Ask anyone in the street about the health service in Northern Ireland and they’ll tell you a story about waiting lists. It could be themselves they’re talking about, a sibling, parent, a child or a friend. Everyone has a story.
And it’s no surprise. Over a quarter of NI’s 1.9 million population (26%) are on a waiting list of some description. This 26.2% compares to 12.4% in England and 24% in Wales. Waiting to be seen by a consultant for the first time as an outpatient (OP). Waiting on several OP lists for multiple chronic diseases at the same time. Waiting for a diagnostic scan. Waiting for surgery/treatment as an inpatient or day case. Waiting on an acknowledgement that you’re still on a waiting list; wondering what number you are ‘on the waiting list’ and waiting for the day when you’ll get ‘the call’. Pretty much everyone is just waiting.
According to Department of Health (DOH) waiting time figures there are 428,858 patients waiting for that first OP appointment. Nearly half of those (49.5%) have been waiting more than 52 weeks. Then there are 115,929 patients waiting for surgery/treatment, and over half (51.9% or 60,161) of those have been waiting over a year for admission. Some surgical specialties are worse than others like general surgery, trauma and orthopaedics and ENT however our regional and paediatric surgical services are also feeling the brunt of emergency medical pressures elsewhere in the hospital system. Children waiting for paediatric surgery in some cases can face waits of up to 4 years. Then we have 188,850 patients waiting for diagnostic scans. So many lives on hold, in pain and in limbo.
Shining Bright Like a Diamond or Jaded?
Surgeons, Doctors, nurses, dentists, social workers and all of our allied health colleagues work every single day to deliver a safe service to NI’s patients who are accessing help, treatment and support. They are the jewel in the crown of NI’s NHS. It is true to say they are emerging from the pandemic era extremely battle fatigued, jaded, their brilliance dulled a little bit. On top of this, NI’s health care staff are facing such an intensity of patient demand, couple with exceptional acuity levels that we know when we turn up for work, we are able only to scratch the surface. Expectation on each individual has never been higher and they are working in circumstances that many could never have imagined.
A UK wide surgical workforce census spanning all four UK nations told us Northern Ireland surgeons are burnt out, stressed out and can’t get into theatres to operate as much as is required to try and address demand. 91% of responding consultants (aged 55–64) also told us they plan to leave the health service within the next four years. From networking with our health colleagues in nursing, primary and emergency care we know they too are facing extraordinary strains. These stresses are exacerbated by staffing shortages which includes significant consultant and SAS gaps, coloured by a high reliance on expensive locums which government reports consistently highlight is not ideal nor sustainable.
Westminster
Mapping out what can be done to attract more people into the (medical/healthcare) profession and stay should be one of the returning Health Minister’s top priorities. At the end of March the NI Affairs Select Committee at Westminster published a report into the funding and delivery of public services and called for a public services transformation board to be created urgently to drive forward a step–change approach in health, education and policing. RCS England Northern Ireland’s previous Director gave evidence to the committee in 2023 and recommended the introduction of a statutory duty on health officials to publish an assessment of workforce needs.The NIASC’s report endorsed this approach and ultimately recognised that we must plan for a workforce of today, tomorrow and much farther into the future. When demand shows no sign of slowing down it is imperative we act without delay.
The 3 R’s: Recruitment, retention and retirement
We need to make sure that a refreshed and resourced workforce strategy is delivered by the NI government so we have the staff in place to care for our ageing population patients in the short term but also long term. Workforce projections and a credible workforce plan that is informed by patient demand is key. There is no doubt that workforce shortages are having a negative impact on staff wellbeing and development and are creating risks to patient safety. A strong and supported workforce underpins any chance of success we have in banishing long elective waits for good. The health service of today must also nurture those studying to become the surgical consultants, anesthetists, nurses and GPs of the future. These young students are our diamonds in the rough. Without appropriate support, time and equitable schemes of training, these talents will leave our shores and disappear to other more attractive, and supportive locations. Finally, to say staff need to feel valued in order to stay is a truism often quoted and with good reason. Let’s make NI’s health service a great place to work through investing in a properly resourced retention and recruitment strategy that meets the demands of today and the future. Let’s help our workforce shine bright, and become again the jewel in the crown of our NHS.
Niall McGonigle is a thoracic surgeon and Director of the Royal College of Surgeons of England in Northern Ireland. He is also Deputy Head of School of Surgery at the Northern Ireland Medical and Dental Training Agency (NIMDTA) and Training Programme Director (TPD) for Core Surgery. Niall qualified from QUB in 1999 and spent his Houseman’s year at the RVH before embarking on a surgical career.
He completed his training in Cardiothoracic surgery in 2011 and was appointed as a Consultant Thoracic surgeon to Harefield Hospital, London. During his time in London he was Lead for Thoracic Surgery, Chair for Cancer Services and TPD for NorthWest London for Core Surgery. In 2017, he returned to his native Belfast. He has taken such roles as Lead for Thoracic Surgery, and Chair of the Lung Cancer Clinical Reference Group at NICAN. He works with various charities including Roy Castle Lung Cancer Foundation and Mesothelioma UK.
