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Break a leg: Is the new ‘Sláintecare’ plan still keeping patients in the waiting room?

Image by the National Cancer Institute on Unsplash

With over 85,000 patients waiting for their first inpatient treatment by the end of March, Irelands’ Health Care System is yet again under criticism. For 45,731 patients this exceeds the maximum waiting time target of 12 weeks, as recommended by the 2017 Oireachtas Sláintecare Report, 6,111 of which are children.

According to recent data, released by The National Treatment Purchase Fund (NTPF), a total of 594,858 patients are currently awaiting their first hospital outpatient consultation.

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In a first-time cross-party consensus in 2017, the Sláintecare Action Plan was introduced to effectuate a universal single-tear public health system to provide accessible and affordable services to all citizens. Key concerns of the most recent 2021-2023 report of the ten-year strategy included the implementation of a Waiting List Reduction Plan[iv] to meet said waiting time targets of 12 weeks.

Central themes of the Waiting List Reduction Plan comprised elements such as ‘Workforce planning’, ‘Reporting all waiting lists’, and ‘Rewarding best practice and innovation’.

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Taken from the official transcripts of the Waiting List Meeting, it was stated that “while the key WLAP targets were not achieved, there was a trend of positive progress on long waiters, as well as significant OPD downward trend in Q4 2022 resulting in 5.3 % annual reduction.”

In the most recent waiting list ministerial meeting held on the 27th of February 2023, the Minister noted that “he has reviewed and signed off the 2023 WLAP, subject to the HSE exploring potential to increase core activity target.”

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Details on the renewed plan are not yet available for viewing. Regarding upcoming information on the next phase of the Sláintecare Action Plan, Denise Molloy, Clerical Officer at the Freedom of Information Unit enunciated that “the Minister did not appear before the Joint Oireachtas Committee on Health so far in 2023.”

The Department of Health has admitted that given the historically long waiting time and the impacts of the Covid-19 pandemic, the new Sláintecare waiting time targets will experience a setback by 2023.

Responding to this forecast, a lack of medical staff or a lack of beds is often at the centre of the waiting time discourse. Any data relating to the medical register are summarised in an annual report by the Irish Medical Council.

Their latest report showed that Ireland’s medical workforce stood at 21,680 doctors. The number of new doctors who registered in 2021 was 2,605, which represented a 14% increase from the previous year.

Updated data on Ireland’s workforce will be published in the third quarter of 2023.

“We are currently processing, analysing and preparing raw data relating to the Medical Council’s annual registration data, including the demographics of those retaining and withdrawing from the register, General Division information, Irish graduate/International graduates etc,” states Bernadette Rock, Head of Research at the Medical Council.

Despite the increase in medical registrations in 2021, this investigation finds that Ireland is significantly below the OECD average on the number of consultants and GPs required per head of population.

In 2021, Dr Clive Kilgallen, Chair of the Consultants’ Committee of the IMO expressed: We simply do not have enough doctors to fill critically important positions all across Ireland, a problem which stems from the enactment of two-tier consultant pay inequality nearly a decade ago, and patients are the ones who have suffered as a result.”

Additionally, the number of beds per 1000 people is now substantially below the OECD average of 3-0 vs 4-7 in 2015.

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“We don’t have enough beds; we don’t have enough space or enough staff to deal with that. Non-urgent procedures need to be postponed and this, obviously, disappoints even more patients. The problem is when we don’t have space for emergencies, we deal with them the best we can but it’s not easy – for anyone,” shares Stefania Del Sette, Midwife at the Emergency Department and Outpatient Department of the Coombe Hospital.

“We understand what it means to wait for ages, we are people and patients as well once we take off our scrubs. It is frustrating and I would like to do more but, apart from giving them the best care possible, the logistics are dealt with at higher levels, unfortunately”

-Stefania Del Sette, Midwife
Image by Huyen Pham on Unsplash

Putting all the recent data into perspective, it clearly showcases that Germany significantly underbids the average wait time for a doctor’s appointment when compared to other EU nations. According to a 2018 BMC Health Services Research survey, the average wait time for a doctor’s visit was 4.0 days. Participants from Western Germany had to wait 3.3 days, compared to 6.6 days for East German respondents. Only somewhat longer than those with private insurance (3.3 days) was the wait time for statutory health insurance subscribers (4.1 days).

“This is ridiculous, I came here to study for a year and even upgraded by international health insurance, but that doesn’t even matter because the GPs in my living radius don’t take on any new patients,” expounds a 26-year-old student from Germany, Sophia Roik.

“Fortunately, I am not reliant on any constant medication or other, but it is sad to think that a doctor can just send you away or tell you, you might have to wait for months just to get an appointment.”

It remains unknown what the next phase of the Sláintecare Action Plan comprises. Looking towards additional actions to reduce the waiting list times, the latest ministerial meeting coincides with the following:

  • HSE to explore increasing its 2023 core activity targets.
  • HSE Community Ops to engage with DoH primary/community care counterparts on proposed plans for use of recurrent funding in reducing community services waiting lists.
  • HSE to provide more detailed updates/reports on reform initiatives, including a weekly report on surgical hubs, including for future TF / Ministerial slides.
  • DoH to schedule a meeting with HSE and NTPF on publishing data on activity and Sláintecare targets.
  •  HSE to look at publishing rolling annualised activity figures.
  • DoH to schedule a meeting with HSE and PHA to progress engagement and determine capacity for the coming year.

Concluding this investigation into the Irish Health Care System, Sláintecare continues to face difficulties upholding its aims for universal health care that is accessible and affordable for everyone. One difficulty is the doubt expressed by some stakeholders over the finance, which they consider insufficient for the plan’s implementation. Others have criticised the action plan’s slow development and the lack of specific deadlines for its complete implementation. The COVID-19 epidemic has also hampered the execution of the response plan, causing delays and rescheduled deadlines.

While there is no one-size-fits-all solution, measures such as improved funding, streamlined processes, improves staffing, and investment in technology may prove to be effective. By taking inspiration from other European countries such as Germany, Ireland could potentially make great strides towards providing a more efficient and effective health care system for its citizens. As there have not yet been any updates on the next phase of the Sláintecare Action Plan, it is uncertain when Irish citizens can expect a general improvement in their health care.


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