“The future is already here, it’s just not very evenly distributed”

Tristen Kelso reflects on last week's NICON conference and the state of the current reform agenda.

‘Transformation in Practice: Delivering Together’ was the theme adopted for the Northern Ireland Confederation for Health and Social Care (NICON) annual conference that took place last week

While the case for radically reforming how health and social care is delivered hasn’t waned, the political context has added to the already significant challenge of moving from talking about change, to actually delivering a comprehensive reform programme.

At NICON 16, there was a palpable sense that such a process was inevitable. The work of the expert panel led by Professor Rafael Bengoa was concluding and the political parties were generally reconciled that change was necessary. Michelle O’Neill, the Minister of Health at the time, made clear her desire to get on with implementing what was required.

In the year that has passed, we’ve witnessed a number of fairly sizeable political events, starting with Brexit and then. six months later, the pausing of Stormont's power-sharing Executive. Sir Muir Gray put his finger on it this year when he said: “leadership changes culture”. The difference in tone at NICON 17, however, was the current absence of the political leadership needed to effect real cultural change at a system-wide level.

It would be unfair to say the process hasn’t begun. The Executive united behind Bengoa's report, Health and Wellbeing 2026: Delivering Together. The language of co-production has grown more prominent, the many references to ‘co-production’ on the conference programme being evidence of this. The momentum that had been gathering around the implementation of the reform plans is now slowed.

There were some really valuable insights over the course of the two-day event. Speaking of his experience as a healthcare provider in Utah, Chris Wood MD told how healthcare can be about both providing the best outcomes for citizens, while achieving the lowest prices. Scott Adams, of BT Global Services, explained how technology can deliver "predictive healthcare", augmenting the wellbeing agenda. We also heard from Singapore, where proactive contacts with persons considered ‘most at risk’ brings a smarter approach to health and wellbeing that benefits citizens and the public purse.  

Talking about change and having the culture necessary to take that change programme forward are very different things. “The future is already here," said novelist William Gibson, "it’s just not very evenly distributed."