Record waiting lists could spiral further before end of year as over 900 Consultant posts remain unfilled
No waiting list plan will ever work without addressing shortage of Consultants
- Waiting lists may increase by over 20,000 in 2022 instead of target reduction of 132,000 (18%) despite €350 million Waiting List Action Plan;
- Record 910,000 people on some form of public hospital waiting list – surpassing previous high set in September 2021; up more than 68,000 (8%) since August 2020;
- 49,500 people removed from waiting lists without any treatment in first six months of 2022 through ‘validation’ of lists at a cost of €3m;
- Number of unfilled Consultant posts rises to over 900 for first time as spend on medical agency staff increases by 25% in first half of 2022 compared with same period in 2021;
- Urgent action needed to address public hospital capacity deficits and Consultant vacancies.
IHCA President Prof Alan Irvine: “Not one of the 45 actions listed in the 2022 Waiting List Action Plan addresses the fundamental issue of the overwhelming shortage of Consultants, public hospital beds, theatre and other frontline resources. The Government and health service management needs to engage with the IHCA and agree a realistic and properly funded plan with ambitious waiting lists targets. This can only be achieved by addressing the ongoing and deteriorating Consultant recruitment and retention crisis and ending the pay discrimination imposed on Consultants appointed since October 2012.”
The Irish Hospital Consultants Association (IHCA) has today (9 September 2022) projected that the number of people on public hospital waiting lists to be assessed or treated may increase by more than 20,000 by the end of the year compared with the number waiting at the start of 2022, rather than reduce by the 18% (132,000) promised by Government.
The stark warning comes as the latest figures from the National Treatment Purchase Fund (NTPF) released today reveal that there were 910,073 people on some form of public hospital waiting list at the end of August, an increase of 68,600 (8%) since August 2020.1 This surpasses the previous record of 909,900 set in September 2021.
The Government’s €350 million Waiting List Action Plan for 2022 set a target of reducing waiting lists for outpatient appointments, inpatient and day case treatment, and GI (gastrointestinal) endoscopies by more than 18% by the end of the year compared with the number waiting at the start of 2022.2
Outgoing HSE CEO Paul Reid said last week that the HSE could not forecast whether a reduction in the waiting lists of 18%, 15% or even 10% could be achieved by the end of the year.
The latest NTPF figures for the end of August confirm that over 15,500 additional people are now on the three main waiting lists compared with the start of the year. New analysis from the IHCA suggests that, if the current waiting list trend for 2022 continues to the end of December, 14,000 additional people could be added to the outpatient waiting list and a further 6,700 patients added to the inpatient/day case waiting list compared with the start of 2022 – more than 20,000 in total.
The HSE is more than 147,800 outpatient appointments and procedures away from meeting the reduction targets set out in the 2022 Waiting List Action Plan for the end of the year, including 141,700 outpatient appointments, around 4,200 inpatient or day case procedures and 1,900 GI scopes.
Consultants have again questioned Government priorities as new figures show that the HSE is spending almost €3 million employing 68 administrative staff involved in waiting list management, including the validation of lists.3 According to separate figures supplied to Sinn Féin health spokesperson David Cullinane, 45,561 people were removed from outpatient waiting lists this year up to the end of June through the NTPF’s validation programme, with a further 3,942 patients removed from inpatient/day case waiting lists – or 49,500 in total.4
Given that the Waiting List Action Plan envisaged 60,000 people would be removed from waiting lists through ‘validation’ over the entire year, this is the one area in which the HSE is not only meeting but exceeding its target.
In addition, Medical/Dental Agency spend by the HSE in the first six months of this year was €55 million5 – an increase of €10.8m (25%) compared with the same six-month period in 2021.6 The full year spend on medical agency staff is therefore expected to be over €100m by the end of 2022 – the first time it has exceeded this level since 2017.7 This is at a time when the number of unfilled permanent Consultant posts is understood to have risen to over 900 for the first time ever.8
Commenting on today’s record waiting lists, IHCA President Professor Alan Irvine, said:
“Not one of the 45 actions listed in the 2022 Waiting List Action Plan addresses the fundamental issue of the overwhelming shortage of Consultants, public hospital beds, theatre, and other frontline resources. Furthermore, indications that as much as 25% of care could be outsourced to the private system was always questionable in view of the capacity limits in the sector.
“The Government and health service management needs to engage with the IHCA and agree a realistic and properly funded plan with ambitious waiting lists targets. This can only be achieved by addressing the ongoing and deteriorating Consultant recruitment and retention crisis and ending the pay discrimination imposed on Consultants appointed since October 2012, as “unambiguously committed to” by Minister Stephen Donnelly two years ago.
“In particular, it is imperative that the over 900 approved Consultant posts that are vacant or filled on a temporary, locum or agency basis are filled as needed with permanent appointees if we are to effectively address the record public hospital waiting lists.
“The negotiations between the Association and the health service management on a proposed new consultants’ contract is a critical element in ensuring that we can recruit the number and the calibre of Consultants who are so urgently required.”
1. Latest NTFP data as at end of August 2022: https://www.ntpf.ie/home/nwld.htm
2. 2022 Waiting List Action Plan, 25 February 2022: https://www.gov.ie/en/publication/323b5-the-2022-waiting-list-action-plan/
3.HSE PQ response to Deputy David Cullinane, 4 August 2022: https://www.hse.ie/eng/about/personalpq/pq/2022-pq-responses/july-2022/pq-37407-22-david-cullinane.pdf
4. Dáil PQ response from Minister Stephen Donnelly to Deputy David Cullinane, 14 July 2022; https://www.oireachtas.ie/en/debates/question/2022-07-14/846/
5. HSE PQ response to Deputy Duncan Smith, 27 July 2022: https://www.hse.ie/eng/about/personalpq/pq/2022-pq-responses/july-2022/pq-38332-22-duncan-smith.pdf
6. FOI response to Catherine Reilly, Medical Independent, May 2022, https://www.medicalindependent.ie/in-the-news/latest-news/rising-hse-expenditure-on-medical-agency-staffing/ and https://www.ihca.ie/_fileupload/HSE%20Agency%20Spend%202021%20Copy%20of%20Appendix%201%20to%20FOI%20C270%2022%20(1)%20(002).pdf
7. HSE PQ response to Deputy David Cullinane, 11 May 2022: https://www.hse.ie/eng/about/personalpq/pq/2022-pq-responses/april-2022/pq-19425-22-david-cullinane.pdf
8. There were 882 permanent Hospital Consultant posts not filled as needed as at 3 May 2022, including 473 permanent Consultant posts totally vacant (HSE PQ response to Deputy Paul Kehoe, 11 May 2022: https://www.hse.ie/eng/about/personalpq/pq/2022-pq-responses/april-2022/pq-19432-22-paul-kehoe.pdf). The number of vacant Consultant posts increased to 507 as at 7 June 2022 (HSE PQ response to Deputy David Cullinane, 19 July 2022: https://www.ihca.ie/_fileupload/HSE%20PQ%20Response%20David%20Cullinane%2011%20July%202022%20PQ%20ref%2037453%2022.pdf). Adding this figure to the 342 posts filled by temporary and locum consultants, and the additional 61 posts filled on an agency basis in May, suggested there are around 910 permanent Consultant posts currently not filled as needed.