‘More questions than answers’ as NOCA reveals inpatient waiting list doubled during pandemic

Data unveiled at National Healthcare Outcomes Conference also highlight decrease in amount of hospital discharges

The Chair of the National Office of Clinical Audit (NOCA), Mr Kenneth Mealy, has admitted there are ‘more questions than answers’ after new figures revealed the number of patients waiting longer than nine months for inpatient or day case treatment soared by 111.1 per cent.

In a presentation at the National Healthcare Outcomes Conference today (April 13), Mr Mealy also outlined a significant reduction in discharges and surgeries between 2019 and 2020.

Mr Mealy, who is also Co-Lead of the National Clinical Programme for Surgery, said there has been an 18 per cent decrease in total discharges across all specialties and a 20 per cent decrease in elective stay discharges during this time.

In addition, cancer discharges have decreased by 15 per cent – with a 26 per cent decrease in colorectal cancer surgery and a 38 per cent decrease in breast cancer surgery recorded.

Data extracted from the National Quality and Improvement System (NQAIS)/ Hospital In-Patient Enquiry (HIPE 2020), National Pricing Office, and Health Service Executive, he said, highlighted a 26 per cent reduction in emergency surgery and a 15 per cent fall in emergency colorectal surgery; while respiratory discharges decreased by 21 per cent, and COPD and asthma discharges by 23 and 26 per cent respectively.

Reductions in the amount of hip replacements (28%), unilateral hernia repairs (36%) and gall bladder surgeries (34%) have also been recorded.

Out-patient waiting lists have increased by 12.2 per cent, with patients waiting for longer than nine months have increased by 40.8 per cent.

Waiting lists for day cases or inpatient care have increased by 31.7 per cent, while patients waiting for longer than nine months was up 111.1 per cent.

Commenting on the data, Mr Mealy said that ‘at this point of the pandemic we have more questions than answers about why we have seen this dramatic decrease in discharges and surgical care’.

But he said the figures presented an opportunity to understand the factors behind hospital admissions.

“Perhaps more care can be appropriately provided for in the community. Perhaps better access to senior decision-makers and diagnostics would reduce the need for hospital admissions and give more timely hospital care for those who need it,” he continued.

Noting that scheduled healthcare would always be compromised when hospitals were under pressure, Mr Mealy said the new NOCA data indicated that high quality patient care has been provided throughout the pandemic.

“However, it is clear that our failure to separate scheduled surgical care and emergency care has exacerbated the negative impact on non-Covid medical activities,” he admitted.

“Some patients have been appropriately cared for in the community, others remain on or have been added to a waiting list. There is a clear impact here for serious non-Covid conditions. It’s important that these patients are quickly identified, so they can receive the care they need. Many will be in pain and their conditions will deteriorate while they wait”, he added.

The National Healthcare Outcomes Conference was hosted by the RCSI.

Prof. Jan Sorensen, Director of the Healthcare Outcomes Research Centre at RCSI, said the data presented by Mr Mealy highlighted the challenges in the post-pandemic world.

“This calls for tough decisions towards future use of healthcare resources and an urgent need to integrate service data into the decision-making process,” Prof. Sorensen said.

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