Fearing he risked paralysis waiting on NHS surgery to correct his deformed spine, Kevin McIvor took a gamble. The former joiner left his home and young family in Co Derry last July and headed to Turkey with his brother for an 11-hour operation.
Hooked on prescription drugs and struggling to breathe from the chronic spinal condition, scoliosis, the 37-year-old had run out of options.
“I was panicking. My body was telling me it was shutting down. My legs were constantly spasming and giving way,” the Bellaghy man says.
“Obviously I visited the facilities in Turkey beforehand and was reassured by people who had gone there. At the same time it was the unknown, I just didn’t know what I was going into.
“But I didn’t have much choice. If I stayed on the NHS, they told me it could be four or five years for the operation; and it wasn’t even guaranteed. I couldn’t wait that length of time. I’d waited long enough.”
Mr McIvor was among the 335,000 people on the North’s waiting lists last summer to see a consultant following a GP referral. That figure has now risen to almost 360,000, equating to more than one in four of Northern Ireland’s population.
Some patients are facing seven-year delays to see a specialist in areas such as rheumatology and neurology. But those waits are slashed to a matter of days or weeks if a patient pays for a private consultation — which is often with the same NHS medic.
Speaking for the first time since the surgery in an Istanbul clinic, the father-of-four says his trip was only made possible through a GoFundMe page set up by a friend, raising £43,000 in eight weeks. “I lost a lot of blood during the operation and needed a transfusion. I knew it was going to be one of the risks. I was having awful nightmares and the surgeon told me I was in withdrawal from Pregabalin,” which is a highly addictive prescribed medication used to treat nerve pain and epilepsy.
“I probably feel even younger now because a lot of the pressure is off my lungs and my spinal cord. I’ve no headaches any more. My spine is straight as a die and I’m off the painkillers. The surgeon basically reversed everything ... It’s changed my life.
“Looking back, the health service failed me. I was angry but I knew it just wasn’t me. It’s not right in 2022 that you have to rely on eastern Europe for surgery.”
More than 20 years since legislative powers were devolved to Stormont, seven fundamental reviews of the North’s health and social care service have been commissioned. All called for a radical overhaul of the system but this has not happened, and waiting lists continue to spiral.
Warning the “status quo was not an option” and a “systems collapse” was on the horizon, the late Maurice Hayes said people were “crying out” for decisive action in his landmark review in 2001. The respected academic made the case for more centralised care, arguing there were too many hospitals for the size of the population.
Similar recommendations were made in the subsequent reviews but largely ignored with experts singling out a lack of political will to act for fear of losing votes.
Poor workforce planning by the North’s department of health, particularly in relation to nursing, has also come under intense scrutiny over the past decade.
Meanwhile, the top-heavy nature of the North’s health administration — one review said it had “more pilots than the RAF” — has been repeatedly slated.
So has devolution failed the healthcare needs of the North’s citizens?
“It doesn’t seemed to have worked in respect of the operation of our health service,” says Ciaran O’Neill, a professor of economics at Queen’s University Belfast (QUB).
“Here we are in 2022 talking about the same issues that were raised by Maurice Hayes and picked up in the other reviews.
“If you had a functioning, devolved assembly — functioning in the sense that it actually improved the lot of the people who voted in members in there — then the conversation should have moved on.
“Why has it not moved on? I know there’s been collapses of powersharing but even when the Assembly was sitting it just seemed to be like an insect trapped in amber. They didn’t seem to progress.
“I think it is important to say that the main positive is the dedication of staff; they have done a tremendous job and continue to do that under very difficult circumstances, and are now dealing with a public that has become less patient with their ability to deliver.”
Last month two waiting list patients mounted a legal challenge in Belfast’s High Court claiming their human rights had been breached, in what is the first case of its kind in the UK.
May Kitchen and Eileen Wilson say authorities acted unlawfully by failing to provide them with necessary medical care within a reasonable time.
Prof O’Neill points to an apathy around the crisis in recent years: “It’s almost as if we’ve become inured to waiting lists. It’s the elephant in the livingroom that nobody actually sees any more ... and in some respects, I do actually think we are maybe even beyond the tipping point that Hayes warned of.
“We know that decisions have to be made. We’ve known for some time what those decisions are, but it requires political leadership to actually make those decisions. And even before the sort of hiatus that we seem to be entering into again, and the hiatus this was before that, there just did not seem to be evidence of a willingness to actually make the political decisions that were necessary to be made.”
Figures from the London-based think tank The Nuffield Trust show that by December 2021 some 26 per cent of the North’s 1.8 million population was on an NHS waiting list; the equivalent figure for England was just 7 per cent. And 14 per cent of those on the North’s lists had been waiting longer than one year, compared to 0.6 per cent in England.
By March 2022, 47 per cent of patients in the North’s A&E departments waited longer than four hours to be seen, treated or discharged. In Wales the equivalent figure was 35 per cent, England 28 per cent and Scotland 28 per cent. Current targets in all countries is that 95 per cent should be seen within four hours.
Nuffield’s chief health economist Prof John Appleby led two of the big reviews into the North’s health service and describes the latest waiting times as “incredibly depressing”.
“Just putting Covid to one side, because that’s obviously been a huge unforeseen impact on all health systems around the world, you only have to look at the trends for Northern Ireland’s non-emergency waiting lists and waiting times for A & — they’re frankly appalling. They’re the worst across the UK and they have been consistently.”
Unlike England, the North’s health service is integrated with social care and has an annual budget of about £6.5 billion — accounting for almost half the block grant Stormont receives from the UK government.
“It’s the biggest chunk of public spending but the performance is nowhere good enough as it should be given the amount of money put into the system,” he says.
“You can never be completely accurate about this and comparisons can be challenged — there’s always some wriggle room — but broadly Northern Ireland has more money per head than other parts of the UK at the moment.
“It has more GPs per head than in England ... massively more; has more nurses per head, has more consultants, medical and dental staff per head. So it’s not like it’s lacking things that could explain why its performance is so bad. It looks like on the resourcing side Northern Ireland is okay. It’s what it does with those resources — that’s the issue.
“That’s what all those reports have been about: how are you using your staff; how efficiently are they able to work; what sort of outcomes are you getting for the money and staff you are putting in.”
Despite figures showing the North has a greater headcount of frontline staff compared to England, health service trade unions highlight the large numbers of staff quitting due to burnout, “unsafe” working conditions and pay.
Prof Appleby says getting proper data in the North can even be a problem. “The Department of Health couldn’t supply us with the numbers of nurses who work in health as opposed to social care — which tells you something.”
Meanwhile, fears about the future of GP services have also been raised due to increasing numbers of older doctors retiring, and no one to replace them, amid the demands from a growing and ageing population.
So how can things be improved, aside from restoring the Assembly? Prof O’Neill says the solution could lie in “taking the health service out of the hands of the politicians” and establishing an Independent body similar to the North’s policing board to hold decision makers to account.
“This a model where politicians along with other Independent people hold to account the department and are given both the authority and resources to actually run health. But they’re not given carte blanche, they can be dismissed if they’re not actually seen to perform.
“But that could be a model which actually works because it takes the backlash away from politicians when difficult decisions have to be made.”
Prof Appleby insists, however, that politicians are required to “hold the ring” and make tough decisions about the overhaul of health services as these are “publicly funded services and people are going to have their lives affected”.
Attempts to transfer services from rural acute hospitals to more central facilities in recent years have led to public protest rallies, with some Assembly members backing campaigners demanding the retention of services. “There will be some difficult trade-offs to grapple with but at least if you set them out for people and show the options, you’re going to save more lives. But more people are going to have to travel [to other parts of the North],” says Prof Appleby.
As Kevin McIvor continues his recovery, he regards himself as “one of the lucky ones”. The health service “is just not there for everyone. That’s the way it’s going and it’s sad really, especially for those with life-threatening illnesses like cancer patients. I feel very sorry for those people”.
“If I hadn’t had surgery it was only a matter of time before I would have become paralysed and in a wheelchair because the scoliosis was that far gone.”
Asked if he thought devolution had failed the health service, Northern Ireland’s Minister for Health Robin Swann said: “My views on devolution and health are a matter of public record. We know what needs to be done in health and social care and we know the scale of the challenges. Political stability and budgetary certainty are both required.”
He said he was committed to doing “the best I can” to rebuild services post-Covid, citing the recent announcement of “a series of funded initiatives to treat more people on hospital waiting lists”. He added, however, “these investments are not without risk given the absence of a health budget for this year”.
