Saturday 17 March 2018

Missing the target - why do our patients have to wait 15 months to be seen?

Britain's NHS promises to see every patient within 18 weeks so Maurice Gueret asks why our bullseye is now 15 months.

Noel Browne
Noel Browne
Dr Maurice Gueret

New data was released on Irish hospital waiting lists over the Halloween holidays. It made for some particularly scary reading. There are 530,000 people now waiting for public treatment.

That's just over one-in-eight of the entire population of the Republic. Considering that 45pc of the population has private health insurance, this makes the true picture a hell of a lot worse. It means that as many as one-in-five uninsured patients is now on a hospital waiting list. So how long are they waiting? Well the target time, set as if it is some sort of international norm, is 15 months. In fact, it isn't a norm anywhere. If an archer was aiming at that particular bullseye, he might skewer a passing seagull one hundred feet overhead. The target time across the Border and in the rest of the UK is 18 weeks. The performance of government in health in recent years has been nothing short of dire. And the reason you mightn't have noticed how dire it has become is that the opposition's performance on health has been even worse. They say you get the politicians that you deserve. You must have all been very naughty children.

* There was one other figure in the recent batch of bad stats that I need to comment on. That's the number of people who don't show up for hospital appointments. Last year, 416,000 patients were no-shows. There is no single reason for this, but the HSE says it is important as it represents 50pc of their outpatients capacity for new patients. In an outpatient clinic that sees 30 patients, there might only be a handful of slots for first-time attendees. In the psychiatric services, sometimes as few as one or two new patients are seen per clinic, as a first-time visitor takes up a lot more time. So if just one existing patient does not show up, then a slot that could go to a new patient goes unused. It's a long time since I worked in hospitals, but it looks very much as if the old failings are still there. Too many inexperienced doctors putting off big decisions. Too many patients kept on for lifelong attendance. And too few slots being allocated to new patients. There are half-a-million reasons that patients don't show up for appointments. But if my dentist can text every patient 24 hours before a visit requiring confirmation, then there's no reason public hospitals can't do the same. If that's too difficult, we should devise a national cancellation system, where a single freephone line or email could be used to cancel any healthcare appointment. It's not rocket science; it's bloody obvious.

* I have been greatly enjoying your letters and emails with tales of ghostly goings-on in the Irish healthcare machine. Margaret has been in touch about the supernatural county of Louth. Back in the early 1950s, she was a patient in one of Dr Noel Browne's new sanatoria in Drogheda, which was on the grounds of what became St Mary's. There were a number of sightings of a nurse in old-fashioned garb who would come to tuck in the sheets at night, and then disappear through walls, or glide away into the ether. One patient that she tended to was a Scotsman, a former pilot in the RAF. He was a tough cookie, and perhaps not the sort who would believe in ghosts. Margaret and the other patients were aware that there was one locked room on the corridor that housed the TB wards. During her nine-month stay, it was never opened once.

* Margaret's own mother had been a nurse and she did night duty at the old County Home in Dundalk, which was previously the town's workhouse. She took charge of the older patient population each night, but was warned by other nurses that on no account should she be out of her office around midnight. Matron, who was a Mercy nun, told her that if there was a knock on her door, she should ignore it, lay low and stay quiet. Dundalk County Home was haunted by a previous matron from many years before, who still did her rounds at midnight. Margaret's mother never encountered the phantom matron on night duty. But, one night, as she stole a few hours' sleep in the little nurse's bedroom at the top of a winding stairs, she woke to find a second person "with a head full of stubble" beside her in the bed. When she hopped out to switch the light on, there was nobody there, and the door was still locked, as she had left it. That small room at the top of a winding stairs had once been used to house new male inmates until they were washed, disinfected and deloused.

* The Road Safety Awards will take place in the middle of December. Nominations have closed for the 'Leading Lights' of Irish road safety. Award winners and prominent flames of our 'Blame the Driver' culture will make their way to Farmleigh House for a right old hooley. That's if somebody can be bothered to repaint the road markings in Dublin city. It's all very well to blame tired drivers, drugged drivers, fast drivers, careless drivers, drunk drivers and red-light runners. They deserve society's opprobrium. But the Road Safety Authority needs to take a back seat from driver-bashing and have a look out the window at the state of the roads that very good drivers are forced to navigate. Stop lines and lane lines have disappeared all over the country. Dublin seems to have run out of paint for yellow boxes. Cyclists pedal around according to laws of the jungle. Superfluous signs abound, blocking the view of traffic lights already invisible because of unpruned trees. I'm guessing there will be no award on the night for pointing out home truths.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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