HEART BEAT: I have been asked to explain my antipathy to the National Treatment Purchase Fund (NTPF ). My answer is simple: it should not exist, writes Maurice Neligan.
Let us apply logic here. A patient goes to hospital, either to the emergency room, or by referral from his or her general practitioner. They should be seen promptly and appropriate treatment decided.
By and large, if the situation is an emergency, it is dealt with quickly and hopefully satisfactorily. Apart from the seemingly inconsequential matters of unacceptably long waiting times, appalling conditions for patients and staff alike, and inadequate facilities throughout the State, the acutely ill do get treated.
This speaks volumes for the dedicated medical nursing and paramedical staff entrusted with their care.
But it is with the second group that the problems arise. These are the patients who are referred to the consultant by their practitioner, for consultation, further assessment and treatment.
This is the point where things go seriously wrong.
Firstly, there is a hidden waiting list which features in none of the official information or, more correctly, misinformation. These are the people who await their initial consultation, be it in neurology, cardiology, dermatology, or whatever speciality you care to name. They may wait for weeks, months or even years to make it to an official waiting list.
Sooner, or more often later, these patients are seen, and treatment decided. It may be surgical or medical and may require in-patient assessment or definitive treatment. Therefore they require admission, and a hospital bed.
These beds are not there in the numbers required, either because:
a) they are full of the emergency patients, finally processed onwards from their trolleys;
b) they are occupied by patients ready to be discharged or moved onwards to a step down or long-term care facility, and for whom no space is currently available;
c) there are no staff of whatever category to man the beds;
d) that the beds do not exist, having been leached from the system and never replaced.
Accordingly, those whose problems are not speedily resolved are placed on the waiting list. The sum of these lists, collated nationwide, becomes the "official waiting list".
They are waiting for the consultant under whose care they were specifically placed, to acquire a bed in which to treat them. They are not waiting for an amorphous body without any patient responsibility, to select them by whatever process, and to transmit them to the private sector, where their procedure is carried out.
Those selected or applying are mostly surgical cases. The NTPF (correct me if I am in error) makes little impact on medical waiting lists. Many of those selected are chosen on length of time on the waiting list rather than the urgency of their condition.
As my colleagues have repeatedly pointed out, a cancer patient requiring surgery should not have to wait at all, whereas some other conditions while causing discomfort and pain, may not be life threatening.
These distinctions, of course, ought not to exist in a properly functioning and caring service.
The mechanism of paying for these outsourced procedures is also unclear.
The public do not know if value is being obtained, but they have a right to know. We have been told that this is economically sensitive information. I just bet it is! But why we can not be transparent and open? Let us know the cost per procedure and if tendering from suitable hospitals was sought.
I would also ask who bears the responsibility when the litigation starts as it assuredly will in this island of ours. It would, I suppose, be almost churlish to point out that under EU law long waiting patients already have the right of treatment in another member state, if such cannot be expeditiously provided at home. It is not a benison from any Minister or his department.
This brings me back to where I started.
In my opinion the NTPF should not exist at all. It is a finger in the dyke exercise designed to prevent the public waiting lists from vanishing over the horizon.
We have had many cynical vote catching exercises over the years - abolition of car tax and abolition of the domestic rate spring readily to mind - however one of the most despicable was free hospital treatment for all. This was at a time when the system had the same problems as today.
Today, 50 per cent of Irish people carry private health insurance because they know that while public hospital treatment may be almost free, they cannot readily access it when required.
Fix the public system, or develop a new system. Then the NTPF becomes redundant. Those responsible for today's problems in reality should not be part of the solution.
Let us have caring, concerned people who put patients, not empires, first.
Dr Maurice Neligan is a cardiac surgeon.