Unprecedented demand forces the pause and rationing of diagnostic scans as 260,000 people remain on waiting lists

IHCA calls on the Department of Health to increase funding to the NTPF for the provision of diagnostic scans

• Vouchers for 55,000 radiology scans already issued by NTPF by end of February; 79% of allocation for entire year;  
• Remaining balance of scans (15,000) to be rationed across health regions; 
• Over 260,000 people on diagnostic waiting list at end of 2023; an increase of 75,700 people (41%) over the past four years;
• More than one-fifth are waiting longer than a year for essential scans;
• IHCA President Prof Rob Landers: “The Association is extremely concerned that the NTPF has decided to pause and ration these diagnostic scans for the remainder of 2024, due to a lack of available funds. The withdrawal of the scheme is also counterproductive given that the NTPF continues to fund other clinical waiting lists initiatives which serve to generate more radiology requests.”

The Irish Hospital Consultants Association (IHCA) has warned of the potential impact on patient outcomes from new restrictions on the issuing of vouchers for diagnostic scans by the National Treatment Purchase Fund (NTPF).

The IHCA has learned that the NTPF paused the commissioning of CTs, MRIs and ultrasounds at the end of February because it was already fast approaching its funding limit for 2024 due to an unprecedented level of demand. This is occurring against a backdrop of more than 260,000 people on diagnostic waiting lists.

The NTPF informed the HSE on 29th February that while it had funding to arrange 70,000 radiology scans nationally in 2024, some 55,000 voucher codes for scans had already issued to hospitals up to that date – 79% of the total annual allocation. 

The NTPF issues Emergency Diagnostic Authorisation Numbers (EDANs) to hospitals to carry out diagnostic tests, with each EDAN redeemable for one scan. At the end of February, the Fund informed the HSE it was unable to issue any new diagnostic vouchers to hospitals despite requests coming in for them, and that no new initiatives would be approved for 2024. 

At the time, it is understood some hospitals had already exceeded their EDAN voucher allocations for certain types of scans and were in the process of ‘retracting’ a number of arranged scans for patients that were due to be carried out by private providers.

In correspondence sent to the IHCA, the NTPF said it appreciated the “significant concern” that this move had caused Consultants. However, it explained that the “unprecedented demand” for scans meant that a “temporary pause has been placed on the routine issuing of EDANs while additional funding is being sought by the HSE”.¹

The development comes as new analysis from the IHCA confirms that more than 75,700 people have been added to diagnostic waiting lists over the past four years – an increase of 41% since the end of 2019.²

There were more than 260,000 people on waiting lists for diagnostic scans at the end of 2023, with a fifth of these (53,600) waiting over a year for tests.³ The NTPF provides the Department of Health with quarterly reports which set out waiting list data for CTs, MRIs and Ultrasounds.

The Government’s 2023 Waiting List Action Plan earmarked funding of €11 million for the NTPF to arrange 65,000 diagnostic scans last year.⁴ While this year’s Action Plan fails to reference any specific funding or activity levels for diagnostics, the NTPF confirmed that funding has been provided for 70,000 scans in 2024 – an increase of around 8% on last year’s allocation. 

Commenting on the NTPF decision, IHCA President Professor Rob Landers said:
“The Association is extremely concerned that the NTPF has decided to pause and ration these diagnostic scans for the remainder of 2024, due to a lack of available funds. This is occurring against a backdrop of over 260,000 people currently on waiting lists for essential hospital diagnostics.

“The withdrawal of the scheme is also counterproductive given that the NTPF continues to fund other clinical waiting lists initiatives which serve to generate more radiology requests.

“The NTPF is a sticking plaster which only serves to highlight the many deficiencies in our public health service. However, given that this may be the only avenue currently available to secure timely care for patients, the outsourcing and insourcing of treatment or diagnostic scans remains a vital option.

“Although the EDANs specifically cover diagnostic radiology, it must be acknowledged that waiting lists will also be negatively impacted in specialties such as Histopathology and for other laboratory diagnostics due to ongoing funding pressures. 

“The HSE wants to ‘progress towards’ achieving the waiting time target of 10 days for diagnostics as outlined in the Sláintecare report. In reality, waiting times are steadily getting worse, with the HSE unable to indicate when such targets are ever likely to be met.

“The high number of people waiting for procedures such as CTs, MRIs and ultrasounds is especially concerning given that these diagnostic tests are used to either confirm or rule out a disease or condition, including cancer. If these tests are being delayed by months or, in a fifth of cases, for more than a year, it could have a significant impact on patient outcomes.

“Failure to provide outpatient radiology will also lead to increased acute patient presentations to Emergency Departments and longer lengths of stay in hospital in order to get scans completed. This will only compound the current overcrowding crisis and result in a failure of admission avoidance pathways.”

ENDS
1. Letter from NTPF to the IHCA, 3 April 2024: https://www.ihca.ie/_fileupload/letter-from-ntpf-ceo-to-ihca-28-03-24.pdf 
2. Dáil PQ response from Minister Stephen Donnelly to Deputy Neasa Hourigan, 25 January 2023: https://www.oireachtas.ie/en/debates/question/2023-01-25/179/
3. Dáil PQ response from Minister Stephen Donnelly to Deputy David Cullinane, 15 February 2024: https://www.oireachtas.ie/en/debates/question/2024-02-15/397/
4.  2023 Waiting List Action Plan: https://www.gov.ie/pdf/?file=https://assets.gov.ie/249526/8b203212-06b9-4ddc-96f7-9938b0707e19.pdf#page=null
 
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