‘Impossible’ to believe North’s hospital waiting lists are not costing lives, says health expert

Seven-year wait is facing patients referred by their GP to consultant neurologist for first assessment

It is “impossible” to believe lives have not been lost in Northern Ireland due to long waiting lists, a leading healthcare economist has said, as new figures show some patients face a record seven-year delay for assessment.

Prof John Appleby of the Nuffield Trust also accused Stormont of failing the population’s healthcare needs “to an extent” after repeated collapses of powersharing that left civil servants in charge. “Civil servants and others know they don’t have the mandate to do anything other than keep the system ticking over. But keeping it ticking over hasn’t been good enough, when we see the figures on waiting times and lots of other things,” said the health economist who led two major reviews of the Northern Ireland health service over a decade ago.

Figures seen by The Irish Times show a seven-year wait is facing patients referred by their GP to a consultant neurologist for their first assessment. The target is nine weeks. Patients deemed “urgent” for general surgery are experiencing a five-year delay for an outpatient appointment, according to the leaked health service document recording wait times until December 2021.

Reacting to the spiralling delays, Prof Appleby expressed frustration with those overseeing the healthcare system and said they should feel “ethically responsible” about service reform. He also referred to the “moonlighting clauses” in National Health Service (NHS) contracts that allowed consultants to do private work, leading to widening health disparities. Some NHS medics can be accessed within days if patients pay up to £250 (€290) for a private appointment.


“In teaching, you’re not allowed to have a second job. If you work for a state school you work for a state school. You can’t go off and moonlight and do something else,” Prof Appleby said.

“It’s a really tricky one to completely ban private work. I think various governments have seen it’s more trouble than it’s worth.

“The answer is for the NHS service to be more productive and to reduce waiting times. It’s not impossible to do.”

The London-based Nuffield Trust advises governments not only in the UK but around the world on health economics. Prof Appleby reviewed the efficiency and performance of the North’s health system in 2005 and 2011 and is scathing at the lack of progress: “Why are so many people even waiting for a first outpatient appointment? To wait years is outrageous.

“It’s not like we don’t know how to fix it. It’s not like it’s a problem that’s almost an act of God; there are people in charge of this. I feel they should feel ethically responsible for being as efficient as they can and doing the best they can.”

Latest quarterly reports from the department of health show the delays in Northern Ireland are consistently the worst in the NHS and among the worst in Europe.

Prof Appleby added: “It’s hard to believe that lives haven’t been lost. It’s hard to believe these long waits haven’t created more disability and death than short waiting lists, but nobody’s measuring that. It’s not easy to measure but it’s impossible not to believe that [deaths] are happening.”

Caretaker Stormont health minister Robin Swann last month warned of “significant” funding pressures but said there was a “relentless drive” to tackle waiting lists, announcing a £46 million initiative covering April-September 2022 lists despite “ongoing budgetary uncertainty”. He confirmed Omagh Hospital will become the North’s second regional day procedure centre, treating more than 1,700 patients in general surgery and urology.

The private sector will also be employed to assess and treat NHS patients as part of £700 million plan unveiled by Mr Swann last June, in which he pledged to “banish” spiralling waiting lists by 2026.

Meanwhile, Prof Appleby is among a group of economists working on new research investigating the fiscal sustainability of the North’s public finances, with the first report focusing on healthcare spending due out this summer.

“Healthcare has the biggest chunk of public spending now consuming about half the block grant [from the Westminster government] but the performance is nowhere good enough given the amount of money put into the system,” he says.

Population projections for the next 50 years and what it means for healthcare spending are also examined in the report for the Northern Ireland Fiscal Council, an independent body set up earlier this year to “bring greater transparency and scrutiny” to public finances.

“We’ve looked ahead to 2060 when there’ll be fewer women than men. The population will start levelling off in the next five to six years and then start decreasing,” Prof Appleby added.

“We examined to what extent the spend would outstrip the block grant potentially or start to eat into the available money for other services.”

Healthcare waiting times - the numbers:

  • More than 658,00 people were on a waiting list in Northern Ireland at the end of March 2022. Of this, 358,807 people were waiting for a first consultant-led outpatient appointment - 23,765 more than the same period the previous year. Over half were waiting more than a year. The ministerial target is for 50 per cent of these cases to be seen within nine weeks.
  • A further 15,247 patients were waiting for their first consultant appointment at a Day Case Procedure Centre (DPC) for cataract treatment.
  • A total of 122,820 patients were waiting to be admitted to hospitals for treatment in Northern Ireland, a 10 per cent jump on the previous year.
  • Almost three in five patients were waiting more than 52 weeks for either a hospital inpatient or day case admission.
  • The number of patients waiting for a diagnostic test hit 156,270, an increase of more than 19,000 on the previous year. Almost a third of patients (46,312) were waiting more than 26 weeks for a diagnostic test.

Seanín Graham

Seanín Graham is Northern Correspondent of The Irish Times