Debate of the week: meet the new plan, same as the old plan

27 Oct 2016 Ryan Miller    Last updated: 27 Oct 2016

Illustration by Patrick Sanders
Illustration by Patrick Sanders

The new Health Minister brought her 10-year plan for health reform to the floor on Tuesday.

No topic has exercised Scope as much as health reform.

Northern Ireland faces many challenges but none are as pressing or as important to the welfare of local people as turning our health system away from its current course that will lead to collapse.

So this week Debate of the Week will take a slightly different format. This serves as part three of our focus on the parallel publications, on Tuesday, of the Bengoa report and Health Minister Michelle O’Neill’s accompanying 10-year plan to restructure Health and Social Care (HSC), Health and Wellbeing 2026: Delivering Together.

Instead of trying to capture the debate as fully as possible, we will be searching for barriers that MLAs might be planning to put in front of reform.

This should be read alongside our other pieces on, broadly, the reasons for change and why it has not happened and a focus on the dangers presented by obstacles that still exist.


Ms O’Neill commended her plan to the house, outlined the reasons behind change – mentioning Transforming Your Care (TYC), Donaldson, and Bengoa - then took questions.

Regarding obstructions to change, the answers themselves were less interesting than the questions that were asked (no offence to the minister, who was consistent and outlined her case thoroughly).

Ulster Unionist Jo-Anne Dobson noted that TYC failed due to a lack of funding, and asked for assurances that Health and Wellbeing would not go the same way.

Paula Bradley, the Health Committee Chair and DUP MLA, asked the very pertinent question about how communities, frontline staff and political representatives would be brought on board to ensure the “tough decisions” are made a reality.

Sinn Fein’s Catherine Seeley asked how mental health would be given parity of esteem with physical health (which is perhaps not directly aimed at the reforms, although these are relevant, and this is one of the biggest single problems with health provision as it stands).

SDLP MLA Mark H Durkan said the report includes “extremely sensible and necessary proposals” but asked when more concrete proposals will be brought forward.

Alliance’s Paula Bradshaw asked how the lack of GPs will be addressed in the short term; the DUP’s Gary Middleton asked specifically how waiting times for elective care will be reduced; Sinn Fein’s Ian Milne asked how better use will be made of community pharmacies.


As is probably obvious, the majority of questions brought forward were harmless, in the terms laid down by previous blockages. There were further enquiries about whether nurses and midwives would get extra money if they were asked to expand their roles; how reform will address inequality; how hospital bed blocking will be improved; whether the ambulance service will receive extra resources, particular to help rural areas; if money is available for transition costs – and so on, and so on.

Overall the debate largely avoided any of the wrangling that saw previous, similar plans fall to pieces, but there were a few worrying moments.

The first question of any concern – and no more than a hint of concern – came when George Robinson, of the DUP, asked for a timescale for additional GP training noting problems in Limavady, in his own consitutency. It is not the question, so much as the constituency focus. It is a tough ask for politicians to see HSC not in terms of their own back yards, but as a whole, but that will be required for reforms to move on. Moreover, Mr Robinson effectively campaigned against TYC the year after it was launched, by helping to demand the retention of services at the Causeway Hospital.

On a similar note, the SDLP’s Richie McPhillips first welcomed the proposals and noted that HSC is “at breaking point” – before asking what acute services would be provided in the Western Trust area, which includes his constituency of Fermanagh and South Tyrone. Another innocent question on its own terms, but local competition to fight for services is the main danger to Health and Wellbeing.

TUV leader Jim Allister had a rant about the number of reports into HSC that have come and gone – fair enough – before observing that that Executive has “since 2011… reduced beds in our hospitals by 10% and [is] then surprised by the chaos that results”.

The transformation ahead may well see closures of entire hospitals, never mind beds, and there will be service problems along the way. Those driving the changes should be prepared for more criticisms of this stripe.

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