To ask the Minister of Health to detail (i) the steps being taken to reduce waiting lists for children’s outpatient appointments, particularly in relation to the recommendations from the Royal College of Paediatrics and Children’s Health; (ii) the reasons behind the 172.6 per cent increase in these lists from June 2016 to June 2023; and (iii) his assessment of the long-term risks to a child’s future mental and physical health if conditions are not treated as a child, relative to those of an adult.

The issue of children on prolonged outpatient waiting lists is something that is of high importance to me. Unfortunately, longer waiting lists are something which has been experienced by paediatric and adult services regularly in Northern Ireland. The RCPCH “Worried and Waiting” Report highlights the key issues facing the service but also means to address same. Many of these recommendations also reflect the key priorities of my department.

the steps being taken to reduce waiting lists for children’s outpatient appointments, particularly in relation to the recommendations from the Royal College of Paediatrics and Children’s Health

My department published the Paediatric Palliative and End of Life Care Strategy and the Strategy for Paediatric Healthcare Services in Hospitals and in the Community in 2016. Both strategies were completed after considerable consultation with all relevant stakeholders across the sector in NI and beyond to ensure they were as comprehensive as possible;

In each strategy there are 23 ambitious objectives that cover a wide range of issues: -

Within paediatric palliative care, from diagnosis of a palliative or life limited condition through to bereavement support for families of those children who have passed away;

Within Hospital Care and Community – from issues in community/primary care, urgent and emergency care, paediatric surgery to the need for networked approaches and accurate data to better manage the needs of children and young people in NI;

The strategies were introduced in part to introduce a new way of working in children’s health care services to meet the demands of a system in the 21st century with increasing demands upon the system and advancements in how conditions are now treated. These strategies offer the means to change how our healthcare services for children and young people are delivered and ultimately improve waiting list demands.

the reasons behind the 172.6 per cent increase in these lists from June 2016 to June 2023;

Whilst both strategies were published in 2016 additional funding to help implement the objectives were not available until 2019, and of course the funding provided was only to start to implement the strategy, more funding is required to fully implement the strategy. From this point the system worked collectively to find means to implement systemic change on how services are delivered for children and young people which would have had also had positive implications on waiting lists.

However, with the arrival of the COVID-19 pandemic in 2020 this had a huge impact on children and young people across NI. Whilst the pandemic didn’t have serious clinical implications for the vast majority of children and young people they were impacted by many of the indirect implications of the pandemic. This included access to school and many of the societal things that children need to thrive.

During the period many children’s health care services were suspended and only the most urgent/emergency clinics continued. Clinicians identified innovative ways to manage the lists, for example using virtual platforms, etc. but undoubtedly this period was a major factor in the huge increase on waiting lists both in terms of new presentations as well as those already on lists.

Since 2021 the Trusts have worked to try and alleviate some of the pressures faced by the service. Regional workshops on community paediatrics and paediatric surgery were held to identify means to improve the services provided for children and young people and identify actions to address these needs.

Some paediatric surgery lists are now being carried out in District General Hospitals across NI and discussions around regional waiting lists have been held for some conditions and the DOH “Getting it Right First Time” project will address areas such as paediatric orthopaedic surgery.

Consultation was also held across the system throughout 2021 on lessons from the pandemic as well as the key issues facing the service and the issues facing children and young people and it was agreed that a system wide change in how services could be delivered was needed.

This has resulted in the agreement that a Child Health Partnership Programme Board be convened that includes strategic leadership across the HSC. This group, if given the necessary support and scope required could offer the means to make a systemic change to how children’s and young people’s health services are delivered in NI, thus ultimately improving outcomes for children and young people. However, funding constraints may limit what can be achieved here.

his assessment of the long-term risks to a child’s future mental and physical health if conditions are not treated as a child, relative to those of an adult.

It is known that a prolonged period on a waiting list can have lasting impacts on a child. This may include both physical issues, such as prolonged pain and discomfort through to the potential for lasting physical issues.

Prolonged periods on a waiting list can also impact psychologically, this is worrying for the child and family, and will also affect societal issues as a child may not be able to fully engage in their normal activities due to a health issue. It is therefore crucial we find a means to address this.

The RCPCH “Worried and Waiting” report highlights the issues facing children and young people and builds on a similar report “More than A Number” by the NI Children’s Commissioner Office in 2021.

However, I hope that with the necessary support over the coming months we can introduce the necessary systemic changes required within the service to ensure that we can begin the process to improve health outcomes for children and young people across NI. The will be challenging with the current funding constraints.