New initiative to clear waiting lists

The HSE is to penalise hospitals that fail to deal with long inpatient waiting lists as part of a new action plan to reduce treatment waiting times.

It is also ordering hospitals to validate their waiting lists and to clear backlogs of patients waiting longer than six months as a matter of urgency.

The HSE is planning in future to force hospitals who do not clear their lists promptly to pay for the treatment of patients on these lists when they are referred to other hospitals to get the treatment they are waiting for.

The health executive is responding to a request from Health Minister Mary Harney urging it to take more effective action to ensure that hospitals deal with long-term waiting lists, particularly where patients have been waiting longer than a year for treatment.

The Minister also said more effective action was needed by hospitals on the validation of waiting lists and indicated that some hospitals were not managing their waiting lists properly.

The Minister, in a letter to the HSE last October, ordered it to develop and implement a plan to address long-term hospital waiting lists, both in terms of ongoing validation of the lists and ensuring that patients do not have to wait an unnecessarily long time for treatment.

She asked the HSE to develop proposals for a set of incentives and disincentives that would encourage hospitals to manage waiting lists effectively, with particular reference to patients waiting longer than 12 months for treatment.

In response, HSE Chairman Liam Downey told the Minister in late November that the HSE was planning to introduce an incentive scheme which will reward hospitals for good performance on waiting lists.

The scheme, he said, will require hospitals that fail to meet waiting time targets to refer patients on to other hospitals, either public or private, for treatment. However, this treatment will be charged to the original hospital, rather than to the referral hospital.

The Minister, in her letter to the HSE, expressed concern about the continuing problem of patients being on long waiting lists for inpatient treatment, some for more than a year.

She pointed out that information supplied by the National Treatment Purchase Fund (NTPF) showed that just five hospitals account for over 60% of those on inpatient hospital waiting lists for more than a year, and another five hospitals account for a further 20% of patients.

The NTPF arranges treatment in other hospitals for patients who have been on public hospital waiting lists for more than three months, and collates the waiting lists in all public hospitals.

The Minister, in her letter, pointed out that information from the NTPF shows that a number of hospitals are not adhering to the waiting list guidelines, which results in an over-statement of the numbers actually awaiting treatment.

Ms Harney said the NTPF data indicates that the details of over half of all those on a waiting list for more than a year are awaiting clerical/administrative follow-up by individual hospitals and a further 8% have already declined treatment by the NTPF at least once.

"These situations underline the importance of all hospitals maintaining accurate, up-to-date waiting lists in accordance with NTPF guidelines so that the true number of patients who need treatment can be established and they can receive an appropriate service," the Minister said.

Ms Harney said in cases where it is considered clinically appropriate that patients should be treated in the hospital whose waiting list they are on, given the small numbers involved, arrangements should be made to provide them with treatment as soon as possible.

She ordered the HSE to follow up as a matter of urgency on the five hospitals with the largest number of patients recorded as waiting for more than 12 months and to ensure that HSE-funded hospitals validate and update their waiting lists, and in referring without delay patients who are suitable for treatment under the NTPF.

Mr Downey, in response to the Minister, said the hospital managers had been reminded of the absolute necessity to adhere to the guidelines on the management of waiting lists.

He said in addition, the specific hospitals with patients waiting more than six months for treatment have been directed to validate and update their waiting lists and to ensure that all patients remaining in this category are either treated directly by the hospital concerned or immediately referred to the NTPF as appropriate.

Mr Downey said hospitals had been ordered to address this issue urgently and ensure that existing backlogs are cleared within a month.

While inpatient waiting lists have been shrinking in recent years, there are still thousands of patients who have been waiting for up to two years and more for treatment.

Latest figures from the HSE show that 7,669 adults and children are currently on inpatient waiting lists,with 3,111 waiting over six months for treatment.

In addition, there are 10,519 on day case waiting lists, with 3,152 of these waiting more than six months for treatment.

The figures show that the hospitals with the highest numbers of patients waiting more than a year for inpatient or day case care are Crumlin (295 patients); Tallaght (197); Cork University (125); St John's, Limerick (125); Temple Street (116); the Mater (89); and Sligo (65).

A recent report from the Comptroller and Auditor General pointed out that many hospitals take patients off waiting lists once a date for treatment has been fixed; therefore the official figures do not take account of when operations are cancelled.

In addition, outpatient waiting lists are estimated to be much higher than inpatient and day case lists.

The C&AG report stated that as many as 175,000 people around the country are on outpatient waiting lists, and some are waiting many years for a consultation in a public hospital clinic.

The HSE says it is taking action on outpatient waiting lists and is currently trying to validate these lists.

[Posted: Thu 07/01/2010]