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There is no instant cure for delays - but here's a plan that might help

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I have no instant cure for spiralling hospital waiting lists which are leaving so many patients facing woeful delays. But we cannot indulge ourselves as we are, while the problems get worse.

It's not that complicated and if I were to meet Health Minister Leo Varadkar, this would be the five-point plan:

1) Cut down on the layers of management which are growing larger by the day. One of the major problems is the number of experienced hospital consultants who are involved in managerial roles with new titles.

The knock-on effect is that they then spend less time with patients because of the new responsibilities they have been given.

It is argued they are bringing their coalface medical expertise to improve administrative decision-making.

But this is a luxury we cannot afford right now, at a time when the desperate frontline needs of patients are so huge.

What is the point in them attending meetings when they could be attending patients? The same applies to non-medical managers, more of whom are needed on the hospital floor to properly organise clinics more efficiently.

2) We have taken 8,000 acute beds out of the hospital system in the last 10 years and these need to be replaced. We have a chronic shortage of beds now. It means that some patients are being discharged too soon. I know of patients who have had an acute illness who were not admitted and sent home.

If a doctor is not tough enough, they will be sent home or put on some trolley in the emergency department.

It also means there is a revolving door system where patients who are discharged before they are ready have to be readmitted days later.

3) Efficiency often boils down to simple things, such as having the same experienced person running the clinic, not a different person every week. It can be as basic as making sure the phones are answered.

In the public hospitals, clinics can be cancelled due to shortage of nurses or doctors.

You should be able to have contingency plans to ensure this does not happen. Otherwise, patients can be pushed back for months to another clinic.

4) We are short of doctors but even if you increase their numbers it does not follow the service will automatically get better. The hospital may not provide the full facilities needed for them.

And, increasingly, consultants are returning as sub specialists, concentrating on a particular branch of disease.

Some of that is good but in a situation like ours you need "heavy lifters" - doctors who will see lots of patients. You go in, roll up your sleeves and you get through as many patients as possible.

5) Too many services have been pushed into the big hospitals, such as Beaumont Hospital, which cannot cope with so many patients.

They have become uncomfortable and impersonal.

The size of waiting lists makes it akin to a war situation now. It means there are choices to be made. Otherwise I can only see the problems deteriorating.

Prof Michael O'Keeffe is an ophthalmologist in the Mater Hospital and Temple Street Hospital.

Irish Independent