As a surgeon, Mark Taylor has witnessed the effects long waiting times have on patients.

That is one of the reasons why he agreed to be Northern Ireland’s first regional clinical director for elective care – a post intended to turbocharge efforts to cut these delays.

He took on the role this summer, shortly after Northern Ireland’s health department published its elective care framework, and made it clear from the outset he wouldn’t mince his words. When his appointment was announced, he called hospital waiting lists ‘nothing short of a national shame’ – and that was in the health department’s own press release.

Professor Taylor (pictured above), a consultant liver and pancreatic surgeon at the Mater Hospital in Belfast and a visiting professor at Ulster University, has never shied away from difficult jobs. For example, he was a member of the five-person panel, led by the Spanish public health and management expert Professor Rafael Bengoa, that came up with the Systems not Structures report in 2016, and spent five years as Northern Ireland director of the Royal College of Surgeons of England, stepping down two years ago.

It is his clinical experience that helped persuade him to take on his new post – something he calls his ‘last rodeo’ before retirement.

‘Gallbladder disease is one area I look after as a surgeon, and it can cause a condition called necrotising pancreatitis, which occurs in 15 per cent of cases,’ he explains.

‘The majority of people who get pancreatitis from gallstones are in hospital and they go home two or three days later after a bit of pain relief, rest, fluids, and it is all fine. The 15 per cent who get gallstones necrotising pancreatitis – apart from the fact that there is significant mortality – can spend months in hospital.

‘The longest patient I looked after was in hospital for one year, seven months – he had multiple investigations, multiple interventions, he was in ICU apparently dying on multiple occasions. Yet a 30-minute operation to remove his gallstones would have negated his necrotising pancreatitis. That is as raw as I can make it. The major problem we have with our waiting list is that there are people out there playing Russian roulette with their lives, waiting, and that’s only one small example.’

We are speaking just after the Northern Ireland NHS Confederation conference, in a small side room at the leafy La Mon Hotel on the outskirts of Belfast. It’s been an inspiring – although tiring – day and a half of keynote speakers, panels and workshops, mainly attended by health service management.

The mood has generally been upbeat – health minister Mike Nesbitt spoke about the great efforts being made to cut the numbers of people waiting more than four years for treatment, and first minister Michelle O’Neill and deputy Emma Little-Pengelly also expressed their commitment to health as a priority.

However, the fact remains that waiting lists in Northern Ireland remain the worst – by a considerable way – in the UK and will doubtless take more than the £215m earmarked for elective-care initiatives in the current financial year to solve that.

Prof Taylor expresses optimism, however – although he freely admits many of his colleagues thought he was crazy to take on the role.

‘I’m a surgeon, so I’m going to be really blunt,’ he says. ‘I wouldn’t have taken the job when the minister asked me if it hadn’t been for the fact that we had Mike Farrar as permanent secretary and Mike Nesbitt as the minister coming near to the end of his political career.

‘I’ve been involved with the Bengoa report, and we’ve been trying to bring about a change to the health service for a number of years. This conference has really highlighted one thing to me, and that is that the planets are aligning. That’s not taking away the massive burning platform we have, with the financial constraints, the health inequalities, the rising demand, and the innovations – as a liver and kidney surgeon, the things I was doing 20 years ago seem historic, with modern medicine, for example, we have tablets and injections doing the same as what required major bariatric surgery.

‘So, the health service never stands still but I don’t think there has ever been a more optimistic way forward.’

Similar sentiments have been expressed before. Since devolution, there have been many reports and initiatives aimed at transforming Northern Ireland’s beleaguered health and social care system, including one led by former England CMO Sir Liam Donaldson. None has so far been successfully implemented.

Prof Taylor, however, comes out fighting on behalf of the Bengoa report, calling it ‘laziness’ to say it has been gathering dust since publication in 2016. Apart from anything else, he reckons that Lord Darzi’s Ten Year Health Plan for England owes a great deal to its contents. He also stresses many of the problems facing the health service in Northern Ireland are experienced by health systems worldwide.

However, he accepts there are additional pressures which have made transformation harder.

‘Political instability has not been a friend to the progress needed to bring around a sustainable health and social care system,’ he says carefully, presumably referring to the fact devolved government was suspended from 2017-2020, then from 2022-2024.

He insists he is already seeing a difference on the ground, however. ‘One word that came out of Bengoa was “silos”, and I can tell you that these silos are not the same silos as they once were.’

He credits Mike Farrar – who worked with health organisations in Northern Ireland in a consultancy role before taking on the permanent secretary job – for breaking down boundaries between Northern Ireland’s health and social care trusts and creating a regional sense of everyone working together for the greater good, rather than one driven by rivalry and competitiveness.

‘These boundaries have gone, and Mike has flattened the hierarchy, and that is extremely important,’ he adds.

Prof Taylor says he has had a good response from people working in the health and social care service, including from the medical workforce. It helps, he says, that he is still one of them. ‘They don’t think I’ve jumped sides because I’m still practising,’ he says with a smile. ‘That’s really important.’

That’s not to say it was an easy choice, or is always an easy job.

‘I’ve asked myself the question for the last six weeks – why did I do this? There are several reasons. I actually believe the planets are aligning, I think there’s momentum. The fact that the deputy first minister has said that every one of the ministers in the executive has to be a minister for health, the fact that they [the executive] made waiting lists part of the programme for government. Waiting lists are a symptom of a challenged health service, but if we can rectify it, it influences unscheduled care, primary care, neighbourhood health, population health, and being proactive – prevention rather than cure.’

It's a similar motivation that drove him to take on his previous role as regional director for Northern Ireland for the Royal College of Surgeons of England. ‘I said then that I wanted to use all the mechanisms at my disposal to get Bengoa over the line.

‘This is my last rodeo, and I’ll go into partial retirement and leave my career as I started it, as a practising surgeon with a research interest. I know I could be away making lots of money in different parts and blah blah blah. But growing up in Strathfoyle – my dad was an electrician, my mother was a hospital secretary but didn’t work after the three children came along – we didn’t have the opportunity to seek private healthcare and we didn’t have the waiting list back then that we now have.

‘So, there’s an obligation – whilst the health and care system has to change, we still must have a system that allows those at their most vulnerable, at their most challenged, to be able to get care without finances being important.’

He clearly believes there is a huge opportunity for Northern Ireland to demonstrate how to create a health and care system that stands up to the challenges of today and tomorrow.

‘We’re a small population, and that has its advantages and disadvantages – it can be challenging to suggest a different way of doing things. But it might sound corny to say it, but Rafael Bengoa said that if we can’t pull off reform of health and social care in a 1.9 million-population small, little part, what hope has the rest of Europe and the rest of the world?’