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Waiting lists may rise despite new plan
[Posted: Wed 01/06/2011 by Niall Hunter, Editor www.irishhealth.com]
Health Minister James Reilly has announced the establishment of a Special Delivery Unit (SDU) to help cut waiting lists and has appointed an international expert in health service improvement to serve as senior adviser on the unit.
However, the Minister said it could take three years to finally solve the waiting list crisis. He also said he could not rule out some increases in waiting lists in the short-term before the planned reforms kick in.
Dr Martin Connor, who previously worked on reducing waiting lists in Northern Ireland, will report to Dr Reilly and will concentrate on first reducing trolley waits in A&Es and on then on cutting cutting hospital inpatient lists, followed by outpatient waiting lists.
According to the Department of Health, the SDU will be a crucial 'agent for change', allowing for an improvement in the operation of structures across the system.
The Unit will receive weekly waiting list data and will hold hospitals accountable for meeting waiting list targets.
As part of the changes, the National Treatment Purchase Fund (NTPF), which has for many years organised private treatment for patients on public waiting lists, will have its role revamped.
According to the Department, 'its resources will be refocused to align closely with the work of the SDU, and crucially will allow for a progressive improvement in the performance of the country's hospitals.'
The Minister said the NTPF would continue in a different form and it had been asked to cease further commitments to patients until the SDU is in place and had decided how best resources to cut lists can be used.
It was unclear at the SDU launch exactly what will happen to those on waiitng lists in the shorter term as a result of this.
Dr Reilly said the NTPF would not be phased out but there would be other initiatives which would lead to more patients being treated.
While NTPF funding will come under the remit of the SDU, there will be no Exchequer cash injection to help clear waiting liits.
Funding is expected to be be moved from some of the NTPF's budget to the SDU to assist its work in reducing the number of long waiters and in reducing trolley waits.
Between 2005 and 2008, Dr Connor, who previously worked with the NHS in England, was special adviser in the North's Department of Health, and helped bring about a major reduction in waiting lists for assessment and treatment.
However, waiting lists have recently increased in the North after a policy decision was made to cut back on private treatment for those waiting for long periods on waiting lists and to concentrate on investment in increasing public capacity.
Asked about this, Dr Reilly said to his knowledge, among the reasons for the recent increase in lists in the North were a change of Government and the fact that necessary reforms to accompany the initiative there were not undertaken.
Dr Connor was according to the Department, instrumental in securing the increased involvement of clinical professionals in decision-making and also developed a patient-level information base to support strategic decision-making while in Northern Ireland.
The Department says Dr Connor will design and implement the operation of the SDU to allow for a maximum positive impact on the operation of the unit. He will preside over the establishment of the SDU over the next six months.
Dr Connor, who will be sitting on the HSE's interim board, said it was possible to generate major improvements in the system even at the present level of constrained resources.
He said there would be a focus on how we improve our use of information in tackling waiting lists and on how the system could be made more accountable.
Dr Connor said he would have a framework with quantified targets for waiting list reductions ready by September.
The initial priority for the SDU would be to tackle A&E trolley waits, in particular, capacity problems caused by the surge of activity in emergency departments each winter, the Minister said.
Challenged on the lack of detail about how the SDU would operate, Dr Reilly said you cannot change the health service on a hunch and you must have hard information to analyse the situation.
He said his was a concrete plan to deliver care in a more efficient way and there would be an emphasis on GP care and on patients being treated at the lowest level of complexity as close to their homes as possible.
The Minister said it remained the Government's commitment to solve the waiting list crisis within three years of coming to power.
However, he said he could not rule out some rises in waiting lists in the shorter term, as initially, the SDU would be delaing with the A&E situation. However, he felt this situation would right itself within 12-18 months.
Latest figures from the HSE show that hospitals have overspent their budgets by over €74 million up to the end of March, and this is likely to put more pressure on waiting lists in the short-term.
The SDU's priorities are:
* To tackle waiting times in A&Es. The Minister said these are unacceptably high in a number of hospitals, often breaching the current six-hour maximum waiting time target.
* Inpatient waiting times. Dr Reilly pointed out that the trend here has been upward recently, despite the work of the NTPF.
* Outpatient waiting times - the time from GP referral to an appointment with a consultant is unacceptably long in many specialties, Dr Reilly said. Around 200,000 people are on outpatient lists.
*Better access to diagnostic tests.
The Minister said Dr Connor's appointment allows the Department to draw on a range of other international resources at his disposal to help refine the development and the operation of the SDU.
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