How we can find a remedy for the squeeze on health
Keeping hospital admissions in Northern Ireland to a minimum is vital as the sector's budgets are being slashed, says Jim Wells
Our health sector faces significant challenges in the coming Assembly term as a result of the sums available to us from the Westminster coalition.
It was inevitable the good years would come to an end, so the Department of Health, Social Services and Public Safety and the entire public sector have been planning for this scenario.
Even if we could squeeze health a few more pounds from the Department of Finance and Personnel, it will not alter the fact that, if we continue doing things as we are at present, we will be in the region of £1 billion short by 2015.
We need to drive up quality, innovation and efficiency. Incremental improvements are important, but the scale of the latest challenge demands more fundamental reform.
Some people will undoubtedly query how £4.63bn can be insufficient, and precious resources must be put to their most effective use.
Commissioning services is a powerful lever for change, but the arrangements here have been weak and hamstrung.
Across the water, commissioning - with strong clinician involvement - has improved primary care services, made prescribing more efficient and created community-based alternatives to hospital care.
There is also evidence that groups controlling real budgets were able to secure shorter waiting times, achieve lower referral rates and reduce emergency bed-days.
There must be the maximum opportunity for charities and other providers with a proven track-record to deliver services.
A UK Department for Business, Enterprise and Regulatory Reform-commissioned report in 2008 stated "different firms and organisations have different strengths in delivering different types of services. This points to a mixed economy model".
We must also pursue simple means of attracting more income, including sponsorship. We need to ask hard questions about services currently offered.
Is it right that hard-pressed taxpayers fund cosmetic surgery, including tattoo removal, for instance? If someone demands a home birth, should it be funded to the same extent as a regular birth on the ward?
Should we allow hundreds of thousands of people to continue failing to turn up for appointments without penalty?
Our health service is more expensive than other countries in Europe, yet on many measures not as effective. Efforts at reform have followed a managerial, bureaucratic approach rather than bottom-up innovation.
Hospital care is phenomenally expensive, so we need to keep out of hospital those who don't need to be there. We must focus more on intermediate care, treating patients at risk of having to come into hospital and those who have just been discharged. We need to reduce preventable hospital admissions, particularly of one night's duration, and we must provide more care for people in their own homes.
The King's Fund found more savings were achievable through reducing durations of stay in hospital and using lower-cost drugs. We need to increase the level of day surgery and make best use of specialised staff and equipment.
Alternative providers need to be considered in areas such as social care, asset maintenance, transport and back-office functions.
Savings can be squeezed in administration, IT, by rationalising procurement and drugs purchasing, reducing marketing and asset sales. We must reduce avoidable ill-health and the costs arising from chronic disease.