Monthly waiting list figures - March 2024

New hospital waiting list figures published today by the National Treatment Purchase Fund (NTPF) demonstrate continued progress over the past year, through the multi-annual action plan approach, in addressing increasing waiting lists and long wait times.

The total waiting list exceeding the 10 and 12 week Sláintecare targets at the end of March 2024 was 463,296 which is a c.3.2% (15,602) decrease compared to the end of February. The total number of patients waiting within the Sláintecare targets at the end of March 2024 was 232,450.

As at the end of March 2024:

• 51,544 people are exceeding the 12-week the inpatient/day case (IPDC) target which is a c.4.4% decrease compared to the end of February 2024
• 9,285 people are exceeding the 12-week GI Scope target which is a c.11.2% decrease compared to the end of February 2024
• 402,467 people are exceeding the 10-week outpatient (OPD) target, which is a decrease of c.2.9% compared to the end of February 2024

Since the pandemic peaks, there has been a c.26% reduction in the number of people waiting longer than the Sláintecare targets, which equates to approximately 164,000 people.

In the last year, since March 2023, the total waiting list has decreased by c.1.4% (9,765). As of the end of March, there were 695,746 patients on the active hospital waiting lists. There have been c.143k additions to the Waiting List in March. There have been c.110k removals from the Waiting list in March.

Since March 2023, the OPD waiting list has decreased by c.9.8k (c.1.7%), IPDC waiting list has increased by c.1.7k (c.2%) and the year-on-year comparison at the end of March 2024 highlights that the GI Scopes waiting list decreased by c.1.7k (c.6.6%) compared to this time last year.

The latest hospital activity report published monthly by the Health Service Executive (HSE) is now available online. This gives regular insight into acute activity levels, with millions of patients being seen and treated annually within our hospital system alone. For the most recently available 12 months of data, covering January 2023 to December 2023, there were c.3.6 million outpatient and c.1.8 IPDC attendances. In addition to this planned (‘scheduled’) care, our hospital system also treated c.1.7 million patients during this same period in emergency (‘unscheduled’) care, which represents a c.2% increase on the previous 12-month cycle and reflects the continuing demands on our hospitals.

Despite the significant challenges from the aftermath of the COVID-19 pandemic, emergency department pressures and other operational factors, including recruitment, our hospitals have delivered improvements which are making a real difference to patients. Many individual hospitals have delivered impressive reductions in both their waiting lists and waiting times. The HSE is currently working to replicate this positive performance across the entire hospital system.

For example, over the past year, University Hospital Limerick has reduced the number of patients waiting over 15 months for OPD appointments by 68% from 5,364 to 1,702. Additionally, Midland Regional Hospital Tullamore has reduced the number of patients waiting over 9 months for an IPDC procedure by 61% from 315 to 123 and Galway University Hospital has reduced the number of patients waiting over 13 weeks for colonoscopy or OesophagoGastroDuodenoscopy (OGD) procedures by 67% from 628 to 208.

As part of the multiannual approach to reducing waiting lists and just as importantly the length of time that patients are waiting, on 27 March 2024, the Department of Health published the 2024 Waiting List Action Plan (WLAP) which sets out 19 Actions across three themes: Delivering Capacity, Reforming Scheduled Care and Enabling Schedule Care Reform.

Funding of €437 million has been allocated to address waiting lists in 2024. A total of €360 million of this funding has been provided for the 2024 WLAP, which includes €179 million for the NTPF, Funding of €77 million has also been allocated for primary care/community-based initiatives. This includes €3 million, specifically to address waiting lists in Child and Adolescent Mental Health Services (CAMHS), which is a priority for the Minister for Health in 2024.

The 2024 WLAP aims to achieve an almost 6% reduction in the overall number of patients on waiting lists, an increase on the 2.7% reduction achieved last year. There will also be a continuing emphasis on reducing waiting times, with a targeted 10% reduction in the number of patients breaching the Sláintecare Time Targets (as of year-end 2023).

It is important that these targets are contextualised based on projected activity rates for 2024. In 2023, the overall removals target was exceeded by 5%, with over 1.74 million patients removed from hospital waiting lists. The 2024 WLAP expects to remove even more patients this year and is projecting that over 1.81 million patients will be removed from hospital waiting lists by the end of December 2024.

However, the rate of additions to the waiting list in 2024 is also projected to further increase beyond the levels experienced last year. The rate of additions in 2023, was 8% higher than targeted in the 2023 WLAP and over 12% higher than the rate of additions seen in 2022. For 2024, the HSE are projecting that the rate of additions will be approximately 5% higher than experienced in 2023.

The HSE is attributing the increases in waiting list additions to both demographic (for example: population growth, immigration, aging population) and non-demographic challenges (for example: increased awareness of services, new service developments, chronic disease and pent-up demand post COVID pandemic).

The strong focus on the outpatient waiting list throughout 2023 - whilst reducing the Outpatient waiting list by 4% - impacted the IPDC waiting list. Approximately 20% (1 in 5) of outpatients are referred for a procedure after having an initial outpatient appointment. These conversions have an obvious knock-on effect on IPDC waiting lists, and as a result, even though the volume of IPDC activity was ahead of target in 2023, the numbers on the waiting lists increased.

In 2024 the same challenge arises with the continued focus on reducing the Outpatient waiting lists. The 2024 WLAP is targeting an ambitious 8% increase in OPD activity compared to 2023 outturn. This will have a consequent impact on referrals to IPDC lists. However, importantly, through increased activity and productivity measures, the number of patients on these lists who are exceeding the Sláintecare wait time targets is targeted to decrease by 10%.

The WLAP multi-annual approach, initiated in 2021, encompasses a two-pronged approach of short-term actions to increase capacity and activity in the immediate term and longer-term reform measures to sustainably reduce and reform hospital waiting lists and waiting times. This WLAP approach is having a positive impact on hospital waiting lists. For example, each of the WLAPs to-date have achieved a reduction in the overall waiting list numbers at the end of each year, namely a 5.4% reduction from September to December 2021, a 4.1% reduction for WLAP 2022, and a 2.7% reduction for WLAP 2023.

With the 2024 WLAP, the Department of Health, the HSE and the NTPF are taking the next steps in the multi-annual approach towards achieving our vision of a world-class public healthcare service, whereby everyone has timely and transparent access to high-quality scheduled care, where and when they need it.