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Northern Ireland’s Health Minister, Michelle O’Neill, today delivered her decade-long vision for the province’s healthcare system in which she reinforced the need for change. Change, which, she said, had to start ‘today’.

Transformation and integration were the buzzwords of the Minister’s report ‘Health and Wellbeing 2026: Delivering Together’, in which she emphasised the reasons for rising demand in healthcare services, such as the changing demographic, an increase in chronic conditions and changing practice in healthcare.

In her speech to the Assembly, Ms O’Neill also reinforced the increasingly important role that integrated care will play in primary care in the future.

Integration is the way forward

‘I will,’ said Ms O’Neill, ‘put in place multidisciplinary teams embedded around general practice that will maximise the benefits that can flow from our integrated system of health and social care. Their focus will increasingly be on keeping people well in the first place and proactive management of long-term conditions. These teams will include a range of disciplines including GPs, Pharmacists, District Nurses, Health Visitors and Social Workers.’

While Ms O’Neill stressed the vital role of the GP, announcing that she was increasing the number of GP training places to 111 per year, with a further 26 additional places over the next two years, the importance of pharmacy was also highlighted, with the Health Minister not only advocating the positive influence of the 54 newly-appointed Practice-Based Pharmacists, but also the continued contribution from Community Pharmacy.

The newly-formed multidisciplinary teams would, she said, ‘work in a more integrated way with all other community services and development work in their area, including Community Pharmacy. Community Pharmacy is an important part of primary care and can help to reduce pressure on other parts of the HSC. We must use them better, especially to support improved public health and engaging in with the public to ensure medicines are being used appropriately.’

In her speech, the Minister referred to many of the perceived successes that recent developments have brought throughout the north, such as the Rapid Assessment, Interface and Discharge team in the northern area. The innovative project means that instead of the traditional approach to mental health referrals for people who come into emergency departments or being admitted to hospital, this team operates seven days a week, 24 hours a day to respond quickly to need, ensuring continuous care and better outcomes.

As happens so often in NI healthcare, while the Minister’s speech – and her report – was heavy on commitment and leadership (‘In short I am up for this’) – it was, as with Transforming Your Care, light on detail.

One thing was, however, made clear….

Change is needed and needed now…

In words reminiscent of those of her predecessor, Simon Hamilton, last November – ‘We change or we fail’ – Ms O’Neill told the Assembly that ‘standing still is not an option’.

And, as if further proof was needed, the launch of the Minister’s report was accompanied by the long-awaited publication of ‘Systems, Not Structures’, the report of the Expert Panel, which was established in January of this year to lead the debate on the future configuration of the province’s health and social care.

‘Perfect storm’ being created for NI healthcare system

In the review, the Panel Chair, Professor Rafael Bengoa, said that change was required if the province was to withstand the ‘perfect storm’ that’s currently being created in its health and social care system.

Professor Bengoa’s report includes 14 recommendations, including:

  • That the HSC should move to formally invest, empower and build capacity in networks of existing health and social care providers (such as Integrated Care Partnerships and the developing GP Federations) to move towards a model based on Accountable Care Systems for defined population based planning and service delivery;
  • That the HSC should continue its positive work to invest in and develop the three key areas of workforce, eHealth and integration:
  • The HSC should immediately develop innovative primary care based models that will allow non-medical staff to work in a way that makes the most of their skills. (For example, these could be based on the community nurse-led care models being implemented in the Netherlands, or the use of pharmacists in community development here in Northern Ireland);
  • The creation of a transformation board, supported by the Department, linked to the Executive’s health and well-being strategy. This board would set the mid-term strategy, oversee the transformation process and would be tasked with creating the right conditions for the local system of care to develop successfully. It should help to transform organisational structures and management processes by promoting local decision making, local innovation and scaling up of best practices among the local systems of care;
  • The system should identify and scale up at least two innovative projects per year where there is clear evidence of improved outcomes for patients or service users.

As with the Health Minister’s report, the focus of Professor Bengoa’s review is very much on integration.

‘An approach to a workforce that responds to a population health model requires one of a blended nature where staff, professional and unregistered/unregulated, are recognised for the combined expertise they bring to a health and social care team that is built around the needs of patients,’ says the report. ‘The success of any new service model will be absolutely dependent on staff being employed and deployed in such a way that makes the best use of their skills and which allows them to continue to develop as professionals while providing the services that users and patients need.’

The Expert Panel was particularly scathing about the current one-year commissioning cycle which, it said, is ‘far too inflexible and short term to allow for any sustained investment or innovation’ and so it has advocated longer term commissioning cycles in addition to a greater level of inter-sectoral funding.

Rationalisation of hospitals?

The inevitable question of rationalisation of hospitals was also addressed, with the report concluding that ‘the current configuration of acute services is simply not sustainable in the short to medium term’. Rather than getting into the ‘which hospital should be closed’ debate, however, the panel decided instead to advocate instead that it ‘will be necessary to reorganise services in such a way that resources are freed up from some part of the existing model in order to allow them to be used for implementing new models that will offer higher value care.

‘Very specialist services can be based anywhere in Northern Ireland,’ the Panel concluded. ‘In the face of increased specialisation and ever rising demand, it is not practical or desirable to try to deliver specialist services everywhere. However, it is true that specialist services could be delivered anywhere. Any acute hospital in Northern Ireland has the potential to become a regional centre.’

‘If the model proposed in this report is to be successfully implemented,’ said Professor Bengoa in his report, ‘then it is inevitable that the way services are currently provided will need to change. Furthermore, changing these services is not optional; it is inevitable. The choice is not whether to keep services as they are or change to a new model. Put bluntly, there is no meaningful choice to make. The alternatives are either planned change or change prompted by crisis.’

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