Hospital Waiting Lists

Earlier this week, RTÉ Investigates aired the results of an investigation into hospital waiting lists. In essence, they found:

evidence that shows there are at least two other significant waiting lists which are not published by the NTPF [National Treatment Purchase Fund], which have tens of thousands of patients awaiting treatment.

The numbers aren't in dispute: the numbers of patients waiting up to 18 months for a procedure on the official lists is about 81,000; plus a Pre-Admit list of 22,927; plus a Pre-Planned list of 59,843 (of which approximately 49,000 are follow-up endoscopies based on initial indicators).

The program's production was hugely effective at eliciting an empathetic response in the public that lasted in the public light for a couple of days before the news cycle moved onto yet another scandal.  

The government response was of course predictable: it comes down to "we didn't set up the NTPF; this is unacceptable, we will fix it with more money; we will focus on some of the specific cases highlighted in the programme."  

Let's think about this from an institutional perspective:

  • Back pre-2002, people waited for an indeterminate period for procedures of both a life-saving and life-changing variety.
  • The Bureaucrats concocted yet another Bureaucracy (NTPF) to address the problem.
  • The NTPF set up (based on "international best practices") an arbitrary 18-month guarantee for treatment, after which time a patient would qualify for treatment abroad.
  • As an taxpayer-funded Institution, the NPTF has a budget and needs to "look good" to the public in terms of being effective.

As with any Institution, its behaviour evolves and adapts to the environment in which it finds itself. In this case, there is not enough capacity in the healthcare system to meet the 18-month timelines and not enough budget to fund overseas treatment...the natural Institutional outcome is that the waiting list "self-optimises" to make sure that the Institution survives, and in this case that means keeping people off of the official waiting list.

This is not to say the NTPF has not worked - the situation now is better than it was in 2002.  It's just not good enough...and to fix that it seems that what will be done is throwing more money at the problem.

But is that what should be done? What is the problem we are really trying to solve here?

We, the People, want access to non-elective procedures in a timely manner; "timely" being one that minimises the time in which we and our loved ones are in physical pain or mental anguish about a deteriorating condition.

Step back and look at the healthcare system in Ireland.

  • We're training (with taxpayer money) doctors and nurses as fast as we can, but this home-grown talent flees the country at first opportunity for better pay and working conditions. You can see this in OECD numbers when you compare the indicators "Nurses" and "Nursing Graduates."  Economic theory would indicate that our top talent is going elsewhere, leaving us with qualified professionals...but not necessarily the best-qualified professionals.
  • Hospital bed efficiency is not great (average acute hospital stay is 5.43 days in 2014), so not only do we not have enough staff to open all the wards, we're unable to keep patients flowing through those wards. The average number compares favourably to OECD averages, were we able to drill down into specialist disciplines (say, neurology) we'd probably find large variances from the average.

So it's actually quite simple to fix, right?  I suspect that if we kept our current pay grades but made "coming to work" an activity our healthcare professionals enjoyed rather than loathed, we'd staunch the bleeding of talented people.

How do we do that? By focusing on what brought people into the medical profession in the first place:


That's crazy talk, I know...but if we empower our healthcare professionals (both medical and administrative) to make patient-centred changes in process and procedure we can improve outcomes.  This post is far too long as it is, but there is something called Lean Healthcare which has proven to reduce stress in both patients and staff and lead to better outcomes.


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