Plan for GP referrals to be made to hospitals rather than individual consultants

Publication of the waiting times for individual hospital consultants is being considered, under plans to reform the way patients are referred for appointments, according to Minister for Health Stephen Donnelly.

GPs would refer patients to hospitals rather than individual consultants, under the changes under discussion by the Department of Health and the HSE. The hospital would then allocate the appointment to different consultants based on their workload and length of waiting lists, Mr Donnelly said.

The plan for “load balancing” is designed to ensure patients are not waiting for long times for particular consultants when others are available to see them sooner, he told the Oireachtas health committee.

In a small number of hospitals, this arrangement is already in place, allowing the GP to refer into a particular speciality and the hospital to manage the workload of its consultants.

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He said it was “totally unacceptable” that the time children have to wait for scoliosis surgery can depend on which consultant their GPs has referred them to.

Mr Donnelly said he has asked the HSE how quickly “load balancing” of lists can be implemented as a national policy. Some referrals would continue to go to specific consultants due to their particular skill-set, he explained.

New elective hospitals in Cork and Galway will not be in operation until 2028, the committee heard, despite the decision to proceed with them being made by Government back in 2022.

Mr Donnelly said he shared the frustration of deputies over the time it was taking to build the elective hospitals, which were taking “years”.

In the shorter term, he pointed out, 1,500 additional beds and new surgical hubs were being planned.

Asked about the lack of decision on a planned elective hospital in Dublin, he said his officials felt the site chosen was not the right one as it was on private land that would take a long time to get and cost a lot of money.

Committee chairman Sean Crowe described some emergency departments as unsuitable. Speaking of his own experience, he said he found in some EDs toilets and washbasins were not working, while in others people were taking and selling drugs and there was “an air of violence” at weekends.

He called visiting a friend in one ED and witnessed the death of an elderly woman in a corridor, her family praying around her, while beside the woman, a handcuffed patients, “clearly out of his head”, was shouting abuse.

“It was awful. What a way to say goodbye to your mother.”

University Hospital Limerick needs to reform its working practices so senior decision-making staff are rostered for longer hours during the week, the Minister said.

University Hospital Waterford has half the senior medical staff as Limerick but rosters them for longer hours, he pointed out. Yet UHL has the worst overcrowding in the State while UHW recently went over 1,000 days without a patient on a trolley.

Mr Donnelly said Limerick deserved credit for progress in cutting waiting lists and said its calls for extra resources were “fair and reasonable”.

He called on UHL to run the hospital “according to the ways we know work”, for instance by rostering staff over longer hours. In Limerick, the roster for emergency department consultants largely stops at 5pm, whereas in Waterford senior staff are on-site up to 11pm.

Asked whether there has been “pushback” from the hospital to change, Mr Donnelly said there had been “healthy engagement”. The hospital needed to reform its working practices.

It was “unusual” that the management of University of Limerick Hospital Group was not based on-site in the hospital, he added.

The report by barrister Marie O’Shea into the effectiveness of Ireland’s abortion regime will be referred to the committee on Wednesday, the Minister said.

It will then be asked to report back on the legislative proposals in the report.

Mr Donnelly described some of the recommendations as straightforward and others, such as the abolition of the three-day cooling off period, as sensitive.

“This is going to require the kind of solid, reasoned, respectful debate this committee did in the last Dáil on this issue.”

Asked about the recently published report on former chief medical officer Dr Tony Holohan’s botched secondment to a professorship in Trinity College Dublin, the Minister said the Government fully accepted all the recommendations in the report and would ensure every civil servant implemented these recommendations.