Ben Lowry: Prognosis for Stormont is bad if it can't, at last, get health policy right

It is with horror that I recently realised that it is almost five years since I produced a two-day news series for the News Letter, carried in consecutive double-page spreads, on NHS reform in Northern Ireland.

This was in autumn 2011, just before publication of Transforming Your Care (TYC), the review of health and social care provision in the Province. It seems two, at most three, years ago.

But the most alarming aspect of my recollection is that next to nothing has changed in health reform over that period, despite near unanimity among health experts – stretching back almost 20 years – that hospital provision in NI is inefficient.

The articles looked at the matter from an angle: would there be a move towards more efficient provision?

You might say: “Why were the articles not looking at it from a neutral perspective?”

Well, there is a simple answer to that. Coverage of health matters in Northern Ireland has been badly one-sided for many years, perhaps even decades.

If a minister (or an administrator, if the minister is too cowardly) tries to close a hospital, there is uproar.

Remember the Mid-Ulster? Thousands of people on to the streets.

A politician or campaigning group that demands a halt to any closure plan will often be treated as if they have displayed Mother Theresa-like concern for the ill and infirm, bravely standing up to the Dickensian-style cruelty of ‘austerity’.

Or if the protestor is not treated quite so reverentially by the media, then they will not get the grilling that the advocate of closure is given.

But that is exactly the grilling that we in the media should give to these obstacles to reform, and the damage that they do to healthcare.

The 2011 News Letter series quoted a British and American health expert, Greg Parston, who said health provision in the UK relied “much too heavily on hospitals”, but that Northern Ireland “is better placed than most to provide such because it is the only system in the UK that provides health and social care in an integrated fashion”.

Most politicians accept privately that Northern Ireland needs a smaller number of first-rate hospitals, which have better survival rates than an array of smaller hospitals (that are kept open out of terror of local opinion).

Yet little has changed since TYC.

It was the latest in a list of reports such as the 2001 Hayes Report (Acute Services Review Group), which called for six hospitals offering emergency care and inpatient maternity services, or the 2005 publication of the Independent Health Review, or the report by Professor Appleby saying that hospital spending in Northern Ireland in 2010 was 22% higher than in England.

In 2010 the businessman Gerry Robinson accused Northern Ireland politicians of lacking the will to make tough decisions on NHS.

Last year, yet another report – this time by England’s former chief medical officer, Sir Liam Donaldson – criticised the inaction. Sir Liam said that in the rest of the UK, a population of 1.8 million people would have four acute hospitals. NI has 10.

What happened after Sir Liam’s findings? Another consultation.

This is a massive failure by Stormont, and all parties are culpable. Not only have they rejected elementary reform, they joined together to back free prescriptions, an idiotic move that handed precious NHS cash to people such as me who can easily afford our regular scripts (in my case for asthma).

Even a child could see that the situation that prevailed until recently in Belfast – A&Es at the City, Royal, Mater and Ulster – was unsustainable.

Weeks before he was tragically killed last year, I put to Dr John Hinds the fact that his call for an air ambulance would add yet more costs on the NHS when we were not prepared to implement efficient hospital provision.

That impressive young doctor had a nuanced understanding of the issues – Wales, he said, had introduced both an ambulance but also wider reform.

Now there is a window for action in NI. The DUP and Sinn Fein have had a good election in which they both returned a large haul of MLAs. There are no elections now until 2019.

It is to be hoped that Michelle O’Neill, the health minister, is up to the challenge. It is also to be hoped that the new cross-party opposition is up to its own key role. There will be a temptation for it to attack any reform from the perspective of demanding yet more money for the NHS, that is squandered in the same old provision. It will be particularly tempting for the SDLP to take this line, now that People Before Profit has MLAs.

There are global concerns that democracies across the developed world are unable to take the difficult financial decisions that they must take for the sake of the future generations who will have to pay the debts we rack up.

Politicians demand tax cuts but also increased public spending. This has pushed nations such as Greece to near bankruptcy.

If Stormont tackles health sensibly, it will be a sign that devolution is maturing. If it isn’t, the long-term prognosis for competent local government is not a good one.

Ben Lowry (@BenLowry2) is News Letter deputy editor

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