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Our Action Plan for Northern Ireland

Northern Ireland Action Plan for surgical recovery: 10 steps not 10 yearsNorthern Ireland Action Plan for Surgical Recovery

Executive summary

Northern Ireland (NI) had a struggling healthcare system before COVID-19, with the worst waiting times in the UK. Outpatient and inpatient targets have rarely been met since 2009. As at December 2020, over 323,000 people are waiting to see a consultant, with 105,000 waiting for admission to hospital for surgery. Together, these figures show over 428,000 patients waiting in a population of 1.8 million. This amounts to roughly 1 in 4 people waiting for a first consultation or a procedure.

The global pandemic has exacerbated NI’s already vulnerable health service and has delayed thousands of important, urgent and life-changing surgeries. The Health Minister has stated it will take 10 years to sort the backlog in elective care. This is a catastrophic assessment. The risk of harm because of long waiting lists is already being observed in all surgical specialties. This has important consequences. Those on waiting lists are now having to seek emergency care because their condition has deteriorated and they now require unscheduled acute intervention. This can now be witnessed by the current demands on our emergency departments in the spring months, which is previously unheard of. In addition, there is a ‘hidden waiting list’ of people who have not yet come forward or who have not yet been referred for hospital treatment.

Restoring timely surgical services should be a collective priority for the NI Executive. While the health system will inevitably experience seasonal shocks, it is imperative that surgical services are not ‘stood down’ again. COVID-light sites will be key for maximising optimal surgical activity alongside the protection of surgical beds. A regional approach involving patient and surgical teams travelling to surgical hubs holds huge promise for the way forward.

In this publication, we outline 10 steps for surgical recovery that, if implemented and resourced, could help to deliver better patient outcomes in a more timely fashion. A health system that we can all be proud of requires collective will and effort, not just from systems and staff but all parts of society.

Surgical recovery in 10 steps

  1. Investment: multi-year funding is required to close the capacity gap and address the elective care backlog, estimated by government at £1 billion. £200 million per year for the next five years is required.
  2. Waiting lists and elective surgery: each trust should publish yearly plans detailing timely access to surgery for patients and committing to the protection of surgery in the face of any future shocks.
  3. COVID-light sites in every trust area to ensure maximum separation of emergency and elective care. Such sites in the post pandemic era could become centres of excellence for elective surgery. 
  4. Surgical hubs: high-volume low-complexity surgery in surgically efficient hubs will accelerate the pace of operations required. Patients and surgical teams are willing to travel.
  5. Elective accountability: the government should publish an annual report setting out its response to the waiting times backlog in NI as well as measures to support  patients facing long waits for surgery.
  6. Recruitment/retention: the wider surgical workforce needs expansion, with particular focus on Perioperative nursing and Surgical Care Practitioners. The NI government should publish a regular assessment of healthcare workforce projections and requirements.
  7. Launch comprehensive review of surgical services in NI, noting particular digital and technological developments affecting the future of surgery.
  8. Wellbeing: trusts should proactively implement programmes that highlight the benefits of physical and mental wellbeing. It is essential that every surgeon feels ‘psychological safe’ in their working environment.
  9. Support surgical trainees: No training today, no surgeons tomorrow. Systems must maximise opportunities for trainees to catch up on missed training opportunities as soon as possible with bespoke programmes of training that include enhanced theatre time.
  10. Collaborate and protect time to learn: ensure that protected time is built into surgical working schedules to enable communication and learning with colleagues from other specialties and primary care for the mutual benefit of improving patient outcomes.

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