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NI waiting list crisis: Seriously ill patients competing with each other for vital operations, senior medic warns


Waiting list crisis for patients needing operations has increased during the pandemic

Waiting list crisis for patients needing operations has increased during the pandemic

Waiting list crisis for patients needing operations has increased during the pandemic

Patients who need surgery to save their sight or stop them from becoming paralysed are competing with cancer patients for vital operations, senior medics have warned.

Northern Ireland’s hospital waiting list crisis has become so severe that some patients have developed a life-threatening complication which can result in a person spending up to a year in hospital.

Stormont’s health committee has also been told there are people in Northern Ireland who have been waiting 20 months for an operation to remove kidney stones, while children are spending the night in A&E, and adults are waiting up to 48 hours in ED just to get a hospital bed to allow them to undergo vital surgery.

Coronavirus Data Graphs

It has also emerged that a third of the theatre nurses at Northern Ireland’s regional orthopaedic hospital have quit their jobs since the start of the pandemic, with only 14 perioperative nurses currently working at Musgrave Park Hospital – down from 100.

There is now so little elective orthopaedic surgery happening in Northern Ireland that the Royal College of Surgeons (RCS) has warned the region is facing a “major orthopaedic training dilemma”.

The depressing state of the health service was laid bare during an evidence session to the health committee by members of RCS on Tuesday afternoon.


Surgeon Mark Taylor pictured at the Mater Hospital in Belfast. Photo by Stephen Hamilton / Press Eye

Surgeon Mark Taylor pictured at the Mater Hospital in Belfast. Photo by Stephen Hamilton / Press Eye

Surgeon Mark Taylor pictured at the Mater Hospital in Belfast. Photo by Stephen Hamilton / Press Eye

Consultant neurosurgeon Mano Shanmuganathan said he and his colleagues now face a “daily dilemma” over which patients should get surgery, which he said is resulting in “moral distress” for medics.

“Examples of this would be a patient who is going blind, a patient who is unable to walk, a patient who is going to die of cancer, and within a limited service we as a body of clinicians have to decide who takes priority,” he explained.

He also described having to “shoehorn” patients whose conditions have deteriorated to the point they have become an emergency case onto theatre lists.

Mark Taylor, director of RCS in Northern Ireland and a consultant general and hepatobiliary surgeon, said: “If you’re on a waiting list for a gall bladder operation you quite often get recurring bouts of problem with your gall bladder that necessitate coming to ED.

“But in a small number of those patients, you will get a very life-threatening necrotising pancreatitis which could mean you spend up to one year in a hospital.

“So, we are seeing examples of people on our waiting lists who have presented with severe necrotising pancreatitis that would not have presented had they had the gall bladder operation in a timely fashion.”


Consultant neurosurgeon Mano Shanmuganathan

Consultant neurosurgeon Mano Shanmuganathan

Mr Mano Shanmuganathan is a Belfast surgeon

Mr Mano Shanmuganathan is a Belfast surgeon

Freddie Parkinson


Consultant neurosurgeon Mano Shanmuganathan

Consultant urological surgeon Brian Duggan explained: “We cover cancer and a significant amount of what’s known as benign conditions.

“But these benign conditions are now repeatedly not being prioritised, a simple example would be kidney stones.

“Patients suffer a lot of pain therefore they go to their GP and they repeatedly go to casualty, they are constantly told ‘we need to do a procedure to remove your kidney stone’.

“But when it comes to prioritising lists, a cancer case inevitably - these are difficult issues - but if we have young man with a testicular tumour that young man must go ahead of the patient with the kidney stone.

“Therefore the patient with the kidney stone waits and waits and waits and some of them have waited now until March 2020 and there is damage done.

“The longer you leave untreated kidney stones, the more harm will come to that kidney and in some cases permanent kidney damage.

“A so-called benign condition is not actually benign if you don’t treat it.”

Mr Taylor said Northern Ireland’s hospital waiting times were “tragic before Covid and unfortunately they are now much worse”, as he revealed 474,445 people are currently waiting for surgery or a first hospital appointment.

Much of the blame for the deepening crisis lies with the shortage of nurses in Northern Ireland, said the surgeons as they called for urgent action to retain nurses.

Orthopaedic surgeon David Swain said many theatre nurses at Musgrave Park Hospital were unhappy about long-term redeployments as a result of the pandemic and had “voted with their feet” by leaving the profession entirely.

“Pre-pandemic, Musgrave Park Hospital, which provides somewhere between two thirds and three quarters of elective orthopaedic activity for the province, had about 100 perioperative nurses,” he explained.

“Forty of our nurses are redeployed across the trust in other areas, some in Covid ICU, some in other ICUs, but more nurses are deployed in other surgical arenas to allow other colleagues to get on with their work.

“Very sadly 31 of our 100 nurses have now left and many of those have actually left nursing completely, they have given up their registration.

“So, of those 100 nurses we had in Musgrave Park in early March 2020, we are down to 14 and we now face a prospect that, even if every one of our nurses was given back to us, we would only get back to 70% of our nursing body and therefore 70% of our workload.”

The situation in children’s services is also bleak, with consultant paediatric surgeon Isaac Phillip warning the Royal Belfast Hospital for Sick Children consistently operates at over 100% capacity.

“Many of our children need time critical care and if you don’t intervene in the correct time then there are consequences that would be there for the entire lifetime,” he said.

“Even today an elective list has been cancelled because of a lack of beds.

“We have had several occasions where patients are actually coming to casualty and actually crammed overnight so they could get in to have a bed in the hospital to get scheduled care.”

Meanwhile, earlier this month, the Belfast Telegraph revealed so few elective operations are currently happening in the NHS that surgeons are having to work in the private sector to keep their skills up-to-date.

It is also impacting on the ability of trainee surgeons to gain the necessary experience and speaking at the health committee, Mr Taylor said: “I think there is some critical incidents at this time and that is that we are going to have a major orthopaedic training dilemma on our hands if we don’t radically address the resumption of orthopaedic surgery.”

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