Analysis: the long-term solution to thousands of people waiting for hospital treatment, including outpatient treatment, is an increase in capacity

Figures released by Fianna Fáil last week suggested that there are nearly one million people waiting for health care in Ireland. This generated some headlines, but, in reality, the waiting list figures did not suddenly increase dramatically. Rather, this figure includes some categories of people not included in the waiting list figures published by the National Treatment Purchase Fund (NTPF), which focus on hospital-based treatments and are usually used in discussions about waiting lists. The additional numbers include people waiting for diagnostic scans, speech and language therapy and occupational therapy, among other categories.

The NTPF figures show that there were 78,014 people awaiting inpatient or day case (IPDC) treatment in June. Of these, 13,423 were waiting longer than 12 months, including 5,807 who were waiting longer than 18 months. A further 18,279 were waiting for inpatient or day case gastro-intestinal (GI) endoscopy. These patients are on the "Active" list, which means that they are awaiting an appointment date.

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From RTÉ Radio One's Morning Ireland, Brian Turner discusses the past, present and future of Sláintecare

In addition to the Active list, there is a separate "To Come In (TCI)" list, with people who have been given an appointment date. A third inpatient and day-case list is the "Suspended" list which, according to the NTPF, consists of "patients with an offer of a TCI date who, for clinical, personal or social reasons, are not ready to proceed with their care and/or treatment" or "where patients are being processed through various Insourcing or Outsourcing initiatives". A further list for inpatient and day case care is the Planned Procedure list, which consists of patients who have had treatment but require additional treatment at a future date. The numbers on each of these lists are shown below:

Waiting lists June 2018

Waiting List

 

Number Waiting

Inpatient/Day Case

Active IPDC

78,014

 

Active GI Endoscopy

18,279

 

To Come In IPDC

18,867

 

To Come In GI Endoscopy

9,973

 

Suspended IPDC

6,710

 

Suspended GI Endoscopy

2,462

 

Planned Procedure IPDC

12,567

 

Planned Procedure GI Endoscopy

56,979

 

Planned Procedure Suspended IPDC

105

 

Planned Procedure Suspended GI Endoscopy

2,048

Outpatient

 

511,415

Total

 

717,419

Source: National Treatment Purchase Fund

By far the biggest number on the waiting lists is those who are awaiting an outpatient appointment. In June, there were 511,415 people on this waiting list, of whom 148,209 were waiting for more than 12 months, including 80,697 who were waiting more than 18 months. In total, this gives a figure of 717,419 people waiting for hospital-based treatment as at June. While some progress has been made in recent months in reducing the inpatient and day case list, the outpatient list has continued to grow

It is quite normal in most health systems to have a certain amount of waiting for non-emergency medical procedures. Indeed, waiting lists are one way to ration care, as health systems have limited budgets relative to the demands for care.

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From RTÉ Radio One's This Week, Brian Turner predicts the cost of implementing the Sláintecare project

However, the length of time that people are waiting in Ireland is unusual by international standards. The 2017 European Health Consumer Index, which ranks 35 health systems across Europe based on consumer experiences, notes that even if the government achieved a 2015 target that no patient would be waiting longer than 18 months for treatment, we would still have the worst waiting time situation in Europe. This contributes to Ireland being ranked last on accessibility and 24th overall.

The release of the waiting list figures coincided with the launch of the implementation plan for Sláintecare, the 10-year plan for the Irish health system that was proposed by an all-party Oireachtas Committee and published in May 2017. The implementation plan refers to funding for the NTPF to reduce waiting times. It does this by purchasing care privately for public patients who have spent long times on waiting lists and it has been allocated €55m in 2018 for this aim. Between its establishment in 2005 and 2011, when it was subsumed into the Special Delivery Unit, the NTPF contributed to a significant reduction in average waiting times.

However, while it may be a pragmatic short-term measure to help reduce waiting times, the long-term solution to waiting lists is an increase in capacity. This is acknowledged in the Health System Capacity Review, published earlier this year, which projects that, if Sláintecare is implemented in full, we will need 2,590 additional hospital beds, along with significant investments in primary care in order to reorient the health system towards this level of care.

Minister for Health Simon Harris 

The Sláintecare proposals also envisage the removal of private practice from public hospitals, which would free up some capacity for public patients, at an estimated cost of €649m per annum. A review group is currently examining this proposal and is due to report by the end of this year.

In the meantime, the high numbers on waiting lists and the length of time they are waiting are having an impact on health spending in Ireland. The Irish system has been criticised in some quarters for poor outcomes despite having relatively high per capita spending.

READ: Ireland's health spending needs to be put into perspective

While this can partly be explained by historic under-spending relative to other countries, another contributory factor is that patients in Ireland, by virtue of the long waiting times, are in many cases being treated at a later stage of illness, thus requiring more intensive treatment. A similar issue is evident at primary care level as research has shown that many people put off going to see a GP because of cost.

While tackling waiting lists will require resources in the short-term, such investment should benefit the health system in the longer-term through savings generated by treating patients earlier. The less time the system has to wait for this investment the better.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ