Unique health identifier would provide number of people on waiting lists


It would be useful if official waiting list data for Ireland included the number of people on waiting lists – which could be facilitated by the use of a unique health identifier-  as  current numbers do not refer to unique individuals, according to a Department of Health paper.

This paper, Acute Hospital Waiting Lists and Times: International Comparisons and Trends in Ireland to end 2021, examines how Ireland compares internationally on wait times and analyses trends in public waiting lists and long waits in Ireland in the eight years to end 2021. The views presented in the paper, do not represent  the  official views of the Minister for Health.

It also suggests we need the waiting list inflows and outflows which drive changes in waiting list stocks and the wait times of patients treated from the list, which it says could supplement current wait time data for Ireland, which only refers to patients still on the list.

The analysis says it would be informative to be able to compare the size of waiting lists for acute hospital elective care relative to the population in Ireland to that of similar waiting lists in other OECD countries.  However,  data  to  make  such  comparisons  was  not  currently  collated  by  the  OECD  or  other  international organisations.  

It says comprehensive international data on wait times was not available. Internationally published data on wait times related to three high volume procedures and so it was not representative of wait times on overall inpatient and day case waiting lists.

“Comparing these high-volume procedures, the most recently published data for wait time of patients on the public list show that as of 2019,Ireland was placed mid  table  for hip  and  for  knee replacements. Previous  research  has suggested  that  Ireland  performs  relatively  worse  when measured  by  wait  time  of patients treated from the public list. Nevertheless, Ireland’s international public wait  time  rank  for  hip  replacement  and  knee replacement improved between 2015 and 2019 reflecting improvements during 2018 and 2019 when median wait times of patients on the public waiting list reduced considerably.”

The paper said that during the first year of the COVID -19 pandemic all 12 countries for which data was available from the OECD experienced an increase in mean wait  times for the  three  high volume  procedures above as public health restrictions were introduced for non – urgent care and elective surgery.  The OECD does not collate data on the wait times for specialist consultation which means that comparisons on wait times for outpatients cannot readily be made across countries.

Turning to trends in public waiting lists in Ireland to end 2021, the paper said that over the period, there were three large annual increases (+10.5%) in waiting lists In 2016 and 2017 (pre-pandemic increases were due to rising demand driving rises in waiting list  inflows) and in 2020 (due to a COVID supply shock which reduced activity and waiting list outflows). 

“Public waiting list performance for inpatient and day case procedures (IPDC) improved during 2018  and  2019.  The  numbers  on  the  IPDC  list  fell  in both  years  (down  11,264 or 13.8% and down 3,641 or 5.2% respectively) as did the number of long waits (down 3,324 or 24.8% and down 944 or 9.4%). This followed a gradual increase in HSE available IPDC beds and elective IPDC  discharges  from  2015onwards and  increased  use  of NTPF insourcing, outsourcing, and administrative validation from 2018 onwards.

“During 2020, the overall public IPDC waiting list increased by 5,912 or 8.9% to 72,475. However, the number of long waits doubled, increasing by 9,444 or 103.6% to 18,561. This was due to a reduction in public hospital elective IPDC discharges, down 209,921 or 17.7%, and a reduction in the estimated number of IPDC waiting list removals, down by 70,256 or 22.4%. 

“During 2021 elective public IPDC activity increased (as did the number of consultants and beds) with  elective  IPDC  discharges  increasing  by  96,475  or  9.9%,  and  IPDC  estimated  removals increasing, up 40,376 or 16.6%.  However, the IPDC waiting list increased slightly, up 2,983 or 4.1% to  75,458,  as  additions  also  increased  and  while  elective  IPDC  discharges  were  above 2020s level, they were below previous years (close to 2015 levels). Nevertheless, the number of long waits on the IPDC waiting list declined, down 1,698 or 9.1%, to 16,863. 

“Examining  data  for  Ireland  shows  that public outpatient  waiting  lists  increased  year on  year from 2016 onwards to end 2019, albeit at lower rates in 2018 and 2019, and increased during the  pandemic. OPD  long  waits  followed  a  similar  trend,  although  they  reduced  in  2021  as activity increased above the low of 2020. This pre-pandemic trend in OPD waiting lists coincided with modest  increases  in outpatient  attendances that  did  not  keep  pace  with  growth  in demand. 

“The period to end 2019 was characterised by emergency care accounting for a growing share of  activity, relative  to  elective  care,  and  this  continued  during  the  pandemic.  Comparing  the shares of emergency department attendances and attendances for outpatient appointments, shows that the share for emergency department attendances rose. There was a similar trend for  hospital  inpatient  discharges,  with  the  share  of  inpatient  emergency  discharges  rising relative to inpatient elective discharges.”

The paper said that waiting  lists  relative to the  population were higher in 2021  than in 2014  (except  for  IP). The share of waiting  lists  accounted for by long waits was also higher in 2021 than  in  2014 with notable increases when there were substantial increases in waiting lists.

It said the policy implications were that performance on public specialist waiting lists  and wait times was  inextricably linked to attendances, activity and throughput from the acute hospital sector.

The ongoing increase in the share of activity for emergency relative to elective care pointed to the need to understand  the reasons for growth in emergency attendances and suitable responses and the importance of finding sustainable ways to increase hospital  discharges through increased productivity, e.g., weekend discharges.

The increase in long waits, following the increase in waiting lists in 2016/2017  and then in 2020, was of note, and warranted the increased policy and operational emphasis on reducing waiting lists that had been adopted. 

*Robert Murphy & Ailish Kelly, Research Services & Policy Unit, Research, Development, & Health Analytics Division, Department of Health.