Wednesday, 7 February 2018
Hospital Appointments Administration
I welcome the Minister of State. As I know that he has come from a meeting of the Joint Committee on Health, I will not delay him. This matter was touched on at the committee meeting. It is about people who have appointments to attend hospital outpatient clinics. The figure given at the committee meeting was that 479,000 people had not kept their appointments, but that figure does not necessarily refer to 479,000 different people. Some people might have failed to turn up for a number of appointments. If one divides 479,000 by 52, it comes to approximately 9,211 per week. If one divides that figure by five, it comes to 1,842 a day. What initiatives can be taken to help to reduce this level of non-attendance?
The reason I have tabled this matter is that I was speaking to some hospital staff during the Christmas period and one or two of them advised me that the level of attendance at their clinics was as low as 50%. That results in a huge waste of staff time and resources. Staff could have been doing a lot more or made appointments for others on the waiting list. Has the idea of introducing a text messaging service across the board been considered? Another idea that could be considered is that, rather than have 50 people turn up at 9 a.m., 25 might be given appointments at 9 a.m. and 25 at 10 a.m. What has been looked at in that regard to make the system more efficient, reduce the level of waste and avoid using up the valuable time of the front-line doctors and nurses who are running the clinics?
I thank the Senator for raising this issue which, as he said, was referred to at the committee meeting earlier. When one thinks about it, it is an incredible statistic. As many as 2,000 people a day are not turning up for their appointments, at a time when we have chronic waiting lists. Clearly, there is a serious issue to be addressed. I, therefore, genuinely welcome the opportunity to answer the Senator's question. It is welcome that it has been raised in the House.
Providing patients with access to clinicians in a timely manner is a key priority. Reducing the number of "did not attends", DNAs, is essential to ensure available appointments are utilised fully to see and treat patients.Outpatient activity has increased year on year. However, the gap between referrals and appointment activity continues to widen. Waiting list data at the end of December 2017 showed an outpatient waiting list of 500,800. The HSE has advised that last year 479,000 outpatients did not attend their outpatient appointment. By way of example, according to the National Children's Hospital, Temple Street, one in eight outpatient appointments is missed. That means that valuable appointment slots are not being availed of, which is leading to longer waiting times for all patients.
In the light of such stark figures, it is clear that technological and e-health solutions have an important role to play in helping to resolve some of the most pressing and practical issues affecting health services. A Programme for a Partnership Government seeks to drive improvements in the management of health services by mandating the HSE "to engage strategic partners to help with the planning, financing and roll out of a 21st century IT health infrastructure, working towards the universal use of data to improve integrated care and outcomes across primary and secondary care". Potential solutions to the problem of "did not attends", DNAs, are being considered in the context of recommendations from the National Treatment Purchase Fund, NTPF, and the Sláintecare report on access management and e-health.
In regard to ICT supports for managing DNAs, the office of the chief information officer of the HSE has outlined a number of possible technology solutions to assist in improving the efficiency of the current arrangements. A waiting list validation service has been proposed to focus specifically on DNAs. The proposal is to validate waiting lists using SMS reminder messages, which will speed up the validation process and increase efficiency. It is to remind patients of their upcoming hospital appointments via text message. This solution has the potential to reduce the number of patients who do not show up for appointments and, most importantly, reallocate the appointment slots to other patients.
Currently, 31 hospitals use text message based solutions to manage DNAs. The HSE and the NTPF are working to develop a standardised national approach and enable a reminder service that can process patient replies for hospitals that currently do not have solutions in place. Further phases of the programme would see the standardised approach and solution being deployed nationally. The Department is examining funding mechanisms for this proposal.
Overall, outpatient waiting lists remain a significant challenge to be addressed in 2018. A number of steps, including the commencement of a national waiting list validation project by the HSE, are being taken to ensure the lists are accurate and these efforts are to intensify in the coming months. In order to help patients to access timely appointments, I encourage all patients to let their hospital know as soon as possible if they cannot attend scheduled appointments. That simple action on the part of individuals could free up almost 500,000 additional slots in outpatient departments which could have clear benefits in the context of overall waiting lists.
I thank the Minister of State for his comprehensive reply. In the 31 hospitals that have engaged the text messaging solution, is there any indication as to whether it has helped to improve attendance levels and reduce the number of non-attendances? I understand the overall number of outpatient appointments across all hospitals is 3.2 million per annum. That figure was not indicated in the Minister of State's reply. He might clarify if my information is correct.
From my knowledge, that is the correct figure; there are in the region of 3.2 million outpatient appointments per annum. There is feedback from the hospitals which are using the text messaging system that it has had a positive impact, which is encouraging. The HSE is anxious to have a national standardised system that it can apply in all hospitals in order that they can all learn what is good and bad, but, overall, the response on the use of the text messaging system has been positive. It has focused the minds of those with appointments to either cancel or show up for them.