It's time to get our ailing care system up off its sickbed
The Compton health service review is about quality of care, not cost-cutting. But hard decisions must be taken, says Edwin Poots
Commissioning this review of health and social care is the most important act of my time as Health Minister to date. Following through with it will be my priority for the rest of my tenure.
Our health service is vital to everyone in Northern Ireland. We in the Executive and in the Assembly, as leaders, are duty-bound to protect and enhance this service.
My primary aim is to drive up the quality of care. Putting the patient first is the driving force behind Transforming Care - The Review of Health and Social Care.
My priorities are clear:
- improve and protect health and reduce inequalities through prevention;
- improve the quality of services and outcomes for patients, clients and carers;
- develop more innovative, accessible and responsive services, promoting choice and making more services available in the community;
- involve individuals, communities and the independent sector in the design, delivery and evaluation of services;
- improve productivity by ensuring effective and efficient allocation and utilisation of available resources; and
- ensure that we look after the most vulnerable in our society and the children, the future for this country.
To meet this challenge we must stop doing what does not work, challenge out-of-date practices and acknowledge that some services are no longer fit for purpose.
There is no "do-nothing" option. To continue as we are would leave us with an unsustainable service, with consequences for patient care and safety.
This is why I commissioned this review. I asked for a blueprint for reform.
I laid down a challenge to the review team: to examine the future provision of services, including our acute hospital configuration, the development of primary healthcare services and social care and the interface between sectors to meet our priorities.
This review is not about cost-cutting. It is about quality, accessibility and safety of patient care. As the financial situation tightens, there needs to be a radical shift in where and how that money is used.
I am not naive. I have always known that the review would make recommendations that will be challenging and I will not shirk hard decisions.
However, commissioning this review was not a difficult decision. Indeed, it would have been irresponsible of me not to do so in light of the issues facing us.
The proposals in this report represent radical change, which will provide a more citizen-focused and effective health service.
The evidence - collected through engagement with more than 3,000 people - speaks for itself. Our people feel that improvements are necessary.
The review proposes a model which places the individual at its centre. Health and social care services will be increasingly accessible in local areas.
Patients will deal with fewer professionals and will be at the centre of decision-making about their treatment. There will be a significant shift from provision of services in hospitals to provision of services in the GP surgery, closer to home, where it is safe and effective to do this.
Services will regard home as the hub and ensure that people can be cared for at home, including at the end of life. Where specialist hospital care is required it will be available - with patients being discharged into the care of local services as soon as their health and care-needs permit.
The review proposes hospitals will work as a system, with each facility contributing to the provision of a total service to its population. This will mean change in all sites over a five-year period. A key aspect of this approach is that critical clinical staff will be employed to work in a hospital system and will be a resource for each population working as necessary across hospital services and facilities.
The review envisages change at several of the current acute hospital sites - it suggests a likely position, over time, of five to seven major acute hospital networks in Northern Ireland.
However, the key test for any future service configuration has to be sustainability and resilience in clinical terms.
It will be on that basis that we are able to determine whether an acute hospital is viable.
I recognise fully the need for greater productivity from the resources available to us, particularly in these times of austerity, and it is in that context that I firmly believe that the greater involvement of frontline professionals in decision-making and service development is essential. Local commissioning, too, has a crucial and powerful role to play in driving change and innovation.
The five commissioning groups, working with the trusts and local communities, will now have a key role in developing plans by June for their areas to meet the parameters laid down by the review team. And I want to see a shift in care currently being carried out in hospitals into the community, with patients being treated in the right place, at the right time, by the right people.
From today, the challenge is take forward the implementation of this review. We have been given a path, but we will need leadership to follow. I am prepared to do just that. The recommendations of this report affect us all, so I ask you to read it carefully at: www.dhsspsni.gov.uk/hscreview131211.htm.
In doing so, you will better understand the challenge facing us and the solutions we believe will improve healthcare for us all.