THE waiting list crisis in Northern Ireland's healthcare system is in need of "radical surgery", according to an independent health think-tank.
Around 130,000 people are waiting more than a year for treatment in the north.
In an opinion piece in today's Irish News, Deirdre Heenan and Mark Dayan of the Nuffield Trust, London say they believe "waits this long create real risks to patients and may result in increased disease and preventable deaths".
They have produced proposals to cut waiting times, including analysis and monitoring to "spot exactly where delays are being caused by bottlenecks for individual patients" as well as splitting planned care and emergency care onto different sites, in areas such as Belfast, where many hospitals are near one another.
"As at March 2019 approximately 1 in 12 people in England and Scotland were on an elective waiting list," they said.
"However, in Northern Ireland the figure was about one in every five. 130,000 people in Northern Ireland have been left waiting a year for care to start.
Read More: One in three NHS doctors 'burnt out'
"In England, with its much larger population, the figure is just 1,400."
They say there are "lessons to learn from other countries" to try to resolve the waiting lists crisis, but there is "no quick fix".
"It’s not as simple as just increasing the volume of operations to take more people off the front of the queue," they said.
"In fact, a review of waves of reform in England found they worked better when they focused on speeding up the process, rather than just expanding capacity."
Read More: Ambitious plans to 'transform' health service welcome but challenging to deliver
They said previous research in England suggested "a sustained focus on the task of reducing waits, at organisational level and fed right down to individual consultants who can make an important difference" was needed.
"Progress took time, and permanently fixing the situation was more difficult than just clearing the list once through a big drive only for it to re-emerge," they said.
"One-off drives like this, based on paying for overtime, are expensive and may mean staff expect clearing waiting lists to only be a temporary - and lucrative - activity.
"Successful managers used analysis and monitoring to spot exactly where delays were being caused by bottlenecks for individual patients.
"They remodelled how whole hospitals and the wider NHS system of referrals and transfers worked to sort these problems out.
"These strategic ideas were supported by smaller measures: the careful management of beds, ensuring the full use of theatres, and making sure social and community care were operating at full potential to get people home and make space for the next patient."
There is also a suggestion of "splitting planned care and emergency care onto different sites".
"This is something the English NHS is backing in its long-term plan, because it can prevent the space for planned care from being overwhelmed by urgent patients at crunch periods.
"Along with other steps for greater efficiency it would be compatible with the Northern Irish service’s plan for 'elective care centres' and may be politically and financially easier than actually closing sites to centralise care."
