Belfast Telegraph

Northern Ireland health and social care is on the critical list

Analysis

By John Simpson

Northern Ireland’s biggest and most complex personal services business is in urgent financial and organisational need. Health and social care is currently failing in critical ways to meet the expectations of people who are in different queues on waiting lists or waiting for a domestic care plan.

There is a long litany of past efforts to fix the system with documented targets and aspirational goals. Most recently, these were evidenced in the Compton report on Transforming Your Care followed in 2016 by the report from Professor Bengoa.

Bengoa delivered a competent analysis. However, it stopped short of offering an operational plan. Faced with useful advice from Bengoa, alongside the emerging and increasing evidence of inadequate capacity to provide acute services, Health Minister Michelle O’Neill has published a detailed 42-page plan to transform and reform the provision of elective care services, centred on waiting times for treatment, care and diagnostics.

Now that the election is over (although there is still no functioning devolved Government), the challenge for the politicians and the business managers, including the clinical and professional managers, is to deliver a workable implementation plan for improved services, managed with leadership and business-like efficiency. Organisationally, this is Northern Ireland’s biggest, most diverse, personal service business provider.

The recent ministerial elective care plan offers a much more secure starting point to ease the current crisis than any of the earlier statements. That said, it merits further development into an accountable delivery process.

It also merits the addition of proposals to assess and deliver an appropriate caring framework for care in the community (including residential care) for older people with a need for non-acute support.

Even within the narrower context of the minister’s plan, it has attracted attention with an inappropriate emphasis on only part of the delivery process. Publicity has focused on a first stage commitment of £31.2m extra spending in 2017-18 to fund actions to clear the backlog of patients waiting more than 52 weeks for a first outpatient appointment or for inpatient or day case treatment.

The allocation of a one-off £31.2m falls well short of an acceptance of the need to adjust the total health budget. Neither the minister nor her officials have yet outlined the scale of their financial bid for the 2017-18 recurrent budget. The elective care plan specifies six delivery strands but, regrettably, has not published the resources and costs of each even though this must have been known in building up the components of the £31.2m.

How much of the £31.2m will be directly allocated to waiting lists? The plan is reticent in revealing how much extra effort will (or could) be bought from the independent sector hospitals and clinics. In the current crisis, prejudice against using other local capacity seems unnecessary.

Three of the six delivery strands have only modest financial implications. These include one where patients are better enabled to self-manage their own long-term conditions. Also, proposals to improve access between primary and secondary care as well as proposals for some reform and modernisation of secondary care services seem more like common sense than an extra cost.

The other two proposals do have more discrete funding implications.

The capacity and capability of primary care is to be expanded and enhanced. That points to increased staffing and new specialisms: where and when? Operational details are awaited.

The most conspicuous additional services are to come from the creation of a small number of regional elective care and treatment centres. These would keep many with less life threatening ailments away from hospital visits and provide non-complex routine surgery.

The need now is for an early commitment and quantification of funding for the implementation of these ideas.

Simultaneously, an agreed increase in the overall recurrent budget is required.

The minister needs to finish the job. The annual budget needs much more than £31m.

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