Belfast Telegraph

Monday 22 September 2014

NHS overhaul limbo ‘crazy’ says chemist

The resignation of the man charged with radically reforming Northern Ireland's Health Service was the latest event to throw well-advanced plans into chaos. Health Correspondent Claire Regan hears the concerns of one professional caught up in the uncertainty

Laurence O'Kane: "RPA is supposed to be about saving money to put back into front line services. It's obvious when you look at what has happened in trust management teams that no savings will be made"

Within hours of confirmation that David Sissling was leaving his post as chief executive of the new Health and Social Care Authority, his departure was branded "a casualty of McGimpsey inaction" by the DUP.

While many expressed regret that the highly-regarded figure was standing down as chief executive of the fledgling health authority, no-one was surprised Mr Sissling had decided to leave given the doubt recently cast on the future of his role here.

Mr Sissling's arrival last August was seen as a big coup for plans to completely overhaul how Northern Ireland's Health Service is run under the Review of Public Administration.

The HSCA was set up under the RPA to come into power next April, with Mr Sissling at the helm, when it would replace the current four health boards as part of wider efforts to streamline services and save cash.

Health was the first government sector to begin RPA changes back in April when our 18 Health Trusts merged into five.

Plans for the new overarching authority were at an advanced stage when Mr McGimpsey made a surprise decision during the summer to put them on ice.

The future of the super authority was thrown into doubt when the minister ruled there would be no further changes until at least April 2009 — if they are given the go ahead at all. He said he wanted more time to examine all possibilities before pushing ahead with further changes.

The delay also applies to seven Local Commissioning Groups set up in shadow form to also come into power in April. They were set up to replace the role of the boards in commissioning health and social care services in their respective areas.

Draperstown pharmacist Laurence O'Kane is one of 62 people — including GPs, dentists, pharmacists, optometrists and community representatives — who were appointed to join board staff on the LCGs by the Department of Health. He is a member of the North West LCG and works for it two days per month.

He branded the current situation of uncertainty as "crazy" and spoke of his frustration over the limbo.

"At the minute everybody is really frustrated. We have nothing to do on the LCGs other than build up as much information as we can. But we can't do anything with that information as we are not empowered to make any de cisions until at the earliest April 2009, if ever at all," he said.

"We are going to basically sit here twiddling our thumbs and get quite well paid for it."

The Department of Health confirmed to the Belfast Telegraph that LCG members get paid between £157 to £207 per session, plus expenses. Expenses can include locum coverage for GPs, for example, and travel expenses. Members get paid for two days' work per month, while LCG chairs work six days.

DUP health spokeswoman Iris Robinson is among the voices raising concerns about the RPA stalling — and the money being spent on what was supposed to be a cost-cutting measure. She recently asked the Health Min ister how much has been spent to date on running the LCGs to which he replied £285,180.

When speaking about her disappointment over Mr Sissling's departure, the MP also spoke of her frustration that LCGs "are also being denied the opportunity to get on with their work".

It's an annoyance shared by Mr O'Kane. The south Derry chemist said: "All the primary care professionals and community representatives were up for the challenge, putting themselves through a rigorous appointment process, but now I can see my colleagues' sheer frustration that our knowledge is not being utilised in the commissioning of services.

"We are all keen to get working properly but there's no prospect of that now because everything's been stalled and we still don't know what's happening. It's a crazy situation."

The pharmacist said he had sympathy with the minister "in trying to get to grips with such a shambles".

"But at the same time, he's trying to change his horse mid-stream and it's left a lot of people in limbo," he added.

"It's very unfair on the board staff and employees. These people have mortgages and ordinary lives to lead and the uncertainty is most unfair. They need to know what's happening and quickly."

Mr O'Kane also criticised the money wasted on a process that was designed to save cash.

"RPA is supposed to be about saving money to put back into front line services," he said. "It's obvious when you look at what has happened in the trust management teams, in their restructuring and given current employment legislation, that no savings will be made.

"It's fair to say, even at this early stage, that no money will be saved in the restructuring. The anticipated savings are unachievable and grossly misleading."

Mr O'Kane also highlighted concerns that the boards' current capacity to operate has been "greatly reduced" because they have lost senior staff to the shadow structures.

"Therefore the monitoring of trusts and the delivery of service may not be as rigorous as it should be," he said. "And this is at a time when the larger trusts are forming and close monitoring of all services delivered to all parts of Northern Ireland by these new larger organisations must be very carefully scrutinised."

The pharmacist said he could not envisage the LCGs going ahead in their current form, given that they were designed to reflect the seven new super councils' due to replace the current 26 councils, also under RPA.

"As there is no final decision on the actual number of councils then guesswork comes into play as to the correct number of LCGs to cover the region," he added.

"My own gut feeling is that the minister will favour five LCGs to ensure at least co-terminosity with the new trusts, with political representatives added to the management boards.

"So, in other words, the number of LCGs will change, the geographical areas they cover will change and the membership will change. How can we continue in such a vacuum?

"It's also worth reflecting on where structures were when this process began with one department and four boards. Are we going full circle while in the midst of this all we have created is confusion, uncertainty, spec ulation, genuine concern and increased stress for all staff with no clear vision or guidance — and worst of all no improvements in service delivery for our patients? I can only say again, it's crazy."

A Department of Health spokeswoman outlined the work it expects the LCGs to carry out "during the transition stage".

"LCGs are working closely with commissioners in health boards to inform and influence planning and commissioning and are working with boards to contribute to developing care plans and priorities," she said.

"Particular emphasis has been placed on bringing together the added knowledge that comes from local primary care professionals and their understanding of service gaps and how this affects the patient, with the ex pertise of board care professionals, planning and finance staff to achieve a comprehensive view of health and well-being that puts the patient or client firmly at the centre."

She also confirmed that LCG chairs attend board meetings and are represented on meetings between commissioners and trusts.

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