EXPERTS, ADVOCATES AND healthcare professionals agree that some of the biggest problems facing the Irish healthcare system are the lengthy public waiting lists for procedures, tests, or even just initial appointments with a consultant. 

Patients can end up waiting many months or even years for routine procedures or to meet a specialist, which adds further strain to a healthcare system already under extreme pressure.

Successive governments have failed to tackle the issue, and the problem has only worsened over the last two years as a result of the Covid-19 pandemic. 

“[Waiting lists] went from being really bad to being much, much worse because everything but essential care and urgent care was suspended,” said Dr Sara Burke, assistant professor in the Centre for Health Policy and Management at Trinity College Dublin (TCD).

“It’s a major, major challenge that needs a big response.”

Earlier this year, Health Minister Stephen Donnelly launched the 2022 Waiting List Action Plan with a view to tackling the problem. The plan commits €350 million to cut the numbers on active waiting lists by 18% by the end of the year.

“While this plan focuses on significant numbers and targets, it is fundamentally about ensuring people receive the right care in the right place, at the right time – reforming our health service through the fundamental principles of Sláintecare,” Donnelly said in February.  

However three months on, waiting list numbers have only slightly decreased, while opposition party members and hospital consultants say the plan isn’t working.

Waiting lists 

Ireland has some of the worst waiting times for hospital care in Europe. 

The data for people on waiting lists is collected and published by the National Treatment Purchase Fund (NTPF), a corporate body that works closely with the Department of Health and the HSE.

Every month the NTPF publishes figures for how many patients are awaiting appointments or procedures, and how long they have been on a list. These are called active waiting lists, and are broken down into the following categories:

• Inpatient – Active: patients waiting for an appointment date for their treatment
• Inpatient – To Come In (TCI): patients who have a scheduled date for their admission
• Planned Procedures: Patients who have had treatment and require additional treatment
• Outpatient: People waiting for a first appointment at a consultant-led outpatient clinic
• GI Scope: Patients waiting for a GI endoscopy treatment 

(These categories do not include people waiting for access to community care services including psychology, physiotherapy, occupational therapy, etc. Latest figures show that over 224,000 people in Ireland are on such waiting lists).

Outpatients who have not had a first appointment make up the vast majority of those on waiting lists and are the biggest challenge faced when trying to address the issue. This is followed by patients in need of a procedure.

Before the Covid-19 pandemic in February 2020 there were a total of 558,554 people on the outpatient waiting list, and 66,705 on the inpatient list. 

Latest figures for April 2022 show that there are now a total of 624,773 people on the outpatient list, and 79,943 on the inpatient list. Of the 624,773 people, 143,878 have been waiting for an appointment for over 18 months. 

In total, at the end of April, there were 732,463 people on active waiting lists in Ireland. While this is slightly lower (by about 400 patients) than the end of February, it remains higher than at the beginning of the year. 

“While active waiting lists have grown since the start of the year, such an eventuality was anticipated in the Waiting List Action Plan,” a Health Department spokesperson said.

The spokesperson cited the continuing impact of Covid-19, the usual focus on unscheduled care early on in the year, and the time needed to plan and initiate increased activity, as reasons for this. 

The Action Plan

The Government’s action plan commits to reducing active waiting list numbers by 18% by the end of the year, bringing them to the lowest point in five years. It also commits to treating “almost all” of the 75,000 patients who were in need of a procedure at the beginning of the year.

This is despite the fact that, according to the plan, 1.55 million people will be added to active waiting lists this year. The government commits to remove 1.7 million people in the same period, resulting in a net reduction of 18%.

To achieve this, the plan sets out four key areas to be addressed:

• Delivering capacity in 2022
• Reforming scheduled care
• Enabling scheduled care reform
• Addressing community care access and waiting lists

Under these four headings, 45 short- medium- and long-term actions are set out, aimed at cutting the numbers.

The €350 million is divided into €200 million for the HSE, along with an existing €100 million for the NTPF, as well as additional funding of €50 million for the NTPF. 

Of the €200 million for the HSE, €152 million will go towards ramping up activity across the above areas, with €70 million allocated to inpatient services, and €30 million going to outpatient care. The plan commits €15 million to gynaecology, paediatric orthopaedics and bariatrics.

The government aims to use funding for the NTPF to remove 273,000 patients from waiting lists. It said that the money will go towards supporting “public hospitals to treat more patients, commissioning care in private hospitals, validation, data quality, reform and systems and process development”.

The Action Plan also sets out 15 key, high-volume procedures that it will address. Anyone waiting over six months for these procedures – which include hip replacement, knee replacements, cataracts, among others – who is clinically suitable will be offered treatment. 

Finally, the remaining €48 million will go towards reforming the system, “including supporting a range of modernised scheduled care pathways and local innovations and capacity proposals from hospitals”.

Criticism 

The plan was met with strong criticism when it was released from hospital consultants and opposition politicians, who stated that it will not do enough to increase capacity and deal with long-term structural issues in the system.

“The whole point of waiting lists is that you can’t fix them in a year. You need a multi-annual waiting list plan that’s also linked to workforce and recruitment, and changing where the care is provided,” said Dr Sara Burke. 

“You can’t just pick off one bit of it and do it. And they haven’t published that multi-annual waiting list [plan].”

The Irish Hospital Consultants Association (IHCA), a representative body, was strongly critical of the plan and its implementation.

“Three months after the 2022 Waiting List Action Plan was published by the Department of Health, it is abundantly clear that the end of year reduction targets will not be achieved,” a spokesperson told The Journal.

“Waiting lists will not be brought under control if the consultant recruitment and retention crisis and capacity deficits in our public hospitals are not resolved.”

The IHCA points towards Ireland’s low number of consultant specialists – with 838 consultant posts not filled in the country – as one of the key problems affecting the healthcare system. As well as this, the low number of hospital beds in the healthcare system is also cited as an issue. 

“Today we have fewer public hospital beds than we did in 2008,” the spokesperson said.

“The physical capacity in our public hospitals is lower than in 2008 while the population increased by more than 500,000 (12%) and has aged significantly.”

The IHCA said that people are still being added to the country’s main waiting lists, and that the plan will fail to meet its targets at the end of the year, as it does not address the long-term structural issues at the heart of the problem.

“Unfortunately, the targets will not be achieved as not one of the 45 actions listed in the Government’s Waiting List Plan provide real solutions to the fundamental issue of the overwhelming shortage of consultants, acute hospital beds, theatre and other frontline facilities,” the spokesperson said. 

“The growing waiting lists demonstrate the impact of years of consultant shortages and underinvestment in capacity across our public hospitals.”

The IHCA called for talks to resume between the government and doctors on a public only consultant contract, which stalled five months ago when the chair of negotiations was appointed to the High Court. The organisation said that a new chair needed to be appointed. 

“This is vital if we are to address the root causes of the consultant staffing crisis and bring down waiting lists.”

The co-leader and health spokesperson for the Social Democrats, Róisín Shortall, also criticised the plan when it was released, echoing the main concerns of the IHCA.

“Recycling previous plans, which failed to address the waiting list crisis, suggests the Health Minister is bereft of ideas and bereft of a credible plan,” said Shortall. 

“Unless we see swift and significant progress in the implementation of Sláintecare, the waiting list crisis will inevitably deepen.”

In a statement to The Journal, a spokesperson for the Department of Health said that the plan was working, with the overall reduction in the numbers on waiting lists ahead of target.

The spokesperson said that an increase in Covid-19 cases at the beginning of the year impacted the progress of the action plan, but that the Department is confident that it was being delivered in line with the targets set out.

“Progress was impacted by the Covid situation in Q1, but we remain confident that the plan will be delivered.

“Delivery of the Plan is being actively overseen by the Waiting List Task Force, co-chaired by the Secretary General of the Department and the CEO of the HSE.”

This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work is the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.