Reviewing health

stethoscope-3 Radical changes to health and social care are expected from the Compton review. Peter Cheney reports.

The way ahead for health and social care in Northern Ireland will be marked out over the next two months as a comprehensive review of the system approaches its deadline. The review was announced by Health Minister Edwin Poots in June and is due to report back to him by 30 November.

Poots selected John Compton, the Health and Social Care Board’s Chief Executive, as its chair due to his extensive experience but he is assisted by five independent advisors (see box).

The BMA questions the short timescale but Poots says “it is important that clarity is provided urgently”.

Media attention will focus on the future number of hospitals but several services can be provided in primary care centres instead. At present, Northern Ireland has 11 acute hospitals (three in Belfast) and five local hospitals.


The review should take account of the Minister’s own vision and strategy for health and social care (see issue 48, pages 8-11), existing policy and strategy statements, the system’s structure, staff terms and conditions, and the resources allocated by the Assembly in the 2011- 2015 Budget.

In a frank brief to the review, Poots states: “It will be necessary to stop doing what does not work, become more assertive in challenging out of date practices, and acknowledge that some of today’s services and their current design are no longer fit for purpose.”

Best practice on providing safe and effective services will be considered, including guidance from the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence.

Studies for analysis include the McKinsey report (2010) and the two Appleby reports (2005 and 2011). The latter Appleby report found that the health and social care system required an extra £1.1-1.5 billion to catch up with England.

The review must provide a “strategic independent assessment” across all aspects of services and produce a specific implementation plan containing proposals for specialities and major hospital sites.

Two major factors are outside the review’s scope: organisational structures and funding.

OFMDFM is reviewing all arm’s length bodies accountable to the Executive, including the health structures. The DUP has manifesto commitments to merge the Public Health Agency into the Health and Social Care Board, and review the Business Services Organisation and Patient Client Council.

Since April 2007, the system has saved £49 million and shed 2,259 administrative, clerical and support jobs.

The DFP’s Performance and Efficiency Delivery Unit (PEDU) is investigating the scope for further savings. For perspective, the DHSSPS was allocated £4.31 billion to run health and social care services this year: 42 per cent of the whole Executive’s total current expenditure. Elected representatives are best placed to make spending decisions.


The case for reform is clear from three statistical indicators. In 2010-2011, 674,400 new cases went through A&E and hospital admissions stood at 583,599. New cancer diagnoses stood at 56,286 in 2009-2010, the most recent statistical year.

This means that, over a four-year timespan, new A&E attendances were up by 35,900, hospitals took on 27,602 more admissions, and 4,250 new cancer cases were confirmed.

Initial A&E cuts at Lagan Valley and Belfast City hospitals would increase pressure on the Royal Victoria, Ulster and Mater units. To help reduce the resulting pressure, Poots wants an end to “time wasters” turning up at A&E departments. If all patients with minor ailments went to their GPs, casualty staff could focus on treating strokes, heart attacks and major traumas.

Over the next five years, the Belfast trust wants to establish the RVH as the ‘major trauma site’ whilst retaining smaller A&E units at the City and Mater.

Collectively, the public sector unions have agreed to organise “a co-ordinated campaign of industrial action”. They expect “a prolonged period of industrial strife … where specific services and jobs are under immediate threat.”

Poots’ announcements are expected in early 2012 and will be among the most significant ministerial decisions in the 63- year history of the Health Service.

Review panel
John Compton Chief Executive, Health and Social Care Board
Trained as a social worker
Mark Ennis Executive Chair, SSE Ireland
Responsible for public and regulatory affairs
Professor Chris Ham Chief Executive, The King’s Fund
Professor of health policy and management,
University of Birmingham
Professor Deirdre Heenan Provost and Dean of Academic Development,
University of Ulster at Magee
Dr Ian Rutter General practitioner
National Deputy Clinical Director for Primary Care, England
Paul Simpson Retired senior civil servant
Former Chief Executive, Health and Social Services Executive,
and Deputy Secretary, DHSSPS


Professional views

British Medical Association
We have had situations in the past where services have been allowed to worsen until there was no choice but to close them, to the dismay of staff and patients alike. This is not acceptable. The review must result in better outcomes for patients. Patients are at the centre of everything that doctors do, and they must be at the centre of the Health Service, however it will be shaped in the future.
Dr Paul Darragh
Northern Ireland Chairman

Royal College of Nursing
Front-line nurses are working under unprecedented pressure, bearing the brunt of staff shortages as a result of cuts. Nurses know that difficult decisions need to be made now, in a planned and structured way, and want to be engaged in planning for the future rather than subjected to ill-judged, short-term crisis responses.
Janice Smyth
Northern Ireland Director

Royal College of Midwives
We’d like a commitment that any review of maternity services will take into consideration that not all women need (or request) to be cared for in high-tech consultant units. The further development of community midwifery units will offer women with low risk pregnancies the opportunity to continue to give birth in a local maternity unit.
Breedagh Hughes
Northern Ireland Board Director

Royal College of General Practitioners
We understand the budgetary constraints placed on health and social care over the next four years and the need to re-examine the delivery of healthcare in Northern Ireland. As we have seen from events in England and Wales, it is imperative for patients that any radical change to secondary care is based on the soundest evidence and not just political whim.
Professor Scott Brown
Chairman, Northern Ireland Council;

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