Fix urgently needed for health and social services before it is too late
The network of health and social services in Northern Ireland is in need of a major transformation.
For the new financial year, £5,424m has been earmarked for current spending, £237m for capital spending and a further £100m is available for health transformation.
The brief (and inadequate) budget statement of a month ago shows that compared to the year now ending, 2017-18, the current health and social services budget will be £270m or 5.5% larger in 2018-19. These figures will also be adjusted for the Barnett consequentials of the salaries award recently added to the budget in England.
The new budget statement leads into two complications.
First, the Permanent Secretary of the health department has added: "This allocation leaves a shortfall in relation to the spend required to maintain existing services… further allocations are required through in-year monitoring and/or savings measures."
Second, the combination of an above inflation budget award sits uneasily beside a plea for help in maintaining existing services. Has the department decided that the budget increase will leave little (or no) scope to begin any transformation?
The department, while gaining some funds for transformation, is offering no detailed plans on its delivery. Whilst plans for transformation are the core ambition, the public are not being given a confident articulated phased programme.
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The claim may be that at least it is a start, but the pathway is far from clear. Imprecisely, the department adds that transformation represents a 10-year agenda.
The department has been unfairly criticised for its decision to use £30m of the earmarked £100m for transformation to take steps to reduce waiting lists. Arguably waiting lists are linked to the current provision of services and transformation funding should be about improved services.
Waiting lists are such a serious problem that a decision to use £30m to pay for delayed treatments is an inescapable piece of logic provided the other £70m is specifically directed to clear transformation goals.
The central weakness in the actions of the department is the absence of a comprehensive transformation plan accompanied by steps within civil service competence. The department deserves the credit for a wide-ranging effort to identify necessary actions but has been slow to make decisions. Even the search for more efficient delivery seems to be paused as if managerial authority is paralysed.
The official response that ministerial decisions are needed is inadequate. The department needs to specify what ministerial decisions are needed. To the credit of the department, some months ago the Permanent Secretary set up over 30 special work streams to suggest how the services might be better organised to better meet the needs of the population. No comprehensive overview of the expected impact has been released.
This longer-term vision does not need the closure of acute hospital services. The growing need for acute hospital services should be met within a reorganisation of services, not a reduction.
Two landmark documents have been issued:
1. Power to People: proposals to reboot adult care and support
2. Transformation and reform of elective care services
Both documents are useful and path-breaking but not adequately costed.
Adult care is too often a bottleneck in allowing recovering patients to leave acute hospital care. Discharge from hospital to other forms of care should be seamless, not an obstacle course.
Elective medical care services have been carefully examined to show where improvements are possible and new care facilities would prove beneficial: but where?
To take pressure from hospital services, further reform of GP services awaits actions to extend the treatments available in primary care. Major transformation steps are still awaited.
The Permanent Secretary acknowledges that "we also need to increase public trust in the system". That calls for firm, time constrained progressive steps. Why not do it?
Company report: AJ Power
AJ Power has been established in Craigavon for over 10 years. The firm manufactures diesel-powered generating sets for international markets.
The group reports that it is starting a major expansion plan whilst adding to significant new facilities at its headquarters.
This will mean an increase in capital spending in the year now under way. The manufacturing footprint will be increased by about 50%.
The group says that, in comparison to the previous year, it has achieved increases in the percentage levels of gross and operating profits. This has provided the base to undertake the future financial commitments needed for the expansion programme.
Turnover in the year to June 2017 was 3% lower than in the preceding year which, in turn, was slightly lower than in 2014-15..
Operating profits and pre-tax profits to June 2017 were higher than a year earlier and maintained the levels of 2014-15. In recent years the company has operated with lower levels of net borrowing and, as a result, pre-tax profits have performed slightly better than operating profits.
Capital expenditure at £295,000 was lower than in the two preceding years.
Dividends to shareholders, at £187,000 in 2016-17, were lower than in each of the two previous years: £394,000 in 2014-15 and £429,000 in 2015-16. The company still retains a high proportion of its post-tax earnings which are added to its accumulated reserves.
Employment remained stable last year and averaged 121 people.
The balance sheet value of shareholders' funds in June 2017 rose to £11.1m.