North’s health service under ‘intolerable pressure’ as waiting list grows by 185%

The number of people on the waiting list for non-emergency care in the North has risen by 185 per cent in nine years, according to a report published on Tuesday by the Northern Ireland Audit Office.

The North’s Comptroller and Auditor General, Dorinnia Carville, warned that waiting times had deteriorated “to a point where significantly increasing numbers of patients risk developing serious conditions and illnesses which damage their daily lives and which ultimately become much more complex and expensive to treat”.

She said there was a “risk” the “current serious situation could deteriorate further”, potentially placing the health service under “intolerable pressure” and it was “imperative that the necessary funding is allocated as soon as feasible to both clear patient backlogs and drive longer term transformation”.

Northern Ireland’s Department of Health said it would “carefully consider” the report’s recommendations and it “accurately highlights what is required to turn the current unacceptable situation around”.

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“This involves long-term investment and an ongoing drive to develop dedicated elective care centres in NI,” the department said, adding that the report “correctly emphasises the crucial need for a sustainable funding framework for our health service”.

The study, Tackling Waiting Lists, details an “alarming growth” in elective care waiting times, with the numbers awaiting either an initial outpatient appointment, inpatient treatment or a diagnostic test increasing from about 244,000 patients in March 2014 to just under 700,000 patients in March this year.

The length of time patients spend waiting for assessment and treatment has also increased, with 49 per cent of people waiting over a year for an initial outpatient appointment in March 2023, compared with 21 per cent in March 2017, and 54 per cent of patients waiting more than a year for inpatient treatment compared with 14 per cent over the same time frame.

“Urgent and timely action is required to reduce the already extreme waiting times, instead of allowing them to continue growing to even further unmanageable levels,” the report warned.

Northern Ireland has the worst hospital waiting lists in the UK, and recent research by the Department of Health in the Republic demonstrated waiting lists in the North are twice as long as in the South.

The report noted that “serious waiting time pressures... had been building for some years”, which were exacerbated by the lack of funding and the growing demand for care due to an ageing population.

While the Covid-19 pandemic “exacerbated the challenges” it also noted “that the deterioration in waiting times has been long-standing”.

The failure to secure longer term budgets has “persistently hindered the development of more sustainable funding and planning”, the report found.

It highlighted that a five-year departmental plan to substantially reduce waiting times in 2017 was estimated to cost up to £909 million (€1.052 billion) to implement fully, but in practice just under £200 million was made available.

Under an updated framework in 2021, an estimated £707 million was required just to ensure that by 2026 waiting times did not exceed a year, but only £193 million was allocated and, with the funding situation exacerbated by the collapse of the Northern Executive in 2022, the department now acknowledges these latest targets cannot be met.

“Unless and until a more sustainable HSC [health and social care] funding framework is established, very significant numbers of patients will likely have to continue enduring very long waits,” the report concluded.

The Auditor General issued a stark warning of the consequences if underfunding continued, saying that “unless and until a longer term, sustainable funding framework to enable health service transformation is established, the department will likely have to address the most pressing clinical waits through available short-term funding.

“This approach is totally unsuitable and almost certainly stores up huge problems for the future,” she said.

The report did note some “limited progress” towards developing dedicated elective care services to increased productivity and protect services from unscheduled care pressures, but said Northern Ireland remained behind the rest of the UK in this regard.

The department said establishing a network of dedicated elective care centres in Northern Ireland was a “central component” of its approach and “important progress is being made”.