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Outpatient Waiting lists exceed 600,000 in July 2020 while COVID-19 cases rise

In July 2020, over six hundred thousand people, 601,362, were on waiting lists for outpatient procedures, according to data released by the National Treatment Purchase Fund (www.ntpf.ie).  Outpatient waiting lists have increased, year-on-year, since 2014, with the largest percentage increase between 2016 and 2017 (14.7 per cent), and an overall increase between 2014 and 2020 of 66.7 per cent (Chart 1).

Chart 1:  Outpatient Waiting Lists, 2014 to 2019 

Source:  Analysis of data from the National Treatment Purchase Fund, Outpatient / Waiting Lists, Group Hospitals, Various Years

Note:  Data relates to July each year

Of those on the July 2020 waiting list, almost a quarter are aged 65 and over (145,222) and 13.9 per cent are aged between 0 and 15 years old (83,298) (Table 1). 

Table 1:  Outpatient Waiting by Age Group and Length of Time, Number of People, July 2020

  0-3 Months 3-6 Months 6-9 Months 9-12 Months 12-15 Months 15-18 Months 18 Months + Total % Total by Age Group
0-15 14,132 13,655 12,210 9,080 7,475 6,319 20,427 83,298 13.9
16-64 74,407 59,040 52,228 43,653 33,518 26,190 83,806 372,842 62.0
65+ 30,202 22,453 20,059 16,798 13,410 9,373 32,927 145,222 24.1

Source:  Analysis of data from the National Treatment Purchase Fund, Outpatient / Waiting Lists, Group Hospitals, July 2020

The distribution of waiting times is relatively even across all age groups (Chart 2), however there are currently a higher proportion of people in every age group waiting 18 months than in any other waiting time.

Chart 2:  Outpatient Waiting by Length of Time, by Age Group, July 2020

 

Source:  Analysis of data from the National Treatment Purchase Fund, Outpatient / Waiting Lists, Group Hospitals, July 2020

This is notwithstanding the Government’s commitment, referred to in the Euro Health Consumer Index 2017 (p.16) with reference to a memo from the HSE and Department of Health referred to in the Euro Health Consumer Index 2017 (p.16), in response to the 2015 publication, advised of to a programme to reduce waiting lists to no more than 18 months.  Even where that target is reached, the Index stated, it will still be the worst waiting time situation in Europe.  The number of outpatients on waiting lists for 18 months or more increased year on year to July 2020 (Chart 3).  The largest percentage year-on-year increase was between 2016 and 2017 (194.4 per cent).  Between July 2014 and July 2020, the number of outpatients waiting 18 months or more increased by over 2,000 per cent.  Thirty-nine per cent of all patients awaiting treatment for 18 months or more were children or older people.

Chart 3:  Outpatient Waiting List, 18 Months+, 2014 to 2020

Source:  Analysis of data from the National Treatment Purchase Fund, Outpatient / Waiting Lists, Group Hospitals, Various Years

Note:  Data relates to July each year

The largest cohort of outpatients (73,101 in total) were awaiting Orthopaedic treatment, followed by those awaiting Otolaryngology (ENT) – ear, nose and throat (68,182).  Apart from Small Volume Specialities (where there are less than five patients waiting in a particular speciality or hospital), Paediatric Oncology, Palliative Medicines and Radiology were the specialities least likely to have waiting lists (Table 2).

Table 2:  Outpatient Waiting Lists by Speciality, July 2020

  0-3 months 3-6 months 6-9 months 9-12 months 12-15 months 15-18 months 18 months+ July Total
Orthopaedics 10,946 10,749 11,018 9,806 7,820 5,624 17,138 73,101
Otolaryngology (ENT) 7,912 7,652 7,434 6,558 6,056 6,072 26,498 68,182
Dermatology 8,863 6,046 6,080 5,713 4,605 3,284 10,346 44,937
Ophthalmology 5,694 6,177 5,523 4,677 4,018 2,985 13,976 43,050
General Surgery 16,215 9,096 5,339 3,389 2,069 1,468 1,986 39,562
Urology 5,308 4,426 4,162 3,689 2,835 2,057 9,177 31,654
Gynaecology 7,673 5,986 4,861 3,536 2,144 1,717 3,740 29,657
Cardiology 5,759 5,472 5,010 3,992 3,084 1,952 2,468 27,737
General Medicine 5,559 4,259 3,613 2,474 1,794 1,329 3,523 22,551
Neurology 3,697 3,072 2,717 2,645 2,219 1,651 6,455 22,456
Rheumatology 3,015 2,753 2,679 2,144 1,967 1,671 5,658 19,887
Respiratory Medicine 3,025 2,911 2,892 2,518 1,971 1,594 3,786 18,697
Plastic Surgery 3,192 2,378 2,359 2,072 1,574 1,074 3,885 16,534
Gastro-Enterology 4,399 2,495 2,049 1,534 712 436 1,236 12,861
Vascular Surgery 2,795 2,012 1,769 1,868 1,334 845 2,231 12,854
Endocrinology 2,196 1,957 1,892 1,596 1,085 834 3,190 12,750
Pain Relief 1,354 1,461 1,535 1,381 1,427 1,162 3,945 12,265
Paediatrics 3,890 3,008 2,480 1,390 525 267 481 12,041
Haematology 2,126 1,347 1,118 939 618 407 754 7,309
Paediatric ENT 529 923 1,026 792 966 950 2,066 7,252
Maxillo-Facial 592 661 644 603 502 340 2,152 5,494
Breast Surgery 1,941 1,010 656 334 242 314 556 5,053
Paediatric Dermatology 578 580 499 492 470 357 1,901 4,877
Paed Cardiology 815 769 834 704 551 396 619 4,688
Neurosurgery 1,167 837 774 516 403 370 208 4,275
Paed Orthopaedic 694 557 563 554 498 353 1,024 4,243
Paediatric Surgery 930 819 504 394 337 232 412 3,628
Clinical (Medical) Genetics 479 608 498 271 267 161 875 3,159
Nephrology 934 711 429 226 126 114 590 3,130
Oral Surgery 261 351 329 362 260 201 1,336 3,100
Clinical Immunology 408 426 432 303 267 319 937 3,092
Geriatric Medicine 1,505 705 312 135 74 50 181 2,962
Paediatric Respiratory Medicine 194 311 314 269 294 197 704 2,283
Anaesthetics 321 155 205 186 140 99 883 1,989
Clinical Neurophysiology 382 306 353 265 234 214 174 1,928
Diabetes Mellitus 289 317 332 255 154 79 130 1,556
Paediatric Urology 180 172 205 130 119 126 378 1,310
Paediatric Neurology 262 236 191 125 87 85 226 1,212
Paed Gastro-Enterol 149 170 118 87 92 104 437 1,157
Developmental Paediatrics 62 98 87 142 143 120 312 964
Paed Endocrinology 205 177 163 128 99 87 62 921
Immunology 65 67 48 59 26 40 246 551
Accident & Emergency 470 81 0 0 0 0 0 551
Dental Surgery 58 94 99 53 44 41 82 471
Oncology 381 43 18 3 1 0 0 446
Paed Nephrology 102 114 70 59 30 18 28 421
Cardio-Thoracic Surgery 202 120 35 21 8 11 18 415
Infectious Diseases 268 97 16 1 1 0 0 383
Paed Haematology 82 72 54 37 13 16 11 285
Psychiatry 188 56 10 7 2 1 0 264
Gastro-Intestinal Surgery 69 35 27 24 24 19 15 213
Pathology 34 22 20 19 15 12 42 164
Paediatric Infectious Diseases 68 32 32 8 3 3 0 146
Metabolic Medicine 28 27 22 16 21 3 3 120
Chemical Pathology 24 24 18 5 6 8 1 86
Paediatric Neurosurgery 22 15 1 5 0 1 34 78
Paed Metabolic Medicine 35 22 8 1 0 0 8 74
Paediatric Anaesthetics 7 0 0 9 10 7 34 67
Hepato-Biliary Surgery 31 23 3 3 2 0 0 62
Radiotherapy 44 2 3 0 0 0 0 49
Clinical Pharmacology 8 8 2 1 12 4 0 35
Rehabilitation Medicine 11 11 4 1 0 0 2 29
Neonatology 10 5 2 2 1 1 0 21
Child/Adolescent Psychiatry 9 2 6 0 1 0 0 18
Obstetrics 13 4 0 0 0 0 0 17
Radiology 3 6 1 3 1 0 0 14
Palliative Medicine 6 6 0 0 0 0 0 12
Small Volume Specialities 7 2 0 0 0 0 0 9
Paed Oncology 1 2 0 0 0 0 0 3

Source:  Analysis of data from the National Treatment Purchase Fund, Outpatient / Waiting Lists, Group Hospitals, July 2020

As we look likely to be living alongside COVID-19 for the foreseeable future, it is clear that an over-reliance on acute care within a two-tiered healthcare system is not fit for purpose.  Investment in primary care teams and community healthcare networks must be prioritised in Budget 2021.

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