Belfast Telegraph

Northern Ireland health service needs radical surgery, and a new Executive needs to make it their top priority

By David Gordon

The health service - and more specifically health reform - should be close to the top of the Stormont talks agenda.

That's not just because health is important.

It's also because the massive challenge of health reform could seriously destabilise the next Executive. Assuming, of course, that there is going to be another Executive.

If there isn't a strong Stormont consensus in favour of health reform, then the vital task of transforming services will be very quickly jeopardised.

That will be bad for health care as well as for good government, functioning politics and budget stability.

It can be argued that the consensus is already there - that the five main parties all voiced support for the general direction of travel mapped out by the Bengoa expert panel report published last October.

But the devil is always in the detail. Bengoa reforms will include some very tough decisions, including the centralisation of some hospital services.

That's always met by understandable concern in local communities. Any change can all too readily be caricatured as "austerity" and "Tory cuts". When the "hands off our hospital" demands inevitably emerge, what will politicians and parties do?

Will they join the protests and the photocalls with campaigners, table debates in the Assembly, urge the Health Minister to think again? That's largely what has happened up to now.

It's a safe bet that even party colleagues of the next Health Minister - whichever party that is - will instinctively want to side with the protesters.

All politics is local. MLAs refusing to side with 'Save Our Hospital' campaigners in their own constituencies could feel very exposed very swiftly, especially if rival MLAs and their parties are among those brandishing the placards.

With those pressures breaking out in various locations, it's not hard to see the whole reform process going off the rails.

If all the expert opinion is only half right, that would be very bad news for patients. Frankly, anyone who believes in the health service shouldn't be able to sleep at night after reading the Bengoa report.

It paints an intensely disturbing picture of a health and social care (HSC) system that needs radical surgery.

Its current configuration - the way services are currently spread and organised throughout the province - is outdated. It is not delivering the way it should in terms of patient care and effective and efficient use of resources.

It is not coping with the increasing demands, stemming in part from the "demographic timebomb" of increasing numbers of people living longer and requiring more care.

The recurring headline grabbing day-to-day crises in the system - like waiting times, A&E delays and GP pressures - are all tied to the way the HSC is presently configured.

The current system is not sustainable. Let's repeat that: the current system is not sustainable.

The Bengoa report put it like this: "The stark options facing the HSC system are either to resist change and see services deteriorate to the point of collapse over time, or to embrace transformation and work to create a modern, sustainable service that is properly equipped to help people stay as healthy as possible and to provide them with the right type of care when they need it."

That means, among other things, shifting more resources into primary and social care, tying up less expenditure staffing and otherwise propping up the acute hospital sector in its present form.

Making the case for radical transformation, the Bengoa report also said: "This is not an easy thing to do; change and transformation are always difficult, they create uncertainty and they require us to give up what we have in exchange for something new."

It's hard to think of a bigger and more pressing challenge for our politicians than overseeing major health reforms.

Back in October Arlene Foster, Martin McGuinness and Michelle O'Neill stood shoulder to shoulder with Professor Bengoa on the day his report was launched.

Their united message was clear. The Executive would deliver on the reform agenda; provide the political leadership to transform our health and social care system.

Martin McGuinness said: "Change has to happen and the only question is whether it will happen in a controlled, planned fashion or unfold out of control. There is only one responsible choice to make."

I have no doubt they meant every word of it. I was there, not just at the Press conference but in the discussions behind the scenes beforehand. The big test, of course, would have come down the line, when changes to existing services would inevitably have faced a political backlash in different constituencies.

We will never know what would have happened. Other problems and other politics got in the way, and the Executive collapsed.

We don't even know if devolution will come back, if health is going to be back in the hands of locally-elected politicians anytime soon. But if there is a talks agreement, could it include a cast-iron commitment to the Bengoa reforms?

Could all five parties sign a clear pledge: assure us they will deliver the changes, that they've got this?

Or is that too much to ask?

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