Northern health minister Paul Goggins promises a wait-free service which will be the envy of the world. Dan Keenan, Northern News Editor, reports.
Trolley waits will be abolished within two years under plans which amount to a "seismic shift" in the delivery of hospital services, the North's new health minister has promised.
Paul Goggins is pointing 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.
If successful, the transformation from an inefficient and debt-ridden health system could act as a model for the Republic.
In a speech to healthcare professionals in Belfast, Goggins envisaged a health service for Northern Ireland which remained free at the point of delivery for patients which would be "the envy of the world".
Trolley waits, he pledged, would end by March 2008 with patients either being treated and discharged or admitted to a ward - and all within four hours.
Contrasting current provision with his description of the cash-strapped and low morale health service of just a few years ago, Goggins said: "Four years ago people needing a hip replacement could be waiting for as long as seven years; and people who needed cardiac surgery or a cataract operation could be waiting five years.
"Over 60,000 were waiting for an inpatient or day case procedure and 15,000 of those were waiting over 12 months, almost 10,000 over 18 months - and financially trusts were collectively overspending to the tune of £20 million [ €29 million] per year."
Waiting lists are still long at 180,000 or one in nine of Northern Ireland's population.
But nowadays the minister claims virtually no one waits longer than 12 months and that the books have been balanced. However, he believes the ship is only slowly being turned and thorough reform of healthcare structures as well as the detail of their delivery must continue apace.
Speaking amid an overhaul of management structures - the current direct rule administration is waging war on bureaucracy, duplication and the ballooning number of official bodies and quangos - the minister has clearly quantified his objectives.
"We need to see people treated in their local community as far as is medically possible," he said.
"When they need a hospital bed they should get one as quickly as possible. That is why I am pledging to eliminate trolley waits. Around 140 people per week are lying in trolleys in our hospitals for more than 12 hours. Many of these patients are frail, elderly, vulnerable and in pain, sometimes being cared for in corridors. This situation is intolerable. I don't expect the public to accept it. I am not going to accept it."
He wants a 72-hour time limit for discharge of patients declared fit to go home to end the scourge of bed-blocking.
He also wants nurse-led and community pharmacist involvement to ease the burden on already hard-pressed consultants at the North's key hospitals.
Some 200-300 patients are waiting needlessly in hospital each day to see medical professionals when they are fit to go home.
But putting an end to this requires much more joined-up service provision.
"It will mean many different agencies working together. It will mean intermediate care services established, bridging the gap between hospital and community care.
"It will mean personalised care plans for people, which get away from numerous people making numerous separate assessments on people," says the minister.
"It will mean much more medical prescribing by district nurses and community pharmacists."
Goggins, a former social worker, should know something about the difficulties of inter-agency co-operation in health and personal social services.
Money is a factor, he admits, and a £2.9 billion (€4.2 billion) investment programme over the next 10 years to modernise hospitals as well as primary and community care infrastructure is earmarked.
However, Patricia McKeown from the health service union Unison reacted sceptically to Goggins's plans. She said it was "another soundbyte from another health minister".
"We have had five of those in the last three years," she said.
"I am sorry I am cynical about it, but I think we are about to see very serious problems stacked up for our healthcare system."