Waiting lists may be higher than reported - C&AG

Official figures may be hiding how severe the waiting list situation really is, according to a new report.

The report shows that in January of this year there were 37,200 people on waiting lists for non-emergency procedures, and 18,500 had been waiting more than three months for procedures.

According to the Comptroller and Auditor General's (C&AG) latest annual report, in-patient and day case waiting list statistics used by the National Treatment Purchase Fund and the HSE exclude patients from lists once they are scheduled or have been accepted for a procedure.

However, the Comptroller's report points out that this does not take account of the fact that there would be a high risk of cancellation of scheduled procedures under pressure from emergency department (ED) activity and delayed discharges from hospital beds.

The report says in order to get a true measure of hospital performance, a waiting time measure for elective (non-emergency) admissions should be calculated for patients up to the point of treatment, rather than when a treatment is scheduled.

This would help give a more complete indication of the average time patients are actually waiting, it adds.

The C&AG report also found that there were differences between the hospitals in how patients who had received dates for admisisons to that hospital were classified.

Some excluded patients who had received admission dates while others continued to record those patients on the waiting list, causing anomalies in the statistics.

The report noted that in January, 61% of children had been waiting longer than the target waiting time of three months while 21% of adults were waiting longer than their target of six months.

It noted that performance in this area was much poorer in relation to waiting lists for children, with the majority of hospitals deemed by the HSE as requiring urgent attention in this area.

The C&AG report said a validation process on the NTPF system for clearing waiting lists by offering private treatment found that fewer than 10% of those waiting longest for elective treatment are available for treatment under the NTPF scheme.

"Consequently, it is difficult to see how the NTPF can discharge its functions in relation to those waiting longest for treatment," the report states.

It says hospitals were not following-up on patients who failed to respond to previous contacts and patient should have been temporarily or permanently removed from lists.

"These administrative weaknesses militate not just against effective provision by the NTPF of faster treatment, they must also reduce the ability of hospitals to schedule their own patients for treatment, " the report states.

The report also found that the number of patients waiting over nine months who have been recorded as unwilling to accept private treatment under the NTPF is surprising and must be a matter of some concern for the treatment purchase scheme.

The C&AG report states that the NTPF disputed the figures on long waiters reported as not being available for treatment when called.

The report shows that procedures purchased from private hospitals under the NTPF generally cost less than those carried out in the publicly funded hospital system.

It proposes that the HSE should explore to what extent an increase in public hospital capacity (due to longer working hours recently agreed for consultants) or the use of any spare capacity already there could be used to reduce or eliminate waiting lists.

The C&AG also proposes that hospitals might be incentivised to maintain more accurate waiting list information.

[Posted: Mon 14/09/2009]