Belfast Telegraph

Saturday 30 August 2014

Plan is a healthy start to our care transformation

The Executive's healthcare reforms call for difficult decisions that will demand both professional and cultural change, says John Simpson

Edwin Poots, as Health Minister, has published proposals for a radical series of changes across the whole range of health and social care services. The 99 recommendations are a matrix of interdependent changes found in Transforming Your Care (TYC): the Compton report.

The proposals pose complex organisational and behavioural changes. Key professionals are now expected to play a more demanding role.

The reorganisation proposals reallocate £83m away from funding for acute hospitals. Acute hospitals will share their workload with neighbours. That frees up new resources for other services.

Two strands are particularly critical. First, patient services through GPs and other primary-care services must be greatly improved. Second, the access of patients to services in acute hospitals must be more selective.

Stemming from these changes, there are implications for care of the elderly, care for people with different types of disability, care for mothers and children.

Critically, patients and professional staff will benefit because services are organised to focus care at, or from, home.

The challenge, recognising the financial constraints, is to offer better services within the allocated budget.

Northern Ireland spends £1,975-per-person-per-year on health and this is nearly 4% more than the English average (but slightly less than in Scotland).

The Compton review (December 2011) has attracted much public attention - partly because the reorganisation envisaged starts with an ambition to spend 5% less on acute hospitals.

In all, £83m is to be taken from their budgets over the next three years and is offset, temporarily, by a phasing of £70m of transition funding to expand other social and community services.

Health service professionals accept that there is currently too much demand on acute hospitals which is either inappropriate, or relies on duplication of facilities.

Conventionally and misleadingly, the debate focuses mainly on A-amp;E and ward closures. The challenge for management skills is to build in interdependence between hospitals and to retain 'minor' services in the community using better primary-care services.

Hospitals must be better organised to limit unnecessary admissions from A-amp;E and, after a patient is admitted, better organised for early discharge to other appropriate care outside the acute hospital setting.

Ultimately, Health Minister Edwin Poots has difficult decisions to make on the capacity and size of some acute hospitals.

The most important feature of the Compton review is the introduction - facilitating better primary care - of the new Integrated Care Partnerships (ICP). Seventeen are proposed, but that is probably an understatement of what is merited.

These partnerships are the critical building-block. When they work well, GPs will offer extended services, minor treatments in GP surgeries will be expanded, out-of-hours arrangements will be more flexible, some hospital consultants will visit GPs and back-up social and paramedical professionals will link in closely.

The devil, for successful implementation, lies in the detail. Efforts to implement the whole package of 99 recommendations simultaneously could ask too much of a small number of key implementation managers.

TYC must be subject to an approach that creates orderly, prioritised changes, gradually extending their reach and working to a reasonable timescale.

At this point, before the Minister Edwin Poots moves from a draft Implementation plan into formal consultation, the risk is that he expects too much to change too quickly.

TYC depends on many critical assumptions. Implementation will, in some respects, be unpopular. But in total, there are more gains than losses.

For the average adult patient, improved health and social services will mean:

• A broader range of health services through GPs;

• Less frequent need to go to an acute hospital;

• Better ability to look after ourselves, particularly using new technologies;

• Greater reliance on day surgery, or shorter hospital stays;

• More emphasis on care at home; and

• Greater discretion for personal budgets to organise personal care.

A critical need is that the minister should build in incentives to motivate these changes.

After the normal care for adults is reformed, then the agenda can focus more widely, including services for the elderly, for mothers and children and the needs of people with a disability.

TYC stops short of an adequate plan of how to reform change and reduce the scale of institutional care for people with mental illness and people who have severe learning difficulties.

TYC has no clear suggestions to cope with the growing tensions of how, and by whom, care for the elderly will be financed.

Minister Poots has made a good start; now he must reinforce the momentum and appreciate that this is only a start.

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