Treatment purchase fund may be used to alleviate outpatient lists

Public patients who have been waiting years for hospital outpatient appointments may be seen privately as early as next year.

The National Treatment Purchase Fund (NTPF) will consider the move if it continues to succeed in reducing inpatient lists. Waiting lists for inpatient procedures declined by nearly 2,000 in July as waiting lists in other areas increased or remained broadly the same, figures released on Thursday showed.

In an interview with The Irish Times, NTPF chief executive Liam Sloyan said it may start looking at addressing the outpatient list (hospital-based doctor appointments) once the inpatient list is brought under control.

“When we get the inpatient list down you could start thinking about how can we work on the outpatients more,” he said.

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“The Minister [for Health Simon Harris] is keen that we have a look at what we can do so, perhaps next year. If we get lists down in some of these areas in the [inpatient/daycare cases] then maybe we can look at turning to the outpatients.

“Like if we get the ophthalmology [inpatient] list under control maybe we can look at the outpatient ophthalmology list.”

Range of procedures

Since June 2017 the inpatient waiting list, which tracks the number of patients waiting on a wide range of hospital procedures, from tonsillectomies to serious heart surgery, has fallen from 86,111 to 76,156.

The decline is partly a result of the work of the NTPF, which has so far this year made 12,008 offers of private treatment.*

“It shows the benefit of having a small, agile organisation with a bit of funding that can see the problems with the system and go after them,” Mr Sloyan said.

Since 2016, the NTPF has been tasked with identifying pressure points in the inpatient health system and intervening to relieve pressure on those waiting lists. As part of its 2018 action plan it is focusing on seven “high volume” procedures including cataract operations, angiograms and hip and knee replacements.

Mr Sloyan said it was on track to meet its 2018 target of offering treatment to everyone waiting for nine months or more for one of these seven procedures.

Inpatient waiting lists have decreased almost every month since June 2017. The two exceptions were last December because of the Christmas period and February due to procedures being cancelled because of Storm Emma.

The reduction in the inpatient list is one of the few pieces of good news to emerge from the health service in recent months.

Earlier this month Fianna Fáil claimed nearly a million people were on all waiting lists combined, while the Irish Nurses' and Midwives' Organisation said the numbers on trolleys waiting for beds had increased 32 per cent compared with the same day last year.

Figures released on Thursday show there were 511,675 people on the outpatient waiting list which measures the number of people waiting for hospital-based doctors’ appointments. This was a slight increase on the 511,415 waiting in June.

The NTPF is already providing a small amount of funding for additional outpatient clinics in public hospitals such as weekend and evening clinics.

Mr Sloyan, who was appointed in May 2017, said if given the funding the NTPF was capable of expanding its remit to reduce the outpatient lists but conceded it would be challenging.

“Certainly the outpatient list, if we turn our attention to that, will bring a whole new set of challenges; just the numbers alone will bring its own challenges.

“There’s plenty to be done in the waiting lists, so we could be given a lot more to do. That’s not a matter for me to determine,” he added. “So the challenges could be huge but I think we’re well able to deal with it.”

*This article was edited on August 17th, 2018, to inserted the text "which has so far this year made 12,008 offers of private treatment".