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All hail the mighty waiting list
[ by Niall Hunter, Editor www.irishhealth.com]
For your delectation and despair, here's yet another statistic to add to all those grim health headlines of recent years.
As revealed in irishhealth.com a few weeks ago, and aired again in the media this week, around 1,900 people are currently waiting more than three months for a colonoscopy, many of whom are being checked (sometime in the future, whenever you're ready, there's no big hurry) for potential bowel cancer.
The waiting list for what can be a life-saving test has doubled in the past year. Some people are waiting over six months, some even over a year, for a test that should in any self-respecting health system be carried out within a few weeks.
Except that many parts of our health system seem to have lost any semblance of self-respect some time ago.
Some of the people awaiting a colonoscopy could have bowel cancer, even if they're not officially classified as 'urgent.' But the HSE assures us that nearly all 'urgent' bowel tests are carried out within a month, so that's all right then isn't it?
Well, no, actually. The Irish Cancer Society points out that we currently have no standard national definition of what constitutes an urgent and a non-urgent case.
And it points out that some people without obviously severe symptoms could be put on a 'non-urgent' longer waiting list but could turn out to have bowel cancer - a type of cancer that really needs early diagnosis. Many people without severe symptoms can end up being diagnosed with advanced cancer.
The Society itself makes no distinction between urgent and non urgent cases when it comes to colonoscopies, so why does the HSE?
Admittedly some hospitals have practically zero or small waiting lists, while others have lengthy ones, but that does not make the issue any less urgent.
You can argue till the cows come home about the confoundables - the chances of someone left on a long waiting list actually having bowel cancer are probably fairly small, the fact that some on the colonoscopy list may be getting checked for a condition other than cancer.
The fact remains that this is essentially a cancer service waiting list, and as far as bowel cancer is concerned, this is still a two-tier service. With cancer, there should be no 'Rolls Royce option' for some patients when it come to diagnosis, it should be quick and equal access for all.
And if you think that's too 'populist', 'alarmist' or 'the usual hysteria from the media', let's put it into this stark context:
The bottom line is that in Ireland, in 2010, if you or your GP thinks you might possibly have bowel cancer, if you're a private patient you can get checked out right away, and if you're a public patient you simply go on the waiting list and take your chances.
At some stage you may come off the waiting list, but for all the wrong reasons, because with late-detected bowel cancer, you can die, as did Susie Long.
Sorry for getting so crude, but by any moral standards, this situation is clearly wrong.
The growing colonoscopy waiting lists are an insult to the memory of a brave campaigner and victim of the system. Ms Long died died of bowel cancer in 2007 having waited seven months as a public patient for a colonoscopy.
We were promised at the time that the situation that created the Susie Long tragedy would become a thing of the past. This was a public pledge that was breathtaking in its hollowness.
What transpired was an Orwellian conceit - if you give a problem a different name, but don't actually do anything about it, perhaps people will forget about what was wrong in the first place.
The Susie Long incident was used as a 'never again' example to introduce, with a new consultant contract in 2008, a 'common waiting list' for diagnostic procedures, including colonoscopes, in public hospitals.
We were told: 'consultants will provide outpatient and diagnostic services on a 'one for all' basis, so that all patients are seen at a key entry point to public hospitals on the basis of medical need alone.'
A translation of this would read that the 'key entry point' for public patients potentially with cancer turned out to be a year down the road, when it might be too late. One-tier access to tests is all very fine, but this simply turns into a waiting list if no resources are put in.
The promise was that there would be no distinction between public and private patients on hospital waiting lists - those who needed to be seen quickly would be seen in a public hospital regardless of their bank balances.
The reality is that three years later most hospitals have common 'one-tier' waiting lists for tests. But you won't find many private or insured patients on them.
Understandably reluctant to play Russian Roulette with any potential cancer cells lurking inside them, most of those who are worried and faced with the option of going on a long public colonoscopy list or being tested quickly in that nice place down the road with the water feature in the lobby will choose the latter - and who would blame them?
With the 'common waiting list' you may not be able to queue skip for a test within the public hospital if you are a private patient but you still have the comfort of knowing that you can get that test done quickly elsewhere.
The Blackrock Clinic, for example, told irishhealth.com that it has no waiting list for urgent colonoscopies, and non-urgent cases get seen within a month. Unfortunately, those without private insurance would have to pay over €1,000 for this service.
But surely in a civilised health system, the Blackrock Clinic's waiting times would be common to every public hospital in the country with a colonoscopy unit.
So essentially, Mary Harney's Musketeer-like 'one-for-all' waiting list promise in 2008 was meaningless.
But wait, there's always the NTPF. If you've been on a public colonoscopy waiting list for more than three months, you can always ring them and they can probably get an appointment for you to have it done privately at the State's expense in another hospital.
There are so many flaws with this particular aspect of our public/private contortionist act that it's hard to know where to start.
Firstly, not many patients on bowel test waiting lists seem to know about this NTPF facility as hospitals, and perhaps the NTPF itself, don't seem to tell people about it very much.
Secondly, why do patients have to wait as long as three months for the NTPF to step in for such a vital test? Especialy when the HSE's maximum target waiting time for urgent tests is only a month.
Thirdly (be patient, this is a longish list) how big an indictment of our public health system is it that it has to rely so much on the private sector to bail it out? Why are taxpayers paying on the double for this?
Fourthly, how can those doctors who work in both the public and private systems, however good at their jobs and hard-working they may be, morally justify what can often be a 'queue-skipping' service for those with serious illnesses?
It's unfair to put the blame for the private-public divide solely on them, as this system suits quite a lot of people at many levels, none of whom are individually 'bad' people (your honour). The system suits everyone (even public hospitals who rely on private income) except the public patient. How can those running the system or those elected to govern our system justify it?
Department of Health officials, in a recent briefing note for the new Health Minister, said bed numbers 'were not a meaningful currency' for measurement of hospital system performance.
Ignoring the arrogance of this statement for a second, it can easily be contradicted. The only 'meaningful currency' in measuring our hospital system performance at the moment is the almighty, insatiable waiting list.
These waiting lists can be for tests, for outpatient appointments or for hospital treatment, and they are all growing every month.
Their existence dictates much of the administrative and policy priorities of our hospital service.
Policy revolves not so much around the concept of getting rid of the waiting list, but on feeding it, appeasing it, counting it, hiding it, spinning it, building semi-state bodies around it, and ensuring that some benefit from it.
For without the almighty waiting list, much of the raison d'etre for private practice, and indeed private health insurance, would essentially vanish.
Dr James Reilly has pledged to perform this difficult vanishing trick. But will it all be all smoke and mirrors? How much longer will be have to put up with our inequitable system? And how difficult will it be to change it?
The new Minister has made a lot of promises. He obviously won't be able to keep them all and has already tripped up on one particular pledge. Yet he will be forgiven a lot if if achieves a one-tier system and true universal healthcare.