TWO YEARS ago the then health minister for Northern Ireland outlined a series of ambitious patient targets. Direct Rule minister Paul Goggins, a social worker before he became a British Labour MP, was the fifth health minister in three years and public sector unions reacted to his aims with some scepticism.
Regardless, Mr Goggins pledged a "seismic shift" in healthcare provision.
He promised a transformation in the National Health Service (NHS) in the North from one creaking under a 180,000-long waiting list and riddled with debt to one which would be "the envy of the world".
His grand plan saw the retention of that core NHS principle of free healthcare delivery for all at the point of use. But he also looked to a future with more nurse-led healthcare provision, better services in the community and more efficient use of hospital resources only for those who really need them - and all within 24 months.
Direct Rule from Westminster has since gone, Mr Goggins retains just the justice portfolio, and ministerial responsibility for health has transferred to Stormont.
Michael McGimpsey, the UUP minister now in charge, has presided over some momentous changes.
Next month he will begin a staged plan to introduce free prescriptions for all. Waiting lists for key certain health services have been dramatically cut while trolley waits have been all but abolished.
Some 22,215 patients were waiting more than 13 weeks for a first consultant's appointment when Direct Rule ended. This was reduced to 55 at the end of March this year.
The target of a 21-week wait for surgery, including day procedures, meant that 1,982 patients were waiting in the year to April 2007. This has now fallen to just 56 in March, the end of the accounting year.
Statistics concerning diagnostic tests, such as an MRI scan, showed that 7,649 were waiting between 13 weeks and two years in June last year. However, this has now been reduced to zero. Also cut to zero was the waiting list of 3,545 patients who were waiting for six months to see allied health professionals such as physiotherapists.
Regarding the provision of accident and emergency services, Mr McGimpsey can boast that whereas of April 2007, across Northern Ireland some 81 per cent of patients were seen within four hours. By March 2008, this had increased to 92 per cent.
"The improvement in AE performance is perhaps the most remarkable - without any major new money, we have all but eliminated long trolley waits," he said at the time.
"This is a significant achievement which shows the real benefits of teams in trusts working with focus, sharing improved practice and co-operative working across the health and social care service."
The most recent statistics, released earlier this month, show that the total number of patients waiting for hospital inpatient treatment at the end of September 2008 was 36,766.
This total has increased by 693 (up 1.9 per cent) compared with the previous quarter (end of June 2008), and has risen by 1,456 (up 4.1 per cent) compared with the same quarter in the previous year (end of September 2007). At the same time there were 74,390 people waiting for a first outpatient appointment at the end of September 2008. This represented a decrease of 2,701 (or -3.5 per cent) on the previous quarter (end of June 2008) and a decrease of 12,399 (or -14.3 per cent) over the year.
Of those facing long waits, 7,910 patients were waiting more than nine weeks for a first outpatient appointment, of which just 317 were waiting more than 13 weeks.
Addressing his party's annual conference on December 6th, he trumpeted the Ulster Unionists as responsible for establishing the NHS in Northern Ireland 60 years ago.
Portraying himself as having won "the battle of budget" he looked to greater things in the Northern healthcare system and the abolition of the £6.75 fee for prescription items.
The contrast between North and South seems particularly clear given the recent Budget and street protests over the then proposed withdrawal of medical cards for some elderly.
SDLP deputy leader Alasdair McDonnell is also a family doctor practising in south Belfast.
He trained at UCD and knows both health systems well.
According to him, they are "totally different", but he stressed that free access was vital especially for older patients.
"GP visits are important for elderly patients," he told The Irish Times. "Some suffer a lot of illness and there is need to have free and reasonable access to a doctor. I find a lot of elderly, especially those living alone, often neglect themselves. It is not always related to their particular level of wealth or poverty. People who are relatively comfortable can still neglect themselves. I am very committed to ensuring that the elderly get free and easy access to GP visits and care."
Many people already have free prescriptions also, Dr McDonnell added. "Everyone over 60 gets a free prescription. But there are a number of situations which are also covered."
He said those with a need for open-ended medication such as diabetes sufferers and those with thyroid problems do not pay prescription charges. Others, including those on some welfare benefits, expectant mothers and those under 18, also receive free medication.
"It is also possible to pay an annual charge of just under £100 [€116] for a year's prescriptions. So no one should be paying more than that for a whole year," he added.
The removal of the prescription charge will cost Mr McGimspey's department just £13 million (€15.97 million) at today's prices. Nearly 97 per cent of the entire drugs bill was met from the departmental budget anyway. But with demand rising and health costs spiralling, Mr McGimpsey is having to find efficiencies and to cut the NHS workforce.
He is relying on natural wastage, claiming this will provide the vacancies he needs without having to cut back on nurse training or to compromise the investment in hospital infrastructure already under way.
"The fact is that around 750 nurses leave the system each year . . . so we would anticipate a reduction of about 2,000 over the next three years," he said in October when health jobs fears arose.