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Surgeons outline 10-step plan to tackle backlog as half of patients wait over a year for planned surgery

25 May 2021

- One in four people in Northern Ireland is on a waiting list. 
- Some patients on waiting lists for up to 4 or more years. 

 The Royal College of Surgeons has proposed a 10-step action plan to kick-start the post-pandemic recovery of surgical services in Northern Ireland and tackle devastatingly long waiting lists for surgery.  

Northern Ireland’s healthcare system was already struggling before the Covid-19 pandemic, with the worst waiting times in the UK1. Outpatient and inpatient targets have rarely been met since 20092

The most recent Department of Health figures show 105,159 people waiting for surgical treatment, either as an inpatient or day case admission, with half (56,242) of these patients waiting more than a year for their procedures. In total, 428,333 people were waiting for either a first outpatient appointment with a consultant, or an inpatient or day case admission.3 The figures are not expected to improve when waiting times for the first quarter of 2021 are published later this week.  

The Health Minister, Robin Swann, has stated it could take 10 years4, and an estimated £1 billion5 in extra funding, to tackle the backlog.  

The Royal College of Surgeons says that with planning and resources, the backlog could be dealt with in less than 10 years. Its ‘Action Plan for Surgical services in Northern Ireland - 10 Steps Not 10 Years’ sets out solutions for addressing the backlog of patients waiting for operations. The plan’s 10 recommendations include a call for increased investment, protected surgical beds, expansion of COVID-light sites, surgical training enhancements, and an expansion of the wider surgical workforce, alongside programmes to support staff wellbeing. The College also calls on the NI government to publish an annual report setting out its response to the waiting times backlog, as well as measures to support patients facing long waits for surgery. 

Commenting, Mr Mark Taylor, The College Director for Northern Ireland, said:  

“Northern Ireland already faced a monumental task on waiting times before the Covid-19 pandemic began. The situation has only worsened over the last year, and our health service is in deep crisis with half of patients waiting more than a year for their treatment.  When you add in those patients waiting for their first consultant appointment, one in four people in Northern Ireland is on a waiting list3.  

“These patients will be waiting in pain and uncertainty, some of them unable to work or go about day-to-day life. They will be waiting for treatments ranging from hip and knee replacements to post-mastectomy breast reconstructions, and children’s surgeries such as putting in vents for ear glue. The statistics also belie the true scale of the problem – we know there are a considerable number of patients waiting two, three and four years for their treatment. Some will seek expensive private treatment.” 

“Northern Ireland’s leaders are now faced with a choice. They can either continue to let things spiral out of control, or they can use the easing of Covid-19 pressures as a turning point, an opportunity to do things differently and get our health service, and in particular waiting times, back on track. We propose ten steps to improve the situation, and potentially solve it in less than ten years.”  

More than 4,000 "red flag" cancer procedures, including surgery, have been cancelled since the beginning of the pandemic. Patients waiting for general surgery, trauma and orthopaedics, and ENT or urology procedures are those worst affected. Waiting times for orthopaedics are especially bad and, in some areas, urgent cases can take between 1.5 years (80 weeks) and nearly 5 years (255 weeks) for treatment. Children’s surgery has also been severely impacted with routine procedures taking anywhere between three and four years to be carried out.    

Mr Taylor added:  

“We must ensure that no matter where a patient lives in Northern Ireland they can expect the highest quality of surgical care. Surgeons have already demonstrated great flexibility in adapting to the challenges of COVID-19 and the limitations placed on capacity. Protected surgical beds, COVID- light sites, a strong surgical team and surgical hubs are key parts to any meaningful solution. The Royal College of Surgeons stands ready to work with all stakeholders in delivering a surgical service fit for the 21st century.” 


Notes to editors

1. Northern Ireland health service waiting times 'worst in UK'. Belfast Times 18 October 2017. (cited May 2021). 

2. Thompson J, McKay K. Waiting Lists and Waiting Times for Elective Care in Northern Ireland: Taking stock. Research and Information Service Paper 02/20. Belfast: Northern Ireland Assembly; 2020. The ministerial target for outpatient waiting times, states that at least 50% of patients should wait no longer than 9 weeks for a first outpatient appointment, with no patient waiting longer than 52 weeks.  

3. Department of Health, Northern Ireland. Hospital waiting times: key statistics outpatients, inpatients and diagnostic testing, quarter ending 31 December 2020. (cited May 2021). 

Key figures: 

- 105,159 people waiting for surgical treatment either as an inpatient or day case admission (of this figure 56,242, are waiting over 52 weeks).  

- 323,174 patients waiting for a first outpatient appointment with a consultant (of this figure 167,806 people are waiting over 52 weeks). 

- Taken together, these figures show over 428,333 patients waiting in a population of 1.8 million. This means that roughly one in four people in Northern Ireland are on a waiting list. 

- Of the 105,159 patients waiting for admission the biggest waits per specialty are: General Surgery 22,539; T&O 20,535; ENT 11,869 and Urology 9,074. 

- 144,433 people waiting for a diagnostic test. 

- All waiting time figures exclude Patients waiting at a Day Case Procedure Centre for varicose veins or cataracts (an additional 3,893 people). 

4. Connolly M-L.NI hospital waiting lists could take 10 years to tackle. BBC News 13 April 2021. (cited May 2021). 

5. Northern Ireland Assembly. Official Report: Minutes of Evidence Committee for Health, meeting on Thursday, 11 March 2021. Waiting Lists and Waiting Times: Department of Health; Health and Social Care Board. (cited May 2021). 



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