Health and care services

General surgery limited progress

Although the Department of Health claims that “significant progress” has been made in the implementation of the actions in the Review of General Surgery, of the 10 actions in the review, only one has been completed and delays to delivery are anticipated for three actions.

Of the 10 actions in the review, one action has been completed, six actions are green using a RAG rating system (identified as on target to be delivered), and three are amber (some anticipated delay to delivery).

When the Review of General Surgery in Northern Ireland was published in June 2022, then-Health Minister Robin Swann MLA said: “We are not providing the best possible care for our patients. Whilst our surgeons and wider multi-disciplinary team do outstanding work, our systems are not providing them with the tools to do the best they can.”

The former Health Minister was citing the failure to implement the 2016 Bengoa report, a major aspect of which was the digitalisation of health services.

The Review of General Surgery in Northern Ireland outlined 10 key objectives within this broad framework to accelerate the transformation of hospital services, with the Bengoa report’s ultimate objective of improving the efficiency of Northern Ireland’s hospital services.

Although the Department has been denied political leadership with the dissolution of the Executive forcing Swann’s resignation as minister, it states in the Progress Report of the Review of General Surgery, published in June 2023, that “significant progress” has been made with the completion of one of the 10 actions outlined in the Review of General Surgery. This action, the establishment of a Regional General Surgery Network, aims to drive forward a multifaceted transformation programme for general surgery at a regional level, whilst incorporating best practice from other parts of the UK.

Whilst the Department states that work is underway to meet the other nine objectives, the objective of ensuring that the Department of Health develops an integrated dashboard for general surgery has not been met, meaning that digitalised means of improving patient experience, quality and safety of care, and activity and access to care, cannot yet be brought forward.

The Department further outlines an objective that the British Association of Day Surgery (BADS) targets regarding the proportion of specific procedures which should be carried out as day cases will be used to compare day case rates for specific procedures at a local and regional level and will be used to drive performance and efficiency.

However, this measure too faces delay, as the Department explains that “work will continue over the coming months to include all relevant procedures”.

“BADS produces a directory of over 200 procedures that includes targets for day case surgery rates. Though not unique to general surgery the Department has developed a dashboard to compare surgery rates across the region for a basket of procedures which are benchmarked against the recommended targets set BADS,” the progress report states.

“At a strategic level, the Elective Care Management Team is monitoring performance against BADS targets and will direct any necessary action by Trusts. Implementing and achieving targets set by BADS will reduce length of stay in hospital for some patients and will therefore generate potential efficiencies such as releasing beds so that more patients can be treated, reducing overcrowding and long waits in emergency departments.”

The Department is more optimistic when it comes to the objective of establishing of elective overnight stay centres (EOSC). With this action categorised as ‘on track’, the Department states: “An EOSC will provide a range of specialities including general surgery, urology, gynaecology, and ear, nose and throat (ENT) with the aim of improving patient outcomes.”

Further promise is expressed when it comes to the objectives of “continued regional collaboration to rebuild elective paediatric lists” and “continued support for the Child Health Partnership (CHP) as it develops age appropriate pathways, training opportunities and models for delivery of paediatric surgery”.

Part of this relative success was enabled by a Regional Paediatric Surgery Workshop, held by the Department in January 2023 which had representation from a range of paediatric surgical specialties, the Royal College of Surgeons, and the Royal College of Paediatrics and Child Health.

“The workshop enabled clinical and managerial teams across the region to discuss methods of improving collaborative working and address systemic challenges, as well as reinforce the support available from CHP and the Department,” the Department of Health states.

The publication of the progress report will be seen as promising for department officials, but the direction being pursued by the Department continues to be disjointed in the absence of political leadership.

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