The recently published Framework for Rebuilding Health and Social Care in Northern Ireland is not the necessary roadmap needed for long-term transformation of services, writes Ulster University’s Deirdre Heenan.
At the beginning of June, the Health Minister Robin Swann launched his Framework for Rebuilding Health and Social Care in Northern Ireland.
Acknowledging that the health and social care system was in very serious difficulties long before the pandemic, he stressed that the virus had multiplied the challenges and pressures. Disappointingly though, this document is not a roadmap nor a detailed strategy for reconfiguring health and social care and creating a modern sustainable service.
The title of this document is a misnomer and perhaps ‘An Interim Plan for the Next Phase of Coronavirus’ would more closely reflect the content and ambition of this publication. It is not strategic and does not address the fundamental issues including waiting lists, workforce planning, social care reform, technological advancements and the need to focus on prevention.
Prior to the pandemic, the health and social care system was in an all too familiar state of turmoil, stretched to its limits, struggling to cope with record levels of demand, including soaring costs, worst ever performance figures and missed targets for A&E care, operations and cancer treatment.
The Health Minister has conceded that these are just the tip of the iceberg and the July figures reflecting the impact of Covid-19 will be ‘even more depressing’. Waiting lists this long result in increased disease, poor mental health and preventable deaths. To date though, there has been no strategic response to the staggering differences in waiting times in Northern Ireland and the rest of the United Kingdom. Whilst real term spending on health and social care across the UK has stagnated since 2010, spending in Northern Ireland is still higher than the UK average. A sustained focus on this issue is required which includes a detailed strategy addressing issues of capacity, the scaling-up of elective care centres and the outsourcing of care to the private sector.
This would be accompanied by indictive timescales, monitoring frameworks, performance metrics, data analysis and expected outcomes. Disgracefully also, we are no nearer to addressing the significant issues with social care which were brought into sharp relief by the virus. How will they be dealt with? We can only guess.
The response to the pandemic has shown that the health and care system can be agile, responsive and collaboration can address silos and fragmented service delivery. Decisions were taken at pace and entire hospitals were reconfigured. Undoubtedly, lessons have been learned and the Framework acknowledges that good practice and innovations such as increased use of virtual clinics and telephone triages should be embedded into primary and secondary care. However, in the grand scheme of transformation, whilst these changes are welcome, they are simply tinkering at the margins.
The Framework sets out a proposed new management board to oversee the rebuilding of the health and social care system. However, it is difficult to see how this new board will add value and not be simply another bureaucratic layer in an already over-administered, complex system. The proposed membership largely consists of those who are already in managerial and official positions in healthcare, and as such, it seems unlikely to deliver the much-needed transformation which is so long overdue. Despite an oft repeated commitment to the principle of co-production, service users are not specifically included in this board. It is also notable, notwithstanding the crucial role that they played throughout the pandemic, there is no representation from frontline workers. In a recent Health Committee, Alliance MLA Paula Bradshaw referred to the proposed membership as a “cabal”.
Realistically, in the aftermath of the pandemic rebuilding any health system will be incredibly onerous, let alone one with problems as deep-seated as Northern Ireland. Infection control measures will greatly slow productivity and impede progress and it may not be realistic to expect significant improvements in 2020.
We cannot tolerate any return to a system in perpetual crises with short-term sticking plaster solutions. Wringing our hands and repeatedly outlining the difficulties is not a sufficient response. The global healthcare emergency witnessed an unprecedented outpouring of public support and goodwill towards the NHS. It is crucial to ensure that this goodwill is converted into the momentum and political will to make the required seismic changes. The challenges are gargantuan. Post-virus we desperately need a roadmap, a much better plan to address the fundamental issues and deliver a safe and sustainable system.