Where now for our health service?

04 July 2016 - by Tristen Kelso

One Voice –Time for Change was the theme adopted by NICON (the Northern Ireland Confederation for Health and Social Care) for its annual conference that took place last week.

As the largest annual gathering of over 440 professionals involved with planning, commissioning and delivering Health and Social Care here, the two day event gave an excellent insight into the direction of travel for the NHS locally.

The message coming loud and clear is implementation of major reform and reconfiguration of how Health and Social Care is delivered here is coming, and it needs to start immediately.

There has been a long history of compiling reviews of the HSC over the past ten years, to the point of report fatigue. This point was acknowledged by Minister O’Neill, who very clearly committed to providing the strong political leadership necessary to deliver transformation, and the implementation of major reform.

Minister O’Neill’s words are highly significant, as Professor Bengoa and his Expert Panel prepare to conclude the work they were tasked with of setting out recommendations on the best future configuration of health and social care services in Northern Ireland. Bengoa is regarded as a worldwide expert on health reform, and has previously advised the European Union and Obama administration.

Speaking on what is likely to come out of the Bengoa recommendations when they are presented to the Minister in the coming weeks, Expert Panel member Mark Taylor said the focus will be on ‘implementation’ of reform: “Hospitals are not the only show in town. Reshaping the workforce is important.”

Much of the groundwork has already been done to ensure widespread political buy-in for the major reform programme that is likely to emerge, not least with re-allocation of services, particularly where some services are to be regionalised.

The ‘Bengoa Principles’ were presented at a cross-party health summit earlier in the year. They call for a health service that is designed around patient need, illness prevention and that builds on the integrated nature of HSC. Importantly, all political parties have been asked to weigh in behind the need to implement the widespread reform agenda.

Skeptics could point to how we have been here before, and that the chances of turning the oil tanker that is HSC here around are slim. However, this time round, there appears to be a united voice calling for, ‘Time for Change’. Budgetary constraints, an ageing population, and huge public health challenges means it is simply no longer an option to continue with the status quo.

Optimists would say the stars are aligning for change. The new outcomes based approach to the Programme for Government around a well-being agenda allows for better cross-departmental working and collaboration around key priorities. It recognises the need to stop throwing resources fixing society’s ills, and to invest more in preventative measures, helping people live well for longer.

It would seem the case for change among HSC leaders, policymakers and politicians has been accepted. The real challenge will be how local communities can be persuaded they have nothing to fear from service reconfiguration.

Local populations, particularly in more remote parts of Northern Ireland will need to be convinced that quality healthcare is not necessarily predicated on having services delivered in local buildings. On the contrary, our fascination with maintaining buildings has come at the expense of providing optimal, world class health outcomes for the population.