Let’s play shuffle the Granny! The absurdity of our health service waiting lists…

Good report by Seanín Graham in today’s Irish News on the surreal situation of patients going abroad for surgery. Essentially a patient can pay to get treated in another European country and the health service will reimburse them the cost when they come home. With waiting lists up to 4 or 5 years for operations like hip replacements many patients are taking this approach, and who could blame them. From the article:

A SPIKE in the number of patients travelling across Europe for operations due to Northern Ireland’s dire waiting lists has cost the health service almost £1.5m ­– in a ‘last resort’ scheme under threat from Brexit. Desperate pensioners facing five-year delays for hip replacements in the north’s hospitals are among those getting loans of up to £10,000 to fly to Lithuania and other parts of eastern Europe for cut-price surgery.

Figures obtained by The Irish News shows a huge rise in the number of applications to the EU scheme which was introduced four years ago and allows patients to pay upfront and then be reimbursed by the NHS. Just 14 people used the little-known initiative in its first year but as the north’s waiting lists rocketed and publicity around the ‘EU Cross Border Directive’ increased, application numbers surged to more than 700 in the past year.

A total of 1,007 people were ‘approved’ by the north’s Health and Social Care Board since 2014 – with £1,536,234 paid out to 416 patients. Not everyone who successfully applies “decides to proceed” with treatment, a board spokeswoman said. Private hospitals in Dublin are currently running newspaper advertisements urging patients to apply for the scheme, warning that time is running out with Brexit looming.

Now in some respects, this scheme is a good thing if it gets people the operations they need. But where it gets surreal is when you find out that Kerry pensioners are coming up to Belfast for hip and knee replacements to avoid a four-year wait in the Republic’s Health system. From The Journal:

DEPUTY MICHAEL HEALY-RAE is booking buses to take people from Kerry to Belfast for hip and knee replacements because they are waiting between three to four years for the operations in Kerry.

Tomorrow, 14 people awaiting cataract surgery will make the six-hour journey from Kerry to Belfast, joining 2,234 Irish patients who have had to travel outside of the State for healthcare in 2018.

“In our hospital here in Kerry we have not done an operation on a hip or a knee since June,” said Healy-Rae.

“It is ridiculous to think that people are on a list, but what they don’t realise is that there is no movement on that list.”

Healy-Rae has been running bus trips north for those who require cataract surgery for almost two years and following the discovery that no hip and knee replacements were being performed in Kerry he started to organise buses for those patients too.

The buses are booked by Healy-Rae, paid for by the patients and provided by a local bus company. On 21 October the first group of 10 patients requiring hip and knee replacements travelled to Belfast.

That was the first of three trips they will take before the surgery is completed. They left Kerry at 4.30am to travel to Belfast and arrived back home late that night.

So we send our pensioners off to Lithuania and Dublin for surgery, the Republic sends their pensioners up to Belfast, and we have grannies and grandas shuffling round Europe like health refugees.

So the obvious question you are asking is: if Kerry pensioners can be treated in Belfast, why can Belfast pensioners not be treated in Belfast? Well as the Journal explains:

The Kingsbridge Hospital in Belfast carried out the consultation and assessment in one day. The patients were assessed within weeks of their request and were then given appointments for surgery scheduled to take place within eight weeks, said the TD.

So they are using private clinics. But Brian, I hear you ask, if the health service will reimburse me for fecking off to Lithuania for an operation, could I not save a trip and just go private in Belfast and the health service reimburse me? That is a very good question. My understanding of it is the patient is saying you can not provide me with this service in Northern Ireland, therefore, I need to go abroad.

I asked some of my contacts in the health service to explain the situation with waiting lists and frankly, it is very complex as these situations often are. A few key points:

The health department commissions operations from the health boards. So, for example, the health department says we need you to do 500 hip operations this year, and the trust says, no problem, we can do that. The health trust gets paid in advance for doing 500 hip operations, so far so good. Now, this is the part that will blow your mind. If during the year the trust only manages to do 300 hip operations they do not need to give the surplus money back, they get to keep it. There is no incentive at all for the trust to run more efficiently. They get paid either way. Why not just pay the trusts for the operations they actually do? Well, the issue is they need the money in advance to open the hospital doors and keep the lights on.

Then you have the consultants and surgeons. You might have to wait for 4 or 5 years for an operation on the NHS but if you go private the same surgeon can do it within a few weeks. As you can imagine some surgeons have learned to play to the system. They may do 4 operations a week in the NHS but be able to do 4 of the same operations in one day for their private work. The system creates disincentives for consultants and surgeons to be efficient in their NHS work if they know they can redirect the same patients to their private work. Now to be fair, my contacts say consultants don’t do as much private work as you might imagine. But still you can understand how the public can have a perception of a 2-tier health system.

The whole thing is a mess but it is clear to me that the issues are structural, not financial. The health service is a bottomless pit for money and without reform, it will just continue to hoover up money. The Health Department have been introducing some recent changes like the new elective care centres. Essentially staff are ring-fenced to do routine operations whereas before they could be called upon to do emergency work. This should reduce the waiting time for some procedures.

But with people waiting less than a year in England for surgery compared to five years in Northern Ireland, it is clear we need change now.

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