Why doing nothing is not an option for our health service
The SDLP's Declan O'Loan has made a thoughtful intervention into the debate on the future of our health services. He stated that the health service is not giving value for money and needs radical reform:
"The Health Service is costing every man, woman and child in Northern Ireland 2,300 each year.
"Is it giving value for money for that expenditure? I am not at all convinced that it is. Is the answer to increase the amount spent on health?
"I hear the Minister talk about needing to get an extra 600 million a year. That sort of money is just not available. It is equivalent to the total being spent on the departments dealing with Culture, Agriculture, Enterprise and Environment all put together.
"We need to look at major structural change in health. It means change in how the health system is actually delivered.
"Secondly, it means change in how the health system is managed. Our current service does not stack up against comparisons with the best UK performance.
"We spend a lot of money and we do not get results to match it. High levels of illness need to be seen as a measure of the failure of our system, not merely an argument for higher funding.
"The place we need to be looking at is our structures and management. If we do not correct them, we will be condemning ourselves to repeat the poor performance of the past.
"I have very serious concerns about the postponement of the setting up of the Health and Social Services Authority, and the subsequent resignation of the Chief Executive Designate, David Sissling.
"This single body was to replace the four Health Boards and offered the opportunity for a much higher level of strategic thinking."
His comments were a welcome injection of realism into the debate from the SDLP.
They chime with much of what my colleagues and I have been advocating but are at odds with the populist approach of his party's spokesperson, Carmel Hanna, who on December 17, criticised me for making exactly the same case and highlighting the opportunities the Minister was passing up.
Declan O'Loan also said: "There has been significant reform in other places, including across the water and I think we're behind in the kind of structural reforms that can be done, and that within the existing parameters of a service that is free at the point of use, you can make very, very substantial improvements.
"We do need those improvements and I think we need to be prepared to as politicians think radically and in some ways be prepared to bring in the best kind of management and then give it the freedom to operate."
It is very difficult to disagree with a single word of this. The echoes are uncanny. We have been making exactly the same points repeatedly since the commencement of devolution.
Maybe this is an indication that there is much more common thinking than some might imagine.
In Carmel's article, she harks back to Nye Bevan and 1948, but unfortunately for her, 60 years on we cannot run the health service as though it is still 1948. Of course the health service should be free at the point of use but, in order for that to continue, doing nothing is not an option.
Carmel describes the NHS as "pure socialism", the "most socialist initiative ever undertaken by any democratic government", but admits "there will never be enough resources for health and personal social services" and "it will always be a case of limited resources addressing almost infinite demand".
Then however she proceeds to attack proposals from some of us outlining where improvements can be made, as merely "a distraction from the real issues".
She is wrong to imply that efficiency savings should be the height of our ambitions, that this should satisfy everyone.
Simply shaving off a little here and there is not going to turn the system around. That can only ever be a stop-gap measure getting the Minister through to the end of a single term in office.
In order to make a genuine difference, he must institute radical change to overhaul how services are commissioned, with proper incentives and sanctions to drive increased performance and productivity.
Carmel admits "no one will disagree with calls for greater efficiency, innovation, effectiveness and value for money in the deployment of health resources" but merely calling for these will not achieve them.
Politicians need to have ideas and solutions how this can be done. It certainly won't happen by not acting and allowing things to happen as they have always happened. Around the province meanwhile numerous UUP, SDLP and Sinn Fein councillors have voted against the Programme for Government devised by their own Ministers.
The Health Minister has barely taken time to draw breath amidst his pleading to have more money at his disposal.
At one point, he was demanding an increase based on practice at Whitehall Departments which would have equated to 90 per cent of the Northern Ireland block grant. On Friday, in response to the news that rates would have to more than treble if the Minister's requirements were to be met, it was reported "Mr McGimpsey said he already 'considerably pared down' his demands for additional cash to more realistic levels".
I'll leave it to him to explain why they were unrealistic in the first place, but if he has moderated his demands, then that is certainly positive.
The difficulty the Health Minister has faced is that he wants more money for his Department, yet claims he is opposed to rates going up or spending being removed from other Department allocations.
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Tuesday 14 February 2012
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