Health service reform will improve both patient care and morale among staff
Overhaul of system about creating world-class hospitals, not saving money, says consultant Mark Taylor
Many authorities and reports have highlighted the unsustainable nature of the current status-quo of our Health and Social Care Service. Almost daily, we hear reports of targets missed, waiting lists growing and difficulty accessing appropriate care.
As a doctor working at the 'coal face', I see these problems too, but I also see the great successes, the innovation, the care our staff provide and the positive feedback from patients. Our patients demand and deserve the very best care, wherever they live in Northern Ireland.
But with an ageing population, the increasing use of technology and expensive therapies, the current 'reactive' model of health and social care is no longer fit for purpose. There are numerous health care systems in the world facing similar pressures and indeed undertaking similar reforms.
Over the last 10 months I have had the great privilege of meeting numerous health service colleagues, community and voluntary groups and, most importantly, patient groups.
Gaps in workforce rotas, increased demoralisation of staff in all aspects of care, the burden placed on voluntary carers and the increasing problems of unscheduled care are recurring themes.
The message has been that we need an open and honest discussion about the need for change in our current 'failing' model of health and social care, with collective political leadership and without political point-scoring.
The remit of the panel, under the leadership and expertise of Prof Rafael Bengoa, was to develop a set of principles to underpin reconfiguration of health and social care and to develop a 'clinically-informed' model for the future to ensure a world class service for everyone in Northern Ireland.
Many of our peers in the health and social care community demanded that there should be no more "reviews" but action instead. This report builds on the excellent work of the 'Transforming your Care' process and from evidence-based literature from around the world.
Our reforms are built around the Institute of Healthcare Improvement (IHI) Triple Aim framework, characterised by simultaneous focus on three objectives:
- improving the patient experience of care (including quality and satisfaction);
- improving the health of the whole population;
- and achieving better value, by reducing the per capita cost of healthcare.
Given the feedback we received, we believed that any strategy would not work if we did not pay attention to the people who deliver the services on the ground. Therefore, the panel recommended adding a fourth dimension, based on improving the work life of those who deliver the care.
Sir Liam Donaldson stated in 'The right time, the right place': "Proposals to close local hospitals tend to be met with public outrage, but this would be turned on its head if it were properly explained that people were trading a degree of geographical inconvenience against life and death."
Many colleagues expressed the view that unless our report contained a detailed list of hospitals and services that should close, then it will be judged to have failed.
I disagree. Our report is called "Systems not Structures". We need to move away from the mindset that every hospital must provide every service for every patient. It is inevitable that the services we currently provide will have to change.
Implementing such change is not about saving money but, as Sir Liam said, delivering the highest possible quality of care. Similarly, changing the delivery of such acute care is not like flicking a switch; they simply can't be turned off and on at will.
Therefore, our report sets out clear, clinically agreed criteria for assessing the sustainability of services, with a prioritised list of services which require urgent attention. These are complex issues and we believe this is the most responsive way to take this work forward without compromising patient safety.
The process must be clinically led and planned, with the ultimate goal being better outcomes for our patients. Patients may well need to travel further for care, but that care will be the best care available.
The report also concentrates on a long term reconfiguration, based around a more patient-centred population health model which will not only address the health and social care needs of localities within Northern Ireland but be active in the promotion of health prevention and greater patient involvement in their own care.
Over the course of yesterday I heard some negative comments about money and lack of detail. The funding issue is for the Executive to determine and I feel that the panel has fulfilled its remit.
Unfortunately, we don't have a choice with reform. The alternatives are either planned change or change prompted by crisis. The health minister fully supported our report as well as setting out her vision "Health and Well-being 2026: Delivering Together".
This lists the actions that she wishes to take over the next 12 months.
She has made a call to all clinicians (doctors, nurses, AHPs, carers, social workers, voluntary and community workers) to work with her to transform our health and social care service to be a world leader.
It is our job as providers and patients to engage in the process and make the changes needed. I certainly look forward to the challenge ahead.
- Mark Taylor is a consultant in general and hepatobiliary (liver, pancreas and gallbladder) surgery, based at the Mater Hospital in Belfast. He is a member of the Bengoa review panel