SDU is not a magic bullet

The new Special Delivery Unit may not be a magic bullet but many are saying that it will need a sprinkle or two of fairy dust, if it is to fulfil its brief without any extra money, writes Maureen Browne.

Dr. Martin Connor, who is heading up the Minister for Health’s new Special Delivery Unit, has just a few months to achieve what the HSE and successive Ministers for Health have failed to do over decades, despite millions of euro, countless initiatives, and famously on one occasion, even declaring it a national emergency. And he is being asked to do it without any additional financial or other resources.

Maureen Browne
Maureen Browne

He has been tasked by Dr. Reilly to sort out the unacceptable waiting times in hospital Emergency Departments and the hundred of thousands of patients who are awaiting hospital admission or outpatient diagnosis or treatment.

His appointment would seem to be the main plank of Dr. Reilly’s pre-election promise “to solve the waiting list crisis within three years.”

He comes with a formidable reputation – the SDU, which he headed in Northern Ireland, managed to get 57,000 patients on the waiting lists treated over an 18 month period.  There are, however, two snags – the authorities poured into the initiative the kind of money, described by one senior manager there as “a king’s ransom” and inpatient and outpatient waiting lists in Northern Ireland have since soared again to a point where they are now proportionately higher than in the Republic.

He comes with a formidable reputation – the SDU which he headed in Northern Ireland managed to get 57,000 patients on the waiting lists treated over an 18 month period

However, both the Minister and some senior managers interviewed in Northern Ireland blame this on the lack of long term sustainability in the wake of Dr. Connor’s departure and failure to pursue underlying reforms. Others say that once the money dried up and private outsourcing was no longer possible, the problems began to re-appear.

On the face of it, Dr. Connor, who took up duty on June 1, has just six months in which to sort out our problems -his contract expires on November 3. He is due to present his proposals to the Department – and presumably the public – on September 1, which will give him just three months to carry out his plan, unless of course his contract is renewed for a further period or his job is seen to chart a roadmap of the way forward. The Minister said that at the end of six months a tender will be put out for the job of head of the SDU.

Dr. Connor has stated that the work cannot be rushed, but cannot take too long. He said he told the Minister he wouldn’t “take a day longer than he needed, but he would take every day he needed.”

He will be based in the Department of Health, report directly to the Minister for Health, have a direct line to the HSE (through his appointment to the interim Board of the HSE) and to the NTPF and will receive a total of €250, 000 (to cover his fee, hiring outside expertise and commissioning necessary research) for his six months contract.

The latest figures from the Department of Health show that in May of this year there were 25,730 public patients (including children) waiting more than three months for in-patient and day case procedures. Of these, 7,580 adults and 1,042 children were waiting over three months on hospital in-patient waiting lists and 15,682 adults and 1,426 children waiting over three months on hospital daycase waiting lists.

Due to reform of OPD data collection systems, the HSE has not produced reports to date in 2011 but it is estimated that an additional 200,000 patients are waiting on outpatient waiting lists. The HSE says that it is envisaged that reporting will commence “sometime this year.” It would, also, be instructive and helpful if we had breakdowns of the length of time in patients, daycase and outpatients are actually waiting for diagnosis and treatment and the number of long term waiters.  The fact that this type of information is not routinely available will pose the first challenge for the SDU. .” Already requests for additional information is going out to acute hospitals from the HSE.

The Minister has stated that the initial focus of the SDU will be on tackling trolley wait times in hospital Emergency Departments and the surge in ED admissions during the winter months

The Minister has stated that the initial focus of the SDU will be on tackling trolley wait times in hospital Emergency Departments and the surge in ED admissions during the winter months.  It will then tackle waiting lists for in-patients and then outpatients.

Perhaps, significantly, the Minister has set no timelines or targets for the new initiative. He also admits that things could get worse before they get better – and waiting lists could rise in the short term.  However, within 12 – 18 months he believes progress will be made.

Neither will there be any additional funding, although the SDU will have at its disposal money originally earmarked for the NTPF. According to the Department, details of the reallocation of resources are “under consideration.

The five main planks of the SDU would appear to be: To ensure that as many patients as possible are treated at primary care level; to  get real time information on numbers waiting in each specialty and consultant waiting list in each hospital; to work with individual consultants and hospitals to clear the numbers and to encourage hospitals to work more efficiently in the admission and discharge of patients.

Speaking at the launch of the SDU, the Minister urged that people should be treated at the lowest level of complexity, there should be integration between primary and secondary care and consultants and more emphasis on home care. He also said we needed more hard information. “We need real time information” he says, “we cannot plan on the basis of information which relates to two months previously.”

Dr. Connor himself has said the SDU is not “a magic bullet,” but will act as “a catalyst for change”. While everybody in the health services wishes the SDU well, many are saying that while it may not be a magic bullet, it would obviously benefit from a sprinkle or two of fairy dust, if it is to fulfil its brief without any extra money.

However, Dr. Connor has stated that he believes it is possible to make significant improvements even at a time of constrained resources.  He says that to get the best possible outcomes for current resources will be the focus of the SDU’s attention for the first three years and then it will be economic reforms, including new technology and continuous quality improvement.

This would seem to indicate that what Dr. Connor will do is set out what he sees as a road plan to solve the current crisis.

A priority with the new unit is expected to be to put systems in place which will deliver real-time information on waiting lists for individual specialties and consultants.

This was an important focus of the SDU in Northern Ireland.  A senior manager who had worked there at the time said Dr. Connor can be expected to make a major improvement in the quality of information available.  “That’s what he did in Northern Ireland. Then he held those figures up, like a mirror, to clinicians and the majority of them were motivated to work smarter.” However, he said it must also be borne in mind that a considerable number of waiting list cases were cleared by outsourcing the treatment of less complicated cases to the private sector (it is understood that about €40 million was spent on this in one year) and lists began to climb again when the money for private care ran out.  It is understood that the number waiting over three months for hospital care in the North nearly trebled in the 12 months between December 2009 and December 2010.

However, he and other senior managers in Northern Ireland said that Dr. Connor’s achievements cannot be easily dismissed.  They see the centralised waiting information system, which gave very detailed and very specific information on the numbers waiting in each speciality in each hospital, which were then raised regularly with hospital CEOs as a major step forward.  This, they said, led to more consciousness of targets and much more closer management of waiting lists in co-operation with clinicians.

In tandem with greater accountability, a team of people from different professions was assembled which could be helicoptered into a hospital and do significant re-engineering in different areas.