Hospitals have set budgets so waiting lists are an artificial way of placing limits on spending.

For as long as I have been covering health, there have been waiting lists.

Ten years ago, there were 21,000 people waiting for surgical or medical treatment, day case or diagnostic procedures.

At the time the number of people waiting to be seen at an outpatient clinic was not released as health authorities said they had to validate the figures.

In the intervening years we have seen waiting list action plans, targets and the Special Delivery Unit set up to get numbers down.

The latest figures for October show there are 684,800 patients waiting.

The National Treatment Purchase Fund was set up in 2002 and initially was focused on using the private sector to cut lists.

It has had some significant success.

Now a decade on, we have record waiting lists and new targets.

While some small improvements have been seen in some areas, like inpatient, day case and outpatient lists, the overall picture remains bleak.

The ways that lists are collated and presented has also changed, which can make it difficult to compare with the past.

There are a large number of lists to count.

Some patients are now on a separate "Suspended" list because they are unable to be treated at this time, for a variety of reasons.

They may be ill, some may have died, while others may no longer need the care as they went for treatment with private health insurance.

Some patients are also now making use of the EU Cross Border Healthcare Directive to get treatment abroad faster, and get repaid the costs afterwards.

Hospital overcrowding has an impact on waiting lists.

That is because Increased emergency admissions take up beds that would otherwise be used for planned operations.

There were 8,900 patients on trolleys last month according to the Irish Nurses and Midwives Organisation.

That is up 15% compared with October last year.

When you review the key factors people have cited for long waiting lists over the years, bed capacity is a common thread.

Health staff point to a shortage of staff, to the fact that the population has grown significantly, and to the fact that it is an ageing population too.