Serious unfinished business awaits our new Health Minister
In the last five years the Northern Ireland systems of health and social care have been dissected and analysed by reports from Donaldson, Compton, Bengoa and most recently (then) Health Minister Michelle O'Neill.
If well documented reports led to effective improvements, by now we would have world-class health and social services.
The latest well informed critical commentary was published last week by the Northern Ireland Audit Offices offering its assessment of the inadequate delivery of the Compton report, which set out how health and social services might Transform Your Care, now described as TYC.
It described the impact of TYC has "much more limited than expected".
This Audit Office report was prepared against a background of crisis management in acute hospitals, particularly in the provision of A&E services.
The commentary on the partial failures in implementing TYC takes very little account of the continuing increases in waiting times for hospital appointments or in A&E.
The argument is implicitly that, under TYC, more of the health services would be delivered at home - not in hospital -linked to an improved ability for people to self-care and/or access to support in their community.
The tension between orderly restructuring of services and the immediate management of difficult increases in demand using the present structures has become a complicating factor.
This report has been written either without adequate regard to the wider current health service environment or at too early a stage in the transformation changes which are not yet complete. TYC is recognised to have been poorly planned, too ambitious for a four-year delivery timescale, and now needs to be re-enforced by a discrete delivery plan.
If TYC had been successful, the delivery of primary care services, centred on GPs and domestic and community services, would have enjoyed a larger investment programme to build on the newly formed Integrated Care Partnerships and a manpower development programme for people delivering community based services.
An irony of the ambitions of TYC is that at the same time as existing primary care services are perceived to be under strain, a fully implemented and functioning TYC would expect to allow more of the resources for the hospital services to be switched to expand home care services.
The critical working assumptions are that Northern Ireland can have an improved series of health and social services with a reduced number of beds in acute hospitals and a reduction in the provision of residential places for older or infirm people.
If this organisational change is possible then, first, the core message needs to be better understood.
And, second, the range of community-based services, largely provided in the homes of patients, needs to be increased.
The TYC prescription relied on shifting resources from hospitals into a radically changed primary care environment.
The proverbial cart and horse were the wrong way round. The existing serious pressure on both GPs and social care services was not fully appreciated.
One of the unintended consequences of this flaw in the sequential development has been a worsening of the workload pressure on GPs.
TYC set out the correct signposts: it has not delivered in following them up. TYC did not fully recognise that its prescription was operationally inadequately specified.
Better resource planning should be developed and TYC should be explicitly seen as a 10-year strategy; not a five-year process.
Only with the implementation of the delivery ideas outlined in Mrs O'Neill's paper can there be a reasonable test of the potential reforms of TYC.
When a new minister is appointed there is important unfinished business to complete.