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Patients from poorer backgrounds are missing hospital operations because they can't afford to take time off work, a leading health chief has said.
Neil Guckian, chief executive of the Western Trust described it as "an indictment on society".
Giving evidence to the Stormont health committee, he said Do Not Attends (DNAs) were a major issue for the health service.
People "are foregoing their operation at the expense of maintaining their livelihood", according to the chief executive.
Mr Guckian said he initially thought patient absence was due to people having to travel for appointments, but having done audits and phoned patients, he was told this was not the reason.
"I believe it is linked to social deprivation. People do not want to admit that they can't take days off work," he told the committee.
"That is a sad indictment of our society, so we have to have wraparound support to that."
Mr Guckian also said that because patients were often waiting so long for a procedure, by the time they are seen the clinic they attend was the wrong one because their condition had deteriorated.
That was one of the issues which the trust was dealing with through "mega clinic" sessions, aimed at ensuring patients were dealt with in a quicker way, he said.
"They might be a day case, but they need an in-patient clinic because they have actually deteriorated during the course of their waiting list."
The chief executives of all of Northern Ireland's health trusts gave an update to the Stormont committee on Thursday.
Mr Guckian said the health service could not afford to see industrial action because of the current dispute over pay reviews.
He added pay levels for all healthcare workers needed to be addressed as the health service was haemorrhaging staff across the border into hospitals in the Republic of Ireland.
