Belfast Telegraph

Cut number of trusts to save Northern Ireland's embattled health service: expert

As funding crisis looms, expert claims that a radical plan of action could transform stretched NHS

By Claire Williamson

Reducing the number of health trusts in Northern Ireland could provide a way of slashing management costs, a leading expert has claimed.

This week, the Belfast Telegraph reported that there was 42% more non-clinical staff in Northern Ireland relative to our population than in England.

It was also reported that an extra £75 per head was being spent on health here compared to Britain, according to a National Audit Office report.

Up until 2007, we had 19 trusts that were then streamlined into the current five – which are Belfast, Northern, South Eastern, Southern and Western – under the wide-reaching Review of Public Administration.

Andy McKeon, a senior policy fellow at the Nuffield Trust – an authoritative and independent source of evidence-based research and policy analysis for improving healthcare standards in the UK – said that if savings on management could be made, that strategy was a "obviously sensible thing" to pursue.

He added: "There is a point about whether five organisations, health boards or trusts within Northern Ireland is really the right number.

"And the more organisations you have, the more management you have to have."

Mr McKeon said it was not for him to say if there were too many trusts here.

But he admitted: "There are issues as to whether some restructuring might be possible."

Mr McKeon also claimed that, in England, "significant dents in management costs" had been made by cutting organisations' commissioning staff. While he did not believe Northern Ireland was was falling behind, he said the health service – in common with all organisations – should "regulate and see whether you can do better".

"Overall, looking at making savings, management is always an obvious potential source," Mr McKeon added. "(But) you can't eradicate management – that would really be a false economy.

"England has recently had a big drive by a combination of having fewer organisations and just being tighter on costs.

"If you can make savings on management realistic, that's obviously a sensible thing to do. How much they are, I wouldn't know."

But Mr McKeon agreed that reducing the number of trusts "might be one way of doing it".

His comments came as the director of the Royal College of Nursing in Northern Ireland said she did not believe that money was being invested in the right places. Director Janice Smyth also said that nursing services were suffering as a result.

"If you look at health visiting in Northern Ireland, we have got many cases of young children and families who are not getting the support they need and who don't have health visitors," she said

"We agree they should get a number of core visits. This year, we are training 61 health visitors and our district nursing workforce has decreased about 12%.

"There is absolutely no doubt we are struggling to deliver services to patients.

"We are going to start to look at other areas, looking our emergency department currently, and what nurse staffing we need in those.

"When the Regulations and Quality Improvement Authority went in to the emergency department in the Royal Victoria Hospital, they determined that they were 15 nurses short in that department and 25 in the medical assessment unit.

"That is 40 nurses in a small area of practice.

"There is no doubt that there is plenty of evidence that we do not have enough nurses to deliver the care to patients that we need."

She added: "I think we are not investing our money in the right places."

The Department of Health has cautioned against comparisons with others parts of the UK.

The department has also said that it has cut administration staff in the past 12 months.

A spokesman said said staffing levels in the health sector were kept under review to improve efficiency and effectiveness.

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