Waiting lists spark new form of inequality
The number of patients waiting for surgical procedures has gone up, not down. Over the past 15 years or so, there has been a progressive increase in the proportion of surgical procedures that can be performed as day cases have increased.
Due to advances in surgical and anaesthetic techniques and increased provision of day care facilities, a patient being added to a waiting list now may well be expected to be discharged on the day of surgery, whereas a similar patient in the past might have been expected to stay overnight.
The tiny reduction in the waiting list for inpatient admission for surgical procedures might well be explained by such reclassification of patients as day cases.
The reduction is offset by the greater increase in patients awaiting day case admission for surgical procedures.
It is not until the evening after surgery that it becomes clear whether these people are actually treated as day patients, ie, whether they are fit for discharge on the day of surgery. Thus the waiting list for surgical procedures has actually increased. However these data ignore the patients waiting for medical (non-surgical) procedures. When beds are closed as a result of financial restrictions the access of these patients to admission is reduced.
Some of these beds are now being reopened with National Treatment Purchase Fund (NTPF) money but this is not available for medical patients so it can be expected that the numbers awaiting medical treatment are increasing faster than those awaiting surgery.
The NTPF has introduced a new, pernicious form of inequality into the system.
In effect, patients requiring urgent admission, say for symptoms suggestive of cancer, are being denied treatment, because of closed beds, in favour of patients with non-life-threatening conditions, for which extra payments are being made.
If an individual clinician prioritised patients in this manner, it would be considered unethical. It is no less so when practised by the government.
The wait to see a consultant in the first place is not included in the waiting list figures. Compared to norms of other developed countries, we have far fewer consultants in most specialities.
The numbers of haematologists, neurologists, rheumatologists or endocrinologists are a small fraction of those in other EU countries.
Even including the numbers of patients awaiting their first outpatient appointment would underestimate the deficiency as consultant numbers are so low in some specialities that there is little point in referring many patients.
There is no neurology waiting list in the Midland Health Board, because there is no neurology service at all.
Thus the waiting list figures, which are increasing, understate the true deficiency in access to treatment.
Your improbable extrapolation over 20 years might more accurately have stated that if capacity is not increased, surgical waiting lists may have doubled by then, with the numbers awaiting other treatments having increased even more.
Waiting lists are not the only or even the most useful measure of the quality and performance, but they are among the most easily understood by the general public.
It is disappointing then that attempts are made to disguise the true situation by misrepresenting an increase in the numbers (despite the existence of a fund specifically designed to tackle waiting lists, even at the expense of more needy patients) as a decrease.
Gerard Crotty,
Consultant Haematologist,
Midland Health Board,
Tullamore,
Co Offaly.
