Progress report on five-year Elective Care Framework

Date published: 06 July 2023

The Department of Health has today published the third progress report on the implementation of the Elective Care Framework.

Elective Care Framework - Image

Published in June 2021, the Elective Care Framework is a five-year plan with a dual focus on clearing the existing backlog of patients awaiting hospital treatment and closing the gap between capacity and demand. It covers 55 actions to reduce waiting lists and to improve capacity across the elective care system.

The latest update details significant progress in a series of key areas. These include: the establishment of mega clinics for outpatient assessment and pre-operative assessment; the development of day procedure centres and elective overnight stay centres for surgical patients; the launch of NI’s first Rapid Diagnosis Centres; and planned expansion of Post Anaesthetic Care Units (PACU) provision.

The publication of the latest hospital waiting times in May saw some evidence of limited but welcome progress in relation to waiting time targets.

However, due to the current severe budgetary pressures, there are significant uncertainties on the future implementation of the Framework, including the rate at which waiting times will be reduced.

The Framework includes two five-year targets, which were both dependent on sustained funding being committed for this period:

Firstly, by March 2026, no-one should wait more than 52 weeks for a first outpatient appointment and inpatient/day case treatment; or, 26 weeks for a diagnostics appointment. Secondly, by March 2026, the gap between demand and capacity for elective care will have been eradicated.

The recurrent funding required to deliver these targets has not been made available. It is the Department’s assessment, that even if new recurrent investment was provided now, it will not be possible to achieve either objective in the original five-year timescale. The deficit between demand and capacity has been going on for too long and the waiting list backlog has been exacerbated by the impact of Covid.

Notwithstanding the current financial context, dedicated work is ongoing to make positive improvements even in very difficult times.

This includes maximising the available resources and identifying potential areas to deliver more efficient and better services.

Notes to editors: 

1. The newly published progress report on the implementation of the Elective Care Framework details important progress on key initiatives including: 

  • the establishment of mega clinics for outpatient assessment and pre-operative assessment to maximise patient throughput and reduce waits.  Mega clinics are a way of bringing multi-disciplinary teams together to ensure much higher throughput of patients and timely access to clinical assessment. Overall, as of, March 2023 14,693 patients have been seen at mega clinics.
  • the development of day procedure centres and elective overnight stay centres to maximise patient throughout in the most appropriate setting. Much progress has been made on the expansion of the elective care centre model. A regional Day Procedure Centre (DPC) at Lagan Valley Hospital has been operational since 2020 and has treated over 10,000 patients across a range of specialties.  In addition, the Omagh Hospital has been announced as Northern Ireland’s second regional DPC and will see increasing activity in the first half of 2023. The Mater Hospital in Belfast, South West Acute Hospital in Enniskillen and Daisy Hill Hospital in Newry have been announced as elective overnight stay centres, providing a service for patients requiring intermediate complexity surgery, across a range of specialities.
  • Rapid Diagnosis Centres (RDCs) - the first of their kind in Northern Ireland – were launched at Whiteabbey Hospital and Dungannon’s South Tyrone Hospital in December 2022. The clinics are providing a new pathway for patients with vague but worrying symptoms. Over the coming year the sites will expand to accept referrals from GPs across Northern Ireland.  They aim to reduce the time to diagnosis and improve overall patient experience.
  • Post Anaesthetic Care Units (PACUs) - Work is also underway for the phased expansion of 21 new regional PACU beds for elective care. Expanding PACU bed capacity will lead to improved outcomes for patients, with shorter in-patient stay following elective surgery and reduced elective inpatient cancellations due to the lack of ICU/HDU beds. PACUs are operational in Belfast and South-Eastern HSC Trusts and implementation is ongoing in the other Trusts.

2. Underpinning all of these initiatives is the continued development of in-house HSC capacity and investment in staffing.

3. The Elective Care Framework progress report can be read on the Department of Health website.

4. For media enquiries please contact DoH Press Office by email

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6. The Executive Information Service operates an out-of-hours service for media enquiries only between 1800hrs and 0800hrs Monday to Friday and at weekends and public holidays. The Duty Press Officer can be contacted on 028 9037 8110.

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