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Why are so many children waiting for treatment?

Even when the health service looks like it has produced a 'good news' story, more depressing truths are often lurking in the shadows.

Take the National Treatment Purchase Fund (NTPF). This is the State organisation that facilitates people on public hospital waiting lists to get treated in private hospitals.

The scheme has its critics. They point out that the taxpayer is paying twice for public waiting lists to be cleared by the NTPF -- firstly through the money the NTPF is paid to do this and secondly through what taxpayers pay to fund a public hospital system which should have been carrying out the operations in the first place.

It is felt by many that the NTPF is a 'sticking plaster' solution that masks the serious capacity and organisational problems in public hospitals.

Yet the NTPF has had some success.

The Dail Public Accounts Committee was told yesterday that before it was set up in 2002, public patients often had to wait between two to five years for operations. Now, the average waiting time is 2.5 months.

That was the good news.

Behind the headlines there are two serious flaws in the system.

Firstly, nearly 3,000 child patients nationally are on surgical waiting lists, many of them waiting a year or more. Nearly 1,000 children are on waiting lists at Crumlin Hospital.

The NTPF claims Crumlin is not cooperating enough to arrange for many of these children to be treated privately. The treatment fund says it could provide care for a lot of the children currently on Crumlin's waiting lists but is not being facilitated. Crumlin, for its part, denied that it was not cooperating and claimed the NTPF had placed a limit last year on the number of its patients it could arrange treatment for.

Quite apart from the NTPF issue, another question that must be asked is what is the root cause of there being nearly 1,000 children awaiting operations at Crumlin in the first place -- last April the figure was 840. The resourcing issue at Crumlin has clearly not been resolved.

The second elephant lurking in the waiting room is the fact that there are at least 175,000 patients on another waiting list -- the one to see a consultant in his outpatient clinic.

This is a huge bottleneck in the hospital system.

This leads us to an obvious question -- have treatment waiting lists been reduced due to greater efficiency or is it simply because it is still so difficult for people to get into the public hospital treatment system?

Niall Hunter is editor of irishhealth.com