What role do consultants play in health service waiting lists?

Seanin Graham’s exclusive in the Irish News “Desperate Patients Pay for Eastern Europe Opshighlights a persistent problem in our Health Service; lengthening waiting lists.  She focuses on the use by local patients of surgical services in other European states and identifies the lengths some will go to improve their situation.   She has identified the problem and, for very few patients,  an expensive solution, and where this is a useful reminder that as a population we deserve better, she fails to consider why we have unacceptable waiting lists in the first place.

The HSCB knows only too well the complex interactions of factors that make waiting lists grow.  Lack of investment certainly is one with our HS needing about 4% uplift year on year to keep steady which means that perhaps £1 billion of funding was not invested between 2010 and 2017 due to government cut backs and with that lack of funding you can expect problems in the service.

Our HS is far from a simple system but in simple terms; patient suffers symptoms, goes to GP, GP refers to a consultant, consultant assesses patient and, if deemed necessary, gives treatment – a surgical intervention perhaps.  Each step of this pathway has its problems and complexities.  The patient, for example, may fail to see the GP early and the problem is then more difficult to manage; ironically left on a waiting list this has the same outcome.   Or, for example, you cannot get a patient out of their recovery bed after surgery because a care package is not in place at home, the patient cannot go home and the bed is blocked.  Health Service managers struggle to manage and transform the system, and in some specialities, a transformation has proved all but impossible.

But a key factor few are willing to identify never mind tackle is the all-powerful medical consultant.   These are the experts who sit atop the medical hierarchy and can be difficult people to manage.   Their brilliance makes them almost untouchable, certainly formidable and for too long, in some specialities at least, the service appears to be run for the convenience of the consultant rather than the patient.

I have a good friend, a professional woman, who using BUPA medical cover visited a consultant for a private consultation one week after seeing her GP.   He assessed that she needed a hip replacement and offered her an operation at a local private clinic the following Saturday.  She was taken aback with the speed this happened but decided to go ahead and found she was one of four patient who the consultant operated on that Saturday.   This level of efficiency were it to exist in the Health Service, would see a big impact on waiting lists.   There is a glaring perverse incentive in the contractual relationship medical consultants have with the Health Service yet no government seems capable of tackling this.

Off course most medical consultants are hard-working, dedicated professionals, and in some specialities, we do not have significant waiting lists.  And that is not to say where waiting lists exist the consultants are primarily to blame, far from it.  But some medical specialities stand out as problematic.   Perhaps waiting lists are a poor measure of quality in that they quantify the problem but do not allow sufficient insight to what needs to be changed.   Above all, we must make our health services accessible to all dependent on clinical need rather than the ability to pay for private medical insurance.