Save our Health Service

A letter to the editor of the Irish Times, caught my attention the other day as it’s topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor proposed some ideas to solve this problem, measures which would also help to reduce waiting lists and raise funds for hospital services.

The letter was headed “DNA and Hospital Waiting Lists”

save-our-health-service“Madam, – Sheila Gorman (February 19th) notes that last year St James’ Hospital had almost 25,000 “DNAs”. As she explains, a “DNA” is someone who did not attend the hospital for their appointment. They did not call to cancel or postpone and so the hospital’s time was lost.

In my own area of Pembroke-Rathmines, St Vincent’s Hospital had 26,878 “DNAs” last year.

Assuming similar figures for hospitals across the country, waiting lists could be cut dramatically by appealing to those who have made medical appointments which they no longer require to cancel their appointment. This would also help to ensure that those most in need of medical attention get it sooner.

In the UK, NHS dentists request a £20 deposit from patients booking an appointment. This is later refunded or discounted from the bill. If the patient does not attend,and fails to cancel in time, the dentist keeps the £20. A similar scheme for our hospitals would either reduce waiting lists by hundreds of thousands or raise millions of euro to provide better services.

Could this be a simple way to improve our own health service for medics and patients alike?”

Source: The Irish Times online.

There are probably lots of reasons why so many public patients do not attend for hospital appointments but I would say prime amongst them, is a lack of respect for our inefficient health service. I’m all for making our present health service more efficient but only if it results in improved patient care. The sooner we get a system of universal health insurance in place, the better.

For anyone interested, world-famous cancer specialist, Professor John Crown will address a Public Meeting in Blanchardstown tomorrow evening. The meeting, hosted by Deputy Joan Burton of the Labour Party, will deal with issues relating to the future of Connolly Hospital, Blanchardstown and will facilitate questions by members of the public.

Where? St. Brigid’s Community Centre, Blanchardstown
When? Thursday 5th March 2009 at 8pm

Prof. Crown will address the meeting on the importance of introducing universal health insurance to put an end to our 2-tier health system.

11 Responses to Save our Health Service

  1. Ian says:


    There is no indication of the causes of the DNAs. How many people received notifications of appointments after the date had passed? How many sat waiting for ambulances that never came? How many patients were already dead? (I’m not joking, I know of one lady very upset on receiving notice of an appointment some time after her husband had died, and it was for the hospital in which he died). While the aggregates are large, 26,000 a year is 500 a week or 100 for each working day. 100 is probably not a big number in relation to the people attending a major hospital for appointments over the course of a day.

  2. Annb says:

    What I can’t understand is why so much wastage is acceptable? Show me another industry which refuses to implement basic cost benefit analysis structures, ignores scheduling and budgets, and is forced into ‘use it or loose it’ budgeting when providing an on-demand service. We need a complete transformation of the culture which currently exists in health care. I’m talking root and branch here. Performance markers, patient care, efficiency and good outcome rates need to be top of the agenda, but not only on individual institutions. We need to be able to track a patient’s progress from hospital to home with follow up in the community – these services need to work together and not covet each others’ budgets. I am currently counting at least 1 million euro extra spend (and climbing) for my son’s care for the lack of a speech therapist when he needed it 4 years ago. His lack of ability to eat, is a direct result of lack of services. This now continues to cost the state thousands of euros a month, but we have yet to see a feeding expert. They try to plug holes with sticking plaster rather then stopping the leak. I should stop now as I can really feel a rant coming on ….. apologies again!

  3. roy says:

    I know you’re not a big fan, but don’t you think they should fast track the co-location hospitals, they will provide employment for builders during construction and for countless others upon completion, and they run a better shop than the HSE?

  4. Steph says:

    Ian – I agree that there is huge inefficiency in the service. The waiting lists are so long for some specialities, I’m sure a significant number of people are dead by the time their appointment date arrives. You might say that 100 missed appointments per day is not a lot for a major hospital but I see it as one more day of suffering for those patients still on a waiting list.

    Ann – I’m totally with you on the lack of joined-up thinking when it comes to following the patient through the system. It makes my blood boil each time the HSE commissions another management consultant report, paid for out of the health budget when I know that patients like your son, Rory, are being denied crucial treatment through lack of services.

    When my mother still lived at home, she had regular falls which necessitated emergency admission to hospital. As an in-patient, she would receive the full gamut of services – medical treatment, physiotherapy, social worker etc but once discharged, we were on our own. The local public health nurses were wonderful but were so under-resourced, they could not provide adequate home visits. It was a vicious circle as without follow-up in the community, my housebound mother would quickly deteriorate again and end up back in hospital. Instead of funding the services needed to keep my mother safe at home, she ended up in full-time residential care five years ago and this is costing the HSE a great deal more than any homecare package!

    Roy – Harney’s plan to provide extra beds through a system of co-located hospitals, has fallen flat on it’s face. It was dependent on cash-rich developers, a buoyant construction industry, massive bank loans and a thriving private health insurance market, none of which any longer exist. Even if they did get the go-ahead, these sub-optimally sized co-located hospitals are duplicating every expensive facility on our hospital campuses. You may well ask why the HSE doesn’t provide employment for builders by carrying out much-needed improvements to our public hospitals? The answer is simple – the government wants to privatise healthcare in this country so that it can wash it’s hands of responsibility.

    We are facing a perfect storm 😦

  5. Annb says:

    Speaking of new ideologies have you heard of this group? (sorry bout the lack of joined up linking ability with that address) Their basic hypothesis is that inequitable societies are bad for everyone not just the poor. The greatest level of good health is found in societies where the gap between rich and poor is least obvious. Food for thought. Must put it on Harney’s Easter recess reading list!!

  6. roy says:

    Don’t you think Government should “encourage” the Banks to lend OUR money to projects that create employment and also reduce the burden on our health service? I heard Michael Cullen say they (beacon medical)are ready to fire ahead, so long as bureaucracy steps aside

  7. Steph says:

    Ann – I heard a discussion about that on the radio while driving home this evening and it was certainly food for thought. If my memory serves me right, they reported that Greeks enjoy better health (both mental and physical) compared to their European neighbours, because of more equitable living standards.

    Fancy living on a Greek island? 😉

    Roy – I take your point but I wonder where the money is going to come from to pay for care in these places? The health insurance market is set to crash in the next few years as people are forced to prioritise their expenses on essentials only. More and more people will turn to the public hospitals for help and it won’t be there. It’s time to re-evaluate the provision of healthcare in Ireland but for that can happen, we need a new government in place. Health workers are on the brink of anarchy and frankly I don’t blame them. It’s depressing to see dedicated workers lose pride in the service they can provide. We have fantastic expertise in the Irish health service, if only it was accessible to all!

  8. Annb says:

    When can we leave?

  9. Steph says:

    Ann – My bag is packed 😀

  10. Annb says:

    I’ve just had a conversation with a friend who offered a software solution to the HSE to reduce DNA’s by 50%. The estimated saving was in the region of 50million euro. He was offering the service for free and would only collect a small percentage of any savings incurred. If they didn’t save money, they didn’t pay. The HSE refused to see the merits in a cost neutral, large saving that, rather than cut front line services, would actually enhance them. I wonder how many other people have pitched brilliant solutions which have been turned down by these Muppets?

  11. […] Not Attend I recently wrote a post about ways to save our health service. One of the issues I spoke about was the problem of patients not turning up for out-patient […]

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