Declining standards in Irish healthcare in 2009

In the last week alone, four reports detailing the performance of Ireland's health service have been published. Yet they hardly hit the public radar -  blanket media coverage of NAMA is a sure boon for HSE public relations. The reports provide myriad facts and figures - the June and July HSE PR reports, the ESRI HIPE report for 2007, the Annual Report of the Comptroller and Auditor General which has over 50 pages on different aspects of the health service.  So what do these reports really tell us?

Breast Cancer
Take breast cancer referrals. A target of a maximum 2 week wait has been set for urgent referrals, and 82 per cent of cases are meeting this but 18 per cent are not. This means that 1,114 urgent cases had to wait longer than two weeks for a referral in July. There is also a target of all women with potential breast cancer being seen within 12 weeks and just 80 per cent met that target, so 20 per cent or 2,387 cases did not.

In relation to money, the HSE are much closer than ever before in living within their budget but they are still over budget by about €123 million. The majority of this is in two areas: hospitals in the North and West are particularly over budget; and the HSE pension budget is €47 million over budget. The budget for foreign travel of €105,000 in the first three months of 2008 dropped significantly in the second quarter of 2009 to €7,000.

In relation to emergency services, a year ago 86 per cent of ambulance calls were met with in 26 minutes - 26 minutes is the target. In July 2009, this had fallen to 83 per cent - a drop of 3 per cent. The number of people showing up to Emergency Department is down by nearly 3 per cent when comparing first six months of 2008 with 2009. What’s interesting about this is the October budget introduced a charge of €100 for people showing up in Emergency Departments (EDs) without a letter of referral to EDs. So this figure may indicate this increased charge is hitting. Also, the number of admissions has not decreased, so the increased fee may be deterring would-be patients who don’t actually need to be admitted.

Public private mix
All the reports deal with the public private mix in hospitals. In particular the Comptroller and Auditor General (C&AG) had some key findings here. Since 1991, we have what is officially called an 80/20 public private designation in public hospitals. This was put in place to control private care and provide extra money from private patients to the benefit of public care. The most recent HSE figures for July 2009 show 75 per cent of inpatient work is public - it should be 80 per cent. This is 7 months into new and extremely expensive consultants contract which is meant to ensure the 80/20 mix. There are some startling findings in C&AG report:

* 50 per cent of private care in public hospitals not charged for their maintenance
* this is an estimated loss of €356 million for all hospitals in a year
* Rates charged despite significant increase – do not represent economic cost

The C&AG found that current system is “facilitating private medicine without getting the related income for the service it provides”. He concludes that “ensuring equitable access and optimising the recovery of the cost maintenance of all privately treated patients are difficult to achieve simultaneously within the present system”.

The C&AG is unsure whether the new consultants contract will address this, plus further complicating factors that new public only consultants may result in loss of revenue to public hospitals – all making it very clear that the current system ensures private patients privileged over public patients and subsidised heavily by public money.


The C&AG report also looked at the HSE’s new performance measurement system Healthstat. Overall, the report was very positive about Healthstat. But its findings in relation to waiting times were revealing. In January 2009, 37,000 people waiting were waiting for hospital procedures. The government target is a maximum three month wait, yet 18,500 of these patients waited over three months. The HSE target is 6 months – yet 6,300 patients continue to wait over six months

The C&AG report is critical of this measurement, saying that it may not reflect the actual numbers waiting, because in many hospitals, people are taking off waiting list once they have been given an appointment for the treatment not when they have had it.

The report points out that, at the moment, a high number of elective treatments are cancelled due to tight budgets, over-crowding and bed shortages, pressures from A&E (70 per cent of admissions) and bed blockers, and that therefore the 18,500 figure is not a true reflection of the measurement.

In one hospital, the total reported number of patients waiting for treatment was 1,741. In actuality, there were 766 others who had an appointment for treatment.

Sara Burke is a health policy analyst. Sara's blog is