Transforming Your Minister - change at the top could revitalise DHSSPS
The Executive’s health portfolio is an unenviable job.
Assuming Stormont stays on the rails – or any collapse is only temporary – then all departments must deal with shrinking budgets.
However, more than any other, DHSSPS has to deal with rising demand that. Our population is growing, but that isn’t the issue, instead many more people are living longer and with more long-term conditions.
It already has by far the biggest budget, but that is not sufficient and the pressures on services are greater than anywhere else, and getting worse apace.
Scope has written before about how Transforming Your Care (TYC) and the Donaldson report, both compiled by independent and impartial experts, say the same things: our health service has to be reshaped, including more centralised specialisation (so, less hospitals, for one), or bad things will happen.
But to get all this done properly will require roughhousing of political friends as well as foes. Both Northern Ireland’s frequent sectarian lines of divide and more standard political ideological characterisations are irrelevant.
Warning signs continue to appear about our current model. TYC and Donaldson show a way to do more with less and there can be little doubt that Health and Social Care needs to become more efficient or services will diminish.
The political dynamics augur badly. The media will also need to be carefully navigated, especially because at times it seems like they go out of their way to not understand the arguments behind reform.
Succeed and we get a much healthier health service for decades into the future, with short-term flux and big benefits in the long, but which will not necessarily be obvious to the public.
Fail and you might have fewer political and public enemies, and will be just another person who came and went from the health department.
It is not a role to be coveted.
A couple of months ago, Simon Hamilton could hardly have imagined he would now be running DHSSPS.
For a couple of years he shadowed Sammy Wilson in DFP, knowing he was heir apparent. Sammy left, Simon ascended, time to get on with things.
But then Jim Wells said what he said, and events took over.
Moving from DFP to DHSSPS is not a promotion, or a demotion. So, given he was groomed for the Finance ticket for so long, it is interesting that Simon Hamilton was moved into Health.
Hopefully this is a sign that the will to carry out the recommended reforms is genuine; if the plan was just going to keep DHSSPS ticking over, why move across someone in whom so much time was invested elsewhere?
The signs so far are pretty good. On his first day in his new office he said he wanted to “keep the momentum of change going”.
TYC has not progressed very far at all but presumably this was an off-the-shelf compliment to his party-colleague predecessors, Edwin Poots and Jim Wells, issued as standard, rather than high satire.
"The Donaldson report will help shape appropriate changes to the sector across Northern Ireland and I will ensure that a number of his recommendations are implemented as soon as possible. The review of commissioning in line with what was recommended in Sir Liam’s report will also make the system more effective.
"I am committed to continuing with the transformation agenda including the 'Transforming Your Care' (TYC) vision for the future model of health and social care delivery. This will ensure services are structured and delivered in safe and sustainable manner making best use of all resources available to us."
This is not screaming his determination and full endorsement from the roof of Stormont. Almost every assertion comes tempered with a caveat.
However, that is the language of modern politics, and similar sentiments were repeated in ministerial question time last week.
Time will tell if the new minister has the will to take on all comers over reform.
Scope has covered the nature of the resistance to HSC changes before.
But, by way of continuing illustration, in April Stormont held an adjournment debate into provision at the Causeway Hospital.
By and large, local MLAs lined up to praise the existing services and - of course! – the hard work and dedication of staff at the hospital.
John Dallat opened up with the standard illogic: citing an example of good practice at the hospital as rational opposition to the arguments behind TYC and Donaldson.
However, TYC and Donaldson are not saying that some of NI’s hospitals are incapable of doing anything right. What they do say is that a reshaping of the system will mean a better HSC for everyone (including those whose nearest hospitals will close).
The SDLP MLA said that Donaldson is “fatally flawed”, called for the minister (then Mr Wells) to “rise above” it, finishing with: “The Causeway Hospital has not let us down, the people who serve in it have not let us down, and God forbid that the Assembly lets the Causeway down.”
He was not alone.
Gregory Campbell said he hopes the hospital “is not just retained in the services that it currently provides but builds for the future”.
Cathal Ó hOisín: “I fully support fully the Causeway Hospital, the retention and expansion of its services, and the adequate and proper resourcing of those services.
Robin Swann: “What the Causeway needs at this time is certainty, and it is the Minister who can provide that certainty and give the staff of the Causeway, people who use it and the general populous around area that reassurance.”
Adrian McQuillan: “I want to make it clear at the outset that I fully support its retention as an acute hospital and nothing less.”
Jim Allister: “I welcome the fact that there is, at present, the appearance of more stability attached to the future of the Causeway Hospital.”
The issue is not the Causeway Hospital. If the recommendations of Donaldson and TYC are followed through it may well have a future as an acute hospital – perhaps even with increased services. Or maybe not.
The issue is that this is the sort of opposition that meets any suggestion that a regional hospital or other service should shrink or close. All politics is local, and all significant reforms will affect services located somewhere.
Rebalancing HSC will be incredibly difficult, if not impossible. Over to you, minister.
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