It is not acceptable that any hospital should attempt to lower their waiting list by denying patients clinically warranted treatment. Hospitals are expected to accept all patient referrals and prioritise on the basis of strict chronological order, other than in cases of evidenced clinical urgency including relevant cancer cases. It is not unreasonable for larger tertiary referral centres to query why patients are bypassing recently developed suitable services in hospitals closer to them. Attendance at the larger centre may well result in the patient travelling longer distances, to a hospital which is under greater pressure and may have longer outpatient waiting times.
The Special Delivery Unit protocol on the management of outpatient services sets out the process for referral and management of outpatient services. The protocol also helps to maximise efficiency and reduce duplications. In any instance where a decision has been made to refuse referrals, each hospital Clinical Director has to be apprised of the situation and the decision to issue notice to GPs should be done by the senior management team, within the context of good clinical governance.
Improving waiting lists for in patient and day case treatment is a key priority for me and for the Government. My Department is working with the HSE to put in place a plan to eliminate very long waiters by the end of the year. This will involve both productivity improvement and rigorous waiting list management. Further increasing day case surgery rates for specific procedures will be important in improving elective access within available capacity. Priority will be given to adherence to the guidelines in relation to the scheduling of patients for surgery, including chronological scheduling, and this will be monitored by the HSE throughout the year.
The management of competing demands for emergency and scheduled care requires changes in how and where patients are treated. The movement of care and treatment from in-patient to day case and from day case to Outpatient Departments is most important, as is ensuring the appropriate ratio of new to return appointments, reducing unnecessary return appointments. Limiting elective surgery in preparation for, or as a response to, increased Emergency Department attendances is intended to help manage the need for immediate emergency or trauma care. Where it is necessary to prioritise cancer and other complex cases, the HSE assures me that this is being done. Inevitably this will affect waiting lists. The challenge is to minimise the need for cancellation at short notice and to manage the impact of such cancellations effectively, within the hospital and in collaboration with other hospitals. As I have stated publicly in the context of significant emergency pressures currently being experienced by hospitals, realistically I do not envisage significant improvement in elective waiting times in the early part of the year. However based upon the high priority attached to this area in the HSE Service Plan and the first overall increase in the HSE budget in 7 years, it is expected that improvement will occur later in the year.
