Northern Ireland’s health waiting times are the worst in the UK and amongst some of the worst in Europe, even before the onset of the Covid-19 pandemic. Figures suggest that approximately one in every four people are now waiting for a first hospital consultation or procedure.
Although spending on health and social care per person is higher than in England outcomes are markedly worse.
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According to a 2022 report published by the Nuffield Trust, since 2002/3 per capita health spending in the north has been around 7% higher than England.
The report also found that the health and social care system was markedly less efficient than in England. Nuffield found that hospital costs that can be compared on a like for like basis were £410m higher than in England.
Between March 2014 and March 2023 health and social care waiting lists have grown by 216% (initial outpatient appointments), 147% (inpatient treatment) and 151% (diagnostic tests). Patient waits exceeding maximum waiting time targets have also increased by 929% (outpatients), 1,396% (inpatients), and 381% (diagnostic tests) (from March 2017).
None of the formal waiting time targets have been achieved since 2014. For some specialties, such as rheumatology, these average waiting times can conceal much longer waits that can extend to over eight years, effectively amounting to a denial of service.
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Thousands of citizens are languishing on waiting lists longer than their life expectancy. Lengthy waits place patients at risk of developing debilitating and complex conditions, also meaning more expensive treatment may be necessary.
These waits are exacting a heavy toll on patients’ mental health and widening health inequalities. Unlike other regions, the end of the pandemic did not herald getting back on track; waits have steadily worsened.
The devolved institutions were restored a year ago today but remarkably to-date there is no plan to address this dire situation. Compare this to the position in England where the Elective Care Plan published four weeks ago sets out a roadmap to tackle hospital backlogs, and ensure no-one waits longer than 18 weeks for planned treatment.
Since the turn of the 21st century a series of major reviews and assessments of the health and social care system have reached the same conclusions. There is an over-reliance on hospitals, services are spread too thinly, and there is a need to focus on prevention and keeping people healthy.
Radical transformation is required to ensure that the system is sustainable and fit for the future. Every political party agrees what needs to be done but none of them are prepared to grasp the nettle. Closing or downgrading local hospitals is not a vote winner.
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Addressing these waiting times is not solely a matter of increasing capacity. Across the health and social care system there is a pressing need for robust data to inform planning and strategic decision-making.
The lack of detail in the quarterly waiting times produced by the Department of Health hampers any meaningful analysis. The available data is incomplete, and the gaps mean that it is impossible to gain a comprehensive and accurate picture of the problem.
Radical transformation is required to ensure that the system is sustainable and fit for the future. Every political party agrees what needs to be done but none of them are prepared to grasp the nettle. Closing or downgrading local hospitals is not a vote winner
Waiting lists are not managed regionally but individually by the five health and social care trusts. It is not known how many patients are waiting for elective care in more than one area. It is impossible to assess how many people are being counted more than once.
It is unclear how many people are on waiting lists are forced to access care through Emergency Departments. Information Technology solutions that are standard practice in other businesses have not been harnessed due to poor management, a lack of leadership and low levels of digital maturity.
Artificial Intelligence (AI) is vastly underutilised but could be used with significant benefit. It has already reduced the number of missed hospital appointments in over a dozen English trusts. One trust in Essex with a population of 1.2 million estimated a saving of over £27.2m per year using this approach.
Software can be used to arrange convenient appointments and implement back-up bookings. For example, it can offer evening and weekend slots for those unable to attend daily appointments.
It can help by optimising patient scheduling, prioritising cases based on clinical need. Using available data, it can predict those who are unlikely to attend, maximising efficiency and ultimately leading to reducing waiting times and improved patient outcomes.
Digital solutions could save vast amounts of time, staff resource and reduce costs. Embracing and embedding AI into the healthcare system could increase efficiency, productivity and capacity.
Building trust in new technology can reducing waiting lists, change lives and drive a better future for those who have been denied access to care. Rather than repeating the mantra that we have need more money, couldn’t we at least explore the possibility of doing things differently?
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