The Irish Times view on hospital waiting lists: straining to stand still

Proposals to cut hospital waiting lists are like buses; nothing comes for ages, and then a slew of proposals arrive. Minister for Health Stephen Donnelly has announced a new waiting list plan that aims to treat "almost all" of the 75,000 people currently waiting for an in-patient or day-case procedure. The HSE, in its 2022 service plan, makes a broadly similar promise; that no patient will have to wait more than one year for a hospital procedure by the end of 2022.

The proposals are modest, because they have to be. More patients are on waiting lists currently than ever before. In 2014, 386,000 outpatients were waiting to see a consultant; by the end of last year that number was 617,000. Over the same period, the number of patients waiting for a procedure grew from 63,000 to 75,000. There are fears of a spurt in demand, now that the pandemic appears to be winding down. That would see more than 1.5 million people added to the waiting list this year, up from 1.1 million in 2020.

Throw in the challenges posed by an ageing population and it is evident the health service will have to strain hard even to stay still. Donnelly's plan envisages an 18 per cent net reduction in waiting lists. Yet there is significantly more money to apply to the problem compared to previous plans. The Department of Health plans to spend €350 million this year on waiting list initiatives through the HSE and the National Treatment Purchase Fund. Donnelly and his officials are vague about how this money will be spent but it is likely more than half the outlay will go on treating public patients in private hospitals.

Therein lies the problem. Previous plans have foundered, or achieved only short-term success, because they failed to tackle inherent shortcomings in the health service. Some of these are being addressed through the Sláintecare reform programme, but little progress has been made on its central plank, the disentanglement of public and private medicine, in over four years. Talks between the department and hospital consultant representatives on a new public-only consultant contract appears to have stalled.

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Once again, therefore, the political response is to lean heavily on the resources of private health to help get the public system out of a waiting-list hole – while all the time talking about boosting public medicine. Why would doctors planning their career opt for a public-only contract when the private health service continues to be awash with public money? There are also risks associated with the plan, most notably the devastating impact a new Covid-19 variant could have on the health service. Pent-up demand for care could turn out to be much larger than anticipated. Doing nothing was not an option. Donnelly is to be commended for trying to improve the situation, but the odds are stacked against durable success.