Issues

Health service in crisis

Adam Morton takes a look at some of the problems currently affecting Northern Ireland’s health service.

With the news that 2,600 surgeries were postponed last year and 20 per cent of patients are now on hospital waiting lists, Northern Ireland’s ailing health service hasn’t had a great 2015. Things are so bad that Nigel Edwards, the Chief Executive of the Nuffield Trust, a leading national body that aims to improve health services in the UK claimed that “heads would roll” were hospital waiting list figures in a similarly poor state in England. The Royal College of Nursing’s director Janice Smyth has called for Simon Hamilton to return to his post and provide the necessary direction and implementation of plans such as Transforming Your Care. She also urged the Minister to implement the findings of the Donaldson review. With all this criticism being fired at our health service from just about every angle, what are the major problems its facing at present?

Cancelled operations

The latest waiting list statistics show that one in five patients is now on hospital waiting lists. This perhaps isn’t a surprise after the highly publicised cancelling of operations by all five health trusts due to A&E pressures last January. Many of the patients waiting for operations also complain about the lack of communication about their revised surgery dates.

A response to a written Assembly question claimed that a total of 154 surgeries were postponed at the Royal last December but figures reveal this number jumped to 395 by January and only dropped marginally for the following two months. 1,300 operations were put back at the Ulster hospital over an eleven-month period, while Belfast City hospital postponed 1,760 over the same timeframe.

It is statistics like these that have caused the former Minister for Health, Social Services and Public Safety (HSSPS), UUP MLA, Michael McGimpsey to brandish the service ‘inhumane’. McGimpsey claimed that every day a procedure was postponed the patient’s suffering only increased and claimed that the trusts are failing ‘in their duty to look after patients.’

End of private contracts

A key reason for this operations debacle may be Local Commissioning Groups’ (LCGs) belief that they cannot afford to pay private contracts to help clear the waiting lists. Northern Ireland is the only region in the UK that is not using the private health sector as health services in England, Scotland and Wales all use private companies.

In England around seven per cent of NHS spending is spent in the independent sector, whilst in Scotland and Wales around one per cent of their respective budgets are spent there as many officials agree outsourcing appears to keep waiting lists down. Until last September Northern Ireland was also using the independent sector. However the contract between the DHSSPS and Kingsbridge private hospital was not renewed, a factor the Northern Ireland Health and Social Care Board has linked directly to the current waiting list crisis.

It had been hoped that at least £47 million from the Northern Ireland Executive’s June Monitoring round would go towards tackling the waiting list problem through referral to the private sector. Hip, knee and back surgery would have been among the main beneficiaries of this additional money but the current political crisis means the money was never released.

Lack of leadership

The lack of money and the rise in hospital waiting lists are not the only problem areas affecting our health service. The structure of our health service is also under scrutiny. Currently, there is an internal review of the current administration structure including the Health and Social Care Board and the Public Health Agency in an attempt to streamline the health service and reduce job duplication.

The DHSSPS Minister, Simon Hamilton, has acknowledged that Northern Ireland’s health service needs ‘major reform’ but claims at present, there is a lack of suggestion as to what can be done. This problem was also noted in the Donaldson report as it concluded that the design of a system to provide comprehensive, high quality and safe care to Northern Ireland’s population needs much more careful thought. The Donaldson report criticized the lack of clarity in regards to who is in charge of the policy making decisions in Northern Ireland’s health service.

General practice problems

It is not just our hospitals facing a crisis, the chair of the Royal College of GPs (RCGP) has called for more resources to be directed their way. In calling for the training of an additional 400 doctors by 2020, the RCGPs’ chairman Dr John Kelly compared the health service at present to a ship heading for the rocks without a captain on the bridge.

In the RCGPs’ latest document ‘delivering change for general practice’ the college set out clearly a list of objectives they have urged our MLAs to work on. The list includes:

•   setting a target for increasing the number of full-time equivalent GPs in Northern Ireland by 400 by 2020;

•   improving GP recruitment and acting on recommendations of the government’s own GP workforce reports from 2006, 2010 and 2014;

•   increasing medical students’ exposure to general practice;

•   improving retention;

•   encouraging GPs who have left Northern Ireland to return.

With more people living longer, practices are finding waiting lists are longer and this leads to greater pressure on an ageing work force. The college claims Northern Ireland requires an additional 46 people each year to be trained as GPs and a proper workforce plan needs to be put in place in order to plug the work force gap.

The RCGP also highlighted the British Medical Association’s (BMA) claim that more women are choosing general practice as a career. This, they claim places more pressure on the system. Earlier this year a report by the BMA found that the current GP workforce is 55 per cent male and 45 per cent female, compared to 80 per cent male and 20 per cent female almost 30 years ago.

The BMA claims this creates further pressure on the system as female GPs have different commitments outside work, including maternity leave and caring responsibilities. The RCGP is calling for this to change. It says it is committed to the vision of Transforming Your Care and has called for the immediate implementation of the recommendations made by the Donaldson report.

Money wasted

With a lack of money clearly one of the major problems in our ailing health service, the DHSSPS do not need to be spending more money disposing of unused medicines, but that’s exactly what it is doing.

Every year, 39 million prescription items are issued and about 72 tonnes of these medicines are returned to community pharmacies as waste. It is estimated this return costs the health service roughly £400,000 per annum in disposal costs.      

Speaking about this waste the Chairman of the Health and Social Care Board Dr Ian Clements said: “If we patients, members of the public and professionals, all worked together and tried to reduce the amount of wasted medicines, the money saved could be used to fund other vital health services such as more doctors and nurses, or new treatments.”

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