Surgeons respond to Department of Health’s new elective care framework

The Department of Health has today published a new framework for elective care. Responding to the document, which sets out how the Department will tackle long waits for planned surgery, Mr Mark Taylor, the Northern Ireland Director of the Royal College of Surgeons of England said:

“We warmly welcome the 5-year elective care framework announced by Health Minister Robin Swann in the Assembly today, which aspires to banish long waits for surgery by March 2026. It is a substantial and radical document which we will need time to fully appraise.

“This framework document sets out short, medium and long term actions, in line with many of our College’s recommendations, and echoes our own ’10 Steps Not 10 Years Action Plan’. In particular, we are delighted to see the minister call for £700 million over the next five years to fully resolve the waiting lists and develop a sustainable elective care service.  

“For many years, the demand for care has outstripped the capacity of NI’s health care system to meet the needs of patients. This is a wholly unacceptable situation. 

“Covid-19 has undoubtedly made things worse, with a significant deterioration in waiting times. No one underestimates the scale of the challenge we face, but this framework document clearly highlights an action plan for lasting change. We can’t go back to the old ways of doing business in our health service. This new framework is without doubt a step in the right direction. We welcome the opportunity to move towards greater 7-day theatre operating time in parallel with staff engagement and resource. 

“The promise and principles of better data collection, mega clinics, rapid diagnostic centres, separation of unscheduled and scheduled care and utilising all available theatres to address the backlog, whether in the independent sector or HSC, are essential ingredients to address the unacceptably long waiting lists. 

“This plan also highlights the need for transformation of our health and social care system. We welcome the review of general surgery and the creation of green pathways which will focus on increasing capacity, enhanced efficiency and ultimately a service that will not see such backlogs again. With the right kind of support and rest for staff after an immensely tough year, I know we can get the job done. As the minister has said, the time for words is over. We need to see action.”

Notes to editors

1. The Department of Health Elective Care Framework for Northern Ireland is available here: https://www.health-ni.gov.uk/news/minister-unveils-ps700m-plan-tackling-waiting-lists

2. RCS England 10 Steps Not 10 Years NI Action Plan launched May 25 2021: Surgical recovery in 10 steps:

i. Investment: multi-year funding is required to close the capacity gap and address the elective care backlog, estimated by government at £1 billion. £200 million per year for the next five years is required.
ii. Waiting lists and elective surgery: each trust should publish yearly plans detailing timely access to surgery for patients and committing to the protection of surgery in the face of any future shocks.
iii. COVID-light sites in every trust area to ensure maximum separation of emergency and elective care. Such sites in the post pandemic era could become centres of excellence for elective surgery. 
iv. Surgical hubs: high-volume low-complexity surgery in surgically efficient hubs will accelerate the pace of operations required. Patients and surgical teams are willing to travel.
v. Elective accountability: the government should publish an annual report setting out its response to the waiting times backlog in NI as well as measures to support patients facing long waits for surgery.
vi. Recruitment/retention: the wider surgical workforce needs expansion, with particular focus on Perioperative nursing and Surgical Care Practitioners. The NI government should publish a regular assessment of healthcare workforce projections and requirements.
vii. Launch comprehensive review of surgical services in NI, noting particular digital and technological developments affecting the future of surgery.
viii. Wellbeing: trusts should proactively implement programmes that highlight the benefits of physical and mental wellbeing. It is essential that every surgeon feels ‘psychologically safe’ in their working environment.
ix. Support surgical trainees: No training today, no surgeons tomorrow. Systems must maximise opportunities for trainees to catch up on missed training opportunities as soon as possible with bespoke programmes of training that include enhanced theatre time.
x. Collaborate and protect time to learn: ensure that protected time is built into surgical working schedules to enable communication and learning with colleagues from other specialties and primary care for the mutual benefit of improving patient outcomes.

3. The Department of Health’s latest waiting time figures for 2020/21 Q4 (Jan to March 2021) are available here: https://www.health-ni.gov.uk/publications/northern-ireland-waiting-time-statistics-inpatient-and-day-case-waiting-times-march-2021

4. The Royal College of Surgeons of England is represented in Northern Ireland by a Professional Board, comprising 10 elected specialty surgeons, a member elected by the Association of Surgeons in Training (ASiT), the Chair of QUB Medical School Surgical Society, the Head of the School of Surgery and an RCS Council member. The purpose of the Board is to improve surgical outcomes for patients, advocate locally and support the dissemination of good practice and professional guidance.