Mon | Oct 23, 2017

Tufton committed to cutting long waits

Published:Tuesday | December 6, 2016 | 12:00 AM
In this February 2013 photo, porters at the Kingston Public Hospital were kept busy as the police transported workers from the Central Sorting Office after they became ill as a result of noxious fumes in the area.
Teacher in the Paediatric Ward, Cornwall Regional Hospital, Racquel Ustanny, tending to her students during a busy day at the health institution.
A high percentage of Jamaicans bemoaned the poor service; long wait times; appalling treatment from staff; terrible, outdated, filthy facilities; inadequate resources; and shortage of staff, medical supplies, equipment and medication as some of the critical issues they had with public healthcare.
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Shortening wait times at hospitals is perhaps the biggest challenge facing the public health sector today. In an environment of free health care, the public health-care system has seen, significant surges in patient loads and this has negatively affected access to timely care.

The result is overcrowding and long waits. Waiting - for admission, treatment, surgery, diagnostic technologies and drugs - has become the defining characteristic of public health care in Jamaica.

No one is more aware of the magnitude of the challenge than Dr Christopher Tufton, minister of health. In a recent interview with The Gleaner, he acknowledged, "When a man is deprived of attention when he clearly needs it, this could jeopardise his life."

There is ample anecdotal evidence of patients dying while waiting to be treated at hospital. The average wait time from the patient's arrival at hospital till he gets a diagnosis and treatment or is discharged could be as long as seven hours. The minister is painfully aware of the scale of the task he faces to turn this frustrating situation around.

So how does Dr Tufton plan to fix it? The minister explained that as many as 70 per cent of the persons who turn up at emergency departments ought not to be there and should have visited a clinic instead.

This is where the triage process comes in, as it involves determining the patient's level of medical urgency. If properly done, the sickest patients are placed ahead of those whose condition is not urgent. The minister said it is critical to improve the triage process in order to make a better connection between who needs primary care and emergency cases.

To ease the burden of long wait times, specific policy measures have been introduced as a pilot project in six of the country's major hospitals.

"We took six hospitals, identified the six primary health-care facilities that are closest to them, and we are extending opening hours in these facilities from 4.30 p.m. in most instances until as late as 10 o'clock."

Longer opening hours have been instituted at clinics which support major hospitals such as Kingston Public, Bustamante, Black River and Cornwall Regional.

The minister reported that this $350-million initiative was gaining traction, as there were early signs that wait time was trending down.

"The graph is now showing a reduction in waiting time and an increase in the throughput of patients at the clinics with extended hours," he said.

Boosting efficiency in clinics by extending their opening hours, providing new equipment and additional personnel is an idea that will be replicated across the country next year, the minister revealed.

 

Discriminatory pricing for tests

 

But as the health-care system appears to be squeezed from all sides, patients who are unemployed, have financial stress and no insurance and who depend solely on the public system, will face significant waiting times for various diagnostics technologies such as CT scans, and certain types of X-rays. In many cases, the equipment is obsolete or non-existent.

Tufton said he was looking to establish a public-private partnership whereby there is an arrangement between the public system and selected private providers that would allow some amount of discriminatory pricing to be done.

He elaborated, "The Government would negotiate pricing for those who cannot afford to pay. The Government will have to pay something on behalf of those patients, while the private provider will charge market rate for those who have insurance and can afford to pay."

Waiting for surgery is another area of dissatisfaction for poor patients, with the average time ranging from three months to three years. "A person could die waiting," the minister said

To alleviate the stress associated with problem, he advocates for better coordination of theatre facilities, which includes longer operating hours.

"This has to be a multi-agency approach," Tufton explained, citing implications for theatre equipment, including lighting, and support systems such as blood supply.

Radical improvements are also needed in the procurement and distribution of drugs to the sector. The minister wants to get greater value for money spent on drugs through the National Health Fund (NHF).

"We have asked PAHO to assist us to vet our VEN (Vital Essential and Necessary) list. Right now, we have nearly 1,000 drugs serving 16 categories of ailments. And it has become unwieldy. So we are embarking on that process to determine if we really need a thousand drugs. We are also working with PAHO to source some of the drugs through their global funds. We do that now, but we can do more of it."

Although there is nothing ground-breaking in any of these initiatives, the minister has shown a willingness to iron out the kinks that are creating bottlenecks which eventually cause the long waiting period. If properly implemented, these initiatives will ensure a better experience for patients, many of whom have simply run out of patience.