This move will cut red tape and increase accountability
Last year I set out my ambitious and radical plans for transforming our NHS. I wanted to remodel the administrative structures of health and social care in Northern Ireland to make them more streamlined and to reduce complexity.
I proposed that:
- The Health and Social Care Board cease to exist.
- The department would take firmer strategic control.
- Trusts would have more responsibility for planning care in their areas and have the operational independence to deliver it.
- The Public Health Agency would have a renewed focus on prevention and early intervention.
The response to a recent consultation is a clear endorsement for the need to change. In the main, those who responded agreed:
- There is too much complexity in the current system and it is not working to its optimum capacity.
- That the system needs to be better at enabling and supporting innovation.
- Reduced bureaucracy would allow the system to respond more quickly to changing demands.
- A full, competitive commissioning process is too complex for an area as small as Northern Ireland.
While there is broad agreement that our current structures are too complex, too bureaucratic and too slow to support transformation, there is a concern about where responsibility for commissioning of services will reside after the HSCB is gone.
I understand these concerns. While most welcomed my decision in respect of the board, they were worried about what would happen to initiatives they were involved in and feared a loss of momentum in areas where real progress has been made. Equally, concerns have been expressed about 'postcode lotteries' emerging.
While recognising these concerns, I am still convinced that we have too many layers of bureaucracy in our system. So, with the objective of eliminating bureaucracy and aiding innovation, the board will still go, with commissioning for the bulk of health and social care services passing from the board to the department rather than our trusts.
But I still want to see our trusts take on additional responsibility for care in their areas. I want them to have increasing autonomy. And I want them to be held more accountable for what they do.
I have already taken steps to devolve some responsibility to trusts for planning services, within clearly defined parameters.
Additional funding for winter pressures was allocated directly to trusts this year. Next year I intend to further reduce bureaucracy by giving trusts greater authority to spend their budgets in order to best maximise the impact for their patients and clients. No longer will we set centrally driven savings targets. Trusts must work within the budgets set, recycling savings to ensure that they deliver the best possible services for their populations.
But with greater responsibility comes greater accountability. I expect trusts to be fully accountable for the outcomes they deliver and to live within their resources.
I expect them to work in collaboration with all care providers in their areas to deliver those outcomes. Primary care and the voluntary and community sector play a central and critical role in planning and delivering world-class health and social care.
I am also convinced that bringing performance management for the trusts into the department would help improve lines of accountability. I will therefore press ahead with establishing a Performance Directorate with the Department of Health. It will be its job to ensure trusts meet the targets.
There will be much focus on the future administrative structures of our health and social care system. But the most important people are the patients who will benefit from a streamlined health and social care system.
My vision for our NHS is a sustainably financed health and social care system that puts quality, safety and the patient at its centre by providing world-class outcomes. These changes will help us to achieve that goal.