Health reform, part one – here we don’t go again?

27 Oct 2016 Ryan Miller    Last updated: 27 Oct 2016

The Bengoa report has been been published and the Health Minister has released parallel plans for reform. We’ve been here before.

The Bengoa report was published this week.

It begins life in an astonishing position for any policy paper: it says nothing new but might prove to be vital in saving our local health service.

Ideas that are now over a mandate old are again clearly stated to be the only way forward for local health provision.

To summarise – an ageing population and a (not unrelated) increase in the number of people living with chronic conditions for longer periods of time mean that demand for local health services is outstripping supply, and doing so at a rate far beyond what simple increases of funding could fix.

Even if we were living in an economic boom, the spike in demand would be unaffordable; in fact, the public purse has little to spare and if we carried on with our current service model the health budget would represent 90% of total public spending by 2026.

That is clearly untenable.

The only solution – as per 2011’s Transforming Your Care, as per the Donaldson report of December 2014, and now as per Bengoa – is a restructuring of services focusing on decentralisation and prevention.

This, in fact, is a gross oversimplification on the part of Scope but these are not simple reforms that can be adequately described in a couple of words, and we have already written extensively on the context behind and rationale for TYC/Donaldson/Bengoa.

The minister’s new plan

Alongside Bengoa comes new Health Minister Michelle O’Neill’s 10-year plan to complete the necessary reforms, Health and Wellbeing 2026 – Delivering Together.

Again, it is nothing new, but this is no bad thing.

It amounts to high level aims with a lack of fine detail but this is as it should be. That sounds unsatisfactory but the job is too large and will take too long – and, even done perfectly, would see bumps along the way – for a clearer vision to be available right now.

But what that means is the real challenges for the minister begin now. Change needs to start now and to gather momentum. She needs to build detail into the plans as the progress, all the while keeping HSC functional from day to day.

As developments – and the ultimate destination – begin to come into clearer focus she needs to ensure we are on the best possible course.

And, within all this, she will have to deal with enormous criticisms and attacks about every tough decision she makes. If and when she closes hospitals, for example, she might know this is for the best for everyone – including the people living near to wherever is closing – but still has to win the arguments.

It is a huge job.


There is consensus among clinicians about both the need for change and what that change should look like. There has been for years. And, yet, nothing of real note has been done.

The reasons for this are a public that doesn’t understand the issues, a media that doesn’t either, and politicians who are more interested in popularity than averting disaster.

In the case of the media, there is some mitigation. Required reform is fundamental. Nothing will be left the same. Health and Social Care is one complex, interconnected dynamic system. To take any part of the suggested changes in isolation is to take it out of context. This makes it very difficult to articulate. The minister could have done better but it is a narrow path to walk and Nolan is not the easiest forum to fully expand on complicated ideas.

When explaining policy to readers, viewers or listeners, journalists will often try and isolate simple narrative strands, deal with each of these in turn and, thus, complete the picture.

That does not work with health reform, much of which is counterintuitive, and which involves such titanic adjustments that are enormous in scale yet inextricably linked.

Politicians have less of an excuse. For them, they either have not taken the time to understand what is at stake, or are just using specious, populist stances to grab votes.

Part two - looking at ongoing obstacles to change - can be found here.

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