Health in the Programme for Government

Staff and Patient agendaNi finds that more detail is needed to measure progress against the Executive’s targets.

When it comes to hard targets for health delivery, the Executive’s Programme for Government comes up short. The commitments made and the priorities outlined are, of course, worthy in their own right, but there is a disappointing lack of specificity against which actual ministerial or departmental performance can be judged. Previous programmes contained targets for measurable things like waiting lists and specific improvements in patient outcomes. The current Programme for Government is much more aspirational.

The other problem is that the Executive’s Programme for Government, which took a year to produce, covers only the three-year period from April 2012 to March 2015 which means that ministers are only 19 months into the programme – too soon to reach any overall conclusions about performance. For all that, health does feature prominently in the list of commitments highlighted at the start of the PfG document. These include the following:

• reconfigure, reform and modernise the delivery of health and social care services to improve quality of patient care;

• allocate an increasing percentage of the overall health budget to public health;

• improve patient and client outcomes and access to new treatments and services;

• enrol people who have a long-term (chronic) condition, and who want to be enrolled, in a specialist chronic condition management programme;

• invest £7.2 million in programmes to tackle obesity; and

• introduce a package of measures aimed at improving safeguarding outcomes for children and vulnerable adults.

That is essentially all that the Executive is committing to even though it has allocated almost half of Northern Ireland’s total budget to health and social services. There is some further amplification where the commitments are listed alongside milestones and outputs but again not very much detail.

Under the reform and modernisation commitment, there is a target to reduce the number of “unnecessary” hospital stays (excess bed days) in 2013-2014 by 10 per cent compared with 2011-2012. So it is too early to say if this target has been achieved.

Under the public health commitment, there is a target for the Health Service “to be ready” to offer bowel cancer screening to everyone aged 60-74 by April 2014 and to invest an extra £10 million in public health by April 2015. Again, too early to assess the outcome.

The very general commitment to improve outcomes and access to new treatments does target enhanced access to drugs for arthritis, cancer, bowel disease, and psoriasis but the only definitive target is to increase to 10 per cent the number of ischaemic stroke patients who receive thrombolysis. There is also a general, again unquantified, target to develop a new coronary intervention model which should reduce the number of heart attacks by 2014-2015.

The commitment to enrol patients with chronic conditions in dedicated management programmes is amplified in the PfG, in terms of how the work should be approached, but there are no numbers.

Contrastingly, the commitment to invest £7.2 million in obesity programmes is clarified numerically as £2 million, £2.4 million, and £2.8 million respectively across the three years of the PfG. The department is on course to meet this target.

Finally, the commitment to improve safeguarding of children and vulnerable adults is unquantified. The milestones and outputs include the preparation of a strategic plan in 2012-2013, the opening of a sexual assault referral centre in 2013-2014 and the development of policy framework by 2014-2015. The plan was published on schedule and the centre – at Antrim Area Hospital – was opened in September 2013.

Overall, it is too early to judge the Minister or his department against the health objectives set out in the Programme for Government. However, even if it were not too early, fundamentally the lack of meaningful quantifiable targets makes it a fairly limited exercise in any case.

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