It’s no good putting a bush in the gap

The Special Delivery Unit (SDU) has been likened to putting a bush in a gap rather than finding out where the cattle are actually breaking out of the field, writes Maureen Browne.

Bush in a gap

Fears are growing that the initial improvements made by the Department of Health Special Delivery Unit in trolley waits and waiting lists are not and cannot be sustained without money and resources being provided to tackle the underlying problems.

And there is also concern that the recent welcome reduction in the numbers waiting for outpatient appointments will result in a further major increase in those waiting for inpatient and day case treatment as a result of thousands of new referrals.

“At present we get the impression that what is happening is that we are being asked for a quick fix rather than examining the basic issues.  It’s like putting a bush in a gap in the hope that it will keep cattle in the field rather than finding out where they are actually breaking out,” said one disillusioned manager.

Managers generally welcomed the work done by the SDU and the focus it placed on trolley numbers and waiting times.

“The concentration on targets is all very well, but we have to remember that what we are talking about are real people and that is quite different from dry statistics,” said another manager.  “I accept that it is a good idea to admit the “long waiters” but we should not forget that many people who are on shorter waiting lists are also be in dire need of admission.”

Managers generally welcomed the work done by the SDU and the focus it placed on trolley numbers and waiting times.  However, there is a strong belief that – like its Northern Ireland counterpart – the Unit needs an injection of resources if it is to achieve its aims and make sustainable progress.

They cite the fact that despite the work of the SDU and the expenditure of millions of euro since its establishment in June 2011, there are still regular outcries about overcrowding in hospital ED Departments, with trolley numbers frequently exceeding 300 a day, while there are still nearly 50,000 people still on waiting lists for over three months for inpatient or day case treatment.

HSE figures show that in December 2011 there were 59,832 adult patients waiting for in patient and day case care.  In October of 2013 there were 49,325 waiting for inpatient and day case treatment for over three months. However, despite repeated queries, the HSE failed to let me know how many had been waiting over three months in December 2011, it is difficult to see precisely what progress – if any – has been made.

What we do know is that the SDU initially had significant success in reducing the 12 month plus waiters from over 2,500 in mid 2011 to around 360, but the latest figures show that this has once again climbed to 847.

In Jan 2012 The Minister set out the new targets at a national forum in Dublin of key stakeholders from the HSE and the acute hospital sector.

The numbers waiting in each category had increased compared to the situation a year previously.

Those targets were:

  • No one should wait longer than 8 months for elective treatment in hospitals (a reduction from 12 months)
  • No one should be longer than 9 hours on a trolley BUT 95% of people should be no longer than 6 hours.

Both of these targets were to be met by December 31, 2012 or earlier.

In patient and day patient waiting list

The latest figures to hand (which date to October 2013) show that there were over 49,000 medical and surgical patients waiting for elective in patient or day care admission – an increase of nearly 6,000 compared to October 2012.

Of these over 24,000 were waiting more than three months, in excess of 10,000 were waiting more than six months, about 3,500 were waiting in excess of nine months and 847 were waiting more than 12 months.

The numbers waiting in each category had increased compared to the situation a year previously.  There were nearly 5,000 more patients waiting in excess of three months. The number waiting over six months had climbed by over 3,000, those waiting over nine months had increased by about 2,500 and those waiting more than 12 months had increased by 579.

In patient waiting list

In the same 12 months period, the number of medical and surgical patients waiting for in patient admission increased from just over 13,000 to more than 14,300.

There were 7, 000 waiting over three months, more than 3,000 waiting over six months, 1,403 over nine months and 482 over 12 months – in each case an increase on the situation a year earlier.

The target for 2013 was to eliminate the waiting list for all inpatients over eight months. Some 5,989 were people on this waiting list in June 2013.

Day case patient list

The number of day case patients also increased from 30,407 to 35,014 and again the numbers waiting over three, six, nine and 12 months increased in every case.

The Minister for Health issued at press release at the end of 2013 announcing that there had been a 95 per cent reduction in the number of people waiting over 12 months for an outpatient appointment.  The figures said the Minister had been reduced from 103,433 in March 2013 to 4,626 in December. He said that in addition there had been a reduction of 25 per cent in the overall number of patients waiting for an outpatient appointment. He said that at the end of December only four patients were waiting longer than eight months for an appointment.

Depending on the numbers of outpatients referred for hospital admission from this process this will have a very significant effect on driving the waiting lists further upwards.

The SDU money was spent on a range of initiatives including purchase of nursing home beds, provision of additional homecare packages, additional ambulance/transport services, additional staffing for weekend and holiday periods and reopening of closed beds.

On January 1, 2013, the SDU transferred operationally to the HSE but retained its separate identity with a very clear role and special reporting relationship to the Minister for Health and to the then HSE Director General designate, Mr. Tony O’Brien.

On 27 June 2013, the HSE announced that Mr. Ian Carter, the National Director Designate of Acute Hospitals in the HSE and former CEO of St James’s Hospital, had taken over responsibility for the SDU.