THE MINISTER FOR Health has launched an action plan that aims to slash hospital waiting lists to their lowest level in five years.

Stephen Donnelly said a €350 million cash injection will see 1.7 million people treated and removed from waiting lists, and reduce the total number by 18%.

There are almost 850,000 people waiting to be seen for an inpatient or day treatment.

Of those people, 720,000 are on the ‘active waiting list’, meaning they are still waiting for a scheduled appointment or procedure.

This morning, Minister @DonnellyStephen launched the 2022 Waiting List Action Plan with @HSELive and the National Treatment Purchase Fund.

Read the press release & report below ⬇️https://t.co/IE9m8d2Sjd pic.twitter.com/m8vVEDRvqv

— Department of Health (@roinnslainte) February 25, 2022

Donnelly said projections show that over 1.5 million patients will be added to the active waiting lists this year, as many people stayed away from the health service during the pandemic.

“I have met and spoken with a lot of patients and a lot of families, and one of the main issues they raise with me is the amount of time they are waiting for care,” he said.

“It could boys and girls waiting for spinal surgery, for scoliosis, it could be someone in their 60s or 70s who is waiting for a hip or knee operation. It could be people right across the country, waiting for cataract operations, for ENT surgery, or just to see a consultant.

“The wait causes huge anxiety. A lot of the time patients are waiting in pain and while they are waiting they are getting sicker, or their condition is deteriorating.

In Ireland today too many people are waiting too long for health care. We are building up capacity in the public health service has quickly as possible. Hundreds of thousands of people need quick access to care and that is what this plan is about. It’s about getting care as quickly as possible for the men, women and children who are waiting for care today.

The plan identifies 45 actions across four areas: delivering capacity in 2022, reforming scheduled care, enabling scheduled care reform and addressing community care access and waiting lists.

There will be a particular focus on 15 high volume inpatient day case procedures to ensure that every person waiting for over six months who is clinically ready will receive an offer of treatment.

Among these procedures will be cataracts, cystoscopies, hip replacements, knee replacements, skin lesions, varicose veins and angiograms. 

It will also target tonsillectomies, hysteroscopy, laparoscopy, total abdominal hysterectomy and hernia repair.

The €350 million includes existing funding of €100 million allocated to the NTPF for 2022 plus an additional funding of €50 million, along with €200 million that will go towards the HSE.

Donnelly said the plan details how the Department of Health, the HSE and the National Treatment Purchase Fund (NTPF) will introduce measures for people who have been waiting longer than six months for an appointment.

‘Won’t be enough’

“By the end of this year, we aim to have provided treatment for the vast majority of the 75,000 people who are currently waiting for an inpatient or day case procedure,” Donnelly said.

However, he said while the measures will make a huge difference, they “won’t be enough, particularly in light of the significant predicted backlog in demand for health services following the pandemic”. 

Really important announcement this morning on waiting lists. Many of our people have been waiting for too long and we're determined to make progress this year. There will be huge additional demand for treatment after the pandemic but we're aiming to reduce lists by 18% pic.twitter.com/oPIFElBAsY

— Stephen Donnelly (@DonnellyStephen) February 25, 2022

“Without this plan, it is estimated that the number of people on the active waiting lists would increase from 720,000 to well in excess of one million people by the end of the year,” he said. 

The department also acknowledged that there are “significant risks, assumptions, and dependencies” to achieve its targets.

In its report, department officials said: “Specifically, in 2022 there is uncertainty in relation to the number of people who will be added to active waiting lists following reduced referrals throughout the pandemic and the capacity within the public and private sectors.”

Donnelly said that if the plan works it will provide additional care for a significant number of people and will make “inroads” on the current waiting list.

Liam Sloyan, chief executive of the National Treatment Purchase Fund (NTPF), said the reliance on the private sector to help alleviate the waiting list will “come through in the implementation”.

“We will be very focussed on funding additional care in public hospitals where we can, and also in getting available capacity from the private sector,” Sloyan said.

“In recent years, the NTPF fund has been about 50/50 in terms of funding provided in the private and public sector for care of patients.

“Throughout the year we will be taking the best action for the patients regardless of whether it’s the private or public system. The ambition is to get as many patients treated and to get value for money for the State.

“I think both the private sector and the public sector will receive significant funding more than they ever have.”

Reaction

In a statement, The Irish Hospital Consultants Association said it was not consulted in the formulation of the plan and were seeing it for the first time today, adding that it comes at a time “when there is a real credibility issue in our health system”. 

“That official health policy now provides for patient wait times of up to a year for a procedure and 18 months for initial assessment reflects the scale of the crisis we are now in,” it said.

“Almost 900,000 people are currently on a waiting list with 245,000 of these people waiting over a year for either a procedure or to see a hospital consultant. They are waiting for the primary reasons that we have a massive shortage of the hospital consultants, beds, and theatre facilities required to assess and treat patients in a timely manner.

There is no detail in the plan on sustainable additional capacity to meet these latest targets. The 45 actions listed in the plan don’t address the fundamental issue of the overwhelming shortage of consultants, acute hospital beds, theatre and other frontline resources. Indications that as much as 25% of care will be outsourced to the private system is questionable given it is unclear that such capacity even exists at this point.

The IHCA added that there are currently over 700 permanent hospital consultant posts vacant or not filled as needed. Talks on a new consultant contract have stalled with no engagement since December 2021, it said.

“There has been no effort in the interim by the State to agree an independent chair with the representative organisations to oversee the process. Such realities undermine the credibility of this plan as a sustainable solution to the problem of growing waiting lists.”

“Our health system never appears short on aspiration but once again this plan, like many before it, skirts around the hard reality that without the required number of frontline consultants and other resources to see, assess and treat patients, waiting times will continue to be at unacceptable levels.”

Social Democrats co-leader Róisín Shortall said the plan will not work as it fails to address structural issues within the health service.

She said the €350 million investment was already announced in Budget 2022, adding that Donnelly has “merely dusted off previous plans, that failed to address the waiting list crisis, and rebranded them as something new”. 

“Funnelling money into a broken system may reduce waiting lists slightly in the short term, but it will do nothing to address endemic structural problems in the health service that are causing a crisis of delayed care for hundreds and thousands of people,” she said.

Shortall said that unless there is progress on implementing Sláintecare and agreement on a new consultant contract, record-high waiting lists will persist.

She said Donnelly’s Sláintecare progress report detailed key areas of the strategy “are nowhere near implementation”.

“Progress on implementing a multi-annual waiting list reduction plan; removing private care from public hospitals and implementing the Sláintecare consultant contract were all rated as having “significant challenges”. Meanwhile, the crucial development of regional health areas was rated as having “minor challenges” – despite the fact no discernible progress has been made.” she said.

We know that we have a chronic shortage of consultants in the Irish health service providing care. There are currently more than 700 consultant posts which are either vacant on a temporary or permanent basis. This will remain the case for the foreseeable future unless a new consultant contract is agreed. The Senior Counsel who had been chairing negotiations on the contract stepped down last month when she was appointed a High Court judge. I asked the Health Minister this week when she was likely to be replaced and he was unable to provide an answer.

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

With reporting by Jane Moore.