leading eye surgeon, Prof Michael O’Keefe, said: “This is all verbiage really, I’ve heard it all before.” He said public hospitals are “inefficient and ineffective”.

Emergency medicine consultant Fergal Hickey said the health service has suffered such reputational damage over the years through stripping of resources that doctors no longer want to work here.

“There were probably 20 jobs [emergency medicine posts] advertised with no applicants,” he said.

The Irish Nurses and Midwives Organisation (INMO) said HSE figures confirm there are almost 3,500 fewer nursing/midwifery posts in the public health service today compared to 2009.

Mr Harris said: “No one announcement is going to fix everything, and that’s why we have to have a 10-year plan.

“But I have no intention of being inactive on this. It is going to take a period of time. My job is to make sure we come at this from all angles.”

Tackling inpatient care lists

What Simon Harris says: There will be a 50% cut in the number of people waiting more than 18 months for inpatient care by the end of this year.

What does this mean: Like ex-ministers Mary Harney, James Reilly, and Leo Varadkar, Simon Harris has potentially signed his own ministerial death warrant by promising a significant waiting-list cut.

However, unlike his predecessors, the details behind the spin indicate Mr Harris can achieve what he has set out — mainly because it is far less significant than an initial glance suggests.

Currently 530,000 people are on waiting lists, a rate that at one in every nine people in Ireland is extraordinary for a country of 4.5m people.

However, Mr Harris’s first step in the five-point plan will be focussed on just 7,000 inpatients, meaning only 3,500 people need to be treated for it to be a success.

Compared to claims to “end the scandal of patients on trolleys” it is achievable, if far from the most difficult of tasks set out.

Tackling waiting lists

What Simon Harris says: A “clinical validation” of all waiting lists will be completed this month to ensure urgent cases are treated first, no one is on more than one waiting list, and that treatment decisions are made by hospitals “not bureaucrats or ministers”.

What does this mean: As doctors and nurses unions have said, knowing what the problem is is not the problem — putting resources in place to solve it is.

The aim of the “clinical validation” process is to allow the HSE to highlight where logjams exist, allowing targeted funding to be found.

However, while laudable, this process has previously been tried through, the National Treatment Purchase Fund (Mary Harney), special delivery unit (James Reilly), and emergency department taskforce (Leo Varadkar) with each failure showing Ireland’s waiting list crisis is more complicated than simply identifying the issue.

What will happen?

What Simon Harris says: By the end of this month the HSE will give the Department of Health specific plans to improve various hospitals’ waiting lists, including advice on how additional funds will be spent.

What does this mean: The move is meant to dovetail with the “clinical validation” process taking place and will allow the HSE to specifically outline where problems exist and what is needed to address them. Crucially, this will also include advice on how exactly the €50m ring-fenced fund for “waiting list initiatives” announced by Mr Harris will be spent next year, in addition to the €15m NTPF fund and €40m in home help packages to speed-up patients’ departures from hospitals.

In theory, the plan benefits patients. However, it also benefits Mr Harris as any controversial choices on giving money to one hospital while ignoring another will be based on HSE advice — not his own.

Hospitals face beefed-up inspection regime

What Simon Harris says: Officials from the special delivery unit will visit all hospitals to ensure planned reforms are being implemented.

What does this mean: In order to ensure the clinical validation and HSE report steps do not end up leading nowhere, the five-point plan will also see officials from the Department of Health’s special delivery unit check if reforms are being implemented.

Given the health service’s record, this is understandable and vital to guaranteeing improvements written in documents also take place in reality.

However, such a measure is hardly a radical new departure. In effect, it is a beefed-up version of what the Department and HSE officials are tasked with doing on a monthly basis.

Currently, the HSE outlines what progress is taking place in hospitals through its monthly performance monitoring reports, which give full statistical breakdowns of the state of the health service at any given time. This information is provided to the relevant authorities, in most cases hospital group managers and individual hospital chief executives, who are reminded of the local, regional and national policies in place to reduce problems.

Whether the SDU unit’s involvement in the visits will ensure the reforms are fully implemented or not will be key to Mr Harris’s plans.

Named officials to be responsible for improvements

What Simon Harris says: The special delivery unit will appoint an “improvement lead” for each hospital to help reduce waiting lists.

What does this mean: As previously reported last month, Mr Harris is seeking to ensure each hospital and hospital group has a named official responsible for guaranteeing the waiting lists improvements being sought take place.

The move, like many of the others outlined, is a logical step that makes sense.

However, like the other aspects of the plan, it is not a completely new initiative when it comes to the health service.

Both James Reilly and Leo Varadkar toyed with the idea of forcing HSE managers and hospital executives to be held responsible for serious problems at their facilities. However, in both cases the plans were only partially implemented because of difficulties in holding someone fully responsible for an issue more complicated than top-line figures suggest.

At a minimum, the benefit of the “improvement lead” co-ordinator role is that special delivery unit, Department of Health and HSE officials will have clear sight of who they need to speak to in order to get their points across.

However, as both Irish Nurses and Midwives Organisation general secretary Liam Doran and respected consultant ophthamologist Michael O Keeffe both said on RTE Radio yesterday, the ‘new’ plan is ultimately something they have seen too many times before.

— Fiachra Ó Cionnaith