Northern Ireland

Health Service crisis: One in three patients waiting more than two years in Northern Ireland

Waiting times of over two years are rare across the other devolved regions

NHS figures show the size of the waiting list for routine hospital treatment in England was unchanged in March
One in three patients waiting over two years (Peter Byrne/PA)

Nearly 35% of patients in Northern Ireland are waiting more than two years for treatment, a figure drastically higher than the single digit numbers seen in the rest of the UK.

This is despite health spending in the north being greater per person than in England and amid general criticism that four months into a new Executive there is still no plan to improve health service outcomes.

A comparison carried out by data analyst Peter Donaghy has laid bare the disparity in inpatient and day case hospital waiting times across the UK.

Mr Donaghy said: “The waiting times crisis in Northern Ireland is by far the worst in the UK and Ireland.

“Average waiting times here had been getting longer since the mid 2010s, but the situation worsened in the wake of the Covid crisis in 2020 and has never recovered since.

“Waits of over two years are essentially unheard of in England; in Northern Ireland one in three on waiting lists have waited over two years, with one in 20 waiting over five years and eight months.”

The current draft target in the north state that: “55% of patients should wait no longer than 13 weeks for inpatient/ day case treatment; with no patient waiting longer than 52 weeks.”

But the most recent statistics show over half of patients are waiting longer than a year for admission.

And Mr Donaghy warned that the true picture could in fact be worse given differences in the way that data is collated.

In the north if a patient is moved onto a different waiting list through a referral that is recorded as the start of a new wait, resetting the clock, meaning patients could be waiting longer.

A move to a new electronic record system also means that the South Eastern Trust has not reported on their statistics over the last six months.

Patients in Northern Ireland are undoubtedly facing some of the longest waits in the UK and the focus must be on a longer-term solution.

—  Niall McGonigle, Northern Ireland Director of the Royal College of Surgeons of England

Meanwhile, similar waiting times are virtually unheard of in England and remain in the single digits in the other devolved nations.

In England only 4% of cases result in patients waiting over 52 weeks, and less than one per cent wait over two years.

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 north’s health system is 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.

At that time Nuffield also found that since 2016, the unit costs of hospital care had risen by around 28% in Northern Ireland as opposed to 7–8% in England.

Senior Economist at the Nevin Economic Research Institute, Dr Lisa Wilson, said that these waiting lists were the result of Northern Ireland experiencing a sustained period of chronic underfunding.

“It’s always going to cost more to run a health service in Northern Ireland than it is in England because of efficiencies and economies of scale,” she added.

“Our needs base is also different, the percentage of people who have a disability, or have a life limiting illness is higher in Northern Ireland so the needs profile is also different.”

The Nuffield report found that people in Northern Ireland do spend more of their life in ill health than in England.

Without that investment and a focus on transformation we can’t expect the health service to improve.

—  Dr Lisa Wilson, senior economist at the Nevin Economic Research Institute

Dr Wilson said that addressing the current crisis in the north’s health service will require significant capital investment and “transformation”, including fully addressing the findings of the Nuffield Trust report.

“It is the case as well that the health budget can’t continue to eat a bigger, bigger share of our funded allocation or our total pot of money,” said Dr Wilson.

“That’s not sustainable in the long run, so we have to get health spending under control, but we can’t expect just reducing the money that health gets will force transformation.

“It’s a challenge for the Executive to look at the financial position of the health service and to lead on the transformation.

“But an investment is first needed to start bringing these lists down, without that investment and a focus on transformation we can’t expect the health service to improve.”

A spokesperson for the Department of Health said that tackling lengthy waiting lists is a priority for the health minister and that “huge efforts” were being made to maximise existing resources to tackle patient backlogs.

This has resulted waiting times reducing in seven consecutive quarters, the department added.

They added that reform to elective care was outlined in a recently published framework, but implementation would require sustained investment.

The spokesperson added: “The Minister is clear that the 2024/25 Budget outlook falls far short of the funding needed to tackle waiting times for both our long waiting patients and for our cancer/urgent patients.

“Additional targeted waiting list activity will not be possible and we will not be in a position to build sustainable capacity in the HSC system within the existing allocation.”