The heavy-lifting of healthcare transformation

Radical transformation of healthcare will go some way to restoring public confidence damaged by recent scandals, writes David Whelan.

While the need for transformation has long been recognised by the public in the form of spiralling waiting lists and oversubscribed GP surgeries, the recent series of rolling healthcare failures has highlighted just how low the ebb of the public’s confidence in health and social care in Northern Ireland has fallen.

At the turn of the year, the conclusion of a 14-year inquiry into the death of five children who died of the condition Hyponatremia between 1995 and 2003 at the Royal Belfast Hospital for Sick Children, found that four of the deaths were avoidable. The critical report described the health service as “self-regulating and unmonitored”, and categorised four of the deaths as “negligent care”.

Worryingly, one of the most striking themes of the inquiry was the extent to which information was withheld, by some medical practitioners involved, to the victims’ families and to the wider public. As the inquiry’s chairman stated, some medical witnesses “had to have the truth dragged out of them”.

The inquiry acknowledged that the health service environment has went through a transformation since the time of the deaths, however, that does not mean that serious mistakes are still not being made.

In May, an independent inquiry was called into the Belfast Trust’s handling of complaints against neurologist Dr Michael Watt after the biggest ever health recall in Northern Ireland involved over 3,000 patients. “Safety concerns” were identified in some of the consultant’s work following an official complaint in December 2016 by a GP.

It has now been revealed that an annual appraisal – ironically introduced across the UK in 2012 as part of an effort to restore public confidence – was completed in November 2017, five months after he was stopped seeing patients, for the three previous years.

These incidents, while separate, have a cumulative impact on public confidence.

In the Republic of Ireland, the highly publicised case of potential errors and non-disclosure in over 200 cervical screening tests for women, 18 of whom have now died, thankfully, did not have the same implications for Northern Ireland. However, that does not mean that it is exempt. Although unrelated, last month 150 women in Northern Ireland were recalled over “possible shortcomings” in their cervical smears. It is believed that concerns centre on the technique used by a healthcare worker at two doctors’ practices in Belfast.

Low public confidence is also noticeable in the care sector. Undoubtedly, further grim details will emerge from an independent review of actions by the health and social care system in relation to care failings at Dunmurry Manor, following an investigation by the Commissioner for Older People, Eddie Lynch, which found a “horrific catalogue of inhuman and degrading treatment” at the care home.

Rafael Bengoa, who led the transformation blueprint for healthcare transformation in Northern Ireland in 2016, prior to the collapse of Stormont, recently said that transformation is still possible without government.

To some degree he is right. Ministers are needed to legislate for change but that should not mean that an absence of them should halt the heavy-lifting of transformation. The need for transformation is evident in this rolling stream of healthcare failures which are being revealed. Any ambitions to restore some of the lost public confidence must mean that previous mistakes are learned from and change happens quickly.

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