Short Term Political Decisions Will Not Fix Our Heath Service…

I have always been an optimist by nature and really hoped that the NI Assembly, set up after the Good Friday Agreement, would turn away from the divisive nature of identity politics and start focussing on education, social care and health. However, the Assembly has been suspended for over 40% of the time it has existed (primarily by SF and their partners in the DUP) and shows little desire to tackle difficult but essential tasks such as reorganising the NHS

Unfortunately, as I get older and find cancer or other nasty illnesses affecting my family, I find my patience with our politicians evaporating. I have little confidence in the ability of our politicians to remedy the significant problems in our health service. Is there a solution? There are more than enough reports to provide a template for change, what we need is someone to take action.

I have taken time to read several reports on the NHS (see sources at end of article) and it is clear that we spend more per head of population in NI than in any other part of the UK, but still have significant weaknesses in our healthcare system compared with England. In 2021/2 we spent £3483 per person compared to £3235 in England (according to but our waiting times are significantly longer that in any other part of the UK.

Important: None of the negatives below is intended as a criticism of NHS staff – they are not the problem.

What Needs to Change

No-one is satisfied with the state of the English NHS and the NI version of the NHS costs more and delivers lower levels of service, so there is no argument about the need for change. Asking for more money from Westminster is easy, but is unlikely to be the solution. What local problems do we need to address.

Nuffield Trust reports that

  • Elective inpatient care costs 25% more in NI that it would in England
  • Long stay emergency patients cost 33% more
  • Patients stay in hospital for longer in NI
  • Hospital care costs have risen 28% in NI compared to 8% in England over 6 years
  • NI has more registered nurses relative to population than England
  • In NI people are four times as likely to be waiting for planned care as in England
    (Waiting times in Northern Ireland are far worse than in England, with a high proportion in particular of people waiting over a year for treatment despite the budget is considerably higher per person.)
  • We have more hospitals than other parts of the UK – 1 per 150K people in NI compared to one per 250K people (Source: BBC Talkback 25/723) and it is argued that services are spread across too many hospitals, some of which are the wrong location, resulting in less access to the level of excellence that our people deserve.

What Might Need to Be Done

Concentrating Services in Fewer Centres

Lord Warner’s July 2023 report covers the NHS for the whole of the UK and argues that concentrating specialist services on fewer sites saves money AND provides a better service. He indicates that, when specialist stroke services were concentrated in 8 centres in London instead of the previous 32, this saved an estimated 400 lives within two years and £800 per patient because they recovered quicker.

This is very unlikely to be popular with the electorate in NI (note the public reaction to changes to hospital services at Coleraine and Newry) and this is a major problem if we expect our politicians to take the decisions. Politicians need to be popular – they won’t be elected if they are not popular, so to expect any politician to institute plans that will produce short term pain for gains in 10 years’ time when they are unlikely to be in office is not realistic.

Time Limited Public Consultations

Lord Warner’s reports suggests that we need

  1. a time-limited and standardised process by specialty across the country, including public consultation;
  2. the process to be managed by a nationally credible group of clinicians for each specialty; and
  3. elected politicians not making the final decisions on individual hospitals.

Improve Ambulance/Paramedic Services and Public Transport Connections

If we are going to end up with services concentrated in fewer locations then both patients and their families need to be able to travel. Better public transport services will help reduce car use and help with C02 levels, as well as reassuring rural communities that they can reach relatives in hospital.

In emergencies, rural communities will need priority access to ambulances and paramedics who can deliver time sensitive treatments where appropriate. Would transferring funding to such services allow greater flexibility in hospital reorganisation.

Less Time in Hospital

A relative who had a recent 2-day stay in a private hospital was amused by her admission letter which informed her of the expected date of her departure and that her room had to be vacated by 10am, almost in the manner we expect from a hotel. This is not as unreasonable as it first seemed. Hospital beds are expensive and with previous NHS hospital stays of both my mother and my wife, I found getting them out of hospital (when both wanted to go home) took hours or days longer than expected. Hospital stays in NI seem to be longer than in England, costing us money and restricting access to other patients.

Other Issues

This is a complex area with many other issues needing to be addressed, including staff planning, (GP Training is in crisis), Public Heath– we are an ageing nation, too fat, smoking too much and drinking more than we should (I have been guilty of all of these in the past). One issue is common to all of the problems we need to address – they require immediate action, but the benefits to the nation may not be apparent for many years.

A Political Decision, or a Management Decision?

As a retired teacher, I have been able to spend a couple of days reading reports and articles on reform of the NHS; this has confirmed how little I know and how complex the system is. I would like to believe that our politicians have a much greater knowledge of the NHS and have the courage to take the correct decisions for the long term, but in truth I no longer have faith in them.

Recent decisions from more than one political party lead me to believe that short-term thinking and prioritising electoral popularity over long term management of the country will prevent our politicians successfully managing change in the NHS.

I would suggest we build upon the recommendations from Bengoa. We need a senior manager or CEO to make the difficult and probably unpopular long-haul changes needed in our health services.

Appoint a Manager

I suggest that instead of having a politician chosen as Health Minister we appoint a Chief Executive Officer (CEO) with a 5-year contract (with the option of another 5-year extension) and 5-year budget who like the Chief Constable of the PSNI

  • Can make their own long-term decisions and resist political pressure
  • Will have their work reviewed every 3 months
  • Can be replaced by the Executive if they are not up to the job.

The CEO can be a medic, or from a public sector business but their priority must be the long-term health care of our people. After watching the economically incompetent, organised crime gang that is the Tory Party helping their business friends to make millions from the NHS by selling us poor quality PPE, none of us should be fooled into believing that the private sector or the politicians offer all the solutions.

Main Sources

  • Future Funding and Current Productivity in Northern Ireland’s Health and Social Care System by John Appleby, Mark Dayan and Sally Gainsbury – Nuffield Trust (Sept 2022)
  • The NHS at 75: A Reality Check and New Priorities by Lord Norman Warner – Social Market Foundation (July 2023)
  • Systems Not Structures – Bengoa (2016)

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