Belfast Telegraph

Friday 25 July 2014

Health service put to biggest test in its fight to modernise

The Review of Public Administration of the health sector has been in place for over 100 days. Lisa Smyth examines whether the biggest overhaul of the health service in over five decades can be judged a success

The Review of Public Administration (RPA) was the first major examination in over 30 years of how public services in Northern Ireland are organised and delivered.



Formally launched in June 2002, the Executive decided to review Northern Ireland’s system of public administration with a view to putting in place modern, accountable and effective arrangements for public service delivery, including the likes of local government authorities, education and library boards and, of course, the health service.

And while the new Education and Skills Authority and creation of new councils have faced delay and some controversy, the Department of Health has led the way in the implementation of RPA by pushing through a dramatic revamp of health provision in Northern Ireland which was finally completed on April 1.

At the time of the launch of the second and final stage of RPA, which included the establishment of the Public Health Agency and the merging of the four health boards, Health Minister Michael McGimpsey said he believed the new structure will become a best practice model across the UK.

Indeed, Conservative leader David Cameron has already expressed his intention to cut back on the number of quangos, and with streamlining and efficiency the buzz-words of the day in both the public and private sectors, a similar overhaul of the health service could be on its way to the rest of the UK.

Unsurprisingly, Mr McGimpsey is pleased with the results of RPA so far: “There is no doubt that the first 100 days of the new organisations have been extremely busy.

“I have been extremely impressed and am very grateful for the commitment, enthusiasm and understanding of all staff throughout this period. It has been no easy task but they have pulled together as a team. I know it will take a bit more time for the organisations to fully bed in, but they have already shown their worth.

“In particular, at the time I launched the new organisations on April 1 we weren’t to know that swine flu was just around the corner.

“The dedicated focus of the Public Health Agency on improving and protecting our health has been vital and demonstrates the clear need for such an organisation. The new organisations are still relatively young but as we move forward we will continue to see the valuable contribution they will make in driving up the performance of health and social care.”

But, 100 days after the biggest transformation of the health service since it was founded over 60 years ago, what is the verdict of frontline staff?

As the minister said, the implementation of RPA is still at an early stage and has been hindered by the swine flu pandemic — but at the same time the spread of the disease across the globe has certainly put the newly-formed Public Health Agency to the test.

Within weeks of its launch the fledgling body tasked with improving the health and wellbeing of everyone in Northern Ireland, has co-ordinated and managed the Northern Ireland response to what could be regarded as the biggest threat to public health seen in recent years.

And while no-one can doubt that it has handled the constantly evolving situation with professionalism and efficiency, Dr Brian Patterson, chair of BMA (NI) Council, said he has yet to see many of the benefits of RPA as promised by the Government.

“The only thing I have noticed is a lot of people struggling to come to terms with their identity,” he said.

“Certainly, from our point of view, we were looking for a bit of consistency across the province but to date it hasn’t happened. There are still people doing things in the old four-board set-up.

“We are still at a stage where names are going on doors, teams are being set up and they are working out what needs to be done. It is hard to judge them just yet but I’m hoping by Christmas we will start to see a difference.”

The Royal College of Nursing in Northern Ireland is also holding off on a verdict although having lobbied hard to take part in the planning procedure for RPA, the organisation remains confident it will benefit staff and patients.

However, the health service in Northern Ireland is being forced to meet greater public expectations with a shrinking budget, as well as the very real threat of an explosion in swine flu cases over the winter months — without the £50 million requested by the Health Minister to help deal with the pandemic.

Now, more than ever, it is imperative that the structures put in place by Mr McGimpsey succeed in delivering the efficiencies and improvements so desperately needed for healthcare in Northern Ireland.

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