Contagious confusion - mixing up the messages

This week we identified the political tailspin set to smash Northern Ireland’s Health and Social Care (HSC) – the question now is whether we can recover and save our services.

Our politicians talk generally about the necessity of the reforms, as outlined in 2011’s Transforming Your Care and the Donaldson report published in January – but struggle to admit this will mean the loss of services people hold dear.

The News Letter’s Sam McBride said fear of a public backlash is the reason our politicians won’t speak out.

“One MLA said to me, two or three years ago, that his local hospital really, by any objective standard, wasn’t justifiable or big enough to survive.

“This is a man who understands the issues, who understands the needs but who told me, “I just can’t say that publicly”. Their over-riding personal view is that these things are too difficult to say out loud.”

Central to democratic politics is a duality where those in power are required to both lead and follow.

This is a narrow line to walk, but nobody said it was easy and, undeniably, it is the job of all our Assembly members and MPs to work in the public interest. This is not the same thing as telling people what they want to hear.

“I think politicians tend to approach any issues through the prism of how it will play at the polls, and whether they will gain or lose votes. Increasingly politicians tend to be driven by focus groups and limited polling.”

McBride cited John McCallister as one example of an MLA who has gone against the political tide, when he resigned from the Ulster Unionist Party over moves to stand a unionist unity candidate.

However, health and social care is another matter entirely.

Single biggest issue

Former independent MLA Kieran Deeny was twice elected as member for West Tyrone, in 2003 and again in 2007, on the single issue of keeping the Omagh Hospital open, before deciding not to stand again in 2011.

McBride said: “That illustrates that this is something really resisted by the public, probably because they haven’t had someone who understands all the issues explain it to them.”

The News Letter correspondent says Edwin Poots changed the tone of health debate when he took over as minister and following Transforming Your Care (TYC).

Previously there had been moves to close individual hospitals, and accordant campaigns against these moves, but McBride said this was not placed in any wider policy context.

However, as time passed – and it became more about making the changes recommended in TYC – Mr Poots became less and less vocal about the reforms, and although he continually maintained during his years in the Executive that plans were progressing well, the Donaldson report found that the changes had stalled badly.

Sam McBride thinks that we are unlikely to receive any clear communications of difficult messages from our politicians for at least a year, thanks to the upcoming Westminster elections and 2016’s Stormont polls.

Fear of being drummed out of office is likely to prevent any politicians from trying to explain why our health service needs to be restructured – and that this will involve closure of valued services, but that this is genuinely for the best.

Popular message

These fears over a public backlash go beyond elected representatives. McBride recently interviewed Valerie Watts, Chief Executive of the Health and Social Care Board – and found her manner so evasive that he wrote a separate piece about her use of jargon.

However, to her credit, Ms Watts did go on to spell out the difficult truths and core messages within Transforming Your Care and Donaldson.

McBride told Scope: “I really had to push her again and again to get her to say that TYC means small hospitals will close and that this will be for the best.

“I think that illustrates the difficulty for members of the public - senior people at the very top of the health service are reluctant to explain the issues in their entirety, and then they hear that hospitals are going to close without knowing the context.

“Liam Donaldson blames politicians and media but really the people who know the most about this, the minister and his senior officials, they have to take every chance to explain the message and not hide behind gobbledygook.”

Lack of clarity

Confusion and a willingness to please everyone was seen again in Stormont this week. On Tuesday, during question time, current Health Minister Jim Wells addressed questions both on TYC and on the Donaldson report.

SDLP health spokesperson Fearghal McKinney suggested that the closure of hospitals was an issue somehow divorced from the Donaldson report, saying the people of Downpatrick “gave their answer to that” in the form of Saturday’s Love the Downe parade, before asking if TYC was continuing.

The minister welcomed “the huge support that the community has” for the Downe, reiterating that he sees it with a crucial role to play in HSC and noting that the public wants restoration of former services.

He then said TYC is showing “major progress” and “if we do not crack the issue by 2025, the health service simply will not be able to continue in the way that it is going.”

In a subsequent question on Donaldson he said, if we were building a health system for NI from a standing start, that: ”We would never start from where we are, with 10 A&Es, the Royal Belfast Hospital for Sick Children and six local regional hospitals. That is a model that would never be implemented anywhere in the Western world.”

HSC is a vital issue across our social strata. Conflicting messages on the issue transcend party politics. A united voice is needed to save HSC.