Patients taken off waiting list 'in error'
The HSE has admitted that 350 people on public obesity clinic waiting lists at Loughlinstown Hospital in Dublin were placed in error on another list which meant that they were removed from official waiting lists even though they had not been treated.
The health executive said the issue in relation to St Columcille's Hospital in Loughlinstown had now been 'corrected'.
irishhealth.com revealed on Monday that 350 people who had been waiting over a year to be seen at the Loughlinstown obesity outpatient clinic and had indicated to the HSE that they still wanted to be seen were then taken off the official national waiting lists, even though they had not been seen at consultant clinics.
They were placed on a separate list under which they were due to be seen later this year, but these patients were not counted as part of the official national waiting list figures. Consultant endocrinologist at Loughlinstown, Prof Donal O'Shea described this practice as 'Yes Minister gone mad' and said it would not be possible for the hospital to see all 350 patients this year.
The HSE told irishhealth.com this situation had resulted from an administrative error which had now been corrected and the patients concerned would now be added to corrected national waiting list figures for the end of December, which will be officially published shortly. This means these patients, many of whom may have severe health problems, will continue to wait long periods to see a consultant.
The health executive said the correction of the error with the St Columcille's waiting list meant that contrary to what had previously been recorded, the hospital was not compliant with the target of having no patient waiting more than a year for an outpatient appointment by the end of 2012. The HSE said 33 out of 42 hospitals now met the 12 month target at the end of 2013.
It is understood that the Loughlinstown mix-up occurred through an administrative error following unsuccessful attempts to have the obesity patients waiting over a year for a first appointment seen privately.
The HSE said a national outpatient validation process was carried out last year to ensure that patients, particularly those waiting a long time, were prioritised for an appointment.
Each hospital, it said, undertook to confirm with patients that they still wanted the appointment.
"Hospitals made contact with patients by phone and/or letter and those contacted were given five to 10 working days to confirm if they required an appointment. If there was no contact from the individual after this time period, they would then be removed from the waiting list and both the patient and their GP were notified of this."
Consultants have pointed out, however, that some patients still needing an appointment could, for various reasons, slip through the net as part of this validation process.
The HSE told irishhealth.com that 23,037 public outpatient waiting list appointments were 'outsourced' from the original hospital to other hospitals last year, representing around one-fifth of the total additional outpatient appointments provided in 2013.
It again refused, however, to state the total cost of this outpatient outsourcing last year or to confirm consultants are being paid €150 per outsourced consultation in private hospitals to help clear waiting lists.
The HSE said an additional 6,655 elective inpatient procedures on waiting list patients were undertaken in 2013 in comparison to 2012- 4,578 of these were outsourced to other hospitals - nearly 70% of the total.
It said that where a hospital with waiting list patients was unable to provide additional capacity for extra operations from within the hospital, 'other options', including outsourcing the procedure to another hospital, were used.
Most of the inpatient treatment outsourcing was done in private hospitals. The HSE again refused to confirm what the average payment to consultants per outsourced procedure is, nor would it confirm what the total pay-out to outside hospitals was last year for outsourced operations on waiting list patients.
"Fees for carrying out procedures on public patients are agreed with the hospital where the procedure is carried out, not with the individual consultant."
However, the consultant carrying out an outsourced procedure or an outpatient consultation with an waiting list patient would, it is understood, be paid an agreed fee. In the case of eye operations, this fee is reported to be in the region of €500 to €700 per operation.
Recently, Waterford consultant eye surgeon Mr Paddy Condon claimed in some cases HSE-employed consultants were being paid 'top-ups' of €500 to €700 for cataract operations on public waiting list patients. 'which to many of us is considered a double payment by the HSE'.
The HSE has denied that 'double payments' generally occur as part of the waiting list initiative, which is carried out through Health Minister James Reilly's Special Delivery Unit (SDU), set up in 2011 and now run by the HSE.
However, it is believed that in a small number of cases, a patient who might be on a particular consultant's public waiting list can end up being treated by the same consultant privately under the waiting list initiative.
Mr Condon queried why 1,200 public patients in the south-east awaiting cataract procedures were recently transferred to private hospitals for the operations at a cost of €1,900 to the hospital concerned paid through taxpayer's money per patient. He said the operaitons could have been performed more cheaply.
He also argued that the operations could have been carried out in the public system at Waterford Regional by existing surgeons there 'if facilities to do these procedures had not been withdrawn from them during the last three to four years'.
Mr Condon has asked the Dail Public Accounts Committee (PAC) to look at the financial methodology employed by the HSE through the Special Delivery Unit to cut waiting lists in all surgical specialties.
Minister Reilly recently announced a major reduction in the public waiting list for operations, with, he said, 99.99% of adult patients on the elective waiting list now waiting less than eight months for a procedure, and 95% of children waiting under 20 weeks for operations.
He also announced that the number of people waiting over 12 months for an outpatient appointment had been cut to to 4,626 at the end of December, compared to 103,433 in March 2013. This included cutting the number on outpatient lists for over a year by around 50,000 between the end of November and the end of December.
[Posted: Thu 13/02/2014]