Sir, – Hospital referrals are in the news again with the accusation that the HSE is manipulating the waiting list data ("Varadkar denies waiting lists are being manipulated to meet targets", October 7th).
So-called “waiting list validation” is important when managing limited health resources, however the real issue is how this is achieved when you are dealing with vulnerable groups of patients.
Is the HSE aware that approximately one tenth of the population is functionally illiterate and an indeterminate proportion rely on advocates, eg family, neighbours, home helps, etc, when accessing even the most basic of healthcare?
The strategies used by hospital management to manipulate the figures are well rehearsed but one of the many problems encountered by GPs in the southeast is a volume of referrals that are marked “deflect”, a term used by one Dublin teaching hospital to return referrals to the GP on the pretext that they are “out of area”. How many of these referrals are in this “no man’s land” on the way back to GPs is unknown. These patients are usually re-referred to a hospital in another part of the country, usually more distant than the original hospital and usually involving significant inconvenience to all concerned.
GPs use a number of strategies to access care for their patients and commonly refer patients to a number of hospitals for the same health problem in the hope rather than the expectation that they will be seen in a timely fashion. We also send “expedite letters” in their thousands every year at the request of patients and relatives, even if the clinical situation remains unchanged.
Chronic under-resourcing and cutbacks at the gatekeeper stage of the referral are at the heart of this issue. GPs get a derisory 2 per cent of the health budget as opposed to 10 per cent in the UK.
The voracious appetite of the hospital sector ensured that general practice sustained a disproportionate cut in funding to feed the “monster” that is the hospital sector over the past six years. This is compounded by a medical staffing crisis across the board which is steadily getting worse.
There has never been a supplementary budget for general practice, unlike the hospital sector where this annual tradition is part of the credo. It is now time to resource GPs and allow them to commission care for their patients by giving them control of a defined budget.
It takes vision and courage to effect change for our patients but why not start with a little honesty and transparency when it comes to activity levels, or indeed inactivity levels, in health? – Yours, etc,
Dr WILLIAM LYNCH,
Enniscorthy Medical Centre,
Co Wexford.