Waiting for Treatment in Hospitals

A report published today by John Dowdall, the Comptroller and Auditor General for Northern Ireland, examines the performance of the Northern Ireland Health and Personal Social Services (HPSS) in managing non-urgent inpatient and outpatient hospital waiting lists. The report found that the majority of patients do not have to wait long for treatment, and the treatment they receive is generally of a very high standard. However, comparisons with Great Britain show that proportionately more people have to wait longer for their treatment than elsewhere (paragraph 1.4). The report makes a number of recommendations to the Department of Health, Social Services and Public Safety to further improve the management of waiting lists.

Main findings

Northern Ireland’s waiting lists/ waiting times are the longest in the UK

Around 75% of inpatients in Northern Ireland wait for less than 3 months, and around 95% for less than 12 months for treatment (paragraph 1.4). However, Northern Ireland has the highest number of inpatients waiting for treatment per thousand population at 30.04, followed by Wales at 25.87, Scotland at 22.23, and England at 17.87 (Departmental statistics, June 2004). For the number of inpatients waiting twelve months or more for treatment per thousand population, Northern Ireland is again the highest at 4.04, followed by Wales at 3.06, then England at 0.01, with Scotland having no inpatients waiting twelve months or more (paragraph 1.8). The Department considers that these results need to be considered in the context of higher levels of morbidity in Northern Ireland (paragraph 1.9).

Inpatient waiting lists increased from approximately 36,000 in March 1996 to nearly 60,200 in September 2002. Since September 2002 the number of patients waiting has reduced by over 15% to around 51,000 in June 2004 but there has been a net increase over the eight year period of around 42 per cent. The downward trend in inpatient figures since September 2002 reflects an increase in the number of patients treated; action taken by the HPSS to validate lists; and the review of good practice in waiting list management implemented by the Department (paragraph 1.7). Since March 1996 the number of outpatients waiting has increased by some 165 per cent, from approximately 59,000 at the end of March 1996 to approximately 156,300 at the end of June 2004 (paragraphs 1.7 to 1.10).

Within the overall numbers waiting for treatment, the number of patients waiting more than 18 months for treatment in Northern Ireland peaked at 9,158 in September 2002. Since September 2002, the number waiting more than 18 months has reduced substantially by around 65% to 3,235 in June 2004. This included 5 patients waiting for more than 12 months for cardiac surgery (paragraph 1.12). While this recent decrease is welcome, the equivalent figures for England at the end of June 2004 were only 552 inpatients waiting 12 months or more, in all specialties, with no patients waiting 12 months or more for cardiothoracic surgery. The number of outpatients in Northern Ireland waiting for more than 3 months for a first appointment increased during the same period from approximately 16,100 to around 89,700 (457 per cent) (paragraph 1.13). However around 70% of outpatients are seen within 3 months, and around 95% within 12 months.

The Department believes there is no lack of commitment or of effort on the part of the HPSS and it reported that productivity was high with resources being used at virtually full capacity. One aspect which needs to be considered is the spare physical operating theatre capacity reported in the recent Audit Office report on The Use of Operating Theatres. Although 94% of the available funded and resourced capacity of Northern Ireland’s operating theatres was being used, over one-third of the possible weekday physical capacity was not being used and could be brought into use if funds and resources were available (paragraph 2.11).