Waiting lists are the Stormont health minister's curse, reports Dan Keenan, Northern News Editor
Northern Ireland's health minister has signalled root and branch reforms which will deliver greater efficiencies and end the "intolerable misery" associated with the longest waiting lists in Europe.
Shaun Woodward has announced fines for health boards which cannot treat patients who are waiting for procedures within 12 months.
That money would then be used to send patients for treatment to other hospitals, including those in the Republic and Britain.
The minister, addressing health administrators in Belfast earlier last month, announced a dramatic review of health service structures.
He believes Northern Ireland, which has its own department of health, four area boards and 19 hospital trusts, has a bloated bureaucracy which is expensive and inhibits what he called "joined up" and "modernised" healthcare provision. This, in turn, helps lengthen the queues waiting for treatment.
Health spending already swallows more than 40 per cent of the British government allocation to all departments.
Figures produced by the department last March put the waiting list figure at 49,250, a drop of 1,500 in one quarter. Those waiting 18 months or more to go into hospital had more than halved.
However, in the past year, the number of people waiting for outpatient appointments went up by 17,000, with well over 160,000 people waiting.
Some 47,000 inpatients are awaiting treatment, 4,000 of whom have already been waiting for more than 12 months.
Figures for April and May, the minister admits, appear to be going in the wrong direction.
"The figures I have seen for April and May indicate a slowdown in performance.
"It may well get slightly worse in the next set of figures, before it gets better," he said.
Those numbers would be significantly more stark were it not for 3,500 private operations purchased by health boards for patients in the past year.
Government figures released earlier this year showed one reason for the drop is that health boards have been sending people to the Republic or Britain to be treated or to private clinics in the North.
The health boards all claim that by sending away those able and willing to travel, they had been able to reduce waiting times for other patients.
Figures released in 2003 showed Northern Ireland had the longest waiting lists in Europe but that the situation was improving.
That year's waiting list total of 54,257 showed a decrease of 1,157 (2.1 per cent) since June 2003 and a fall of 5,933 (9.9 per cent) since September 2002.
The North's four boards have individually provided The Irish Times with waiting list statistics. The eastern board, which includes greater Belfast and a large proportion of consultants and specialist providers, reports a waiting list of just under 18,000 - a 7 per cent fall on the following year.
This drop has been assisted by the spending of an extra £5 million (€7.35 million). The board purchases procedures from other boards and private hospitals in Northern Ireland as well as in Britain and the Republic, including the Blackrock Clinic in Dublin.
This is on top of other cross-Border patient transfers in both directions to use spare capacity in cases of ward overflows.
During 2004-2005, the northern board says it transferred 750 patients waiting for inpatient or day case treatment, to private and health service hospitals elsewhere in Northern Ireland as well as to the Republic and Britain.
The southern board, which provided separate totals for those sent to the Republic for treatment, says 218 patients have been transferred since 2002-2003.
However, this trend is decreasing as waiting lists overall contract.
The western board, centred on Derry, reports the opposite trend with 82 patients sent to the Republic in the last accounting 12-month period - a leap from just six in 2002-2003 and 35 in 2003-2004. All but seven of last year's transferred patients were cardiac patients.
Such wide variation in statistics points to another key problem with healthcare provision, the minister believes.
"A fundamental principle of the National Health Search [ NHS] is universality of the service and we know that isn't happening at the moment here in Northern Ireland."
He said the service was first class in places, but not in enough places.
"It is patchy and there can be huge variations between one trust and another. Between one hospital and another. Between one waiting list and another. Even between specialism," he said.
Illustrating the service which he felt the total health budget of £3.27 billion (€4.8 billion) should deliver to just 1.7 million northerners, he said: "The public should have a system which ensures that when patients go into hospital, they can expect their healthcare to be provided with a sense of urgency, efficiency, and with the highest standard of professional care and, of course, safety.
"It has to change. It must change and with your help I intend to change it," Mr Woodward told health service bosses.
The minister, a reformed 20-a-day smoker, announced in June that some form of smoking ban would be introduced in Northern Ireland.
The outstanding question was how wide-ranging the prohibition should be.
However, in what is widely interpreted as a large nod and wink indicative of an Irish-style ban, Mr Woodward has been consulting closely with health officials in Dublin about the introduction of the smoking ban in workplaces in the Republic in March 2004.
British Direct Rule ministers, who have to run three or more departments in place of local ministers selected from the suspended Stormont Assembly, have been criticised for not adopting more than caretaker roles.
However, Mr Woodward, who also has responsibility for security and policing as well as regional development, has quickly established a reputation for tackling large issues, despite only being appointed in May.
His record at the department of health could be the making of him and the future of healthcare delivery.