Owen Polley: Stormont has repeatedly let down health workers by ducking reform

Unfortunately, like many thousands of other people in Northern Ireland over the past few months, I needed the help of our National Health Service last weekend.

Monday, 11th October 2021, 10:15 am
Updated Wednesday, 13th October 2021, 8:54 am
MLAs have delayed taking necessary but potentially unpopular NHS decisions. The resulting health crisis shows the inbuilt problems with our devolved institutions. The tendency to shirk responsibility, to think short-term and to ignore hard choices

On Saturday, I fell off my bicycle and smashed my left wrist. As a result, firstly I was sedated and given a procedure to stabilise and reposition the bone. Then, the next morning, my joint was rebuilt during several hours of surgery at Royal Victoria Hospital.

I’ve written about the NHS quite a bit over the years. But an up close and personal experience always helps put things in a sharper perspective.

That’s primarily because, as a patient, you can’t help but be struck by the kindness, dedication and professionalism of almost every member of staff you meet in hospital.

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They really are remarkable people, with reserves of caring and empathy that most of us can only wonder at.

It’s all the more impressive that they display these qualities under such challenging circumstances.

For example, the nurses who show endless reserves of patience through the small hours of the night while they are abused and sometimes even threatened by distressed patients. These are often older people, confused and delirious, who are not in any way responsible for their behaviour, but they still say hurtful, potentially intimidating things. It’s a special skill to be able to deal with that, calmly and firmly, in the middle of a busy shift.

When you are in hospital receiving care, you see that staff are working incredibly hard, often without breaks, while remaining helpful, interested and sympathetic to every patient. But there are difficulties with the system too. It is busy and struggling to cope.

I was unfortunate, or perhaps not, that I had an open wound on my broken joint. There was a risk that it would become infected and that was why I had my operation quickly. The surgeons were blunt that, if it hadn’t been for the cut, I would probably have had to wait much longer.

Indeed, many patients were waiting considerable lengths of time, some of them in terrible pain, for essential operations on broken legs, hips and other bones or joints. The lists for emergency surgery are long and growing.

There is clearly considerable pressure on beds, with some people waiting in discomfort in A & E or in inappropriate wards or bays. But, at the same time, it can be a lengthy and frustrating process being discharged, even after that decision has been taken and plans have been made to fill the bed.

Everybody’s doing their jobs with the utmost professionalism, but there are snags and bottlenecks that hold everything up and give an impression of inefficiency.

For an explanation, we have to go back to Stormont and the failure of successive health ministers to reform the NHS in Northern Ireland. Since at least 2011, and the Transforming Your Care report, but arguably as long ago as 2001 when the late Maurice Hayes published his recommendations, experts have repeatedly pointed out what needs to happen.

We know that there should be a smaller number of acute hospitals with a greater concentration of expertise and more resources should be directed at providing care in the community. In addition, there are difficulties with staffing, particularly in certain jobs and specialties.

Rather than act on these requirements, the executive at Stormont repeatedly delayed taking necessary but potentially unpopular decisions.

In 2014, the Donaldson Report made specific recommendations to close facilities and reorganise services. It was parked, due to one of Stormont’s periodic crises, and when the assembly got back to some sort of normality, in 2016, the new minister, Sinn Fein’s Michelle O’Neill, commissioned a new review, Bengoa, which made broadly the same points, but presented them in more general terms.

It’s an endless, circular process sustained by politicians who refuse to take responsibility for difficult decisions, like closing smaller hospitals. The latest incumbent at the health ministry, Robin Swann, has had to deal with Covid, so you can understand perhaps why reform has not taken priority, but no great change seems imminent. Remember that, just before coronavirus arrived, in December 2019, there was already a nurses’ strike and medics predicted that the system was close to breakdown.

The pattern is clear, and Stormont’s refusal to act has allowed NI’s NHS to become outdated in comparison with services in the rest of the UK. Our politicians have let down its brilliant employees badly and repeatedly.

Indeed, the crisis in health offers a neat case-study of many of the inbuilt problems with our devolved institutions. Their tendency to encourage shirking responsibility, thinking only about the short-term, taking the easiest choices and ignoring more difficult ones, blaming everybody else.

Unavoidably, the unionist parties’ most pressing problem at the next election is the protocol. However, in terms of making Stormont work, an honest, responsible approach to government that confronts long-term problems, rather than denying or ignoring them, is something that voters will think is long overdue.

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