People waiting less than a year in England for surgery compared to five years in Northern Ireland…

Great article by Seanín Graham in today’s Irish News about the ever expanding waiting list for medical operations in Northern Ireland.

In Northern Ireland patients are waiting on average five years for routine operations. This compares to less than a year in England. From the article:

It emerged that one million patients are now waiting in excess of 18 weeks for ‘routine’ operations in England.

But in today’s Irish News, the story of a housebound pensioner who faces a five-year wait for orthopaedic surgery is one that is replicated thousands of times across Northern Ireland.

With a mothballed Stormont and a £60 million bail-out for the north’s health service somewhere in the ether, surely the Health and Social Care Board along with senior civil servants at the department must recognise the need to urgently find solutions to a shameful situation that has made us the worst performing service in the entire NHS.

 The main feature of the story is that some patients are now so desperate that they are going abroad for surgery. It turns out the Health Service can reimburse you for treatment you have had abroad.

To date, almost 300 patients in the north have been approved for reimbursement by the north’s main health body, the Health and Social Care Board, with expenditure set to top £1m once the payments have been settled.

The existence of such a scheme is news to me, and I am sure it is to most of you also. It does bring up some questions:

Could the health department just create a scheme that says your operation will cost X, here is the money if you want to go private or get it done abroad?

Could the health department not do a deal to send patients to overseas hospitals? I know they have arrangements with private hospitals in Dublin, so I assume it would be just expanding the existing scheme.

Could they hire in some of these overseas surgeons for a while to work through the backlog?

To be honest, I don’t understand why the waiting lists are so long. We all hear stories about consultants telling patients it will be a 5-year wait in the NHS or they have the operation done next week if they go private. You also hear stories of surgeons who seem to be on a go slow for their NHS work but manage to blast through their private work in no time at all. Like everything to do with the health service, I imagine it’s a complex issue with no simple answers.

I would be keen to get the opinions of consultants or surgeons. You can contact me at: brian@sluggerotoole.com

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  • wild turkey

    “To be honest, I don’t understand why the waiting lists are so long. We all hear stories about consultants telling patients it will be a 5-year wait in the NHS or they have the operation done next week if they go private. ”

    Brian, that is the $64,000 question, and you put it with clarity and concision. I have kinda been asking similar questions for 30+ years. To date. clear answers = 0.

    good post

    thanks

  • puffen

    And it’s nothing to do with money, we spend more per head than across the water,

  • John

    The last election seemed to sanction the burning of wood pellets creating heat for no particular purpose other than generating a very hefty profit for some of those involved.

  • Brian O’Neill

    Really? Tell us more if you can.

  • jokerswild

    But it’s worth it. It’s great to be British……even if most in Britain count you as Irish no matter how many times you march!!!!

  • Korhomme

    I saw the article earlier today.

    I gather that the unfortunate patient had waited three years to see the consultant; she had been advised a shoulder replacement and told it would be a further two years before it would be done. So, she’s maxed out her credit cards and is planning to go to eastern Europe for the operation.

    I knew that emergency care within the EU (and Switzerland) was covered by the EHIC (European Health Insurance Card) but it was news to me that elective treatment has been covered for the last four years. Whether such elective care, or even emergency care, will be covered after the tragedy that is Brexit isn’t clear at this stage.

    Despite the per capita heading on the NHS being higher here than in England, our services are clearly worse: we hear of GP practices in rural Fermanagh and not so rural Portadown closing, and of the problems with A&E cover in Newry, of inordinate waits for treatment, and difficulty getting an appointment with a GP. Of course, not getting appointments or treatment ‘saves money’.

    Clearly, our health service has major problems. Some of this must involve staffing and difficulty in recruitment; it’s not clear to me why this is so. Some of the problems may be related to the very bureaucratic procedures now in place.

    Nonetheless, the absence of any Executive and any Minister cannot improve matters; it is an utter dereliction of their responsibilities that our politicians will not betake it upon themselves to fulfill their duties to the electorate.

  • Zeno

    We don’t have the same economies of scale because we have a tiny population spread over a wider geographical area.

  • Zeno

    A friend of mine rang for an appointment privately on a Friday, got fitted in for Tuesday, 10am. Had a 30 minute consultation and at 11am had an MRI Scan and the Consultant went through the results with her at 1.30. Treatment was prescribed and she was out by 2pm. It was £650.

  • Korhomme

    I don’t doubt it. And yet that experience was what, more or less, was possible under the NHS some years ago. If it’s possible for a few, I don’t see why it isn’t possible or appropriate for the many.

  • Salmondnet

    Per Capita expenditure stats 2015/16 (most recent readily available):
    Northern Ireland £10,963
    Scotland £10,536
    Wales £9996
    England £8816
    UK Average £9076
    2016 Health Expenditure:
    England £11536 Million
    Scotland £12132 Million
    Wales £6592 Million
    Northern Ireland £4032 Million
    Outside UK £563 Million
    Which, if you do the arithmetic, you will find gives every country except England a greater proportion of total expenditure than it has of the total population, with Northern Ireland well in the lead.
    Given that the bulk of the populations of all the nations of the UK live in cities and the way in which English health care is organised (independent trusts), the “geographical spread” alibi (also used by the Scots) looks pretty threadbare.
    But that’s the perfidious English for you. Doing down the Celtic by unfairly forcing extra spending money on them. Will they stop at nothing?

  • Jag

    Absolutely, and it still is in certain places. In Kensington, I had a back pain, went to GP (no appointment necessary) at 9.30am, got seen around 10am, she sent me down to the Chelsea and Westminster for x-ray THAT SAME DAY.

    WIthin England, there’s a bit of a postcode lottery, but I have never heard any anecdote like the NI woman waiting for five years.

  • Zeno

    “elective treatment has been covered for the last four years. ”

    But if I understand that. You can get your own treatment and the NHS will pay for it? Maybe I misunderstand it, but why do you have to go abroad?

  • puffen

    Thank you for doing the spade work.

  • hgreen

    Meaningless figures. No doubt you are a laffer curve expert as well.

  • john millar

    Enlighten me- in what way are the figures meaningless -are the inaccurate?

  • Surveyor

    And yet Unionists keep trumpeting the NHS as a reason to remain within the UK.

  • Is it the case that a lot of our spend is wasted as we have too many hospitals, each with their own overheads. The advice to slim down the infrastructure having been consistently ignored for decades.

  • Korhomme

    I understood that the EHIC scheme was really for emergencies when you are abroad. This may be a mistaken view.

    The ex-pats on the Costa del fish ‘n’ chips get their medical treatment free as the costs are reimbursed by the NHS.

    The article suggests that people can go abroad from NI for elective treatment, with the cost of treatment paid for by the NHS. Travel and accommodation aren’t covered.

    You ask, why must people go abroad? If we can really buy health care locally from a private provider, I don’t see why we shouldn’t. Somehow, I expect that this won’t work.

  • Korhomme

    The English model has one hospital for every 250,000 to 500,000 people — increasingly the latter. So, we could have three or perhaps four hospitals. Where are they to be? Greater Belfast, extending along both sides of Belfast Lough, up towards Antrim, and along the Lagan valley has about half of the total population. The remainder is scattered about; there are no really big centres of population. How do you provide equality of access and treatment to people from Belcoo and Cultra?

  • Korhomme

    There are hospitals in the Outer Hebrides, in Orkney and in Shetland. They serve very small but remote populations; in other places they would be closed as ‘uneconomic’.

  • hgreen

    All numbers are meaningless without context. As others have said you haven’t considered population density or for example the distance from the SE of England. There are regions in England getting much higher than the average per capita expenditure.

  • murdockp

    The consultants are still having their cake and eating it collecting NHS salaries and private consulting fees on top.

    One of the top ROI hospitals regularly flies (I kid you not, they have a helicopter pad) down NI specialists to oversee and perform operations.

    How can queues reduce with two health services drawing on an already limited pool of labour.

  • MentalMan

    Imagine, if you would, a manager of a Tesco store. He decides that he will limit the number of customers who come into the store on a Monday to Thursday every week. Eventually the customers realise that they can’t wait until Friday to shop if they are unlucky enough to be excluded. They then decide to go to Sainsburys.
    The Manager in Tesco then works out a deal that he does not have to work on a Wednesday and Thursday and he is goes to work for Sainsburys. They pay him a lot more because, for some reason, they get really busy on Monday to Thursday.
    Amazes me that we have Doctors who can create, or at the very least fail to solve, a waiting list problem and then get paid to solve it. £40m a year to ThreeFiveTwo.

  • lizmcneill

    And no economies of scale between say Newry and Dundalk.

  • Zeno

    With respect. I don’t think you know what economies of scale means.

  • Zeno

    https://en.wikipedia.org/wiki/List_of_hospitals_in_Northern_Ireland
    We have 4 Hospitals in Belfast within a 2 mile radius.

  • puffen

    Building the new hospital in Antrim, was big mistake, one big one in the Northern Board made a lot more sense ,

  • Korhomme

    There used to be more. The Samaritan, Malone Place, Claremount Street. The Benn Eye Hospital. I’m sure there were others.

  • Zeno

    One modern hospital, maybe built on the Musgrave site because of good access to M1 and Westlink could replace all of those.
    It’s 1 minute from West Belfast a couple from South Belfast and 8 minutes from North Belfast. The Ulster Hospital could remain as an Emergency Unit to serve the Eastern side of the river.

  • hgreen

    Agree. It’s nuts. Now which political party would like a privatised health service and thus encourages this dual system to exist?

  • Korhomme

    That could be sensible…but

    civil servants and managers have an extraordinary attitude to ‘sunk costs’. They would be unwilling to abandon the newish BCH and the new RVH.

  • lizmcneill

    Would two towns the size of Newry and Dundalk have a hospital each if they were in the same country?

  • Starviking

    In Northern Ireland patients are waiting on average five years for routine operations. This compares to less than a year in England.

    That is not said in the article, it says “some patients facing five-year delays for hip and knee replacements.”

    In fact, there does not seem to be any stats in the article which can allow comparisons to be made between patients in general in NI and England.

  • Brian O’Neill

    Nice in theory but the RVH is humongous. But centralising services is a must.

  • Korhomme

    You’re not comparing like with like. Tesco and Sainsburys are very similar supermarkets.

    The NHS treats all-comers. To be privately insured, you have to be reasonably fit and reasonably free from co-morbidities.

    In the past, juniors learned under an apprentice model — they watched and assisted at operations. Today, training is much more directed. Consultants will assist juniors at operations, something that rarely happened in the past. Such training means that operations take longer than if the boss was doing them. Only the boss operates privately.

    The end result of this may well be that elective surgery moves increasingly into the private sector which takes the ‘cream’, while the rest falls to the NHS. And as the rest will include sicker patients with more complex problems, this will further exacerbate the trend.