Letter: Centres of excellence could bring new revenue stream in the decade ahead

Public service employees in Northern Ireland enjoy generous terms of service while sickness rates in the sector have not improved much in the past decade.

Highly paid jobs are being created for language/cultural commissioners (currently advertised on the NICS website) – and when the new secretariats are taken into consideration, our public sector seems to be expanding at pace.

These unelected commissioners will bear down on the private and public sectors, with useless directives that will cost companies and public bodies a lot more, in that people will need to be employed to ensure compliance – and due to changes in employer National Insurance costs, every new job will cost the public sector more.

Picking up on G Murphy’s letter, public sector jobs in Northern Ireland usually include very generous employer pension contributions.

Yet the politicians at Stormont (two main parties in particular) cannot take meaningful revenue-raising decisions. Hence it is good to consider the remaining NI assets and not just its liabilities.

Northern Ireland has a developed healthcare system, which is evolving to include specialist care units. Further down the line, some healthcare centres of excellence may be possible.

By the end of 2026 all five health trusts will have adopted a new patient care system (from Epic software in the US, where charging for services is routine), so a means of charging for health services rendered here to health tourists will be available.

This could bring a new revenue stream in the decade ahead, as well as prestige to Northern Ireland as a centre of health expertise.

Caveat: accepting just a few health tourists in a specialist area should not disrupt local services much, as long as local waiting lists are first brought under control.

Centres of excellence might accept patients referred from approved NGOs. The idea would have to be integrated with foreign aid plans of the Cabinet in London. Stormont could, at a future date, come up with a revenue-raising opportunity together with a costed business plan.

Meanwhile, there needs to be a review of the diagnostic-led process of referrals from GPs. Dr Suzanne O’Sullivan has written an excellent book on the topic: The Age of Diagnosis.

My understanding of diagnosis in general is that it is a snapshot of a condition at a point in time, with a view to early stage intervention leading to action with various treatments.

With regard to physical conditions, there is usually a diagnosis-led approach, with less focus on contributory societal factors (lifestyle; social status; work).

With regard to mental conditions however, if no danger to the patient or others, then a graded approach – such as medication for a limited period, or managed withdrawal from drug misuse, or other approaches such as CBT (Cognitive Behavioural Therapy) may be relevant.

In the UK, the government is currently looking at tightening the fitness to work rules. Hence temporary socio-mental conditions that are correctible, such as borderline personality disorder, are set to be re-examined.

It has been reported in the news media that online sources are encouraging people to use a combination of diagnoses, as a means of getting social security benefits.

Finally, to return to the matter of diagnosing the bloated public service in Northern Ireland, given that the Labour Party is bolstering the public sector with posts to please Irish nationalism, the Executive Office at Stormont has little incentive to change direction – despite the need to look at ways of reducing public sector extravagance.

Davey Bustard, North Down