Mr. Liam Woods:

On the practical aspects, the Deputy asked about a potential way forward. Unfortunately, we lost approximately 13,000 outpatient appointments on each of the three strike days. We must work this back. That is the most recent significant negative shift associated with that. When we consider the specialties, the GPs and the specialist consultants in the ENT unit in Letterkenny, for example, have agreed a protocol of care, as Mr. Reid stated. They have undertaken an exercise to clear backlogs in waiting lists in order to guarantee priority access for urgent cases and to support that with diagnostics in the hospital. This is part of what is needed. This pilot worked and I believe the GP contract will enable that to work further. The orthopaedic programme has identified that musculoskeletal physiotherapists can remove 85% of the people from the waiting lists now. We are investing in that because it is a critical resource and a community investment. Those physiotherapists really need to be out in a community space. We are aware that there are some 4,000 hip fractures per year and a lot of work has happened to see how falls can be avoided. The outcome of a hip fracture is very difficult for individuals and we are looking at strategies around falls prevention, which will avoid the original need. This is very important.

A final example is ophthalmology. We are now looking at working with clinical leads and some of the hospitals, including the Royal Victoria Hospital in Belfast, to provide ophthalmology services at primary care centres. The crossover is important in order to begin to look at this as a whole system challenge and not an outpatient list sitting there in isolation. We are going to have to address it specialty by specialty. It is also a reality that the referral rate is higher than the treatment rate. There is no question that we must change this.