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Overwhelmed health service is broken, says leading medic

Situation is so grave that doctors now have a ‘responsibility to be honest’ with the public


Dr Tom Black of the British Medical Association

Dr Tom Black of the British Medical Association

Dr Tom Black of the British Medical Association

Northern Ireland’s health service is broken and the hospital waiting list crisis is beyond repair, doctors’ leaders have warned.

In a hard-hitting interview, the head of the British Medical Association (BMA) in Northern Ireland has given his most damning assessment ever of the state of the region’s health service.

Dr Tom Black said the situation has become so grave that doctors now have a responsibility to be open and frank with the public about their concerns.

“The NHS in Northern Ireland is broken, that’s a big statement to make and we’ve never said it before, but we are today,” he said.

“As doctors, we have a professional responsibility not to scare people but we also have a responsibility to be honest and that’s why we’ve taken the decision to speak out now.

“There is a duty that we don’t sit here and say everything is going to be okay when it’s not.

“The only thing worse than no service is a pretend service and that’s what we have currently.

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“At least when you tell people there is no service, they can go elsewhere, but when you’re pretending to provide a service, people hang on thinking they’re going to get the help they need.”

Among the litany of failings threatening patient safety on a daily basis that have been highlighted by Dr Black are:

• Suicidal patients being cared for at home by family due to a lack of hospital beds

• GPs struggling to get ambulances for patients with acute and potentially deadly medical conditions

• One hospital consultant working on-call for 48-hours straight as the only doctor covering their specialty

• Multiple GP surgeries preparing to hand back contracts to health bosses

• Patients waiting upwards of six-months for a cancer diagnosis

• 15% of consultant jobs across Northern Ireland are unfilled

Dr Black continued: “We’ve been having lots of discussions over why we believe the health service is broken and it’s because the system is completely overwhelmed.

“Patients aren’t getting a service, the system is underfunded, there aren’t enough staff, there aren’t enough beds.

“Staff are under an immense amount of pressure, the moral injury they are suffering is huge and by that, I mean the distress experienced by staff because they see the harm being caused to their patients and there’s nothing they can do about it.

“I sat down with the BMA consultants’ committee and asked them how we’re going to fix hospital waiting lists and they said that we can’t.

“Quite simply, there isn’t the workforce there to do it.

“The backlog is so long that we don’t believe there are enough doctors to do it, even using all the traditional waiting list measures.

“We know there are hundreds of thousands of people on hospital waiting lists and even people with urgent and red flag referrals aren’t being seen.

“Waiting lists are so big and the service is so impaired that patients are coming to harm, while some will die as a result of the long waits they’re suffering.

“GPs routinely ask their patients if they have health insurance when they’re referring them to outpatients and health inequalities are only going to get worse as those who can afford treatment are going private.

“However, most of my patients can’t afford to go private.” Dr Black said in his GP surgery in Londonderry he is not aware of any patients who have had elective surgery in recent times without making use of the cross-border healthcare initiative.

The time-limited programme was set up by Health Minister Robin Swann in June last year and allows Northern Ireland patients facing lengthy delays for treatment to access private healthcare in the Republic.

Some or all of the costs are then reimbursed to the patient but the scheme is due to end in a matter of weeks.

Dr Black continued: “There are already huge discrepancies between the most well off and the worst off in Northern Ireland and that’s only going to get worse. As the system is broken, people living in the most deprived areas will suffer even more. For example, the life expectancy for men living in the most deprived areas in 2018 to 2020 was 74.5 years but in well-off areas it is 81.

“Patients are currently waiting 12-years for a hip replacement, so that means if you are 62 and you’re told you need your hip replaced, but you live in one of the more deprived areas, you will die before you get your operation.”

Dr Black also warned GP services are struggling to cope with demand, with a growing number of surgeries preparing to hand back their contracts which could lead to collapse of services in some areas.

“When a practice hands back its contract and a replacement can’t be found, the patients in that surgery are dispersed out to other surgeries,” he explained.

“This creates additional pressures on the staff working in those surgeries and makes it more difficult for patients to get appointments.

“Eventually, the staff in those surgeries burn out, putting that practice at risk of closure too.

“There is a very real concern about the domino effect of these impending closures.”

Dr Black continued: “Nothing we have ever done before will fix the NHS this time. We need to do something radically different, but it’s up to our democratically elected representatives to decide what that will be.

“I’m sure we will be accused of entering into political territory on this but it’s very clear under the duty of candour that we must be honest with the public.” A Department of Health spokeswoman said patients and hard-pressed staff “need to be given hope” the health service can be fixed. “Despite the deep-seated and well documented challenges facing services, this is not the time to abandon hope,” she said.

She said the minister has set out a series of initiatives on waiting times based on investment and reform, although Mr Swann has been clear that budgetary and political pressures “are serious impediments”.

She continued: “However, a counsel of despair is not the way forward. While the pandemic has ravaged services and seriously exacerbated pre-existing problems, the situation can be turned around in time and with a collective will.”

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