Waiting List Action Plan for 2024 aims a reduction of almost 6% in numbers waiting

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The 2024 Waiting List Action Plan has provided total funding of €360 million this year for 19 actions across three themes, namely Delivering Capacity, Reforming Scheduled Care, and Enabling Scheduled Care Reform.

The Department of Health said the 2024 Plan builds on progress achieved in 2021, 2022 and 2023 as part of the multi-annual Waiting List Action Plam approach, initiated by Minister Donnelly to sustainably reduce and reform hospital waiting lists and waiting times, and to move closer to achieving the Sláintecare maximum wait times.

Minister Donnelly said, “This ambitious Plan will continue the positive progress we have been making in relation to our waiting list performance in recent years.

“This Action Plan aims to achieve an almost 6% reduction in the overall number of patients on waiting lists by the end of December. This represents a significant increase on the 2.7% reduction delivered last year.

“Importantly from a patient perspective, in 2023, we achieved significant improvements in waiting times. This is an integral component of our work again this year, with three of the four overarching targets in the Action Plan specifically focused on improving waiting times.”

He said this year’s Plan encompasses four overarching targets to reduce both waiting list numbers and also the time that people wait for their care, namely:

  • Sláintecare Time Targets – reducing the number of patients breaching the Sláintecare Time Targets (as of year-end 2023) by 10%.
  • Patients Waiting Over three years – reducing the number of patients waiting over three years or at risk of being over three years by 90%.
  • National Service Plan (NSP) Maximum Wait Time targets – increasing the proportion of patients who are waiting less than the NSP maximum wait time targets to 90% and
  • Waiting List Volume – reducing the overall waiting list volume by almost 6% by year-end.

The Department said, “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.

“Despite the increased rate of additions, the 2024 WLAP aims to deliver more removals this year compared to 2023, which would ultimately result in a reduction in the overall waiting list from 671,413 in January to 632,086 by the end of December 2024 (a reduction of approximately 39,000 people).”

Minister Donnelly said, “The progress delivered over the last number of years, both in terms of reducing waiting times for patients and our waiting lists overall, was achieved against the backdrop of significantly increased demand for scheduled care services.

“Delivering the targets in this year’s Action Plan, will be underpinned by further increased activity in our hospitals.”

“As such, I would like to thank healthcare staff for their huge efforts that enabled the significant improvements in waiting times and waiting lists to be realised to-date and for their continued commitment to addressing this challenge again in 2024.”

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 Waiting List Action Plan (WLAP), which includes €179 million for the National Treatment Purchase Fund (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 Department of Health worked closely with the HSE and the National Treatment Purchase Fund (NTPF) to develop the specific actions and targets set out in this year’s WLAP.

The Department said, “One of the ultimate objectives in reforming scheduled care is to ensure that people can access care in a timely manner, when needed. A critical metric to measuring progress towards achieving this goal is not the total number of people waiting, but rather the total number of people waiting longer than the Sláintecare waiting times. As such, it is worth noting that three of the four overarching targets for the 2024 WLAP are specifically focused on improving waiting times.

People waiting for an outpatient appointment constitute the majority of the total waiting list figures, almost 84% (based on end December 2023 figures). As was the case last year, there will be strong focus on the OPD waiting list throughout 2024. Given that approximately one in five patients are referred on to the inpatient/daycase (IPDC) waiting lists after having an initial OPD appointment, this increased OPD focus will necessarily impact IPDC waiting lists. However, while the overall volume of patients on IPDC waiting lists is projected to increase during 2024, importantly from a patient perspective, the number of patients exceeding the Sláintecare wait time targets on these lists will decrease.

“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 has 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.

“Under the 2024 WLAP, the HSE is aiming to deliver increased activity levels above the 2023 outturn, namely 5% increases in both IPDC and GI Scopes, and an 8% increase in OPD activity compared to 2023 levels.

The WLAP commits to deliver the extra 3% OPD activity, on top of the NSP activity commitments, through four specific initiatives in 2024. These four initiatives are as follows:

  • Mandated implementation of Patient Initiated Reviews (PIR) for all specialties, where clinically appropriate. This initiative empowers patients to access follow-up care as required, instead of automatic scheduling of a review appointment. The aim is to improve patient experience, reduce the number of review attendances and increase capacity for new OPD appointments, in order to deliver reductions against the OPD waiting list.
    • Mandated use of central referrals for all specialties in all Hospital Groups. This aims to reduce the time from the receipt of referral to triage, decrease waiting times for elective care, and improve caseload balancing among consultants, to help ensure equity in access to care. Under this initiative, a Central Referrals Office (CRO) in each site assesses the referral and issues a priority based on clinical need and an appointment date is issued based on this priority. CROs encompass the referral and booking processes from the decision to refer through to the scheduling of first and subsequent appointments.Mandated outsourced and technology enabled offerings where available to all people waiting more than 12 months who do not have an active plan in sight to be responded to by the Hospital Groups, e.g. through remote or virtual dermatology appointments.Utilisation of new consultants and the new consultant contract to deploy extra clinics and maximise the use of clinic infrastructure for late evenings and on Saturdays.

“In addition, through the work of the new Productivity and Savings Task Force, further initiatives will be progressed to deliver additional care, which will also help to reduce waiting lists this year. For example, this will include considering opportunities for increased activity linked to the new public-only consultant contract, such as extra OPD clinics for new appointments.

“The 2024 WLAP encompasses 19 actions under the themes of “Delivering Capacity”, “Enabling Scheduled Care Reform” and “Reforming Scheduled Care”:

  • Delivering Capacity addresses waiting lists through a number of initiatives, including the delivery of additional HSE OPD, IPDC and GI scope activity, HSE insourcing, NTPF commissioning of treatments and validation, as well as activity to be delivered through the first two surgical hubs, which will open this year.
  • Reforming Scheduled Care includes initiatives such as the further rollout of Modernised Care Pathways; continued focus in addressing waiting lists for paediatric orthopaedics and gynaecology; as well as implementing a number of enhanced productivity and efficiency measures for waiting list management, including the targeted roll out of an enhanced central referrals model. This model encompasses numerous components, including Patient Initiated Reviews, management of Do Not and Could Not Attends and cancellations
  • Enabling Scheduled Care Reform encompasses critical processes and data enablers that will support the whole of-system reform required to improve access to scheduled care and achieve sustained waiting list reductions and wait time improvements. This includes a range of initiatives under the broader eHealth agenda, such as enhancements to the integrated patient management system (IPMS), rolling out a new endoscopy reporting system, as well as enhancing data visualisation platforms to improve productivity and performance oversight, including through further development, validation and use of the new Health Performance Visualisation Platform (HPVP) to provide more detailed analysis and insights on activity and productivity across the health service, including at hospital group, hospital, specialty, and consultant level.”