Eilish O'Regan: 'Waiting list patients are unwitting victims of the toxic culture within our hospitals'
Hospital outpatient waiting lists have managed to set new records this year for all the wrong reasons as the number of public patients needing to see a specialist maintained a relentless spiral.
The figures for September released yesterday show a slight drop of 729 compared to the previous month.
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But 568,769 people, who do not have health insurance, are still in the queue for an appointment - 106,418 for at least 18 months.
This compares to an outpatient waiting list at the end of last year of 516,162.
It burgeoned from 415,584 when the Government took over in 2016.
This is despite the €75m allocated to buy treatment and appointments this year.
Although some progress has been made in tackling surgery lists - down to 67,985 last month, compared to 72,027 at the end of January - the backlog of patients who need to be assessed by a specialist, many with worrying and painful symptoms, points to a deep crisis in this area.
The hope was that the outpatient waiting lists would be stabilised this year but with just a few months to go this target will not be met.
A breakdown of outpatient queues per hospital shows University Hospital Galway has a waiting list of 43,381 while Cork University Hospital has a backlog of 24,824.
Some of the smaller hospitals have very large lists including University Hospital Kerry where 10,087 are in need of a specialist appointment.
The highest need is among patients who are waiting to see an ear, nose and throat specialist, an eye specialist or an orthopaedic surgeon.
The expanding demands of our ageing and growing population have been cited for driving up the demand.
Doctors' organisations blame a lack of specialists in key areas of medicine for adding to the delays, citing pay as the key grievance. But this analysis is too narrow.
They say the arrival of an extra doctor to a team can cut waiting times and point to areas such as a rheumatology clinics in Beaumont Hospital which has seen an improvement because of an extra consultant coming on board.
Equally, when there is an exodus - in the case of dermatologists who leave for private practice - the knock-on effect is that urgent patients, who may be at risk of skin cancer, have to be prioritised leaving those with less threatening complaints like psoriasis to face an ever lengthening delay.
The doctors cite these examples as part of the campaign to end the pay gap which sees new recruits paid €50,000 less if they were hired since 2012.
But the difficulties in attracting doctors are much wider than that as Medical Council surveys revealed this week, with bullying of young doctors - often by consultants - cited as one of the reasons why a relatively well-paid job as a hospital specialist here is becoming unattractive. It appears the hierarchical culture and the vicious circle is contributing to the loss of doctors and affecting the most vulnerable.
It's time for hospital representative bodies to be as vocal about this behaviour by some of their own as they are about pay if they are really serious about filling vacant posts.
The impact which private practice in public hospitals is having on waiting lists has also not been assessed or measured.
Tough questions need to be asked about why there is such resistance to the recommendation in the Government- commissioned de Buitléir report which called for all newly hired consultants to confine their practice to treating public patients.
There also appears to be a slowness to try out some alternative ideas which have worked elsewhere.
Optometrists in the community have long insisted they could free up more hospital ophthalmologists if some of the patients needing eye care were shared out.
Despite the Brexit shadow some €100m was found in this week's Budget 2020 for the National Treatment Purchase Fund to buy treatments and appointments for public waiting list patients.
A spokeswoman for Health Minister Simon Harris said he welcomed the significant progress on hospital operation waiting times and he wants a similar focus applied to outpatient waiting lists.
"He met with the HSE chief executive, the National Treatment Purchase Fund and his department officials today to discuss waiting lists and how the health service can make further progress by the end of the year. He will hold another meeting in two weeks to consider the plan for 2020."
Fianna Fáil spokesman on health Stephen Donnelly estimated yesterday that at the current pace of movement it will take 65 years to clear the outpatient waiting list.