Robin Swann unveils five-year plan to clear waiting lists

Long-term goals include moving towards a seven-day working week for hospital theatres

Long hospital waiting lists in Northern Ireland are to be banished by March 2026, according to a roadmap set out by Health Minister Robin Swann.

More than 330,000 people are on some form of hospital waiting list in Northern Ireland.

The new elective care framework proposes a £700m investment over five years.

It sets out a twin-track approach of investment and reform to ensure that "backlogs do not keep re-occurring".

"The time for talk is over. What we need now is concerted action," Mr Swann said.

• Life on a hospital list 'makes you feel forgotten'

• NI has 'lost control' of hospital waiting lists

The plan, ambitious in itself, also has to build in dealing with Covid-19.

In order to do that, it proposes to implement "green pathways" which will keep elected care services entirely separate from any exposure to Covid-19.

Robin Swann said "the time for talk is over"

It will also see emergency departments kept separate as much as possible from planned surgical hubs.

That means operations for the likes of hips, knees, cataracts and varicose veins can be performed on sites at speed and uninterrupted in order to cut through the waiting lists.

Other aspects of the plan include:

• Surgeries in ring-fenced specialist hubs

• A regional NI-wide approach as opposed to a disjointed postcode lottery system

• Mega clinics for outpatient, assessment and pre-operative assessment clinics

• Ongoing cooperation with the independent sector

• Improved data, reporting and accountability

The framework sets a target of March 2026 for no patient waiting more than 52 weeks for a first outpatient appointment and inpatient day case treatment, or 26 weeks for a diagnostics appointment.

Mr Swann said that if the timeline could be brought forward it would, but he said he had to "acknowledge the scale of the problem that has built up and the capacity restrictions that will limit room for manoeuvre".

"There are currently almost 190,000 patients waiting more than a year for their first outpatient appointment," Mr Swann said.

The proposals must be signed off by the executive and there needs to be confirmation of long-term funding from the executive and the Treasury.

Hospital waiting lists in Northern Ireland are the worst in the UK

"This is almost five times as many as when the abortive 2017 Elective Care Plan was published."

It is also proposed that cash incentives should be offered to staff in areas where waiting lists are more acute, although the plan does not specify whether this includes nurses, surgeons or both.

This could, however, create problems for health unions and would require negotiation.

Analysis: We've been here before

If a lot of this sounds familiar, it's because it is.

In 2017, then health minister Michelle O'Neill published a similar wish list - Stormont was on the political precipice once again and within three weeks of the plan being published the Northern Ireland Executive collapsed.

Northern Ireland is now in a similar position - the big differences, however, are that waiting list numbers are bigger and there's a different health minister at the helm.

While Robin Swann seems to have been in the post a long time, this is his first real test of dealing with bread-and-butter health issues, as the Covid pandemic has been his priority until now.

However, for this plan to see the light of day it is relying on a great deal, including recurrent investment, political backing and, most importantly, political stability.

There is also the added problem of not having enough staff in post to see it through.

The public have been waiting long enough.

While Mr Swann is keen to spread the responsibility among his executive colleagues, ultimately he is the health minister and the buck stops with him.

A new cross-border healthcare scheme is to be set up for a 12-month period from July 2021.

The new scheme is separate from the Cross-Border Healthcare Directive which allowed patients to arrange health treatment in most other European countries, but ended with Brexit.

It allows patients to seek and pay for routinely commissioned treatment in the private sector of the Republic of Ireland while having the cost of the treatment reimbursed.

On 1 January 2021, the Irish government introduced a new "unilateral" arrangement for its own residents known as the Northern Ireland Planned Healthcare Scheme.

This allows patients from the Republic of Ireland to continue to access certain private healthcare treatments in Northern Ireland and apply for reimbursement from the Irish state.

It is envisaged that operations for the likes of hips, knees, cataracts and varicose veins can be performed on sites at speed and uninterrupted

A similar plan, the Elective Care Plan, was published in 2017, however the Northern Ireland Executive collapsed just three weeks later.

The big differences in the 2021 plan are that waiting numbers have increased and the service is also dealing with the pandemic.

The waiting lists plan does not go as far as highlighting where surgical hubs will be based, or how services will be re-jigged on sites - that is when even tougher and more politically sensitive decisions will have to be taken.

'Mega clinics'

The plan distinguishes between immediate, medium and longer-term actions.

For instance, from next month the health service will introduce enhanced rates of pay for staff working in "targeted shifts and delivering priority elective activity".

Also by September "mega clinics" will be in place for orthopaedic outpatients, cataract assessments and for a range of pre-operative assessments.

Some of these clinics will require patients having to travel slightly further than they otherwise would have, but the plan states this should reduce the time waiting to be seen.

By next March, it is hoped detailed proposals will be in place for how the service can provide a rapid diagnostic centre.

Long-term goals include moving towards a seven-day working week for hospital theatres.

And, to mirror how waiting times are measured across the rest of the UK, Northern Ireland will become more "transparent" in how it measures the length of time a person has to wait, for instance from when patients actually see their GP with a medical complaint.

The health minister described the launch of the plan as a "staging post" in the "long struggle" to turn the health service around.

He also said it is fundamental "to restore hope to all those languishing on waiting lists".