merrion street

The latest NTPF figures, published on Friday 6 November, continue to show improvements. There are reductions in the total Inpatient / Daycase (IPDC) waiting list, and in the numbers of patients waiting between 15 – 18 months and waiting over 18 months. This is very positive, as it is the first time that we have seen reductions in all 3 key categories.
Similarly, there are reductions in the total number of people waiting for outpatient appointments, which has fallen below 400,000 for the first time this year. Through facilitating additional clinics outside conventional working hours or by outsourcing where capacity is limited, the end of October sees a reduction of almost 5000 in the overall Outpatient waiting lists and of over 3000 in the number of people waiting between 15 – 18 months for appointments.
The rising trend in numbers being referred for routine GI endoscopy is noted, and the HSE has identified a requirement for strict application of standardised referral criteria, as well as a review of demand and capacity and a clinical review of need. In respect of urgent colonoscopies, there is a 4 week access target and a policy of zero tolerance applies to any breaches.
The HSE is addressing the targets in relation to maximum waiting times with Hospital Groups as part of the regular performance and accountability process. The additional funding which has been provided by the Government in 2015 is being used to both maximise capacity across public and voluntary hospitals as well as outsourcing activity where the capacity is not available to meet patient needs within the maximum allowable waiting time. The application of fines is also aimed at incentivising improved performance in relation to the longest waiters. The total value of fines levied to date is of the order of euros8.47m which is being applied on a monthly basis and takes account of additional breaches during the month.
The Department and the HSE recognise that there are personnel and structural challenges which impact on individual specialties and hospital sites. The impact of ED escalation policies, which require the cancellation of non-essential surgery in order to safely manage demand and capacity, may pose a further challenge which cannot be accurately predicted in advance. All of these factors mean that it is vital to effectively manage waiting lists so that those longest waiting are scheduled within the available capacity, once emergency and urgent cases have been dealt with.
Finally, it is worth noting the following:
% of patients waiting less than 6 months for inpatient / daycase treatment: 60.3%
% of patients waiting less than 12 months for inpatient / daycase treatment: 86.23%
% of patients waiting less than 6 months for 1st outpatient appointment: 59.1%
% of patients waiting less than 12 months for 1st outpatient appointment: 84.9%

It is disappointing, however, to see that the number of people waiting over 18 months has increased slightly. Similarly, the slow rate of decrease in those waiting over 18 months for inpatient or day case procedures is concerning, particularly when this is contrasted with the more significant decrease in the number of patients waiting between 15 – 18 months. The Department requested the HSE to follow this up with hospitals as a matter of urgency. The HSE has directed all hospitals to prioritise these cases within the overall outsourcing programme.
Category total End Sept Difference Over 18 months End Sept Difference Over 15 months End Sept Difference
IPDC 69046 69076 -30 2161 2244 -83 2808 3198 -390
OP 396571 401496 -4925 13353 13176 +177 17936 21087 -3151
GI Endoscopy 16891 16839 +52 31 44 -13 461 538 -77