Health changes require bravery
Northern Ireland's health service is middle of the road, neither better nor worse than any other part of the UK, but it has the potential to be world class. That is the conclusion of Sir Liam Donaldson, who has reviewed service provision here, but he poses us - politicians and public alike - a very serious question: are we prepared to make the changes required to transform healthcare.
His headline grabbing proposal is to reduce the number of acute hospitals from 10 to four, but that will require great courage from our political leaders as closures or downgrading of services in hospitals always inflames public opinion.
Certainly, our largely rural geography and our higher morbidity do mitigate against wholesale closures, but we must also pay heed to Sir Liam's warning that patient care in some parts of the province is below the standard required and may impact on patient safety.
We have seen from the reconfiguration of cancer services that took place in the late 1990s that the provision of centres of excellence can greatly improve patient outcomes as researchers and clinicians work more closely together.
Sir Liam's vision for acute care is somewhat similar in that there would be fewer, but better resourced, acute centres with other facilities being provided in the wider community.
Indeed, he agrees the Transforming Your Care programme that has begun is the right way to go to improve healthcare here, but accepts that its implementation has been far too slow. It is unfortunate that the programme has coincided with a period of relative austerity, but the shortage of funds is another imperative to get the most effective and efficient health service possible.
Northern Ireland spends more per capita on healthcare than other regions of the UK and, even allowing for greater morbidity, it does not get full value for its money. That is due to structural and systems deficiencies in the health service and politicians must take hard decisions in the future. The bottom line is that it is not the number of health facilities that are in place, but the quality of care that is delivered in them.
Sir Liam wants politicians to sign up to new ideas even before they know what they are. That will not happen. But all of us must be prepared to countenance change if we are to get the health service we want. Doing nothing or opposing rational change is not an option.