Ombudsman demands action on hospital waiting lists management
The Ombudsman has called on the authorities to conduct an urgent and detailed review of waiting list management that would enable them to set in place a system based on transparency, accountability and best practice.
His appeal was made in a report following repeated complaints by a foreign detainee at the prisons about delays for a knee operation. The detainee was referred for the operation in 2002 and submitted his first complaint to the Ombudsman in 2003. Following the Ombudsman’s intervention, the operation was tentatively set for February 2004 but in March 2008 the operation had still not been carried out.
In June 2008 the hospital authorities told the Ombudsman that the surgeon would perform the operation in a couple of weeks. They also reported that the surgeon objected to what he termed ‘outside pressure’ by the Office of the Ombudsman, which, in his view, would result in complainant ‘jumping the surgery queue of about 400 Maltese citizens.’
The Ombudsman said he resented the consultant’s attitude and the snipe at his integrity, more so when he had merely requested an explanation from the hospital over why complainant’s case had been put off for so long. He never hinted that anyone should jump the queue.
In discussing the situation of waiting lists, the Ombudsman said the authorities admitted that they had no control on the way that waiting lists for operations at the hospital were established and on managing the admission of patients on these lists.
“Waiting lists are kept on the appointments diary of individual consultants and only in ophthalmic and cardiac cases are the lists of pending operations recorded in a centralized system.
“The officials disclosed that only consultants establish the urgency of any particular case and determine priorities for individual patients who need to undergo an operation.”
The Ombudsman said, however, that the current state of affairs was attributable to failure by the authorities to exercise control over consultants “who keep a stranglehold on current waiting lists in their departments that does not allow an independent check on how these active lists are compiled and managed.”
He insisted that the management of the healthcare system was, and should continue to be, subject to the scrutiny of a review mechanism.
“In a situation where specialists have full rein to exercise their own discretion, the hospital management should disseminate good practice and ensure the existence of a fair and equitable verification process that would remove any shade of suspicion of preferential treatment of patients. This system would guarantee transparency in the management of waiting lists.
”These safeguards are even more necessary when consultants who determine the order of patients to undergo interventions in state hospitals and perform these operations themselves are also allowed the private practice of their profession,” the Ombudsman wrote.
“These arrangements are a fertile breeding ground to give rise to situations that are likely to constitute a conflict of interest.”
He therefore proposed that guidelines should be established to which clinicians would refer, and they would also give due recognition to the role of consultants in decisions about patients who deserved priority. The ultimate objective of the exercise would be to allow an audit trail of cases.
The Ombudsman said that following the submission of his report, he understood that the consultant in question was severely admonished by the health authorities. It was also understood that a working group had been set up to make recommendations to the ministry on waiting list management.
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A. Agius
Jan 26th 2009, 23:02
I'm afraid that the people of this country are sheep and are being lead around by their noses!
The only way that real change will ever take place is that we all forget about our political affiliations and stand as a group. We have to stand up against the arrogance of our government, NP as well as MLP, and demand that change.
We all have a voice in the government, apart from the vote every 5 years. Phone your representative, or better still arrange a meeting with him/her, and discuss your concerns. Let them know that you are not satisfied with the way things are going and that you intend to use your vote accordingly in the next election. Remind them of this every chance you get. Write them a letter every month and ask them how things are going as to your concerns. Send the letters registered so that they have to sign for it. These are your representatives. They are working for you!
Don't wait for some one else to do it. The power here is that we, relentlessly, flood them with phone calls and letters. If you don't speak up for yourself, no one else will!
Ingrid Jones-cameron
Jan 15th 2009, 07:09
The system works like this: Consultants are employed by the state on a full time basis. They also work for a private hospita and in some cases have their own clinics. They are at ALL these places at the same time!!! Check it out yourselves , a consultant is operating at a private hospital at 2pm and is supposedly carring out an operation at mater dei. If you get fed up waiting for your operation at mater dei the same consultant will be happy to operate you for a fee at the private hospital or as the minister in charge of mater dei put ' A part time hospital ,
Frank Portelli 2BFRANK
Jan 14th 2009, 21:43
The Ombudsman is correct
Any public system which allows Doctors to practise privately in parallel with their job in the NHS, there is a financial incentive for surgeons to maintain a waiting list.
To avoid this conflict of interest waiting lists should not be managed by individual doctors but should be centrailized
The next step is to update the waiting list – some patients have died waiting for treatment , others have given up waiting and have had the operation done privately
Several hundred patients are therefore no longer on the waiting list.
Then increase efficiency by establishing a one “stop shop” - where patients are seen in outpatients and tests are performed on the same day so that an immediate decision on their date of operation can be taken.
Then the Ombudsman's idea to Rank patients – ranking is based on a set of defined clinical and social criteria, e.g. progress of disease, amount of disability, dependency on others, age, loss of ability to work - certainly not on who you know.
Establish a ‘priority score’ to determine the order by which patients receive treatment according to patient's needs
Priority is the relative position on a surgical waiting list
Kenneth Galea
Jan 14th 2009, 19:43
The consultants and the authorities must ensure that only those who are eligible to free medical treatment are on the waiting list. Free medical treatment is part of the public resources and only those who have right to recourse of public funds should use it. Hence the ID cards, these should be presented at A&E and health centres for treatment to take place.
B Sant
Jan 14th 2009, 18:18
as if in this country we need any investigation- everyone knows the facts - go private and you get operated - don't go private and you would end up on the last ten numbers of the queue- some relative or close friend must have gone through the process already - we need to put our foot down and not waste time on investigations
mark gatt
Jan 14th 2009, 17:54
This is the state of the art that we always stated ?
Can Dr Gonzi tell us what he meant when saying so ?
Is it the building that this government is interested in or the system ?
I think this was done with a reason so that when we do the system running as it should than we do again a nice ZIGARELLA and Dr Gonzi will cut it infront of lots of blue eyed boys . Guess the date when it will be ? Definitly in the year 2013 but the exact date will be decided in four years time . Good luck hopefully for the next 4 years none of you will need any service in our state of the art BUILDING .
john Alex Iles
Jan 14th 2009, 17:37
Some years back (5 or 7years) a friend of mine went to Gozo and had his knee operation done in FIFTEEN DAYS whereas if he had to go on the waiting list in St Lukes (Those days) he would have had to wait two years! Mind you the consultant was ex pat (I doubt if he has private practice)
Keith Davis
Jan 14th 2009, 17:10
Whilst I acknowledge the government improved our country on many different sectors and even the health service, though I must admit it completely and miserably failed when it comes to health care waiting lists.
It's like they are pushing patients to go to private hospitals. This is unjust.
John Debattista
Jan 14th 2009, 16:52
@ MR Joe Vassallo.
Well said and i agree with you Hundred per/cent.
a.dalli
Jan 14th 2009, 16:43
@ james Magri.
If anything this is the opposite to efficiency. Had things been done correctly Ombudsman intervention was not required - a white collar Mafia type of business.
Prosit to Mr. J Dalli for trying to achieve better results and less waiting lists.
P Caruana
Jan 14th 2009, 16:40
Aren't these matters governed by the medical profession's code of practice? It will be interesting to see what MAM has to say about this issue. This case gives rise to notions of greed, abuse of one's position, favouritism and conflicts of interest and therefore could very easily fall with the realms of being sinful acts and therefore warrant an admonition from the local Diocese, more than an action to condemn the intervention should be a statement in defence of the weak.
Joe Vassallo
Jan 14th 2009, 16:34
My wife and I had to go through an extremely difficult ordeal when she needed an operation recently.
I am convinced, but I have no proof, that we were being put under pressure to opt for an operation in a private hospital…
This is a racket which is being allowed to take place, and the people paying the price is us, the average Maltese citizen, who is powerless against such mighty “gods”.
I therefore think that the Government should have the moral courage to challenge the situation and, at least as an interim solution, invite to Malta Indian medical personnel, such as doctors, specialists and surgeons, to tackle the long waiting lists.
Indian medical personnel are today recognised worldwide as being highly capable and committed professionals, and, given the right financial incentives, I am sure they will have no problem to locate to Malta for 2 or 3 years.
Language should not be a problem because they are all English speaking, as most of us are, and in any case, the present nursing staff can always act as interpreters where required.
The important thing I to provide the Maltese taxpayer with a decent medical service,
J Cilia
Jan 14th 2009, 16:29
I reckon all and sundry can read between the lines and understand what's behind these shameful practices. The citizen, indeed the sick, the ailing, the frail, demand protection from primitive systems susceptible to error and abuse. How can any professional worthy of his/her warrant submit the weak to such practices. In the light of the widespread nature of these practices my confidence in the medical profession is severly shaken. God help us all.
james magri
Jan 14th 2009, 16:17
this is a certificate how competent is this government .
Prosit Dr Gonzi
EGauci
Jan 14th 2009, 15:52
I am very happy to see that someone has taken an interest into the Hospital Waiting List 'Magic'. I thought i learnt mathematics in school, however this is nowhere close to how the hospital maths work.. example
An elderly lady needing Cataract treatment was told last year (November 2007) she has a 3 year wait.
Last November (2008) on her first appointment (remember 1 year wait) to see the 'specialist, she was told that although she hardly sees from 1 eye, the operation is not urgent and she has to wait approx 3 years.
So there you have it - 3 year wait less 1 year = 3 years according to Mater Dei's waitlist