Hamilton's health reform: Mission Impossible?
Health Minister Simon Hamilton is throwing himself into reform of the health service: but is this mission impossible?
When the flagship Transforming Your Care strategy was announced in 2011 its authors made it clear that the price of not implementing it would be the failure of the health service.
It is hard to conceive of a starker warning, yet four years on little progress is discernible. Last year’s Donaldson report was about as damning as it is possible to get.
Amongst the reasons Sir Liam Donaldson cited for the failure to achieve a fit for purpose health service were: a lack of leadership and accountability within the health service and a failure to communicate effectively about the need for change which was exacerbated by politicians who bought into the principles but objected whenever change affected their own constituencies. Media coverage was also criticised.
Donaldson contended that the situation was so dire that the only way to progress was to bring in an international panel of experts whose recommendations would be accepted in advance in order to protect reform from Nimby politicians and put spine into a poorly led service.
Unsurprisingly politicians were having none of that. They saw such a measure as undemocratic, and presumably felt hurt and insulted.
So now Hamilton has leapt into the fray and with the health service already spiralling into crisis there is no room for failure or procrastination.
He’s removing a layer of bureaucracy by scrapping the Health and Social Care Board, setting up a Transformation Fund to invest in change and pulling together a panel of experts to recommend action (although their findings will not be binding and they are local rather than international experts).
He fully understands the scale of the challenge he has set himself and openly acknowledges the failings to date.
It is important to note that the latest reforms are not directly connected to TyC but funding innovation and removing bureaucracy which he sees as a blockage to change could help to smooth the path to the ultimate goal.
Hamilton announced his plans at a conference in Ballymena rather than at the Assembly which irked Jim Allister who saw it as an insult to the democratic process, so Hamilton was summoned to answer questions in the house.
When he appeared he appealed for all party support for his measures and acknowledged that mistakes had been made in implementing change.
“I am prepared to accept that some mistakes may have been made in implementation in the past, and we need to learn from those mistakes. It would be churlish to attack each other on the basis of those mistakes. We need to learn from them, because the challenge that is before us to get health and social care right now and to get it right for future generations is too big a prize for us to get petty about. We need to build the political consensus that I have spoken about; if we do not, we will have a health service and a social care system in Northern Ireland that will fail.”
So Hamilton is delivering a simple, stark message: all parties must work together to get this right, and if we don’t achieve this the health service will be wrecked.
However he has already come under fire from Donaldson who told the BBC that he is not acting fast enough or going far enough: Hamilton envisages the board dissolving in 2017 and says the purpose of the change is not to cut numbers. Donaldson argues that the board should go sooner, as it is not good practice for health to be led for so long by a doomed body and that there should be cuts in the 600 staff to free up funds for front line services.
So already there has been an influential challenge to his reform programme.
But there will be far more trouble ahead.
It is not at all difficult for politicians to sign up for a programme which will remove bureaucracy. The popular view is that there is far too much in the health service and so simplifying it and slimming it down is a good thing.
Where trouble looms is when Hamilton attempts to address unpopular reforms and specifically when he sets out trying to reduce the number of acutre hospitals in Northern Ireland.
The logic for this is inescapable. We have too many for the population and regional hospitals lack the specialist skills required for some conditions. What we need to have is a smaller number each with specialist faciltiies so that we can ensure the best possible outcomes for patients. Also too many people are being referred to hospital when they could be better treated at home by services provided within the community.
The current situation is ultimately unsustainable, is far too costly, and is not getting the best results for patients. It just has to be changed. Putting local convenience above specialist care puts patients’ at risk.
The problem is that the health service has failed to articulate this clearly enough and the general public believe the opposite: closing their local hospital will put patients at risk.
Instead of challenging this, politicians and the media have gone along for the ride.
When Donaldson was published his findings were welcomed by the main parties, save for that of the independent panel.
Yet three weeks later when a rally to “save the Downe” hospital was launched South Down politicians rallied to its support.
SDLP MP for South Down Margaret Ritchie joined the call to arms, calling for “solidarity” and telling people to “show that the health of rural communities is off limits to any cuts” – afterwards calling saying local people would accept nothing less than restoration of the hospital.
Sinn Fein MLA for the area Chris Hazzard delivered a similar message ahead of the demonstration, before telling then Health Minister Jim Wells to “go back to the drawing board” and support the Downe.
Wells’ constituency is South Down, so any message he was to give about the hospital is also one to the people who elect him.
In comments to the News Letter he made no mention of TYC, the reasons behind it, or the need for a huge restructuring of health and social care, instead referring to “assurances I have received from the management team at the South Eastern Health and Social Care Trust that the Downe Hospital will continue to play a vibrant and vital role in the acute network which will deliver essential hospital services now and in the future.”
This is just one example that illustrates just how hard the task is that lies ahead.
And you can understand why it happens: 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.
Hamilton is right in calling for all-party consensus and it is vital that he gets it. This will require much more radical change than abolishing the health board. It will demand that politicians put aside short term political advantage and act collectively and responsibly in demonstrating the need for radical change and the price we will all pay if it is not achieved.
To date nothing has happened to suggest he will receive that.
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