Waiting lists: 3.7 billion is not enough – turn the funds into appointments and tests

For the public, however, there is a second problem – one that is less visible but extremely important: knowing exactly how long they will have to wait. The Court attributes a strategic role to Agenas’s National Waiting List Platform, but notes that the information system remains fragmented, with varying levels of digitisation and data that are not always consistent or comparable across regions. Many of the tools introduced by the 2024 reform are still being rolled out, and it is therefore not yet possible to fully assess their impact on actual waiting times.

The Agenas platform’s initial work has already identified four particularly significant issues: marked regional differences in the use of priority class P (scheduled appointments); the gap between the appointments offered by the CUPs and those actually accepted; the time that elapses between a prescription being issued and the patient’s first contact with the booking system; and the discrepancy between the number of prescriptions issued and the number of bookings actually recorded by the National Health Service. The Court is calling for specific monitoring of these four points.

It is precisely this last figure that raises an important issue: some of the demand may not be reflected in traditional statistics on waiting times. The report points out that the old systems mainly track services actually booked and provided within the public sector, but may fail to capture those who are unable to book an appointment, who forgo treatment, or who decide to seek care in the private sector. The Court itself cites European data showing that in 2024, 9.9 per cent of the population reported having foregone necessary medical treatment, compared with 6.3 per cent in 2019, whilst 6.8 per cent cited long waiting times as the main reason.

Then there is the issue of booking calendars. The Court recommends that the calendars for the public sector, the accredited private sector and in-house private practice be fully integrated into the regional CUP systems, so that the available services are genuinely visible and accessible. Decree 73/2024 (urgent measures to reduce waiting lists) has also introduced a safeguard mechanism for citizens: if the public service fails to provide the treatment within the stipulated timeframe, it may be provided on an intramural basis or at accredited private facilities, with the patient required to pay only the prescription charge where applicable.

Finally, there remains significant regional variation. The Court warns that the regions’ varying capacities to plan, monitor and manage waiting lists risk directly resulting in inequalities in access to care. Furthermore, the strengthening of local healthcare provision envisaged by the National Recovery and Resilience Plan (PNRR) – community care centres, community hospitals and local operations centres – will only be able to alleviate inappropriate demand on hospitals if these facilities become fully operational and are staffed with the necessary personnel.

The assessment of the reform launched in 2024 is not negative: the Court considers it potentially capable of bringing about structural improvement. However, for this to happen, it calls for the national platform’s interoperability to be accelerated, for data to be made comparable, for the way funds are spent to be scrutinised, for resources to be more closely linked to outcomes, for all agendas to be integrated into the CUPs, for staffing levels to be strengthened, and for sanctions and substitute powers to be effectively applied in the event of non-compliance.

Money and regulations are necessary, the Court argues, but they are not enough. The key lies in the ability to turn them into available appointments and treatment provided within the stipulated timeframes. And it is precisely here, according to the Court of Auditors, that the National Health Service still has the greatest gap to bridge.