A report into how patients on healthcare waiting lists in Northern Ireland are kept informed has said that "repeated failures" across the system amount to systemic maladministration.
Margaret Kelly, the NI Public Services Ombudsman, said that this had a detrimental impact on the health and wellbeing of those on waiting lists.
The Department of Health said it would study the report but pointed out that the ultimate solution is a "sustained programme of investment and reform".
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Northern Ireland currently has the longest hospital waiting lists in the UK.
The department is facing a funding shortfall of approximately £470million in the current financial year and this has seen investment in initiatives to tackle waiting lists cut by £34.6million.
The Public Services Ombudsman surveyed more than 640 members of the public for her report Forgotten. The results found that 92% said waiting without clear information had a negative impact, 24% said the lack of information had led to mismanagement in their care and 88% said they felt forgotten.
One patient told the survey: "Well, the impact of no communications whatsoever for five years, I was literally just left in limbo, you know it does affect your mind..." Another stated: "Feel forgotten, a nuisance. Cannot make plans."
The report said some GPs also raised concerns about the impact on patients and on their services.
Ms Kelly said: "This investigation has found a waiting list system which is in disarray and which is having an adverse impact on those waiting to receive care.
"We found that many people placed on a waiting list received no communication at all to tell them if they were on a list, whether they were deemed routine or urgent, and when they could expect to be treated.
"Despite there being a Department of Health procedure since 2006 that trusts have been required to follow, we found they often did not, and there was no one agreed approach not only across trusts but within trusts.
"We also found the departmental procedure had not been updated in 10 years despite waiting lists increasing exponentially. I understand that the healthcare system is still recovering from the impact of Covid and that frontline health staff are working incredibly hard to provide care in a difficult situation, but it is clear that the issue of increasing waiting lists has been ongoing for close to a decade.
"It is even more important in the context of our lengthy waiting lists that people have the information they need to either 'wait well' or make informed choices.
"On the basis of repeated failures in communication in many parts of the system, I make an overall finding of systemic maladministration, and would urge the department to work more cohesively with the trusts, GPs and patient representatives to address the need for improvement.
"I have made a significant number of recommendations and welcome the early acknowledgement by trusts of the need for improvement, as well as the recent launch by the department of the My Waiting Time website.
"I will continue to work with both trusts and the Department of Health to ensure these recommendations are put in place."
A Department of Health spokesperson said: "The report and recommendations will be carefully considered by the department and trusts.
"The department fully appreciates the deep distress and frustration experienced by patients on waiting lists. While improved information provision is required, the ultimate solution is a sustained programme of investment and reform to reduce and eventually eliminate the current backlog of care.
"This backlog has taken years to build up and will take years to be fully addressed. As the NIPSO report states, the department is taking steps to improve the level of information available to patients.
"A number of the recommendations within the NIPSO report would require additional resources, both financial and staffing, at a time of severe budgetary pressures."
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