Consultants question Department of Health productivity stats

By Cillian Sherlock, PA

Consultants have questioned the validity of new Department of Health metrics which calculated that the doctors are not as productive as they were 10 years ago.

It comes as the Minister for Health said she wants to hold hospitals and individual specialties to account over turning increased investment into productivity.

New analysis of HSE data shows that consultants could have held 1.5 million more appointments last year if they were operating on the same productivity as 2016.

A senior official at the Department said it wants to understand the “productivity conundrum” where a “great increase” in the total number of whole-time equivalent (WTE) consultants had occurred against a fall in outpatient appointments per practitioner.

The data shows that a 70 per cent increase in WTE consultants between then and 2024 was met with just a 20 per cent increase in outpatient appointments – meaning a lower average per individual practitioner.

If the consultants had been operating at 2016 levels of productivity, the Department contends they could have held 40 per cent more appointments than they actually did.

The Irish Hospital Consultants Association (IHCA) cautioned that data “must be presented in the proper context”.

It said it welcomed a focus on transparency and performance but said the number of doctor consultations is not regarded as a valid measure of productivity.

The IHCA said this is because consultations differ in complexity, duration and impact, and the metric “fails to reflect the significant volume of care provided to hospital inpatients” as well as time spent on diagnostics, research, clinical governance and administration.

It said: “Any productivity analysis must seek to reflect the value and outcomes associated with care, not merely the volume.”

It said there had been a marked increase in complex, time-intensive direct care delivery by consultants.

It said the issue was fundamentally a capacity crisis and framing it as a productivity issue around one group of staff runs the risk of setting false expectations and undermining collaborative efforts.

The IHCA said: “We are absolutely committed to doing more — but we cannot do it alone.”

A new data dashboard from the Department of Health’s also allows for comparisons on waiting lists and other performance indicators.

While the tool allows specialties and hospitals to benchmark their performance against their peers, the department said the dashboard is a “learning tool” and “not a stick to beat anyone with”.

A senior official stressed that the initial focus of the dashboard was about transparency and “putting a spotlight” on the ability to convert resources into services for patients.

However, there are performance management expectations in health service reforms – with the department figure saying that anyone making major public investment in healthcare would want to be assured that the site has demonstrated an ability to convert investment into improved services.

There were 1,812 WTE consultants in 2016, rising to 3,061 in 2024.

However, the number of appointments per consultant has fallen from 1,686 in 2016 to 1,209 in 2020 – where it appears to have roughly plateaued into the present day.

Using the correlating 3.1 million outpatient appointments in 2016, the department said this meant the same efficiency could have resulted in 5.2 million outpatient appointments last year.

However, this is 1.5 million above the actual figure of appointments which stood at just 3.7 million in 2024.

Department officials said the dynamics behind that discrepancy have yet to be explained, adding that Ireland would have a “vastly more effective service” and “massive reductions in waiting times” if 2016 productivity levels had been maintained.

Acknowledging that consultants may find the blunt comparison unfair given the impact of Covid-19 on the intervening years, officials still said the health service seems to be “a bit stuck” on the roughly 1,200-appointments-per-consultant figure.

A department official said it “definitely warrants a major effort” to push back towards previous productivity levels – even if 2016 rates are no longer realistic.

“The productivity and savings taskforce is really determined that we get to grips with productivity in these kind of very benign and positive times in terms of investment and expansion, because it will be vital if we ever have to deal with more, more challenging fiscal circumstances.”

One of the other key metrics measured by the dashboard is “composite activity output”, which attempts to distil years-long increases in productivity across different types of care into a single figure to allow for comparisons against workforce and expenditure increases.

Officials said it showed that some hospitals are “notably better” at converting their input into activity, adding that they wish to determine the reasons for that.

The department said the dashboard provided an entirely new view on data which had not been previously used sufficiently well to inform service planning and development.

Minister Carroll MacNeill said the dashboard was an effort to present “the best transparency we possibly can” on hospital activity.

She said there had not been enough focus on how hospitals are locally managing increased investment in the most efficient way for better patient outcomes.

Ms Carroll McNeill said: “For too long hospitals have had the opportunity to regard themselves as independent republics.

“They are very much part of a State system that is funded by the State, and it’s a reasonable and appropriate process to shine this light in relation to their activity.”

She said it could not be the case that increased investment in health did not result in increased efficiency.

Ms Carroll McNeill added: “That means more outpatient appointments, that means better use of surgical capacity, that means better use of diagnostic capacity.

“And I think the productivity dashboard here is a way of making sure that we are holding hospitals and individual specialisms to account to manage themselves better.”

Other potential uses for the dashboard include assisting GPs in deciding where to refer patients, having consulted the waiting lists trends in their region.

Officials also believe that moves to a fuller seven-day working week will improve productivity.