Waiting lists decreasing but not at required pace

Over 817,000 patients were recorded on the National Treatment Purchase Fund’s (NTPF) register of patients on hospital waiting lists in November 2023, showing a decrease throughout 2023. The majority of targets for waiting times, set by the 2017 Sláintecare report, continue to be missed.

Of the total 817,180 patients listed in the NTPF’s latest data covering November 2023, 84,287 are inpatient/day cases, 23,279 are on inpatient/day case GI endoscopy waiting lists, and 580,055 are on the outpatient waiting list. The majority in each of these categories have been waiting between zero and six months: 54,988 (65.3 per cent) in of inpatient/day cases; 20,238 (86.9 per cent) in GI endoscopy lists; and 335,308 (57.8 per cent) of outpatients.

Despite these figures, most worrying for government and health officials will be the fact that Sláintecare targets set in 2017 continue to be missed by the healthcare system. The report stated that that there should be maximum wait times of no more than 12 weeks for an inpatient/day case procedure or GI scope, and 10 weeks for a new outpatient appointment. In the case of inpatient/day cases, 57.8 per cent of patients (48,735) on the waiting list as of November 2023 were on the list past the 12-week deadline, a figure which rises to 71 per cent for child patients. 62.6 per cent (14,577) of GI scope patients on the waiting list were still within the 12-week target, making it the only one of the three active lists to not have a majority waiting past its deadline target. It is in the case of outpatients that the health system performs at its worst: of the 588,813 people on outpatients waiting lists, 70.1 per cent of them (406,497) had already surpassed the 10-week deadline by which they should have had their appointment.

Overall, of the 687,621 patients across the three active waiting lists, 67.5 per cent of them have not been seen within their Sláintecare targeted timeframe. Despite this, the figures do show an improvement over the course of summer and autumn 2023 when compared with the NTPF’s data for April 2023, when there were more than 830,000 patients on national waiting lists, including 596,265 waiting for an outpatient appointment. The number of people whose waiting time had surpassed their Sláintecare target times also reduced in the seven months between April and November 2023: the 463,934 in November showed a 5.8 per cent decrease from April’s total of 492,639.

Capacity

At the time of the release of the April 2023 NTPF data, the Health Service Executive (HSE) released a statement that said that additions to the waiting lists in 2023 had been “higher than projected”: “The HSE attributes this trend to a number of drivers, including post-pandemic pent-up demand, and highlight it is also the case internationally e.g., the NHS in Britain is seeing higher additions compared to previous years.”

The Department of Health also stated that there had been 3.4 million outpatient and 1.7 million inpatient/day case attendances in the 12 months leading up to April 2023. “In addition to this planned care, our hospital system also treated 1.6 million patients during this same period in emergency care, which represents a 10 per cent increase on 2019 pre-pandemic levels and reflects the ongoing pressure on hospitals from flu surges and increased emergency department attendances,” the Department stated.

At the time, president of the Irish Hospital Consultants Association Robert Landers called on the Government to make “significant improvements” and “commit the necessary capital spend… to deliver the additional expedited bed capacity” needed. A March 2023 report published by the Research Services and Policy Unit of the Department of Health, Hospital Performance: An Analysis of HSE Key Performance Indicators, attested to the healthcare sector’s ongoing struggles with capacity.

At the hospital level, 23 of 26 hospitals were found to be missing the HSE designated target of 70 per cent admission to emergency departments within six hours; incomplete treatment rates, which are targeted to be at less than 6.5 per cent in emergency departments, were found to be as high as 16.7 per cent in St James’s Hospital and as low as 1.3 per cent in St Luke’s, Kilkenny. Elective day-of-surgery admissions, target at 80 per cent by the HSE, were also found to be as low as 16.5 per cent in St James’s.

In its report, Inpatient bed capacity requirements in Ireland in 2023: Evidence on the public acute hospital system, the Economic and Social Research Institute (ESRI) states that population increases, especially at older ages, will “continue to increase demand for hospital care” in Ireland and that “additional public acute hospital capacity will be required”. The report estimated a shortfall in 2023 of up to “over 900 beds” in acute hospital settings, a shortfall that it stated would increase “the likelihood of overcrowding issues remaining a common feature of the Irish public acute hospital system”. The report also found that while Ireland’s rate of inpatient beds per capita had increased, it remained “among the lowest in the OECD” and that despite the fact that the population aged 65 and over accounts for more than half of all inpatient bed days, the rate of beds per 1,000 population of those aged 65 and over had “decreased considerably in recent years”.

Waiting List Action Plan

The Government’s latest attempt to get to grips with healthcare capacity and thus reduce waiting lists – the Waiting List Action Plan for 2023 – was published in March 2023, setting out 30 actions focused on “delivering capacity, reforming scheduled care, and enabling scheduled care reform”. The plan allocated €363 million of the €443 million dedicated to tackling waiting lists in Budget 2023 to a multi-annual approach to reducing waiting lists and waiting times.

Speaking upon the launch of the action plan in March 2023, Minister for Health Stephen Donnelly TD said: “While the Government recognises that acute hospital scheduled care waiting lists are far too long, and that many patients are waiting an unacceptably long time for care, we are beginning to see progress. Last year saw an 11 per cent fall in number waiting over Sláintecare targets (56,000 adults and children). This represents a fall from the Covid peak of 24 per cent.”

The headline target contained within the plan is that the HSE and NTPF will reduce hospital waiting lists by 10 per cent in 2023. Without data for the full year available, it is impossible to determine the success or failure of this aim, but November 2023 shows a decrease from January 2023. November 2023’s total of 817,180 patients on waiting lists represents an decrease of 0.8 per cent since the start of the year.

There has been a decrease in the number of patients on the three active waiting lists: inpatient/day case; GI endoscopy; and outpatient. January 2023 – a month that recorded significant increases form December 2022 – saw a total 697,893 patients waiting across the three lists; this figure fell to 687,621 by November 2023, a decrease of 1.5 per cent.

While data related to Sláintecare targets is unavailable for January 2023, February 2023 data shows that the situation has also improved in this regard throughout 2023. In February 2023, 75.5 per cent of outpatients, 64.3 per cent of inpatient/day cases, and 44.8 per cent of GI endoscopy patients were waiting past their Sláintecare target deadlines; each of these categories shows improvement in the November 2023 figures detailed above.

“With the 2023 Waiting List Action Plan, my department, the HSE, and the NTPF are taking the next steps in the multi-annual approach towards achieving our vision of a world-class public healthcare system in which everyone has timely and transparent access to high-quality scheduled care, where and when they need it, in line with Sláintecare reforms,” Donnelly said in March 2023.

While there has been marginal improvement in some areas, it is unlikely that Donnelly’s targeted 10 per cent reduction will be possible in 2023, meaning much work remains to be done.