Belfast Telegraph

In a critical condition... six out of 10 hospitals here 'should be closed'

By Victoria O'Hara

Politicians in Northern Ireland have been warned they need to start making difficult decisions if they are to save an ailing Health Service - including closing more than half our hospitals.

Sir Liam Donaldson, the former chief medical officer of England tasked with carrying out a review into our care system, says Northern Ireland has too many hospitals per head of population when compared to elsewhere in the UK. He says any hospital which can't operate on a 24-hour basis could be closed as part of an urgent overhaul of a system that is "not fit for purpose".

Sir Liam warned that patients are now "skating on very, very thin ice" in some parts due to the standard of care. And he highlighted that the 2011 policy Transforming Your Care (TYC) had established that elsewhere in the UK, a population of 1.8 million people would likely be served by four acute hospitals. Northern Ireland currently has 10.

"A proportion of poor quality, unsafe care occurs because local hospital facilities in some parts of Northern Ireland cannot provide the level and standard of care required to meet patients' needs 24 hours a day, seven days a week," he said.

Concluding, he said that the health system here is "likely to be no more or less safe than any other part of the UK," but said change was required. The review, ordered by former Health Minister Edwin Poots (below) last year, is being closely examined by politicians, medical experts and unions who say more clarification is needed over the 10 recommendations. Speculation is also rising over which hospitals could be affected.

Acute hospitals are currently open at Altnagelvin, Antrim, Belfast City, Causeway, Craigavon, Daisy Hill, Mater, Royal Group, Ulster and South West Acute (Enniskillen).

But as the financial pressures grow, the future of Causeway, Downe and Lagan Valley has also been brought into question over the past 18 months. In January 2014, the emergency unit at Downe Hospital in Downpatrick reduced opening hours. Lagan Valley Hospital in Lisburn has also had its emergency hours cut, with a shortage of qualified emergency doctors blamed in both cases.

The report, costing £116,000, concluded that many acutely ill patients in Northern Ireland do not get the same standard of care on a Sunday at 4am as they would receive on a Wednesday at 4pm and a two-tier service is operating.

Sir Liam acknowledged proposals to close local hospitals tend to be met with public outrage, but this would be "turned on its head" if it were properly explained that people were trading a degree of "geographical inconvenience" against life and death.

He also insists that replacing a hospital is not the same thing as closing it and replacing it can mean putting in place even better facilities that are more suited to the needs of the local population.

"There are some difficult decisions to be made; one of the most difficult is there has been a lot of long-standing recognition that the distribution of facilities, hospitals and other facilities in Northern Ireland are too thinly spread so that it is not possible to always guarantee that patients will get the best, high-quality service. Most of the time their care is safe and secure but it isn't guaranteed. They are skating on very, very thin ice in some parts of Northern Ireland and I would like to see that situation changed."

Patricia McBride from Unison gave the recommendations a mixed response, warning that the minister should not rush to close hospitals.

"Importantly and for the first time, the review recognises that the system of commissioning health and social care needs radical change," she said.

"The review looks at the size of the population but not at the state of health of 1.8 million people. If it addressed that core issue it would find that we have outrageous levels of health inequality and high levels of chronic illness.

"We need a new model of public health to turn this around, not an unseemly rush by the minister and his bureaucrats to close hospitals."


Professor Sir Liam Donaldson is recognised as an international champion of patient safety and public health. He was the foundation chair of the World Health Organisation World Alliance for Patient Safety, launched in 2004. He is a past vice-chairman of the World Health Organisation Executive Board. Sir Liam was the Chief Medical Officer for England, and the UK's Chief Medical Adviser, from 1998-2010. He was appointed to lead the review into the way the health service is run in Northern Ireland in April 2014.

Will our politicians have nerve to make difficult decisions?

Significant change is needed if our hospital system has any chance of improving.

That was just one of the key messages embedded in Sir Liam Donaldson’s review — that the healthcare system we have is not the system we need.

To do it effectively the number of hospitals we have — particularly in the acute sector — need to be reduced. It is not a new message. It was the conclusion of the Transforming Your Care (TYC) document in 2011, a policy that has been painfully slow to implement with those working across healthcare criticising TYC after seeing little evidence of it on the ground.

Proposals to close hospitals will no doubt spark an outcry and it also remains to be seen if the tough decisions that will prove unpopular will be made by politicians just months before an election.

In the report Sir Liam acknowledges that proposals to close local hospitals are met with “public outrage” but this, he said would be “turned on its head” if it were explained properly that we are trading a degree of geographical inconvenience against life and death.

He also insists that replacing a hospital is not the same thing as closing. In fact he says replacing it can mean putting in place even better facilities that are more suited to the needs of the population.

The Department of Health has been keen to get the message out that there that there are people who are using A&E who shouldn’t be and are in fact blocking the flow of patients and placing pressure on resources.

Last February the then Health Minister Edwin Poots ordered a review of services at the Royal Victoria Hospital in Belfast. This came after a Major Incident was declared at the hospital on January 8 because of a backlog of patients at the emergency department. At one stage 42 people were waiting on trolleys, and staff described the situation as “horrendous”.

Changes are needed. But while the difficult decisions need to be made the question remains whether the politicians can agree or have the nerve to make them.

At a glance:  Sir Liam’s 10-point action plan  

1. Local hospitals that are unable to provide the level of care needed 24/7 should be closed. An international panel of experts should be set up who would be commissioned to review health provision in Northern Ireland.

2. Strengthen and improve commissioning powers for health bosses. 

3. Transforming Your Care needs a new costed timetabled implementation plan to breathe new life into it. This should be boosted by a bigger role for pharmacists and paramedics in pre-hospital care.

4. There should be greater self-management of chronic disease, such as diabetes. People with long-term illnesses should have the power to manage their own conditions.

5. Better regulation of the whole system. Unannounced routine inspections should take place. The role of Regulation and Quality Improvement Authority could be outsourced, possibly to Scottish regulator. 

6. The system of serious adverse incident and adverse incident reporting needs to be modified.

7. Make patient safety a beacon of excellence. Establish a Northern Ireland Institute for Patient Safety.

8. System-wide data and goals. Northern Ireland health and social care system has no

consistent method for the regular assessment of its performance. There should be new measures for benchmarking service.

9. Technology — There should be the establishment of a technology hub to identify best innovations for quality and safety of care internationally.

10. Stronger patient voice. The Patients and Client Council should be more independent.

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