Deirdre Heenan: Long hospital waiting lists are symptom of a system in chaos

Deirdre Heenan

Deirdre Heenan

Deirdre is a columnist for The Irish News specialising in health and social care and politics. A Professor of Social Policy at Ulster University, she co-founded the Northern Ireland Life and Times Survey.

Waiting lists are a symptom of a system that is not fit for purpose, one in urgent need of transformation and modernisation
Waiting lists are a symptom of a system that is not fit for purpose, one in urgent need of transformation and modernisation

How long must we wait?

Last week an Audit Office report noted an “alarming growth” in waiting lists for elective care in Northern Ireland. The figures reinforce a damning picture of a healthcare system in chaos.

The number of people on a waiting list for a first hospital appointment or treatment here has risen by 185% in less than a decade. Over a quarter of the population is waiting for an inpatient or an outpatient appointment. At March 2023, 54% of patients were waiting more than a year for inpatient treatment compared to 14% at March 2017.

The inability to access timely assessment and treatment is associated with a number of detrimental impacts including worsening conditions, the need for more complex and expensive treatment and, in some cases, illnesses will become permanent and untreatable.

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Being on a waiting list impacts on the physical, psychological and economic wellbeing of patients and their families. As the report notes. this position represents “extremely poor value for money”. Importantly, further deterioration could place the entire health and social care system under intolerable stress.

The research acknowledges that delays are a long-standing issue which have been exacerbated by the global pandemic. However, notwithstanding the impact of Covid-19, waiting times have been unacceptable for well over a decade. This dire position is the result of a number of factors including increased demand from an ageing population, staff shortages, poor planning, a lack of progress in modernisation, poor communication and insufficient funding.

Growing waiting lists are not unique to Northern Ireland. NHS waiting lists have hit record highs in England. However, as the report points out, waiting times here are significantly worse than in any other region of the UK. Why? This poor performance cannot be simply explained by a lack of funding as the north spends more per head of population than any other region of the UK.

This watchdog report notes that initiatives to try to reduce waiting times here have to date been unsuccessful. But it provides little analysis or explanation of why this is the case. It shies away from stating the obvious. We are completely bereft of a credible plan to deal with this crisis.

For example, in June 2021, the Department of Health published the Elective Care Framework. A five-year plan with a dual focus on clearing the backlog of patients waiting for treatment and closing the gap between capacity and demand. It set out 55 actions designed to reduce the waiting lists but many of these actions have not been progressed.

This was more of a wish list than a serious blueprint for long-overdue fundamental reform. It had scant detail on addressing the task through management and clinical effort. It did not deal with the long-term structural issues at the heart of the problem, such as appropriate capacity. There was little evidence of understanding of waiting lists and how they form part of a whole system of care. Scant reference to monitoring, forecasting and evidence-based planning. It was abundantly clear that its ‘ambitious’ targets would not and could not be achieved.

The Audit Office report is simply further confirmation that our waiting lists are out of control. People are suffering and dying waiting for treatment. There is nothing new here. Money or a lack of money cannot alone account for this dire position. Funding is only one of many reasons why patients here wait longer. Of course, the fact that the Stormont is in abeyance does not help, but the absence of a health minister is not they only explanation.

There are serious questions about performance management, productivity, transparency, the efficiency of current arrangements that must be addressed. Where is the accountability in this key area of public policy? What is being done to mitigate long-standing issues about communication and the provision of robust data?

Who is in charge of managing the waiting lists? Why do we not adopt a regional approach? Waiting list pressures are particularly acute for neurology, dermatology and ENT – what is being done to address this? What is the Department of Health doing to drive forward improvements?

Change has been at a snail’s pace with little sense of urgency. Given the seriousness of this issue, one might expect an unrelenting focus on sustainable change.

Waiting lists of this nature and scale are not a backlog that can be cleared with a cash injection. They are a symptom of a system that is not fit for purpose, one in urgent need of transformation and modernisation.