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A painful reminder of health service failings
[ by Niall Hunter, Editor www.irishhealth.com]
Some recent snapshots from our health service:
* There is only one specialist rheumatologist in Ireland dedicated to treating children.
* There is no dedicated paediatric immunologist in Ireland to treat children with immune deficiency.
* A consultant epilepsy specialist at a major hospital cannot take on any new cases due to existing lengthy waiting lists.
* The routine waiting time to get a public outpatients appointment to see the only ENT surgeon at Kerry General Hospital is currently six years and four months.
*Some patients,many of them in pain, have to wait five years or more for an outpatient visit to a consultant rheumatologist.
* The HSE's "target" maximum waiting time for an outpatients appointment in any public hospital clinic in any specialty is 90 days. The average waiting time for a public outpatients appointment across all specialties in all public hospitals is currently 161 days - nearly six months, or 71 days longer than the HSE's target wait.
*We have only half the number of neurologists we should have compared to international norms.
Waiting has always been a key component of Ireland's health system. We have traditionally had a shortage of consultants in many specialties and lengthy waiting lists to see consultants in outpatients.
While the public-private divide may to some extent explain lengthy waiting times in the public sector, a key problem has been, and still is, lack of staffing and resources.
Recently, we have been promised that all this is changing. In tandem with the reforms in working practices to be brought in with a new consultant contract, we were promised hundreds of new consultants to give us a more consultant-delivered service.
The current Minister stated in late 2007, as the talks on a new contract were coming to a close, that we were to get 1,500 additional consultant posts to provide this service. We were told there would be more consultants, working more flexible contracts to provide an expanded, round-the clock-service to patients.
The new consultant contract has been in place for a year, yet the evidence is that the badly-needed extra consultants have not materialised.
While it was never expected that hundreds of new consultants could be appointed right away, the rate of new consultant appointments has been disappointing, according to the Irish Hospital Consultants Asosciation (IHCA).
According to Donal Duffy of the IHCA, the creation of hundreds of new consultant posts does not appear to be taking place. "We are not holding our breath for it to happen, especially with the current budgetary situation."
In the meantime, he says, serious shortages of consultants remain in a number of specialties.
The HSE told irishhealth.com that since the new contract was introduced just over a year ago, 202 new specialist posts have been created.
However, while this figure might seem substantial at first glance, the HSE points out that it includes some posts whose approval dated back to 2006-2007 but could not be filled due to the impasse at the time in the contract talks.
Of the 202 new posts created since April 2008, 156 were approved in 2008 and only 46 have been approved so far this year; 272 posts were created in 2006-2008 in total.
The HSE figures show that the rate of increase in consultant posts since the contract was introduced has essentially remained the same as it was before the new contract - just under 100 a year. At that rate, the promised 1,500 extra consultants will take 15 years to arrive.
The total number of consultants currently in the public system is 2,337, compared to around 4,500 junior doctors currently in the system. We still appear to be a long way off from the plan to nearly double consultant numbers and halve the number of juniors in hospitals.
A Department of Health spokesman told irishhealth.com the number of hospital consultants will be increased, but there will be compensatory savings by suppressing junior doctor posts in hospitals.
The Department said it is still Government policy to substantially increase the number of consultants and to reduce the number of junior hospital doctors in tandem with this, subject to the implementation of reformed work practices.
The spokesman pointed out that consultant posts are exempted from the current public service recruitment moratorium.
The consultant shortage continues to affect patient services.
According to Sarah Gahan of Arthritis Ireland, while there have been a few new appointments in recent years, we still only have one rheumatologist per 400,000 people, while the World Health Organisation recommends one per 80,000. "What is happening in terms of appointments is only one tenth of what should be happening."
According to Sarah Gahan, people with arthritis must currently wait up to five years for an appointment with a consultant rheumatologist.
The problem is particularly acute with paediatric rheumatology.
There is currently only one rheumatologist in the country specialising in children, Dr Orla Kileen, based at Crumlin Hospital.
Arthritis Ireland says she treats over 600 children annually, and she currently has a waiting list of 14 months for an outpatient appointment. It says this waiting time should be be considered against the fact that children with artiritis need to be treated aggressively as early as possible to promote best outcomes.
The Crumlin consultant service currently has one consultant, a nurse specialist (funded by a pharmaceutical company), a junior doctor team, a physiotherapist and partial access to an OT.
However, a unit in the UK serving a similar population would have up to four consultants, two to three physios, two to three nurse specialists and a full time OT, in addition to access to other services such as psychology, podiatry and social work.
Children are growing, so if they are not diagnosed and treated in time they can suffer a growth distortion such as a shorter leg or a disparity between fingers, Arthritis Ireland points out.
According to Mike Glynn of Brainwave, the Irish Epilepsy Association, there remain only 20 filled neurologist posts in the country at the moment, although four have recently been approved and are waiting to be filled.
He says we still only have one half the number of neurologists compared to international norms.
Mike Glynn points out that an epilepsy specialist in one major hospital has recently had to stop taking new cases in a bid to tackle a two-year waiting list.
He says what is particularly frustrating is that nothing has happened even in implementing other relatively less expensive solutions than appointing new consultants.
"For example, we still only have two community epilepsy nurse specialists in the country. Appointing more of these nurses would make a huge difference."
So, after five years of Mary Harney's much vaunted reform agenda, and a lot of the reform was
necessary, most observers would feel our health system is still lacking staffing and beds in key areas.
While there have been some changes aimed at improving services, eg new consultant work practices and a tentative development of primary care teams, public patients (and their numbers are growing) still cannot access the services they need.
Talk of Transformation Progammes will cut little weight with patients waiting in pain for outpatient appointments.
|The Man in Bed 6 Posted: 28/08/2009 21:10|
We have been here so many times that I despair at having to discuss this again. I will just say one thing. The government is following a VALUE FOR MONEY strategy. This sounds quite reasonable. The problem is that they are not explaining what THEY mean by VALUE FOR MONEY. What they mean is that if they believe something has VALUE they will spend MONEY on it. They do not see any VALUE in a good Public Health Sector so they dont put MONEY into it. They do see a lot of VALUE in a strong Private Banking Sector so they DO put any amount of money required into that.
When Brian Cowen said recently "The Government has to write whatever cheques are necessary." it would have been wonderful if he had been talking about the Public Health Sector. He was NOT talking about the Public Health Sector he was talking about bailing out the BANKS.
Now can see what they really mean by VALUE FOR MONEY or are you going to let them continue to play with you.
|jcbd Posted: 29/08/2009 12:07|
What is the Minister's. and HSE's response to the figures and diparities you highlight? What is the time line they envisage to resolve these gaps particularly in rheumatology and neurology? What are the next steps they are taking ? Are there unnecessary administrative delays to implementing policy or is the money not available or being spent? Can we get answers to these questions and cut through everybody's spin? There is not a public difference about why on these question that I am aware of . But like so much else in the health service it is a question of how to and can do?
|Anonymous Posted: 31/08/2009 10:54|
This is absolutely crazy. Why doesn't the dept of health stop wasting money on this report and that report and employ medical staff on the ground, in this case consultant who can get things done, treat people and rreduce these crzy waiting times.
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