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Leading surgeon criticises ‘morally repulsive’ waiting list ‘outsourcing’

Mr Ken Mealy, Consultant General Surgeon at Wexford General Hospital and Vice-President of RCSI, told a recent conference in Dublin that this approach does not reward excellence or give rise to “any sustainable change” and even disincentivises public hospitals from dealing with their waiting lists.

Speaking in Dublin on 12 September at a conference on quality, patient safety, and clinical risk hosted by the State Claims Agency, Mr Mealy commented: “The solution in Ireland for waiting lists is to sell it off to the private sector. But I suspect there isn’t a surgeon in the country that doesn’t find this morally repulsive, the fact that it really rewards the wrong processes and will never fix the problem.”

He argued that, over recent years, waiting lists have tended to increase after these initiatives.

Mr Mealy said over half a billion euro had been spent on waiting list initiatives over the last seven or eight years. “And I don’t need to tell you that this could fund one or two hospitals and staff them for four or five years, which might just make a sustainable change.”

In many cases, theatres are underused by up to 65 per cent of their operating capacity “for all sorts of reasons”, he said.

Validation of waiting lists and and sustainable infrastructural and operational investment are among the key measures in reducing waiting lists, he outlined.

Elsewhere in his talk, Mr Mealy expressed concern about the extent to which quality improvement is embedded in the culture of Irish hospitals.

He pointed to a number of US hospital websites, such as Virginia Mason and the Cleveland Clinic, which prominently feature their work in quality improvement.

“I can’t show you any Irish hospitals’ [websites], because there isn’t a single public acute hospital in this country that has anything of substance about quality improvement on their webpages. And that tells us something, I think. It is a problem, because I do not believe as yet we have embedded quality improvement in the culture of our hospitals and our clinicians and I say this against myself and my colleagues.”

Mr Mealy also underlined that critically ill patients with a high risk of mortality should be cohorted in institutions where all specialties are available and experience is maximised.

On this point, Mr Mealy told the Medical Independent (MI) that this “cannot be done in 26 hospitals, which currently admit acute surgical patients”.

Regarding the main reasons for poor theatre use, Mr Mealy said these include the lack of beds and theatre nurses. Another issue is the “poorly sustained” quality improvement programme, The Productive Operating Theatre (TPOT), which “never got traction throughout the country for various reasons”, mainly lack of funding, appointments, and protected time within theatres.

Mr Mealy also insisted that many surgeons have been vocal about the waiting list problem. Acknowledging that a “small number of surgeons probably do benefit” from outsourcing, he said most surgeons “do not have contracts that allow working off site in private hospitals”.

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