The clinical value and benefit of referral criteria for scheduled surgical procedures will be the subject of a series of rapid health technology assessments by the Health Information and Quality Authority (HIQA). Requested by the Health Service Executive (HSE), the assessments will focus on identifying appropriate referral criteria for certain high volume scheduled surgical procedures currently undertaken in Ireland.

HIQA’s Director of Health Technology Assessment, Dr Máirin Ryan said, “The purpose of the assessment is to ensure that the patients most in need of surgery receive the required treatment as quickly as possible.”

“The need and demand for healthcare services continues to increase and given Ireland’s changing demographics, demand is likely to grow in the foreseeable future. Demand for scheduled surgery in particular continues to exceed available capacity, with the HSE reporting a 22% increase in demand for these procedures in 2011 compared to 2010. As a result, pressure on national waiting lists continues to grow despite increases in activity levels.”

Dr Ryan added, “Clinical referral or treatment thresholds will be developed for certain surgical procedures where the benefits for some patients may be limited unless undertaken within strict clinical criteria. Streamlining referrals from family doctors to surgical services should help ensure that the right patients have the right surgery at the right time.”

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.”

HIQA has convened a multidisciplinary Expert Advisory Group to oversee the process of the rapid health technology assessments and to provide access to expert advice and information as required. The completed evaluation will be submitted to the HSE and to the Minister for Health.

The Terms of Reference of the evaluation are:

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.

Further Information: 

Sinead Whooley, Communications Manager, Health Information and Quality Authority, Tel: 01 814 7488/ 087 922 1941 Email: swhooley@hiqa.ie

Notes to the Editor: 

The membership of the Expert Advisory Group is as follows:

1. Dr Máirin Ryan (Chair), Director of Health Technology Assessment, Health Information and Quality Authority
2. Dr Patricia Harrington, Head of Assessment, Health Technology Assessment Directorate, Health Information and Quality Authority
3. Dr Linda Murphy, Assessment Manager, Health Technology Assessment Directorate, Health Information and Quality Authority
4. Dr Joe Clarke, Clinical Lead, Primary Care Clinical Programme, Health Service Executive
5. Mr Paul Connell, Consultant Ophthalmologist, nominated by the Royal College of Surgeons in Ireland
6. Dr Anne Flood, Director of Nursing and Midwifery, Letterkenny General Hospital, Health Service Executive West
7. Mr John Hennessy, Regional Director of Operations, Health Service Executive West
8. Professor Frank Keane, National Lead, Elective Surgery Clinical Programme, HSE
9. Mr Stephen McMahon, Irish Patients’ Association
10. Mr Paul Moriarty, Consultant Ophthalmologist, nominated by the Royal College of Surgeons in Ireland
11. Mr Kevin O’Malley, Consultant Vascular Surgeon, nominated by the Royal College of Surgeons in Ireland
12. Dr Margaret O’Riordan, Medical Director, Irish College of General Practitioners
13. Mr David Quinlan, Consultant Urologist, nominated by the Royal College of Surgeons in Ireland
14. Mr John Russell, Consultant Otolaryngologist, nominated by the Royal College of Surgeons in Ireland
15. Dr Alan Smith, Director of Performance Improvement (Scheduled Care), Special Delivery Unit, Department of Health, Acting CEO National Treatment Purchase Fund.