Abstract
Introduction: In September 2007, the Health Service Executive implemented a new employment control policy, due to budgetary constraints. The health ministry and the HSE state that there are no adverse effects on patient care as a result of implementing this policy. In our regional orthopaedic unit, these cutbacks resulted in closure of 12 orthopaedic beds and consequently, a loss of a minimum of 40 joint replacements per month. Most of these patients are having their replacements carried out under the NTPF scheme at a rate, which is three times the local cost.
Aim: The aim of this study was to evaluate the impact of bed closure and consequent reduction in elective orthopaedic workload on a regional orthopaedic unit.
Materials and Methods: A comparative review of elective joint arthroplasty was undertaken with regard to theatre workload, length of time on waiting lists and referrals to the national purchase treatment fund from September 2007 to December 2007. This data was compared with same timeframe in 2006.
Results: Since the implementation of the HSE policy, the elective bed capacity was reduced by 66%. Elective joint replacements performed from September–December 2007 have reduced by 72 patients (109 to 37) compared with the same timeframe in 2006, a reduction in workload of 66%. 107 patients added to waiting list since bed closures, which constitutes a 6-fold increase in time on waiting list.
Conclusion: Following the recent implementation of the HSE policy in September 2007 we have objectively quantified a significant negative impact on elective orthopaedic services in our unit. This false economy also has a negative impact on training opportunities as only more urgent and complex cases are performed in the public sector, while routine cases are carried out in the private sector. Should this trend continue, the impact on surgical and hence future patient care may be detrimental to the public health care system in Ireland.
Correspondence should be addressed to Mr Richard Wallace at Musgrave Park Hospital, 20 Stockman’s Lane, Belfast BT9 7JB, Northern Ireland.
