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Health service one of main casualties of political crisis

Analysis

By John Simpson

The crisis for devolved Government in Northern Ireland has quickly affected some major services, including the NHS.

An existing business planning crisis is now compounded by inaction because of planning and financial uncertainties.

Waiting times at A&E departments or for outpatient consultations are a daily barometer of inadequate delivery mechanisms.

The winter performance of health and social services should be assessed on more broadly based evidence than the fluctuating A&E crisis events.

When the critics rely solely on A&E headlines, this deflects attention from the much wider spectrum of services ranging from A&E to acute hospital services, primary care services through GPs, mental health facilities, and further to monitor social and medical care provided in patients' own homes or supplemented by residential and nursing care in dedicated units.

Health and social services are both a service and a business. To describe these services as a business is a necessary discipline. A business organisation philosophy, delivering best value for the available budget, should be a welcome feature.

Health Minister Michelle O'Neill has inherited an organisation that attracts criticism either because services are inadequate, waiting lists and waiting time are too long, or because budgets do not match demand. The inherited criticisms are not new. Successive ministers, senior professional staff and politicians have grappled with apparently insoluble problems.

Four years ago, with official support, Northern Ireland's services were assessed in a report authored by social services professional John Compton, entitled Transforming Your Care.

The Compton report was generally uncontroversial and complimented for its analysis, but neglected through a lack of vigorous implementation.

Most recently, the minister has received further advice from a team led by Professor Bengoa. The Bengoa review has been followed by an extended consultation ending on January 20 to test public reaction to a formal statement of organisational criteria to improve the delivery of services.

The current sequence of consultation on improving the organisation of the range of health and social services is slightly contradictory. It is flawed on content and lacks a clear operational plan. Nevertheless, there is no deviation from the general NHS principles that services should be available, usually free to patients at the time of need.

There are continuing exceptions to that principle where some forms of care are subject to personal (or family) means tests, some of which are too restrictive.

The current ministerial consultation asks for public reaction to suggested formal criteria which might influence policy decisions. Put simply, the criteria are:

  • Services should not fall below acceptable levels either as a whole or in particular hospitals.
  • The desirable pathway to access services should be agreed in advance with patient representatives.
  • Services should be provided which meet minimum standards to maintain expertise.
  • Professional staff training plans should ensure adequate numbers are available.
  • Training of junior doctors must be provided to acceptable levels.
  • Alternative 'out of hospital' and 'shared care' models should be part of services.
  • Where alternative 'out of hospital' services can offer better value for money and better outcomes, they should be used both in preventative services and for alternative treatment plans.

These criteria are essentially non-controversial.

Is there any need for debate? Will this consultation give the minister a new decision making agenda?

The minister, or her successor, should already have operational plans to implement the criteria.

The major issue, under-emphasised by both Compton and Bengoa, is the inadequate preparation for domiciliary and residential care using acceptable means tests.

This issue is proving critical in England but is not yet adequately recognised in Northern Ireland.

If the minister wishes to organise a full range of adequate comprehensive health and social services, the current planning and financial arrangements are not fit for purpose.

Waiting list funding and management are critical starting points.

A good business organiser would recognise these deficiencies.

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