Multiple lists complicate calculation of waiting times

The plight of patients languishing for years on hospital waiting lists, despite the severity of their conditions, has been vividly illustrated in Monday’s RTÉ documentary on the issue.

However, the claim that thousands of patients have been secretly kept off the official public waiting lists overlooks even bigger flaws in the system.

This is because the actual amount of time a patient waits for treatment is divided into spells on different waiting lists, while much of the time spent interacting with the health service goes unrecorded.

In most parts of Europe, waiting times are defined as running from the time a GP writes a referral letter to the date of the procedure. A single central list is maintained and the patient exits that list only when treatment is completed.

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In Ireland, however, we publish separate waiting lists for outpatient appointments and for inpatient procedures, and also for gastro-intestinal endoscopes (tests). We don’t publish waiting lists for the variety of other tests for which patients are referred.

Several years

Thus, a patient might wait several years to see a consultant, with this time recorded on the outpatient waiting list. The patient is referred for tests, but in most cases this time is not recorded on any published list. She or he is then referred back to the consultant – another time on the list. Finally, if the consultant believes treatment is necessary, the person is put in the queue and on the in-patient waiting list.

Thus, a typical patient may have three or four spells on different lists – and other spells when they are invisible to the system – before their treatment is completed. It’s the equivalent of going to the post office and having to spend time on the queue before each hatch instead of joining a combined queue.

Planned procedures

By contrast, the issue of whether patients who have appointments scheduled within six weeks are included on the published list seem relatively minor – though logic suggests they should be. Meanwhile, those patients who are on the unpublished Planned Procedure list aren’t due for treatment until their indicative date, so most of them don’t belong in the published figures either.

A further problem is that many people on the lists should not be there. A thorough checking of lists in the north-east found 30 per cent of those did not want treatment and another 30 per cent did not need it on clinical grounds. That means urgent cases are being deprioritised.

Other countries have tried to control their waiting lists either by throttling demand or increasing resources, but with limited success.

In Ireland, over recent decades, governments have tried to clear waiting lists by outsourcing work to the private sector, or by sending patients abroad. Neither approach works in the long term.

The creation of a single waiting list may work more effectively, as well as providing more candour about patients’ true waiting times. The long-delayed use of IT – for example, through electronic booking – would also help.

Such an approach has been tried recently in the Royal College of Surgeons in Ireland hospital group, with promising results. Patients requiring endoscopies, for example, have been referred to Cavan hospital, leading to a fall in the waiting list from 2,800 last summer to less than 700 today.