Statement on Publication of Elective Care Waiting Times

The latest elective waiting time figures (October to December 2017) again show that Northern Ireland’s Health and Social Care (HSC) system is under huge pressure and the waiting times experienced by many patients continue to be unacceptable.

A combination of factors – including a growing older population, an increased demand for services, and new specialist treatments – means there simply isn’t either the money or required staffing levels to sustain the current model of care.

While additional investment, if available, would allow us to bring waiting lists down in the short to medium-term, the only long-term answer is to continue to transform services.

A range of transformation initiatives, highlighted in the Department of Health’s one-year update report on the strategy to tackle waiting times in Northern Ireland, show that progress is being made. These include primary care alternatives to hospital referrals which will enable patients to receive high quality assessment and treatment more quickly, and which will help to free up appointments and treatment for urgent and complex cases in secondary care.

Rolling out such new pathways across Northern Ireland will require funding support, as part of the drive to transform care.

NOTES:

Financial Pressures

• Elective care waiting times have been increasing sharply since mid -2014 as a result of wider financial pressures facing the HSC system.
• Prior to this, maintaining the waiting time position had been heavily dependent on the availability of additional non-recurrent funding (typically in the region of £80m per year) to enable HSC Trusts to undertake additional activity in elective specialties where there was a gap between funded health service capacity and patient demand for assessment and/or treatment.
• Demand for elective services currently exceeds capacity by around 60,000 outpatients and 35,000 treatments.
• At the end of November 2017, the Department made available a further £7m for elective care in-year. This funding is being targeted at those patients with the highest clinical need as well as those who have been waiting the longest and it is expected that in the region of 25,000 patients will benefit as a result of this additional investment.
• Patients requiring urgent assessment, investigations and treatment are prioritised by Trusts.  In addition any funding that has been made available in the last two years has been targeted at patients of greatest clinical need.

Transformation Initiatives

• Orthopaedic ‘Mega’ Clinics – to reduce the backlog of back/spinal patients, ‘one stop shops’ are being run by GPs with Specialist Interests and Senior Physiotherapists, usually at weekends, also attended by senior spinal consultants. Multiple clinics are held at the same time to ensure that as many people as possible can be seen. Each patient is examined by a clinician, who discusses treatment options and offers advice regarding the future care plan.  Patients who require surgical intervention are reviewed by a senior spinal consultant and, where clinically appropriate, are added to the elective waiting list that day.  This one stop model improves the efficiency of the service and enhances the patient experience.  So far, five ‘mega’ clinics have been held at which around 830 patients have been assessed.  Further clinics are planned and consideration is being given to rolling this approach out to other areas in orthopaedics.
• Ophthalmology – around 15,000 people attend Belfast eye casualty each year and up to 60% of those patients could be managed in the community. Initiatives are underway for primary care optometrists to safely manage non-sight threatening acute eye problems in the community, and also to carry out non-complex post-operative cataract reviews (a high proportion of which do not require to be reviewed in secondary care). If rolled out across Northern Ireland, it is anticipated that these initiatives would deliver over 8,000 annual patient episodes in primary care that would otherwise be delivered in a hospital setting.
• Dermatology – new pathways are being introduced for GPs to manage more general dermatological problems in primary care, resulting in patients getting access to high quality assessment and treatment more quickly, reducing the need for many patients to physically attend a hospital. One example is photo triage – which means that when patients see their GP about a suspicious lesion, a photograph can be taken in the GP practice, sent electronically to the receiving secondary care Trust and reviewed by a consultant dermatologist to determine the best course of treatment. This advice is shared back to the GP practice electronically to enable the GP to advise their patient on an appropriate treatment plan.  It is estimated that around 40% of suspicious lesions could be managed in this way. Specialist GPs are also being trained up to carry out more minor surgery procedures including the removal of non-malignant lesions.
• Vasectomy – by the end of March 2018, for example, a GP-led vasectomy service will be in place in at least one Trust area for rollout to other areas during 2018/19.

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