The hospital waiting list crisis must be "depoliticised" and dealt with by the Government as a purely ethical issue, according to a new report on the problem.
A team of management experts linked to Harvard University has found fundamental flaws in the operation of the waiting list system, in a major study of Irish hospital and outpatient services.
Waiting times are frequently significantly longer than officially stated, the group has concluded. In a research paper, following a Harvard case study of the acute hospital service, the waiting system is described as "flawed, unequitable and in need of re-engineering".
The team uncovered what it says is a three-month "unofficial waiting list" which must be endured by public patients before they ever reach the official waiting list.
Waiting lists are a management issue as much as a funding problem, says the report of the Harvard Association of Ireland, Waiting Lists: Analysis, Evaluation and Recommendations, by Prof Ray Kinsella, director of the Centre for Insurance Studies in the UCD Graduate School of Business.
The association, a group of Harvard graduates in the Republic, volunteered to address the issue of long hospital waiting lists, notably for public patients. They gathered 50 senior managers from across a range of business and technology disciplines unrelated to the health service.
The analysis of the system was conducted by 50 middle-management professionals from a wide range of manufacturing and service industries. They interviewed "key stakeholders" in the acute hospital process, such as hospital consultants, hospital managers, GPs and patients.
The current waiting list of 26,000 people is "totally skewed" towards the eastern region, the researchers report. People from outside Dublin are seeking treatment at specialist units in the city, blocking access for people from the eastern region, it adds.
Waiting-list data are unreliable and "you cannot manage what you cannot measure", it says. Their report, which has been seen by The Irish Times and is due to be published soon, advises the Government to "depoliticise" the waiting-list issue by developing an equitable and transparent "single national waiting list". This would be administered directly by the Central Statistics Office and could be viewed on a website by doctors and the public, it suggests.
A "large swathe" of people who cannot afford private health insurance are being marginalised in large numbers on waiting lists. "That's why waiting lists are not simply an expression of `excess' demand, or a crude rationing device to accommodate demand within the finite resources available to Government: they are an ethical issue, the incidence and impact of which is proportional to the size of the list, and waiting time," the report says.
The report calls on the Government to recognise its ethical responsibility "to ensure timely, universal access to the acute system on the basis of clinical need".
The Government should consider reducing the number of health boards and adopting a policy of "total management" of the acute hospital system. It must focus on "commissioning" healthcare rather than "arbitrarily giving money in the hope that it will make some impact".
It also identifies serious problems in outpatient departments, which are holding patients in a "waiting-list loop" that keeps them returning again and again because proper diagnostics and senior personnel are unavailable. Once listed as waiting, patients categorised as "routine" are "left waiting for years, without realistic expectation of treatment".
Calling for a fair and transparent system of assessing patients' true needs and readiness for surgery, the report expresses concern that "he/she who shouts the loudest may gain faster access while a less vocal person may be disadvantaged".