The waiting time for a “significant proportion” of outpatients at Mater Dei Hospital still exceeds the hospital’s six-month target, despite recommendations issued by the National Audit Office two years ago to reduce this period.

The matter was flagged in a follow-up report in which the NAO analysed the level of implementation of the 16 recommendations it had issued in November 2017.

The call for action had been made in the wake of the fact that the average waiting time for the first appointment was of eight months.

In its follow-up audit, the NAO noted that even though most recommendations relating to strategic, operational and administrative capacity issues had been accepted and partly implemented, in certain areas there had been little progress.

Such a conclusion stemmed from an analysis of the period 2017/18 whereby some clinics and consultants still had waiting times exceeding 26 weeks – the threshold set by Mater Dei Hospital from referral to the first outpatients visit for routine appointments.

This is mainly evident in the diabetes, gastroenterology and urology clinics, leading to over 7,000 patients having waiting times in excess of the hospital’s maximum waiting time.

According to the hospital management, this was due to consultant unavailability, patients not turning up for the appointment, lack of afternoon sessions and walk-ins. The situation largely reflected the findings reported in 2017, the NAO said.

Public-private partnerships

The follow-up audit also flagged the lack of implementation of another key recommendation whereby the hospital had been urged to consider the feasibility of extending the provision of services through contracting out and public private partnerships to decrease waiting time.

Though an attempt was made to evaluate the extent to which outsourcing of certain outpatient clinics would contribute to reach such an objective, it was decided that the proposal was not feasible and consequently put on hold, the report said.

Mater Dei Hospital had also considered farming out some services to health centres or other government institutions.

Steps taken to increase collaboration with the private sector

In this respect, the NAO said that by the time of writing, the hospital management was of the opinion that this would be a slow process and low in numbers.

Furthermore, discussions were still taking place on the establishment of outpatient discharge and appointment criteria, and how this could be validated in a farming out scenario.

The report noted that to date, Mater Dei Hospital had not carried out or commissioned any studies in this regard.

Waiting times not published

One recommendation among those not implemented was to publish the respective waiting times pertaining to different consultants, in order to help patients make more informed decisions on their care.

Though Mater Dei pledged to take action on the matter, no timelines were given in this regard.

The NAO also flagged the lack of key performance indicators relating to reduction in waiting times, with the Mater Dei management saying it was still working on the matter.

Online service improvements

In the case of no-shows, the NAO noted that a pilot project through which patients were sent text message alerts on their mobile phones had resulted in these cases dropping to less than six per cent from 20 per cent. Such a measure would be expanded further, the hospital management said.

On a positive note, the report says steps were taken to increase collaboration with the private sector to book investigations via an online service as well as the exchange of clinical and administrative patient information.

This was done through the introduction of the myHealth online system, which gives access to general practitioners who can order blood investigations and most medical imaging investigations for their patients as well as make an electronic referral or book a hospital appointment for their patients.

In its conclusion, the NAO noted that the implementation of most of its recommendations were being linked to the new outpatients block, which was still under construction and for which no specific inauguration date had yet been set.