Last Friday the latest information on hospital waiting lists slid out discreetly from the Department of Health. There was no fanfare, no photo opportunity, no ministerial press conference. Hospital waiting lists provide the clearest evidence that our healthcare system is in deep trouble. More particularly, they show that despite the mountain of money being spent by the Government on the Waiting List Initiative, the results are dismal.
The Government has spent £66.5 million on this targeted initiative alone, yet the reduction in hospital waiting lists is negligible. Some 30,447 public patients were waiting for treatment when this Government took office. Now, 27,857 public patients are waiting for treatment. In the years in between, the figure actually went up.
The Government can claim the number is now dropping, but this is small consolation. An analysis of the previous quarterly figures published showed almost two-thirds of the reduction resulted from validation - that is, people removed from the lists because they switched to private care, or moved away, or who died before they could access treatment.
How can so much money be spent to so little avail? The reality is even worse than the figures indicate. The Minister for Health used to argue that it wasn't the numbers waiting that mattered, but the length of waiting times. It is true that waiting times are critical for the patient who is often waiting in pain and in deteriorating health, but it is also true that the trend has been for increased waiting times.
Department of Health figures show the proportion of patients who were waiting over 12 months or more grew in all the key specialities during the period from December 1996 to June 2000.
These figures appear in my report on waiting lists which was recently published by the Oireachtas Committee on Health and Children.
I was keen to test the premise - one often presented to justify the situation in Ireland - that hospital waiting lists are endemic; that they occur in all health systems and that our system is really not that much worse than anywhere else. What I attempted was a comparative study of waiting lists across the European Union. What I got was a clear conclusion that, far from being typical, our hospital waiting lists reflect a seriously dysfunctional system based on inequality and inefficiency. One that no other European country would dream of emulating.
In France, for example, there are no waiting lists, except for organ transplantation. Instead, under a "booking" system, every patient is immediately given a date when the procedure will be performed. In Germany, again with the exception of organ transplants, waiting lists as we know them do not exist. A study of waiting lists in Finland in 1997 showed that there was no waiting period for cancer surgery, coronary bypass or minor orthopaedics. For ENT procedures, the waiting time was 90 days.
In Spain, in 1997, in a study of 15 million people, the average waiting time for hospital procedure was just 98 days. Unfortunately there was no comparative information across the EU on waiting lists, so my study was incomplete. A job for the Commissioner, Mr David Byrne, sometime in the future, I suggest, would be to begin to establish baseline rights for patients across the EU that would include access within a reasonable time to healthcare, regardless of income.
It is worth noting that this principle of solidarity underpins European health systems, but it does not in Ireland. Here, if you can afford private health insurance you get to jump the queue. Although there is universal entitlement to hospital care, almost 50 per cent of our population takes out private health insurance in order - as a recent ESRI study shows - to access quality care when it is needed.
For those left behind - the poor and elderly who make up the sickest part of our population - a small drop in the hospital waiting list figures is cold comfort.
So back to the question. How can so much money be spent for so little return? In his article in The Irish Times, Prof Dale Tussing pointed out that a key to resolving the problem lay in the method of payment of consultants. At present the method of payment differs for a public patient and a private patient. That difference is a major factor in the perpetuation of hospital waiting lists. More investment in our health service is needed. Higher staffing levels, more beds and better services at primary level are required. We are all, I believe, in agreement on those measures but the central inequality in the financial relationship between the consultant and his or her private and public patient leads to the inequality in waiting lists and waiting times and unless it is also addressed, the problem will not be tackled.
The Labour Party has published proposals to have a unified, universal, insurance-based system that offers the possibility of eliminating hospital waiting lists. In the Programme for Government drawn up almost four years ago by Fianna Fail and the PDs, tackling hospital waiting lists was given pride of place. It hasn't happened. The waiting lists haven't been tackled. They have been dinted slightly, that is all, even though we live in a time of plenty when millions have been devoted to that purpose. Delivery of that promise would transform the lives of thousands of patients who are waiting months and even years for treatment. Sadly, the wait goes on.
Liz McManus is Labour spokesperson on Health and author of Comparative Analysis of Waiting Lists for Acute Hospital Treatment in EU Countries, a report for the Oireachtas Committee on Health and Children