Treatment provision - HSE targets eclipsed by EU decision

In a reaction to the public outcry elicited by television exposure, the Health Service Executive (HSE) has set itself a deadline of next November to eliminate the need for trolleys and chairs in accident and emergency units through the country.

It also intends to outsource some GP tests to the private sector in an attempt to cut the number of people waiting for diagnostics in hospitals, where they can experience undue delays.

The chairwoman of the HSE’s Accident and Emergency Task Force, Angela Fitzgerald, who announced the moves, said in almost the same breath that staff are working out of hours but that a debate was needed about traditionally negotiated agreements.

It is rather late to be having a debate on what is seen to be a solution to a crisis that has existed for years, long before the HSE metamorphosed from the old health boards.

If the deadline of November is realistic, the plan to bring it about would have been in place before now and debates on agreements would have been concluded.

As it is, this has the bearing of something that coursed from RTÉ’s embarrassing Prime Time television spectacle, which showed the totally unacceptable A&E situation, and the indignities attaching to them, in all its unadorned and shameful reality.

Those conditions existed long before they were the subject of the undercover programme, and have festered to become a national emergency — the description the Government has, belatedly, ascribed to it.

What could be far more important to the unfortunate people experiencing long hospital delays than the HSE’s expressed deadline to eliminate hospital queues — and which will certainly exercise the Government — is the judgment issued yesterday by the European Court of Justice (ECJ).

It found that patients on waiting lists for urgent medical treatment are entitled to be fully reimbursed for the cost of getting care abroad and, critically, did not require the authority of the relevant health board.

While the ECJ decision related to a British woman who was entitled to be reimbursed by the National Health Service (NHS) for her hip replacement in France, it is bound to have serious implications here.

Precisely, it said the determining factor in whether the patient was entitled to be paid for treatment obtained abroad was based on medical need, rather than on the paying body’s waiting list targets.

What the decision appears to have done is put the responsibility for the waiting period into the hands of a doctor to decide what is a medically acceptable time, irrespective of the fact that the procedure would be offered free by the State eventually on a long waiting list.

Because it could seriously shorten the wait far more quickly than has been the experience to date, the court judgment must be welcomed by anybody faced with an unacceptable delay.

Because of the financial factor, it will cause apprehension in Government circles as the ECJ rightly seems to put the treatment on the basis of a medical requirement rather than the exigency of political expediency.

To put the problem into perspective, there are about 30,000 people in this country waiting on lists for necessary treatments, although some are sent abroad under the National Treatment Purchase Fund.

Many have been waiting literally years to have their procedures carried out.