Northern hospitals will be fined if they cannot treat patients on waiting lists within strict timescales, the health minister announced yesterday.
Money will be withdrawn from them and the patient offered treatment in another hospital, possibly in the Republic, the minister Shaun Woodward said.
Mr Woodward said his department was determined to tackle health waiting lists which are the longest in the UK.
Some 4,000 patients have waited 12 months or longer for treatment and 800 of those have waited longer than 18 months. Preliminary figures for April and May this year indicate a worsening of the situation, he said.
Mr Woodward said he would hold to account the trusts which run Northern Ireland's hospitals and pledged to reform healthcare provision and eliminate excessive waiting lists by March 2006.
"We have an agreement with the trusts in Northern Ireland that they will treat in-patients within 12 months. We have paid them to do that. They have the money. Now we insist that they treat the patients."
Announcing financial penalties he warned: "If they don't, or if they can't, then we - from today - will take the money back for the treatment of that patient. We will buy, either from another trust in Northern Ireland, or if we have to, from outside Northern Ireland, the treatment the patient needs and has been kept waiting for. No longer will we tolerate excess waits."
Asked by The Irish Times, the health department confirmed that patients could be offered treatment in the Republic, paid for by the Northern health service. All-Ireland health arrangements already apply and patients are regularly transferred across the Border in emergency cases or when specialist wards are full.
Mr Woodward's statement represents a stark departure from existing health policy.
The medical director of the Royal Hospitals in Belfast, Dr Michael McBride, welcomed it. "We treat a third of a million people every year and we very much welcome the minister's drive to ensure more timely access to care," he said.
"At present we have 45 patients waiting more than six months for heart surgery and we would welcome co-operation in arranging their treatment elsewhere to ensure that they are on the road to recovery as soon as possible."
Sinn Féin condemned the minister's proposals, branding them a disaster waiting to happen. Health spokesman John O'Dowd said: "The net result will be that hospitals that are already struggling will have services further eroded. It will mean hospital closures.
"A quick-fix solution is a mistake. We need to fill staff vacancies and we need to begin to train more medical staff right across the health care spectrum."
The Ulster Unionists however gave the proposals a guarded welcome.