The most urgent issue currently facing health and social care in Northern Ireland is how to transform a healthcare system based on an acute, reactive model of care into a proactive system with the capacity to meet the needs of increasing numbers of older people with chronic, complex conditions. Support for transformation receives widespread, cross-party support on the understanding that, without change, the system will deteriorate until services collapse under pressure.
Transformation requires strategic, long-term investment and scrutiny of the difficult decisions that will have to be made. This has been impeded by the ongoing absence of the Northern Ireland Assembly and Executive, without which it has not been possible for policy priorities to be set and appropriately resourced. Ultimately, it will be up to Northern Ireland’s elected representatives to bring about the change the system requires. However, in the meantime measures must be taken to prevent Northern Ireland’s health system from falling behind the rest of the United Kingdom and the needs of service users. While the announcement by the Secretary of State in 2018 of funding ring-fenced for transformation was welcomed, the current model of non-recurrent funding over a two-year period is not suited to long-term planning. We recommend that a longer-term funding settlement is sought to sustain service transformation.
In addition to an inadequate funding model, we found that many areas of healthcare were operating within a policy vacuum. In the absence of comprehensive strategies in areas such as cancer, mental health and oral health, clear direction for investment has been lacking and funding has been funnelled into plugging holes in existing services rather than service transformation. We have recommended that preparatory work begin on developing strategies in these areas to enable more strategic investment in the future.
Social care is integrated with healthcare in Northern Ireland and can play a vital role in early intervention, preventing people from being admitted to hospital and subsequently facilitating their discharge. However, the current social care workforce is undervalued and in need of recognition. Most social care is delivered by the independent sector yet disparities in wages, terms and conditions and career development pathways between the statutory and independent sectors have led to high levels of churn for independent providers. Steps need to be taken to consolidate the social care workforce and raise the value of social care across the board.
A number of critical areas of healthcare have been subject to prolonged underinvestment. These include mental health, particularly Child and Adolescent Mental Health Services (CAHMS) and the community pharmacy network, much of which is finding it increasingly difficult to remain open. These are areas which have a critical role in reducing demand on acute services and delivering long-term savings for the Department. Funding gaps are acknowledged by the Health and Social Care Board and other bodies and these gaps must be closed if the full potential of these services is to be utilised.
While the impasse at Stormont remains the significant impediment to addressing the challenges currently facing Northern Ireland’s health service measures must be taken in the interim to prevent the service from deteriorating further. We believe that the recommendations in this report will go some way towards meeting those challenges and prevent the service from falling further behind.
Published: 2 November 2019