Monday 26 September 2016

Two-year hip op wait is unacceptable

Patients are living with excruciating pain because cuts mean the hospital can't afford the implants

Stephen Donnelly

Published 12/06/2016 | 02:30

Hospital waiting lists are set to rise Stock photo: Depositphotos
Hospital waiting lists are set to rise Stock photo: Depositphotos

Imagine living with intense, debilitating pain and learning that, while your condition can be dealt with, you'll have to wait two-and-a-half years. That's what people in need of orthopaedic surgery are hearing every day in Ireland. The reasons are few and the solutions are straightforward, but they're not happening, and people are left in agony.

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A few weeks ago, a constituent, Sarah, came to me in despair. She needs a hip operation, but because of a lack of funding for Cappagh, the National Orthopaedic Hospital, she has to wait 15 months. During this time her hip is deteriorating, her pain in increasing, she's now limping and may end up in a wheelchair.

When I looked into Sarah's case, here's what I discovered. The State is paying for the hospital to be open. It's paying for the operating theatre to be ready. It's paying for the surgeon and the theatre team. It's paying for the bed in the ward Sarah needs to recover, and the clinicians needed to help with that recovery.

BUT - because of cutbacks, the hospital can no longer afford to buy the implant Sarah needs. So the surgeons leave early. The theatre teams find other things to do. The operating theatres are left empty, as are the ward beds. And Sarah waits. Her condition gets worse. The required operation becomes more complex. Recovery times go up, clinical outcomes go down, and the final cost to the State ends up being much higher.

Here's how bad the situation is. In the UK, it takes four months to get from your GP to the consultant and into the operating theatre. In New Zealand it takes about three months. In Ireland, once you've been to your GP you'll wait 15 months just to see a consultant. Then you'll wait a further 15 months for the operation. A total time from GP to operating theatre of two-and-a-half years, or 10 times longer than the UK and New Zealand.

And God help you if you need work on both hips or knees, because here's how the system works for that - after your two-and-a-half year wait, you can only have one side done. For your other side, you have to go back to the end of the list and begin the wait all over again.

Believe it or not, the 15-month waiting list for the operation is actually the HSE target - and Cappagh's about to start missing even that. The hospital has been put in an impossible situation. In 2014, its funding was cut. It had the staff, but no longer had the money. So it cut back - costs were reduced, staff were let go - and the waiting lists grew longer. In fact, it did 700 fewer procedures in 2014 than in the previous year. So in 2015 it got more money, but no longer had the staff. So it scaled up again.

By the start of this year it had the staff, but didn't know how much money it was going to get for the year. It worked on the assumption that it would get the same as last year. It started making inroads into the waiting times. But then it learned its funding was being cut again. So it has closed operating theatres, told surgeons to stop working full days in theatre, and is scaling down - again.

Cappagh used to run six operating theatres. Now it's just three. Surgeons who used to get one day each week in theatre now get two a month. They can do an average of five procedures a day, but are have been told to stop after three. So instead of doing 20 to 25 procedures a month, the surgeons are doing just six. Why? Because there isn't the money to buy the implants. For a straight-forward procedure, these cost about €3,000. Some surgeons use ones costing just €1,500. And the patients, like Sarah, are not allowed provide this money.

It gets worse. Because now the waiting lists are going to rise again, to more than the HSE's 15-month target. So it'll be fined, by the HSE, meaning even less money available, and having to slow down even more… leading to more fines. Its hands are tied in other costly ways, too. Because it doesn't know year-to-year how many staff it can employ, it is using agency staff, who cost more money. It also has to use theatre nurses to do jobs in theatre that theatre technicians can do. Theatre technicians are used in some of the best orthopaedic hospitals on earth, and cost a lot less than the more highly trained theatre nurses - but it's not allowed use them.

The staff in Cappagh, both medical and non-medical, are at their wits' end. Cappagh is where our orthopaedic surgeons train, and do their most complex work. They feel a great deal of loyalty to the place. But that's eroding fast, as they watch their patients wait in agony, month after month, while operating theatres lie empty.

Here are five things that need to happen.

First, funding urgently needs to be released for the rest of this year, to allow the hospital buy the implants needed to operate on Sarah and the thousands of others who are waiting. Many are in extreme pain, can't walk, can barely move. Additional funding in the low millions would make a huge difference.

Second, a multi-year funding model needs to be put in place so the hospital can plan with certainty. This should be at least a three-year rolling agreement, and ideally five years. Not only would this stop the damage of having to scale up and down each year, it would help management reduce costs by, for example, moving away from agency staff.

Third, the hospital should be allowed staff appropriately, including the use of theatre technicians, so long as this is clinically sanctioned. This cuts down on costs, meaning more funding available for implants.

Fourth, a national patient database needs to be established, and used to manage case-loads. Different parts of the country have very different waiting times, but there's no balancing of this. If a patient knew that they could be seen months earlier by going to, for example, Limerick, they might well choose to do so.

Fifth, and finally, as part of the work on establishing a long-term vision for healthcare, much more ambitious targets need to be set for waiting times. It is completely unacceptable that we, in Ireland, are waiting ten times longer than in other countries for life-changing medical care. It's time for that to change.

Stephen Donnelly is the Social Democrat TD for Wicklow and East Carlow

Sunday Independent

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