Are patient waiting lists shrinking for the right reasons?

How hospital waiting lists are managed has led to claims of manipulation

Long waiting lists for hospital appointments and procedures represent one of the biggest failings of the current Government.

Over one million people are on one or other kind of public waiting list at present, and for much of Minister for Health Simon Harris’ period in office, this number has been increasing.

However, over the past year, the number of inpatients waiting for a procedure has begun falling, on foot of investment by the Government in outsourcing initiatives co-ordinated by the National Treatment Purchase Fund (NTPF). This support for the NTPF cost €75 million last year and €100 million this year.

The outpatient list, for people waiting to see a consultant, was rising by 7,000 a month earlier in 2019 and it peaked in the autumn. But it started to drop towards the end of the year. Last December, in the biggest drop seen in years, the outpatient list fell by 10,000.


Necessary process

So while the numbers remain large – 553,000 on the outpatient list and 67,000 on the inpatient list – these trends allowed Government Ministers to state – with apparent accuracy – in the first days of the election campaign that things were “getting better” in health.

Patients may no longer need to see the doctor. They may have received treatment privately. They may be dead

As Bill Clinton once said, one of the main questions that matters in public service is: "Are things coming apart or coming together?" Falling waiting lists allow Ministers to show that things are "coming together", albeit late in the Government's day.

But are the lists shrinking because more patients are being seen, or because more patients are being removed from lists without ever seeing a consultant or an operating theatre?

So-called “validation”, the process of checking whether a patient still needs to be on a waiting list, is a necessary process. Patients may no longer need to see the doctor. They may have received treatment privately. They may be dead.

However, the manner in which this process is carried out has been the subject of criticism. In 2018, GPs complained that many of their patients were being taken off lists without their consent and accused hospital groups of “cynical manipulation”.

As a result, the NTPF took over co-ordination of the work and put in place a standardised process. It set a target of sending out 250,000 validation letters and actually sent 266,000.

GPs say the new system is working better. Patients on a list for more than six months receive a letter asking whether they wish to remain on the list or not. If they reply “no”, they are removed from the list and if they say “yes” they stay on it.


If they don’t reply, they are written to a second time, and if no response is received, they are removed from the list. Their GP is then informed of this.

It is unclear what checks were used to ensure no one was taken off a waiting list inappropriately

NTPF figures obtained by The Irish Times show there was a massive increase in validations in the second half of last year. About 75,000 outpatients were validated in the last three months of 2019, for example, compared to none in the first nine months of 2018. Perhaps it is just coincidental that this period coincides with the run-up to the general election.

Curiously, too, the number of patients who asked to be taken off lists is exceeded by the number removed due to a non-response. Last year, 45,270 people were taken off the outpatient list, of which 21,287 specifically asked to be removed. Another 7,651 were removed from the inpatient list, of which 3,296 asked to be removed.

It is unclear what checks were used to ensure no one was taken off a waiting list inappropriately. What we can say is that the biggest contributor to falling waiting lists has been this massive validation exercise carried out over the past six months.