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HIQA to set criteria for Elective surgery.


spidermom

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Benefit of some scheduled surgery to be reviewed - RTÉ News

IF...this is an attempt to reduce clinically unwarranted referrals from GPs, its perhaps not a bad move...(though the implication that GPs are clinically naive in relation to their patients is insulting)...more likely an attempt to reduce elective surgical waiting lists...We can presume that if however you can PAY for your surgery you will get it!!!...:(
 

damus

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Is the review going to be based on a quality and outcomes framework - or is it more of a case does it derive a clear clinical benefit - no - strike out!

Is there any chance that HIQA will morph in to something along the lines of NICE who publish info on guidance, pathways and quality standards.

National Institute for Health and Clinical Excellence
 

ger12

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Is the review going to be based on a quality and outcomes framework - or is it more of a case does it derive a clear clinical benefit - no - strike out!

Is there any chance that HIQA will morph in to something along the lines of NICE who publish info on guidance, pathways and quality standards.

National Institute for Health and Clinical Excellence
Talk alright of a NICE element to HIQA.

Cosmetic surgery on the list. I wonder if that includes some breast reconstructions?
 

spidermom

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Would presume so Damus.(as in along the NICE lines)...would "like" to think its purely along clinical line.

Course,with preassessment of all elective surgeries in most of the teaching hospitals and the way all cases are rated currently that clinical benefit is already measured???


Seems to me its the beginnings of the "money follows the patient" basket....but ONLY if you tick all the boxes of course!!........


PLUS..of course ...If you can PAY...no worries...clinical benefit or nowt!!
 

ger12

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Would presume so Damus.(as in along the NICE lines)...would "like" to think its purely along clinical line.

Course,with preassessment of all elective surgeries in most of the teaching hospitals and the way all cases are rated currently that clinical benefit is already measured???


Seems to me its the beginnings of the "money follows the patient" basket....but ONLY if you tick all the boxes of course!!........
Don't NICE guidelines also take into account the financial implications?
 

damus

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Mrs. Crotta Cliach

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Who would deny sight to anyone by not removing their cataracts? For many elderly their only connection to the world is reading or watching TV, so we are going to remove that contact as well. And let's not replace their hip so they can lie in bed in pain getting bedsores, and the doctor can put them into a morphine coma state so they don't feel the pain of the hip or the sores. Is this what Ireland is coming to? Death panels for real.
 

Merovingian

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Well if you can't see those unsightly veins 'cos they won't do your cataracts then it's win-win!
 

spidermom

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Benefit of Scheduled Surgery to be assessed by HIQA | hiqa.ie

Terms of reference and membership....NO orthopaedic representative.....and Stephen McMahon "our" patient rep..... :(

"4. Consider the impact that implementation of clinical referral/treatment thresholds for scheduled surgical procedures is likely to have including resource and budget impact and the wider ethical or societal implications as appropriate"

NICE...Whooping "Irish" Style!!!

Will have to rattle cages me thinks!!....
 

damus

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Benefit of Scheduled Surgery to be assessed by HIQA | hiqa.ie

Terms of reference and membership....NO orthopaedic representative.....and Stephen McMahon "our" patient rep..... :(

"4. Consider the impact that implementation of clinical referral/treatment thresholds for scheduled surgical procedures is likely to have including resource and budget impact and the wider ethical or societal implications as appropriate"

NICE...Whooping "Irish" Style!!!

Will have to rattle cages me thinks!!....
Just noticed that....and there's also no dermatologist!

The objective of this exercise is to ration services, and Dr. Ryan who is head of Health Technology Assessment at HIQA more or less admitted the same when she made this statement;

Dr Ryan concluded, “By limiting such procedures in patients who may derive limited clinical benefit, there is a potential to free up capacity for treatments of higher clinical value thus maximising population health gain for the limited resources available.”
And it's also about reducing waiting list stats....which in simple terms makes the minister and the SDU look good!

If there's a 22% increase in demand for procedures, surely from an evaluation research point of view the starting point should be to investigate why there is a 22% increase in demand for procedures? Where's the research evidence to suggest that the 22% increase in demand comes down to inappropriate referrals from GP's and patients undergoing procedures that derives limited clinical value? Even if patients are undergoing procedures that derives limited clinical value, surely the bigger issue that needs to be tackled is why consultants are referring patients needlessly for surgery not the GP's referrals?

“The purpose of the assessment is to ensure that the patients most in need of surgery receive the required treatment as quickly as possible.”
Then we look at the TOR which are to;

1. Identify high volume scheduled surgical procedures currently undertaken in Ireland to which it would be appropriate to examine clinical referral/treatment thresholds.
2. Describe the surgical procedures and the associated indications.
3. Advise on appropriate clinical referral/treatment thresholds based on the available evidence of clinical effectiveness, cost-effectiveness and best practice.
4. Consider the impact that implementation of clinical referral/treatment thresholds for scheduled surgical procedures is likely to have including resource and budget impact and the wider ethical or societal implications as appropriate.
Will the methodology include a health outcome analysis of a sample of patients who have undergone any of these procedures, or will the research be totally biased with the starting point being the assumption that in certain defined criteria the clinical benefit for some patients is quite limited?

Out of interest, when is the regulatory powers of HIQA going to be extended to private hospitals?
 
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pandora

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Even if patients are undergoing procedures that derives limited clinical value, surely the bigger issue that needs to be tackled is why consultants are referring patients needlessly for surgery not the GP's referrals?
No patient undergoes even the most minor surgery for fun. They go to their GP because they have a problem, the GP refers them to a consultant who decides they need surgery. Have all three imagined the problem?

This is an exercise in pretending that increased demand and longer waiting lists are somehow the patient's fault rather than being due to a reduction in resources and activity. Instead of tackling the issue by doing more surgery you come up with reasons why there is no need for the surgery in the first place. You tell patients that their pain and suffering isn't that important, unless of course they have the money to pay for the operation when it becomes very important.
 

happytuesdays

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No patient undergoes even the most minor surgery for fun. They go to their GP because they have a problem, the GP refers them to a consultant who decides they need surgery. Have all three imagined the problem?
They go to their GP because they do not have to pay him.
Their GP moves them on to the consultant as fast as possible because he has already received his headage payment and wants as little to do with his patients as possible.

I am a taxpayer.
I pay for public patients' surgeries.
I want some oversight into how MY money is spent.

It is called professionalism.

I do not trust public patients to make good health decisions.
I do not trust GPs with MY money.
I do not trust consultants with MY money.
 

FrankSpeaks

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Will it put an end to infant boy mutilation, also known as circumcision?
 

pandora

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I do not trust public patients to make good health decisions.
I do not trust GPs with MY money.
I do not trust consultants with MY money.
Public patients, just like private ones, make both good and bad health decisions but most people know when they are in pain or when they can't see. Neither set usually have enough education or information to know if their decisions are good or bad so they depend on their doctor knowing what treatment they need.

Who do you trust with YOUR money? HIQA? The HSE?
 

happytuesdays

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Public patients, just like private ones, make both good and bad health decisions but most people know when they are in pain or when they can't see. Neither set usually have enough education or information to know if their decisions are good or bad so they depend on their doctor knowing what treatment they need.

Who do you trust with YOUR money? HIQA? The HSE?
Poor people are more passive in their INTERACTIONS with doctors.
GPs do not explore non surgical alternatives for poor people because the GP wants to minimise time spent.
Hospital consultants cannot be trusted with money.

HIQA is not the HSE why are you conflating the two?
 

rjh

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Your remarks seem insightless and appear to be based on hysterical anti-medical prejudice rather than any grasp of reality

GPs cannot fix patients with Cataracts or advanced arthritis of the hip. They will either go blind in the case of cataracts or probably end up unable to walk with the hip if they don't have surgery, regardless if they are public / private etc.

Consultants in the public system are paid exactly the same regardless of how many operations they preform. There is no incentive to carry out unnecessary hip replacements / unnecessary cataract removals etc - in fact quite the opposite they can't get the patients in for surgery because our health service is run by incompetent morons. (See the PA Consulting report Sunday Indo last week)

Read this as well - you might learn something. Today's Independent

Dr Ruairi Hanley: Arrogance of health watchdog is breathtaking - Analysis, Opinion - Independent.ie


I wrote it by the way

RH
 
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happytuesdays

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The problem is less consultants than GPs.
The GP has a medical card patient for whom he receives a headage payment no matter how many interactions he has with that payment. None or twenty the doctor is paid the same.
Doctors go into medicine for the money and in order to maximise patient throughput they pass the medical card patient on to the consultant for unnecessary surgery.

Paper never refused ink.
 

rjh

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And why exactly would the surgeon operate if it was unnecessary? To impress the GP?

Believe me they don't. And if you spent five minutes working in the public health system you would realise that

And your remarks re GPs are frankly idiotic and insulting.

As I explained above but will repeat for your benefit

"GPs cannot fix patients with Cataracts or advanced arthritis of the hip. They will either go blind in the case of cataracts or probably end up unable to walk with the hip if they don't have surgery, regardless if they are public / private etc"

GPs don't refer for the craic either.

Actually why I am bothering even responding?

That's one thing I will fix immediately
 

damus

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No patient undergoes even the most minor surgery for fun. They go to their GP because they have a problem, the GP refers them to a consultant who decides they need surgery. Have all three imagined the problem?
That will come :-(!

We'll probably end up with a system where all in-patient activity in the public system) will have to be pre-approved by an outside arbitrar, whereas private patients with the ability to pay will have no barriers on access. Realistically, even if there is a certain percentage of inappropriate referrals, how many consultants will go ahead and carry out unnecessary ops on patients where it will derive limited clinical value? Most consultants would refer inappropriate referrals back to the GP! Why is there a 22% increase in procedures? Is it in any way related to the increasing numbers who can no longer afford PHI cover which means that they are 100% reliant on the public system? Like I said, it's a ploy to slash both in-patient and OPD lists....nothing more, nothing less!

Since we're suppose to be heading towards a one tiered system where access will be based on medical need as opposed to our ability to pay, wouldn't it kind of make sense to extend HIQA's regulatory powers to the private system, where they could also introduce the same medical criteria for private patients?
 
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