The Bengoa agenda in the face of pressures – ageing population and winter pressures

As the winter pressures faced by the health system emerge again, we take a look at the history and progress of transformation within health.

The announcement of a departmental review of urgent and emergency care once again highlights the need for transformation within the health and social care sector. 

On 25 October 2016, a ten-year plan for the future of health and social care was launched: Health and Wellbeing 2026: Delivering Together. This policy followed the recommendations contained within the 2015 study conducted by Professor Rafael Bengoa, Systems, Not Structures - Changing Health and Social Care, which made 14 recommendations to secure the future of the health service in Northern Ireland.  

Health and Wellbeing 2026 proposes one of the largest transformations of the health and social care system in Northern Ireland, ensuring service delivery into the future and taking account of new pressures being faced in the sector.

The Transformation Implementation Group, established on foot of the Bengoa report, is made up of 17 members from across the health and social care sector, including specialists from a range of medical professionals, the CMO, the CNO, the Chief Social Worker, five trust CEOs, the Chief Executive of the PHA, the Chief Executive of the Ambulance Service, the Consultant in General & Hepatobiliary Surgery, GP representatives and key departmental officials.

It was initially intended that the Health Minister would chair the group; however, due to the political impasse this position has been taken up by the Permanent Secretary of the Department of Health, Richard Pengelly.

The transformation agenda has not been curtailed by Stormont’s continuing absence. Unlike other government departments, the Department of Health has been free to push on with the delivery of this key policy, having received sign-off from both the Executive and Assembly prior to the stalling of the power-sharing institutions. 

At this year’s NICON Conference, held in April 2018, Pengelly provided details on key transformation priorities, including

• A 10-year health and social care workforce strategy;
• Creation of multi-disciplinary teams in GP practices;
• New digital integrated care pathways, known as Encompass;
• Additional £200m additional transformation funding over two years. 

This was followed up, in June 2018, with the announcement of £100m allocated to projects identified as priorities under the Transformation Fund for 2018/19.

As the transformation agenda continues, it is expected there will be a series of announcements on the future of health and social care in Northern Ireland. With an ever increasing demand upon the health system, particularly during the winter and especially with the pressures of an ageing population, this week Pengelly said:

 “The pressures faced by our emergency departments reflect pressures right across the health and social care system – with the rising demand for services outstripping our capacity to provide it… We need to fundamentally change the way we do things. That’s why we have announced this review, which will be clinically led.”

The review will specifically consider the most appropriate arrangements for the assessment and admission of older people as well as an increase in bed capacity; an increase in staffing both in hospital and in the community; enhanced seven-day services; investments in primary care services; intermediate care/transitional services (to help patients move from a hospital setting); and ambulatory care (e.g. direct GP referral to avoid attendance at emergency departments or reduce the need for admission via emergency departments for investigation or treatment of certain conditions, including respiratory, gastroenterology, diabetes).

Clearly the Department has continued to progress key policies, even as the politicians remain on standby. If transformation is a success, will this be a new model for decision-making in Northern Ireland? Can this model be used to tackle issues outside of health?