Our Health and Social Care Services need to be reformed.
No one is in any doubt about that simple statement of fact, and yet the now delayed report of the Expert Panel chaired by Prof Rafael Bengoa will be another in a long list of reform proposals – we have already had Compton, Donaldson and others. The truth is we are not short of expertise. We know what we have to do to reform the system. Yet we seem unable to do it!
Reform is inevitably complex, and it will be uncomfortable for some. The objective is to secure an improved, world-class Health and Social Care service for those who use it, using all the expertise and resources available to ensure that this is delivered free for all at point of access. It is remarkable how often this objective is ignored; but, to achieve it, we cannot stand still as demand rises and conditions become more complex.
The public should not be fooled by the narrow political focus which inevitably accompanies such reports. Headlines will doubtless again focus on potential “closures”, giving the impression that experts are proposing stripping away services. Such a conclusion is wrong to the point of being dangerous.
It is frustrating that even members of the Health Committee at Stormont have not yet seen the Report in order to discuss it. This already raises suspicions of a Minister who is scared of open debate around the detail. There may be another attempt to narrow the focus of Bengoa’s proposals so as to avoid actually having to implement them. Alarmingly, the Minister’s focus seems already solely to be on those engaged in statutory provision of services, rather than on those actually accessing them (including the many who will do so via third-sector providers with expertise in particular areas).
There seems little reason to doubt that Bengoa’s proposals will be familiar, because we will have seen many of them before. Fundamental to them, surely, will be the principle of “shift left”, so that conditions are better assessed at the outset. GPs are doing an exceptional job in increasingly trying circumstances, but working alone they simply cannot be experts in everything – and thus for patient safety they will use referrals in areas where they lack direct expertise.
By broadening the scope of collaboration between GPs over wider geographical areas (and also practice nurses and other services, such as physiotherapy), initial assessment will be improved and there will be fewer referrals – reducing waiting lists and limiting the pressure on secondary care. The same principle establishes a requirement for better resourced primary care Health Centres providing better interventions locally, with only more complex conditions transferred to regional hospitals. Far from “stripping away services”, such a reform of the system will see people helped more quickly and more safely, leading to better outcomes for service users.
Therefore, proper Health Reform as recommended by experts is in the obvious interest of service users – patients, carers and others. This is why debate should focus on the entirety of the proposals rather than on apparently alarmist, out-of-context headlines designed to suit politicians who do not wish to take the tough decisions.
Patients and Health professionals deserve much better than the odd sticking plaster. It is time for proper reform to relieve the pressure and deliver truly world-class outcomes for all.
• Paula Bradshaw MLA is the Alliance Assembly Member for South Belfast