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Ireland is grappling with a series of challenges that are impacting our citizens’ quality of life. TheJournal.ie is examining solutions to these issues which have worked or are currently being trialled in other states and asking: Would It Work Here?
HOSPITAL WAITING LISTS are causing serious problems: with over 80,000 people on the inpatient list by the 30 December last year, we have the longest waiting times in Europe for Emergency Department appointments, and are among the worst in other categories.
Recently, an RTÉ Investigates programme showed that this huge figure was only a fraction of the real figure, as there are at least two other waiting lists not published by the National Treatment Purchase Fund, which monitors the figures.
In an episode of RTÉ Primetime where waiting lists were discussed, Dr Arne Björnberg, Chairman of the Health Consumer Powerhouse said that if he were to do one thing overnight that would change things, he would send someone to Macedonia to look at its solution to eradicating hospital waiting times.
And it’s not a complicated system – it just involves booking specialist appointments online.
In 2013, Macedonia dealt with their long waiting lists for hospital referrals by introducing an e-booking system, which meant that a GP can book an appointment with any specialist or heavy diagnostic equipment in the country in real-time while the patient sits in the room with them.
This did away with waiting times in less than six months after start-up, giving people quick access to appointments, provided that patients were willing to travel a short distance (the entire country measures approximately 200km by 130km, with the capital Skopje located fairly centrally).
The policy was implemented by the then-Health Minister Nikola Todorov; a 31-year-old with a degree in law who gave 1 July as the date the new policy should be implemented by.
In the 2014 Euro Health Report, Macedonia’s overall ratings jumped from 27th place to 16th, as waiting lists got shorter and patients’ attitudes towards their healthcare system improved dramatically.
Since then, Serbia has adopted the system, and although there is a settling down period where patients and GPs adjust, it’s already shortened waiting lists.
So… could Ireland do something similar?
How does it work?
You book an appointment with your GP, who after assessing you, decides whether you need to be referred to a specialist, or if you need special assessment, like an X-ray.
If you do, the doctor can view a map of Macedonia, where all the country’s specialists, medical equipment, and medical centres are listed.
You can select ‘radiotherapy’, for example, to view all specialists across the country in this area, then select an area that is closest to the patient. You can then view that particular specialists’ timetable in real time, and book an appointment that suits the patient.
It’s a very simple system: the green times are the available slots, the red mean they’re booked.
The map is also available to view by members of the public – but only doctors can book appointments after assessing a patient. But could it work for Ireland?
‘Ireland is perfect for this’
Dr Björnberg, author of the Health Consumer Powerhouse’s health report told TheJournal.ie that Ireland is a “perfect” candidate to try this new system.
“You have a small population and a centralised healthcare system (HSE) which makes Ireland perfect for this (Serbia has a population of 7 million, and it’s already working for them). The system can be licensed from the Australian-Macedonian company which made it, at a very reasonable price.”
It also shows you where the country’s resources actually are.
The project management team is extremely firm, they go around each university hospital and ask for a complete list of every specialist that is supposed to receive patients. The list had to be submitted within two weeks, and nobody was asked if they wanted to participate.
The completed lists would then be added to the appointment scheduler, while patients who want a more immediate appointment and don’t mind travelling can do so.
He says that it’s surprising no country other than Macedonia (and now Serbia) has done this as the technology has existed for at least 20 years.
“Serbia hired an implementation team from Australia and Macedonia, implemented the new system in less than six months, and is now on the track to beating waiting times. There’s absolutely no excuse for anybody else.”
Macedonia also has an e-prescriptions website, which tracks the prescriptions being given by doctors and what conditions they’re being diagnosed for in real time, which has two main benefits.
The first, is for patients who need repeat prescriptions. They can simply apply for prescriptions from home and download the form. This means patients don’t have to keep booking appointments purely for prescriptions.
The second is for monitoring doctors: the real-time information lets healthcare management track the prescriptions that doctors are handing out: meaning if some doctors are too quick to prescribe over a long period of time, they’ll be easily identified.
What could get in the way?
So when every GP has access to an appointment scheduler and can book patient in real time, how exactly does that cut down on waiting lists? Is the current process, where GPs effectively ‘send a request’ for an appointment, completely ineffective?
“Scheduling of appointments…” Björnberg says. “…is not always primarily directed by patient needs. I remember in Ireland a couple of years ago, 75% of specialist neurologists were located in Dublin, which isn’t great for the west of the country, is it?”
He says he hopes that that situation has changed. It hasn’t.
Strong political leadership and firm hospital management are also needed to get the system implemented; he’s hopeful when he hears Health Minister Simon Harris’ promise to ‘take politics out of healthcare’ and to clamp down on hospital management.
So has Harris or HSE management considered implementing an appointment scheduler system for consultant referrals?
TheJournal.ie is waiting for their response.
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Online? Get away out of that. Sure what would the layers upon layers of HSE admin staff do then?
@The Guru:what a great system that is. The problem is is that it only works in countries that already have control over the whole medical community as the two here. No politician here would have the balls to try to implement it or stupid enough to think he would get by the consultants that control the whole shebang.
@David Dickenson: Sadly David you are so right. There are vested interests in Ireland who control the whole mess. Consultants, Pharmacists and the whole of the HSE management layer do not want any change to the system that they cream off for personal benefit.
The HSE still use fax for referrals instead of emails or anything online. That’s not a joke btw! Yes Fax!
@Brian Fal: HSE is obliged to accept referrals as they are sent in, preferably e-referalls but if GPs fax a referral then hse must accept it.
Somebody somewhere would still f–k it up
That would never work here. To much common sense involved.
@Kieran Monaghan:
“Serbia hired an implementation team from Australia and Macedonia”
Every time I see someone on here screaming blue murder abut payment of consultancy fees to management consultants/private companies, I facepalm.
The fact is that some level of Mgmt Consult is necessary for the correct introduction of any system.
So you’re right, Kieran. It wouldn’t work here because it is too sensible and as soon as someone mentioned that we’d need external consultants to help introduce it, people would start screaming about fees and privatisation.
We need to wake up to the fact that the HSE management needs outside experts to help run it.
This does NOT mean privatisation of the Irish health service. It means sensible investment in expertise.
Too much unions involved you mean Kieran
Yeah and anyone remember the ppars debacle ie.the project to standardise the payroll system in hse, I can just picture the budget overruns if this was to be implemented and project “consultancy services” coining it!
I think the distrust of external consultant teams etc is that all too often they’re not really external, with individuals and companies repeatedly offered consultant roles time and agin without a proper successful track record to back it up. People would likely be more open if there was positive successful progression made on the back of the consultant plan, and if people saw that it wasn’t simply an ex manager now calling themselves a consultancy firm.
What will happen is this;
The health minister will decide this definitely needs to be checked out, so he will send a high level delegation of ministers, TDs, Senators, and hangers-on to Macedonia, Serbia, and Australia on a 30 day evaluation trip.
When they come back, they will be so impressed, they will set up a panel, consisting of TDs, Senators, and senior HSE staff, who will undertake a report, which will take a mere 18 months, recommending that, although the system is excellent, we would need a similar, but specialised system of our own. Another panel will be formed to design a tender process, and evaluate the bidders to design and build the system. This will take another 18 months and cost 28 million Euros. A well-connected non-domicile billionaire will buy an ailing software company, which will have its multi-million Euro debts written off, and this company will win the tender. They will commence building the system for a price tag of a mere 3 billion Euros. It will be scheduled to be complete in 2 years. In the meantime HSE staff, consultants, and GPs will demand a pay rise to deal with it, and the HSE will need to hire an extra 2,743 managers to manage it. After 7 years, and a cost which has escalated to 16 billion Euros, it will be decided that the system isn’t suitable for the Irish situation after all.
Wrong! 2744 managers.
That’s so true, Randall Wharton, I don’t know whether to laugh or cry!
@Randall Wharton – so right. So sad. So angry!!! You just summed up in one short comment everything that’s wrong with how our government do things.
We would somehow mess it up and end up running over budget and behind schedule like all the other IT projects that the civil service try to implement.
Macedonia: Population 2 Million, GDP per Capita $14,000, Deficit 3.7% of GDP.
Ireland: Population 4.5 Million GDP Per Capita €66,000, Deficit 3.8% of GDP.
What’s our excuse again?
@Chris Bond: I found the excuse: their system is too cost-efficient for Ireland.
In principal it’s a brilliant and simple idea, but with private health insurance being forced on people, it can’t work because of two tiered system. Solution in my opinion is one health service for all, a little like NHS but a specific payment made to each hospital, and more of our hospitals turned into functional decent general hospitals with 24 HR staffing.
@Catherine Mc: @Catherine Mc: The NHS has been operating this system for a couple of years and it is brilliant. Once you agree an appointment time to see a specialist with your GP you are also given a password. You can then access the booking calendar for that specialist should you need to change/cancel your appointment for some reason. This means less missed appointments and far less admin. Here your GP makes a request for an appointment and ( if lucky ) you are given a random one, which might be on an unsuitable date eg: on hols, exams, getting married etc… should this be the case you will then get another random appointment , no effort is made to liaise. Should you be unlucky enough to get three appointments that clash with your calendar you will find yourself at the back of the queue as they say you have missed three appointments and you will have to book another appointment with your GP to get another referral.
We have “new” consultants with no office,computer,OPD clinic,operating theatres or beds!
As a GP you could refer patients onto their very short lists.Does not mean they would be treated any quicker!!
Irish start up bookinghawk.com is doing this in the private medical sector
I think that is the major problem here. The GP will have two lists of consultant timetables available: a public list for 2 consultants full until 2023, or the same consultants (plus 4 or 5 other consultants who can do the same work) private timetable free next week, using the same public paid-for facilities and equipment. Try to implement a single timetable system will result in doctors and consultants striking, GPs refusing to use the public one, and health insurance companies upping their costs to cover having to implement a link to the public system. It needs a health minister with balls to tackle vested interests for the benefit of patients, not an IT system.
Common sense referral system.
Will stop the HSE fiddling the waiting list figures by their convoluted categorisations, clearly designed to mislead & cover up.
Scandalous to note that they pay people , probably on executive scales, to do this, when it could go to employ nurses.
Heads should roll.
If all the facilities were available in most of the hospitals here then it might work but as it stands now , a lot of people still have to travel to Dublin to see consultants or have treatment ..people should not have to travel the length of the country for this . imagine the hundreds of cut backs there would be in administration if this was introduced? Bring this in , cut back on the admin and re- introduce Martin’s on the wards and that would make a good start in sorting out the HSE …
* Matrons
@Suzie Sunshine:thanks. I wasn’t sure if you meant Doc Martin’s or Pine Martin’s.
For a second there I thought you wanted Micheál Martin back as Minister for Health!!!.
“So when every GP has access to an appointment scheduler and can book patient in real time, how exactly does that cut down on waiting lists?”
The article asks this question, but doesn’t really attempt to answer it.
Bit more info here:
http://vlada.mk/node/10101?language=en-gb
Friend of mine has medical problem got a referral from his GP to see a specialist got appointment in June to get appointment for medical procedure !
It won’t work in Ireland because the joint policy of the DoHC and HSE is to defer medical treatment, however appropriate and even beneficial, for public patients as long as possible. A patient does not become an expense unless or until the patient is treated. Deferring treatement is deferring expense and that is a saving, although a false saving.
What no one wants to tell the public is that health services are severely rationed in Ireland. A system such as that in Macedonia would nit work because of the multiple inbuilt blockages in the Irish health service.
There is massive wastage of expenditure in the Irish public health service but that is only one part of a much larger picture.
A unitary system would be the first step towards reform but those who have priority in the private treatment sector would not tolerate equality for all.
A&E is being wrongly used as an admission processor and pre treatment evaluation system but that is primarily a symptom rather than a cause.
Ireland is a first world country with elements of a third world health service.
so remove waiting list by just giving people a date years in the future so they are on another list. legit idea.
so if you have a medical problem in Wexford – and the consultant in donegal’s waiting time is only 6 months, you would be happy to travel to see a consultant in Donegal?
Waiting lists are a joke. My 4 year old was due to attend the eye clinic in January but list is so bad they are now calling patients due to be seen in April 2016.
Adopt a system that Macedonia used. This is ridiculous . Macedonia is almost a 3rd world country . I’m all for anything that works but I’d doubt this is the answer . Something tells me if I was Macedonian and got sick tomo I’d be in a bad situation . Just saying
With those kind of research skills you’d be great in the Irish civil service.
@Paul Kelly: That was on 2015. In 2016 guess who has the worst health service in eu, according to the same source:
https://www.kildarenow.com/news/irelands-healthcare-is-one-of-the-worst-in-eu/70245
Who is the Health consumer Powerhouse?
Who funds them?
There goes job security. I have a stack of appointment letters saved from 2 bouts of cancer. I’m sure they are batch processed. But I chuckle when they arrive, each letter on heavy stock in 5-colour printing. I reckon the cost per letter at around a Euro. On line appointment services would be a real 21st century leap forward, and likely pay for itself in months not years. But wait, we’ve always done it the phone and letter way!
We have an ageing population, this won’t work but may be in the future
How can this system increase the capacity? Sure, it is convenient and transparent, but if the problem is too many patients and not enough doctors, no fancy online system can fix that.
Besides, we already have online or instant bookings for many things already, though they could be more integrated.
But, ultimately, capacity is the problem. Most consultants already have enormous numbers of patients.
I just sent this article to a junior doctor I know. The response: “I’ve seen this proposal before. The problem is that it would be too efficient and would thus make too many people surplus to requirement” I’m confident that this is the real reason that this system hasn’t been implemented and likely never will be. It’s also one you will never hear a politician say!
Surely wed rather pay 20 times more for something that doesnt work? Im sure Dennis could whip sonething up.
Unions will ensure this gets blocked if it’s efficient it’s the enemy
have your say