Northern Ireland's Healthcare System Is Crumbling and Nobody Seems to Care

“All the nurses will tell you that sometimes they don't even get the chance to go to the loo. They don't even get the chance to have a break or to have a drop of water.”

Nurse Mohammed Samaana spent a cold day in January on the picket line outside Belfast City Hospital, the largest general hospital in the UK. Between chatting with supporters and passing on tins of sweets, he described the conditions for nurses in Northern Ireland, where one in eight positions are unfilled and staff are under constant pressure.

“It’s not safe for patients to have such low levels of staffing,” he said. “It’s dangerous for the patients and dangerous for the staff.”

Mohammed joined 9,000 of his union colleagues across Northern Ireland in strike action over December and January. It was the first time the Royal College of Nurses (RCN), the largest nurses union, has taken strike action anywhere in the UK in their 103-year history. Mohammed believes it was necessary – nurses here have been pushed to the brink.

“You go home exhausted,” he said. “You don’t have the energy to do anything else, really. So that's impacting people outside work as well.”

Experts have warned that the health service here is “at point of collapse”, and that the lack of investment and longterm strategy has left services at “breaking point”. Northern Ireland has the longest waiting times in the UK. More than 300,000 people – or one in six of the total population – are waiting to see a consultant.

The number of people waiting over a year for their first consultant-led outpatient appointment (including urgently needed treatment) was almost 100 times greater than in England, despite England’s population being 30 times bigger. In the worst affected areas, people are waiting up to four years for the first surgery appointment, according to the Royal College of Surgeons.

“It just throws your life into chaos,'' said Gillian Magnall, describing her encounter with health services when she needed surgery for a hip replacement. Being younger than you normally would be for such an operation, she says that GPs wouldn’t listen to her reports of pain. “I kept getting fobbed off.”

Six months later, she found a doctor who took her seriously and ordered an X-ray. He made a referral straight away. Gillian waited another eight months for a pre-op assessment appointment, and then three months more for another appointment.

“I had told everybody in work, ‘that's me off for ten weeks’,” Gillian said, as she organised her life ahead of the surgery. “But the night before my operation, I got a message to say it was cancelled.”

Her options: go back on the waiting list only to be bumped off again months later or go on the cancellation list and undergo surgery at short notice. “So I did that because I thought, ‘Well you know that's the only way to get it done.’”

She was discharged the day after her operation and describes the aftercare as minimal to nonexistent. “I was on morphine, I had nobody at home…” A nurse came a few days later to take her staples out. It wasn’t until six months later that she got called in to see a consultant. The appointment lasted five minutes.

Gillian knows she had it better than others; the waiting times have increased since then, and many employers would not be considerate if you have to take ten weeks off with only a couple of day’s notice.

In the run-up to the second set of strike days, the heads of the Northern Irish health trusts warned that they would cause ‘significant disruption’ and could push the health system ‘beyond tipping point’. In Belfast alone, over 1,300 appointments or treatments were cancelled on a single one strike day.

However, as Iona McCormack, a nurse practitioner, points out, such disruption is also a daily occurrence. There were almost 17,4000 appointments cancelled in 2018/19 – or 700 every working day – when there was no strike action taken by nurses.

“If you look at our waiting lists as well, it’s quite horrific,” Iona told me. “If you look at all the patients, in pain, waiting on hip replacements, knee replacements, and the length of time they are waiting to get those procedures done, it’s just… crazy,” she said.

This is something that affects her personally. Like many others in nursing, she uses the health services herself. “I mean, I’ve been sitting on a waiting list now for close to a year, with no sign of any hope of getting the surgery that I need done actually carried out.”

Part of the problem is difficulties in the recruitment and retention of nurses. Nurse staffing levels are a major concern, with thousands of posts unfilled. The union says this level of staffing is unsafe: patients are not getting the care they deserve and nurses are burning themselves out.

Interlinked to this is the ongoing issue of pay disparity. Nurses here are on lower wages than their colleagues in the rest of the UK, with a starting nurse in Northern Ireland earning up to £2,000 less.

This creates difficulties in retaining current staff and recruiting new ones. Staff here are moving to Britain, out of the UK altogether, or are retiring early. Until 2014, healthcare workers across the UK were paid equally. This was ended by the then-Northern Irish Health Minister and nurses here saw their wages stagnate.

The problems have only become more acute over the past three years. Following a still unresolved financial scandal, the devolved government collapsed. Without a health minister, decisions on health policy or pay increases were left untaken.

During the strike, political leaders and party health spokespeople released statements in support of the nurses, while members of different parties came down to their local pickets.

“I suppose it’s very nice of them to support us and to make an appearance - but I guess that's all it really is, it’s for appearance’s sake,” said Edel Coulter, a staff nurse in cancer services who joined Mohammed on the picket line. “Nurses are losing a day’s pay to be here – politicians in Northern Ireland have been paid for three years while they’ve been effectively on strike. It’s just ridiculous.

“It’s not about nurses getting for themselves, it’s about nurses getting something for all of the people in Northern Ireland,” she said. “The people of Northern Ireland are behind us.”

With the constant sounds of passing cars blaring their horns, and local businesses delivering hot drinks and food to the picket line, that support rung loud and clear.

And it seems it has been heard.

Three years to the day that Stormont collapsed, a new deal was announced by the British and Irish governments. The parties shortly agreed to return to power-sharing.

The strike’s influence was clear. Resolving the healthcare crisis, addressing waiting times and issues of pay parity, where literally top of the agenda for the new government. Negotiations with the RCN and other healthcare unions are ongoing, but the strikes have now been suspended.

But it may be too late for some. An investigation by the Belfast Telegraph showed that more than 22,000 people have died while waiting for treatment since 2014, with some on the waiting list for up to five years. The number of people waiting more than 12 hours in A&E doubled last year despite an overall drop in people using emergency services.

Nor is a return to power-sharing is a cure-all. Many of the problems predate the collapse of Stormont three years ago. Pay parity, a key issue in the nurses strike, was ended in 2014 and maintained by subsequent DUP and Sinn Féin health ministers.

The country is also dealing with the effects of ten years of Conservative-led austerity on public services and, given its reliance on EU funding, will face new difficulties in the post-Brexit future. These problems are far from settled. It might not be long till Mohammed, Edel and Iona might find themselves on the picket line yet again.

@lukejbutterly