Northern Ireland’s hospital waiting lists crisis could be solved in five years – but only with “huge investment” of more than £1 billion, MLAs have been told.
Officials from the Department of Health briefed a Stormont committee on measures required to address the backlog of patients and deal with capacity issues.
Dr Tomas Adell, the department’s director of elective care and cancer policy, said there also needed to be a cultural shift – with more patients going home on the day they have surgery and not automatically returning to see consultants after treatment.
However, he warned that there was “no easy fix” to the waiting list problem, which he said went back to 2010.
Northern Ireland has the worst hospital waiting lists in the UK, with more than a quarter of the population waiting for an inpatient or outpatient appointment.
However, the Department of Health is also grappling with a funding crisis with Minister Mike Nesbitt warning that savings have meant the health service is operating at the limit of what can be achieved without causing “catastrophic harm”.
Dr Adell told the Health Committee there is “no one big thing we can do” to transform the situation over waiting lists.
He instead pointed to a number of reforms and structural changes, such as the establishment of elective care centres.
He said: “This is the big reform. It works in other jurisdictions and we know it works here when it is working well.”
Dr Adell said “difficult decisions” would need to be made, including moving patients away from overnight stays after routine surgeries.
He said: “Many patients assume when you have elective surgery you stay in hospital overnight, that that is the best outcome.
“The reality is that it is best for the patient to go home as soon as possible.
“This is not just for efficiency, it is better for patients.”
He added: “Patients might not be asked to come back to a consultant after surgery but, instead, be given contact information on how to contact the system if they need to.
“This is better for patients, it works, it avoids patients travelling to hospitals unnecessarily.
“It works really well across cancer services, so most cancer patients are not asked to come back for regular check-up but, instead, asked to contact the system if something is wrong.
“That is a big culture shift that we need to go through as well.”
The official said there also needed to be a reconfiguration of services within hospitals.
He said: “We don’t expect everywhere to do everything but, instead, they can specialise in certain areas.
“So, one hospital becomes really good at something and another becomes really good at something else.
“That is better for patients because the staff do it all the time and it is better for efficiency because the system works better that way.”
Dr Adell then addressed the “demand/capacity gap” which he said keeps adding patients to waiting lists.
He said: “The backlog (of patients) is huge, the numbers are completely unacceptable.
“This is not a new problem. This problem has been going on since 2010 if you look at our statistics.
“Fixing something that has been happening for many, many years takes time.
“We cannot fix the huge backlog quickly, it is simply impossible.
“We estimate it can be done in five years if we have huge investment.
“This is not an easy fix.”
Dr Adell said over five years it would take an investment of £80 million annually to deal with demand and capacity and up to £135 million annually to clear the backlog of patients.
He said: “It is a very significant investment requirement in a very challenging context but that is the reality.
“We can’t do this with just efficiencies or by doing things better, we need to invest to fix these things.”
