This is a real blow to hopes of improving the Northern Ireland health service and transforming it into one of both high quality and high outputs. Attracting someone of David Sissling's expertise to the province was a real coup but unfortunately his talents have now been lost. It was inevitable he was not going to hang around while the Minister continued to prevaricate. Let us hope that further inaction does not result in other capable individuals following him.


Andrew Dougal, chief executive of the Northern Ireland Chest, Heart and Stroke Association, stated that David Sissling's resignation could spell "a black day for the future of the Health Service".



He hoped it would not be a "victory for change resistance. Mr Sissling was due to take full powers in April 2008. That was put back to 2009. His early departure is likely to mean going back to the old way of doing things, which is not in the best interests of patients or the Health Service. Effective steps must be put in place to ensure that in the years ahead resources continue to be used much more efficiently in our Health Service".


Dr Brian Patterson, chairman of the British Medical Association in Northern Ireland, has said it was "a pity to lose someone of David Sissling's calibre before he got the chance to prove what he could do for our Health Service".


Dr Patterson has earlier written, "We were looking forward to the end of direct rule to have a full-time health minister, local accountability and an end to delays and endless review.


Sadly our new local health minister Michael McGimpsey announced recently that the second half of the review of public administration would not now occur until at least April 2009. The first part was the establishment of five supertrusts to provide care and the now suspended second half was to determine how their performance was to be managed and how care was to be commissioned and to give localities much more influence. Now we have the prospect of a half completed job and our fear is that this could result in a return to the bad old days where there was very little accountability; overspends and underperformance went hand in hand and the patients were the losers."



After a delegation of doctors met with the Minister at Stormont last month to outline their concerns over the delays in RPA reforms, the BMA said: "We were exceedingly alarmed when we first learned of the Minister's decision to delay the changes to the NHS proposed under the Review of Public Administration. We were very disappointed that the Minister was unable to identify for us his specific problems with the RPA process, bearing in mind that this review received public consultation twice over the past few years.


We are about to lose the gains achieved by previous administrations and that is indefensible. We advised Minister McGimpsey and his officials that the stalling in setting up of the commissioning process has serious ramifications for the future of patient care. The main driver for change in what was to be the new health care environment was to be a revolution in commissioning. The support gained from GPs and the impetus achieved in taking this forward over the past 18 months is in grave danger of being lost entirely. Waiting list targets for inpatient and day cases of 18 weeks by the end of September 2007 were not being met."



What is surely clear to everyone is that we cannot allow the health service simply to muddle along as it has been. We cannot permit the productivity gap between Northern Ireland and Great Britain to persist. Undoubtedly we are providing services to more disperse populations than some areas across the water but this is no excuse for an 11 per cent productivity deficit. Doctors, nurses and other frontline staff work incredibly hard. They can do little more. The problem clearly is how the whole system operates, it must be addressed immediately.




In order to continue defending almost half the budget being directed to just one sector with any credibility, we must be able to point to radical reform and modernisation. Unfortunately, the opposite is the case. The Minister has done nothing to distinguish himself from a Labour Direct Rule Minister. Indeed he has actually blocked some of the reforms that had already been embarked upon.



By postponing structural reforms he has left staff of the four health boards uncertain about their futures. Despite being paid, members of local commissioning groups have been prevented from starting their work by the Minister. Like David Sissling, the general practitioners and other health professionals involved will not wait around forever.
It is essential that the commissioning of services is separated from those delivering them. Innovation and incentivisation are necessary if we are to improve outcomes and overall performance. Productivity must improve. There must be genuine incentives and sanctions to sharpen performance. If a service provider is guaranteed that they will be delivering services to a given geographical population, what encouragement is there to optimise performance.



I want to see the maximum resources devoted to health but we have to be sure they will be put to most effective use. Change cannot be resisted indefinitely. Otherwise even 100 per cent of the block grant will not prove sufficient to operate the health service in Northern Ireland. The NHS has served us well since 1948 but we should not be trying to run it as if we are still living in 1948.