Pre-election health check

24 Mar 2022 Ryan Miller    Last updated: 24 Mar 2022

Photo by Emma Simpson on Unsplash
Photo by Emma Simpson on Unsplash

Healthcare in NI is on its knees. Restructuring the system and reducing massive waiting lists are key electoral issues. But how are people doing in general?


Northern Ireland’s population is around 1.9 million people.

Right now, there are almost 355,000 names on waiting lists for their first consultant led appointment. Around 187,000 of those people – over 50% of the total – have been waiting longer than a year.

This is an immediate crisis. Lots of people need health care, for problems big and small, and this care subject to significant delay. However, while the crisis might be immediate, the underlying causes are not.

Health and Social Care needs radical transformation. It has needed this for some time. The current systemic model cannot keep up with the demand driven by an ageing population, where more and more people are living with long-term needs.

However, that is a long-term fix for a long-term problem. The waiting lists, caused in large part by the slow progress of health transformation over the past decade, represent a short-term challenge that needs its own, immediate solution.

This will be a major issue in the forthcoming election and it will remain a significant challenge for local politicians after polling day, regardless of whether an Executive is formed or not. If a government comes together then our MLAs, the Executive, and whoever is the Health Minister will be measured against how well they tackle waiting lists and health reform. If no government is formed, any time there is news about a struggling aspect of the health service, the decision from some MLAs or parties to stay away from Stormont will come under intense scrutiny.

So, the health service is sick - but how about the people?

Measuring a decade

It is just over a decade since the need to overhaul Health and Social Care became official policy. Transforming Your Care was published in 2011, setting out the broad strokes of change that is required: more focus on prevention and healthy living, maximising people’s ability to live independently (with the home, not clinical settings, seen as the hub for care), greater specialisation of expert care and an according rationalisation of acute services, and so on.

Also published in 2011 was the first annual NI Health Survey. The latest version, released in December, came ten years after the first. How have things changed?

Firstly, it should be noted that that methodology for these reports changed in 2018-19 and so results from what was published at the time are not necessarily directly comparable with the latest statistics. However, the Department of Health has updated those previous results to more closely match current methods, therefore weighted comparisons between years, although not perfect, are still available in DoH trend tables.

In 2011, 33% of people described their own health as very good and 39% said it was good. Per the latest survey, those figures are 38% and 41%. The number of people a decade ago who said their health was bad was 7%, while 2% said it was very bad – compared with 5% and 1% now.

Those numbers appear to be going in the right direction. Similar improvements, of a few percentage points, are seen when looking only at men or only at women.

However, things get better when looking at different age groups, and the total percentage of people who described their own general health as good or very good. For those aged 16-24, that figure was 88% a decade ago and 89% now.

For those aged 35-44, it has risen from 80% to 87%; for those aged 45-54, it has gone from 68% to 74%; for 55-64 it has gone from 61% to 74%, for those aged 65-74 it has moved from 59% to 67%, and for 75+ group it has moved from 45% to 67%.

Some other health inequalities also appear to have closed the gap.

When looking at the population based on where they live by deprivation quintile (i.e. if someone lives in one of the 20% most deprived areas of NI they are in the bottom or first quintile, and if someone lives in one of the 20% least deprived areas they are in the top or fifth quintile), it appears that the percentage of people saying their health is good or very good has risen from 64% to 74% in the most deprived areas.

The second quintile has seen a rise from 70% to 77%; the third has risen from 74% to 79%; the fourth from 74% to 84%; and the fifth from 80% to 81%.

Therefore, while self-reported general health remains an unequal issue, the scale of this inequality has shrunk.

Further findings

Other results from the most recent survey include that:

  • Two-fifths of respondents (41%) reported having a longstanding physical or mental health condition; this increased with age from 27% of those aged 16-24 to 69% of those aged 75 and over.
  • Less than a third (29%) of respondents have a long-standing illness that reduces their ability to carry out day-to-day activities (similar to 2019/20).
  • Almost two-fifths (38%) of respondents reported having concerns about their own mental health in the past year (17% definitely; 21% to some extent).  This was significantly higher than in 2018/19 (27% overall; 12% definitely and 15% to some extent).
  • Over a quarter of respondents (27%) exhibited signs of loneliness by scoring highly on the UCLA loneliness scale. Respondents living in the most deprived areas (38%) were more likely to show signs of loneliness than those living in all other areas (20-26%).
  • 12% of adults smoked cigarettes (down from 17% in 2019/20).  Smoking prevalence has fallen from 24% in 2010/11. Smoking prevalence in the most deprived areas (22%) was around three times that in the least deprived areas (7%).
  • A small proportion of respondents (5%) reported that they currently use electronic cigarettes (similar to 2019/20).
  • Four-fifths (81%) of adults aged 18 and over reported that they drank alcohol.  This was higher than in 2019/20 (77%).  A quarter (26%) of male drinkers reported drinking on three or more days per week, while this was true for 15% of females.  This was higher than in 2019/20 for both males (19%) and females (10%).
  • Of respondents who had been in contact with the health and social care system in the last year, 85% were either very satisfied or satisfied with their experience, while around a tenth (9%) were either dissatisfied or very dissatisfied.

What now?

Northern Ireland’s health is far from perfect. Some of those results are concerning. Mental health clearly remains a huge problem in NI.

But at least there has been good news. The fact that the self-reported general health of older people, and of those who live in more deprived areas, has improved is something to cheer. The inequalities still exist, the gaps are still larger than anyone would like, but progress is progress.

Moreover, all this has happened during a decade when it became clear the health service, as it is, is unsustainable – and during which the effects of this became more apparent as the months and years passed.

This is still a massive problem that needs to be addresses but, despite the challenges, an improving population health picture is great news.

The reasons for this change could be many. Better diet, less smoking, less drinking, better self-care – and, of course, quality healthcare, which our clinicians are still able to provide on an individual basis. The fault lines are broadly systemic, and about ensuring prompt access to effective care.

This is something for everyone to think about. Part of the new approach to Health and Social Care will be encouraging people to look after themselves better. That, on its own, could sound like a cop out or a dodge, the way for officials to shift blame away from creaking services.

It is also true, however. As Scope wrote previously: “It is well established that 40% of health outcomes are determined by socio- economic factors, 10% by our physical environment and 30% by our (health) behaviours, leaving just 20% to healthcare itself.”

Looking at those other factors, and how they have (or haven’t) changed, it seems likely that if population health has improved over the past ten years, people’s lifestyle choices have made a big difference. That is good news.

However, we still need a working health system. People living healthier lives just makes that a little bit easier to build.

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