Dublin MRI Waiting Lists Health And Social Care Essay

Dublin MRI Waiting Lists Health And Social Care Essay

This thesis is looking at the factors impacting public infirmary waiting lists, with a peculiar focal point on waiting lists in Magnetic Resonance Imaging ( MRI ) . Waiting times for everyday MRI assignments in Irish public infirmary are presently up to 16 months in some infirmaries, and this thesis is look intoing whether there are ways to cut down these waiting times, other than excess support. It examines how wellness systems in other states are pull offing their waiting lists by carry oning a comprehensive literature reappraisal, and explores what is already being done in Ireland to assist to relieve the job. Recommendations are so made, based on the information gathered, on ways to better manage MRI waiting lists in Ireland.

Chapter One: Introduction

Irish wellness services have ever tried to follow a consumer-orientated attack to healthcare as set out in the wellness scheme ‘Quality and equity: a wellness service for you ‘ ( DoH, 2001 ) . Yet despite this, there have been studies of public patients on waiting lists for MRI scans for up to a twelvemonth and more ( The Irish Times 9/11/2009 ) .

Hospital waiting lists in general, have become a characteristic of wellness services which are publically funded, and are a consequence of demand transcending supply ( Foote et al. , 2004 ) . As the demand for healthcare resources increases, waiting lists occur and necessarily intensify ( Saulnier et al. , 2004 ) . The effects of this are far making ; waiting long periods for medically necessary interventions may do patients physical and psychological hurting, loss of economic productiveness, decreased quality of life, and in some cases, even decease ( Sanmartin et al. , 2000 ) . Wait times for diagnostic imagination e.g. MRI, are peculiarly of import because they may ensue in holds in unequivocal intervention ( Emery et al. , 2009 ) . In add-on, “ wellness professionals besides experience inauspicious effects of long delaies for service, including a turning defeat associated with the inability to supply seasonably and appropriate wellness attention ” ( Saulnier et al. , 2004 ) .

Waiting lists are a common and inevitable characteristic in all publically funded services, worldwide ( Pitt et al. , 2003 ) . Almost every state that has a publically funded wellness attention system trades with issues with entree to services and waiting lists. Lack of resources, such as staff and equipment, are cardinal factors that contribute to long waiting times. However, merely adding more resources may non supply consistent or sustained betterments, and other factors need to be looked at ( Pitt et al. , 2003 ) .

Background: MRI as a clinical tool

MRI is progressively used in imaging the organic structure as it provides first-class soft tissue contrast and spacial declaration features, allows for multi planar imaging in different anatomic planes, is by and large non-invasive, and does n’t affect ionizing radiation ( Chaipat and Palmer, 2006 ) . MRI provides elaborate and accurate images of the organic structure, particularly in the countries of abdominal, pelvic, cardiac and chest imagination, and the demand for MRI scans is turning as the clinical demand for these processs addition ( Mankad et al. , 2011 ) . Indeed, many current scrutinies that are performed utilizing computed imaging ( CT ) may in the hereafter be undertaken utilizing MRI due to its built-in advantages ( Law et al. , 2011 ) . MRI engineering can be used to measure tumors, show abnormalcies in the bosom, encephalon and articulations, and is besides being routinely used in malignant neoplastic disease attention to assist name disease, find appropriate intervention, and for everyday followup ( Panel, 2009 ) .

As a consequence of the addition in the usage of MRI scanning, the waiting clip for a everyday MRI assignment in a public infirmary has besides constantly increased. The Irish Times ( The Irish Times Archive 9th Sept 2009 ) reported that “ A public patient may hold to wait 18 months for an MRI scan in University Hospital Galway ( UHG ) but can be seen and have consequences within 20 four hours from a public-private partnership installation in Merlin Park Hospital in the metropolis by paying over five 100 euros. New figures show there are now more than one 1000, eight hundred and 60 people on a waiting list for between two and 18 months for an MRI at UHG. ”

A study by Niall Hunter, editor at that clip for www.irishhealth.com in June 2010, stated that “ Public patients deemed by advisers at Cork University Hospital ( CUH ) to necessitate an pressing MRI scan presently face a delay of over four months for these critical scans, while patients at Dublin ‘s Mater Hospital can confront a three-month delay for pressing MRI trials. ” The study besides highlighted the latest HSE statistics and figures, demoing that many patients around the state were presently confronting long delaies for pressing scanning. At Cork University Hospital it was taking one hundred and twenty six yearss for a public patient to acquire an pressing MRI, and those seeking a non-urgent MRI at the infirmary were confronting a delay of one hundred and 40 yearss.

In June 2011, despite Galway University Hospital ‘s MRI unit widening its gap hours over tiffin, there still remained an eight month and over delay for a scan ( galwaynews.ie, 2011 )

The Health Service in Ireland- A Brief Overview

The Government, Minister for Health and Children, and Department of Health, are responsible for the proviso of the wellness service in Ireland. The Department of Health ‘s primary function is to back up the Minister in planing and measuring policies for the wellness services. The Department of Health makes determinations sing wellness policy in Ireland, and the Health Service Executive ( HSE ) is the administration responsible for presenting public wellness services ( www.hse.ie ) . The HSE came into operation in Ireland on 1st January 2005, replacing the 10 former regional wellness boards in order to supply a individual national administration that is responsible for the bringing of wellness attention. On a annual footing, the Department of Health allocates funding to the HSE and each HSE regional country so makes determinations on how the available resources will be distributed in their country ( www.hse.ie ) .

The current economic clime has signalled a lessening in the support available. This support has been diminishing easy over the past figure of old ages, e.g. The gross current estimation for the HSE is a‚¬13,317m as set out in the published Estimates of Receipts and Expenditure 2012 ( HSE, 2012 ) . This is an a‚¬84m decrease in the allotment set out in the 2011 Revised Estimates Volume. The HSE therefore faces the undertaking of presenting more health care with well reduced finance ( HSE, 2012 ) .

Current and Recent Measures to Help Alleviate the Problem

A figure of authorities organic structures have been established late, to seek to undertake the increasing job of long waiting lists in public infirmaries. These include:

National Treatment Purchase Fund / Particular Delivery Unit,

Health Information and Quality Authority ( HIQA )


National Radiology Programme

National Treatment Purchase Fund / Particular Delivery Unit of measurement

The National Treatment Purchase Fund ( NTPF ) was established in 2002, and is an independent statutory bureau established by the Irish Government with the primary purpose of supplying faster interventions for public patients who have been waiting longest on public infirmary in-patient waiting lists for surgery ( NTPF, 2007 ) . This means that patients who have been waiting for more than three months for an operation on an in-patient public infirmary waiting list, may be eligible for intervention. The NTPF purchases surgery chiefly in private infirmaries in Ireland and receives its support straight from the Department of Health, and this service is free for the patient. A National Patient Treatment Register ( www.ptr.ie ) was established by the NTPF, to let patients and general practicians to entree up to day of the month information on delay times for single processs and supply waiting clip information for infirmaries across the state ( NTPF, 2011 ) .

Decreases in waiting lists for surgical and medical processs from 2002 to 2007 as a consequence of the NTPF are shown in Fig.1.1

Fig.1.1 ( NTPF, 2007 )

Fig.1.2 A statistical survey of waiting times for surgical and medical processs in April 2010 as a consequence of the NTPF showed a average delay clip of 2.5 months for all processs ( NTPF, 2010 )

Fig.1.2 ( NTPF, 2010 )

In 2011, the Fund ‘s duties changed well, following the debut of the Particular Delivery Unit ( SDU ) in the Department of Health, and subsequent alliance of both maps. The constitution of the Particular Delivery Unit involved three chief alterations:

( a ) all public infirmaries were instructed to guarantee they have no patients waiting more than 12 months by the terminal of 2011 ;

( B ) the NTPF would aim peculiar backlogs instead than routinely accept referrals of patients waiting over three months ; and

( degree Celsius ) the demand that the NTPF purchase 90 % of interventions in the private sector was to stop ( hypertext transfer protocol: //www.ntpf.ie/home ) .

However, despite these attempts overall waiting lists are go oning to increase, with 30,000 now on lists for the first clip in more than a decennary ( www.irishhealth.com 17/11/2011 ) .

Although the NTPF and SDU are n’t specifically targeted at MRI waiting lists, the authorities has already outsourced, under the NTPF, in Galway University Hospital where MRI waiting times had reached nine months and beyond. In treatment in the Dail on 31/05/2011, the Minister for Health and Children ( Deputy James Reilly ) had this to state:

“ I realise that the figure of patients still waiting on an MRI scan is unacceptable. As Minister for Health, I am determined to turn to the issues which cause holds in patients having intervention in our infirmaries. The Government is committed to set uping a Particular Delivery Unit ( SDU ) to better entree to the exigency and elected attention system. The SDU is a Government precedence and is one of the committednesss from the Programme for Government 2011-2016 to be achieved within the first 100 yearss. ”

Health Information and Quality Authority ( HIQA )

This authorization was set up to develop person-centred criterions for health care services. Its function is to advance quality and safety in the proviso of wellness and personal societal services for the benefit of the wellness and public assistance of the populace. It besides has statutory duty for:

Puting criterions for wellness and societal services ;

Monitoring healthcare quality ;

Health engineering appraisal, ( this subdivision includes diagnostic techniques ) ;

Health information ;

Social service inspectorate ( HIQA, 2007 ) .

The National Standards for Safer Better Healthcare have late been developed by HIQA, and supply the edifice blocks for quality and safety throughout the health care system, making a common apprehension of what quality and safety is ( HIQA, 2012 ) .

These criterions are an of import stepping rock for the execution of National Quality Assurance Criteria for Clinical Guidelines, as they set out the demand for clinical determinations to be based on best available grounds and information, and are intended to help in the development of local clinical guidelines ( HIQA, 2011 ) .

Examples of HIQA Investigations and Recommendations

In 2008, the Health Information and Quality Authority, at the petition of the Minister for Health and Children, announced it would set about an probe of the agreements for supplying services at MWRH Ennis. This was as a consequence of concerns raised by a patient ‘s relation over the attention the patient had received. A thorough probe ensued and a figure of recommendations were made, of which, recommendation figure 8.2 pertained to diagnostic services:

“ A quality confidence system, which includes strict processs and protocols

for bespeaking, prioritizing, reading and describing radiology scrutinies, with

defined timelines and volumes, should be implemented, on a regular basis reviewed

and conformity audited ” ( HIQA, 2009 ) .

In March 2010, Dr Maurice Hayes was commissioned by the HSE to look into the accretion of unreported X raies in Tallaght Hospital ( AMNCH ) . Amongst the findings of the Hayes study, it emerged that, for assorted grounds, there were many GP petitions that had non been processed efficaciously. With the absence of written protocols in topographic point, there was an informal prioritisation taking topographic point ( HSE, 2010 ) . On the footing of this information, HIQA made recommendations, amongst which were:

“ The Hospital should officially reexamine and formalize the patient waiting list for diagnostic imagination on an ongoing footing and set up a prioritisation procedure with appropriate monitoring mechanisms. ”

“ Entree to high demand, low capacity diagnostic imagination ( for illustration, CT and MRI scans ) should be reviewed at a regional and national degree and the HSE nationally should develop, manage and organize entree and waiting times for this type of imaging as a shared resource across all infirmaries and primary attention, peculiarly where there are long waiting times for patients ”


HealthStat is a comprehensive databank of public presentation information from Irish public wellness services. Its steps are grouped into three countries – Entree, Integration and Resources. Access measures the waiting times that people experience for different services, and whether patients are able to entree adviser led out-patient clinics, diagnostic services, etc. within acceptable timescales ( HealthStat, 2012 ) . This information gives the populace an thought of how each infirmary is executing, and what to anticipate sing waiting times, utilizing a “ traffic visible radiation system ” , ruddy being unacceptable, brownish-yellow acceptable, and green good.

A recent study in The Irish Medical Times suggested that the HealthStat ruddy classs disappeared when the Particular Delivery Unit came into operation last summer. HealthStat is now to come under the remit of the Particular Delivery Unit and it is presently being reviewed ( Lynch, 2012 ) .

National Radiology Programme

The purpose of this is to develop a programme to back up bringing of quality radiological services to run into appropriate clinical demands, with a focal point on the countries of entree, quality and cost ( Radiology Programme, 2011 ) .

Amongst its aims, it intends to:

Optimise entree to service to outdo meet ague and elected demand ;

Prioritise on bringing of nosologies to aline with the purposes of the other clinical programmes ;

Achieve optimum describing marks for radiology nationally and 24 hr coverage turnaround where needed ;

Implement relevant recommendations of the Hayes Report and other studies or reappraisals relevant to the purposes of the programme ;

Participate in the Quality Assurance Programme, ( established by the Royal College of Physicians in Ireland ( RCPI ) and the HSE ) , in the aggregation and coverage of a national lower limit dataset for radiology ( Radiology Programme, 2011 ) .

In fulfillment of nonsubjective figure 5, a working group in the National QA Programme in Radiology has developed guidelines for the execution of a National Quality Assurance Programme in Radiology. The purpose of this QA programme ( combined for diagnostic and interventional radiology ) is to “ supply guidelines for practical and implementable QA steps, which, in concurrence with bing local quality systems, will enable each infirmary to supervise and measure their ain public presentation in an attempt to better patient safety ” ( RCSI and Radiologists, 2011 ) .


Public infirmary waiting times are a major job of the Irish health care system. Specific mechanisms have been put in topographic point to seek to cover with this issue, and while some have proven successful, there are no schemes straight targeted at MRI waiting lists. Some of the enterprises that have been implemented have had an indirect consequence on waiting lists in MRI, as have the recommendations made by HIQA etc.