Health funding in Northern Ireland Contents

Conclusions and recommendations

Transformation

1.Transformation of Northern Ireland’s health and social care services in line with the aims and recommendations of Bengoa and Delivering Together is needed urgently if services are to keep pace with the increasingly complex and evolving needs of an aging population. The Committee welcome funding ring-fenced for this purpose. However, the current model of non-recurrent funding over a two-year period is not suited to delivering the truly transformative and sustained change required. We recommend that, if an Executive is not in place by the end of this year, the UK Government work with the Department of Health and the Department of Finance to secure a multi-year funding settlement ring-fenced for transformation. (Paragraph 29)

2.Successive one-year budgets are impeding planning and investment in Northern Ireland’s health and social care services. Without a long-term approach the measures needed for improving outcomes and delivering value for money cannot be taken. We recommend that, following consultation between the Department of Health, the HSC Trusts and the community and voluntary sectors to determine budget priorities, the UK Government work with the Department of Health and the Department of Finance to produce three-year minimum budget allocations. This should be implemented from the next budget. (Paragraph 37)

Cancer services

3.Cancer incidence increases with age and demand for cancer services is likely to rise as Northern Ireland’s population ages. To meet this demand in the long-term a reconfiguration of services under the direction of an overarching strategy will be essential. However, in the medium-term action is needed to slow and ultimately reverse the upward trend in waiting times. The Committee recommends that the Department of Health commit to a baseline assessment to identify where gaps in the HSC workforce are contributing to delays in the diagnostic pathway for cancer patients. The Department should subsequently bring forward a strategy for closing those gaps through the recruitment and retention of an adequate workforce alongside innovations in technology and service delivery, to be published in draft by summer 2020. (Paragraph 50)

4.Northern Ireland is alone in the United Kingdom in not having an up-to-date cancer strategy. Without an integrated, long-term vision for improving cancer services under the direction of a well-conceived strategy, cancer services in Northern Ireland will struggle to keep pace with demand. As such, the Committee welcomes the Department’s announcement that a new cancer strategy for Northern Ireland is in development. However, we recognise that many will be concerned that decisions on a new strategy are awaiting Ministerial approval. We recommend that the Department set out, in response to this report, clear timescales for its programme of work in developing a new cancer strategy and provide regular updates on progress made. This timescale should set out the key milestones where Ministerial decisions should be made. (Paragraph 58)

5.The Committee welcomes the Department’s moves to place Northern Ireland on an equal footing with the rest of United Kingdom in opening up patient access to innovative new treatments. However, there has been a lack of updates on progress made towards realising the full raft of changes announced last year. The Department should update the Committee on what progress has been made so far and provide regular updates on further progress until such time as these changes are fully rolled out, or until the relevant Committee is constituted at Stormont. (Paragraph 68)

6.The Committee welcome the Department’s announcement that FIT will be adopted as the primary screening test for bowel cancer. However, we are concerned that this will not be extended to men and women aged 50 and over as recommended by the UK National Screening Committee. We are not clear why this decision was made. The Committee recommends that the Department consider extending the programme to men and women aged 50 and over. (Paragraph 73)

7.The Committee welcome ongoing work to explore a managed strategy for introducing HPV testing as the primary test in cervical screening. However, there has been a lack of updates on progress made since the Committee questioned the Department in January. The Department should update the Committee on what progress has been made so far and provide regular updates on further progress until such time as primary HPV testing is rolled out fully, or until the relevant Committee is constituted at Stormont. (Paragraph 75)

Social care

8.The independent social care sector is struggling with competition from the low wage sector, particularly hospitality and retail, and a competitive relationship with the statutory sector. High quality social care requires a skilled and valued workforce but social care workers are often on low wages and have little scope for career development and progression. Action must be taken to make social care an attractive career choice and create closer parity between the independent and statutory sectors. The Committee recommends that the Department conduct a review of social care roles across the board to identify inconsistencies in roles, responsibilities and salaries as a step towards consolidation of the social care workforce. This review should be completed by summer 2020. The Department should further set out what steps are being taken to progress the proposals set out in Power to People for equalising pay and conditions across the social care workforce in response to this report. (Paragraph 90)

9.Short-term budgets are having a particularly negative impact on social care, with year-on-year uncertainty impeding the ability of providers to plan for the future and develop service innovations. As we have recommended in paragraph 36, three-year minimum budget allocations are needed for the Department of Health. This should facilitate the Department moving towards a minimum five-year partnership model with community and voluntary providers in which commissioning and investment are based on progress towards agreed outcomes. (Paragraph 96)

10.Social workers are spending too much time filling in paperwork and this does not represent the best use of their skills or expertise. Despite recent efforts at reducing the bureaucratic burden on social workers this continues to be a problem and is negatively impacting on both the profession and the people who depend on it. The solution to this problem should not itself be overly bureaucratic and meaningful change could be brought about quickly and inexpensively. The Committee recommend that a task force be established with the remit and the authority to remove unnecessary and duplicated paperwork and streamline existing paperwork—though this should not be at the expense of high-quality assessments or casework. This should be completed by summer 2020. In the medium-term the Department should implement IT solutions and increase the number of administrative staff available for supporting social workers. (Paragraph 105)

Mental health

11.Despite a higher prevalence of need, the Department of Health spends a comparatively low percentage of its overall budget on mental health. Years of underfunding have meant that those in need of mental health services have struggled to access the same quality of care as those with physical health needs. The Department should increase its level of investment in mental health as a share of the overall health budget in line with recent increases in other UK jurisdictions, with the aim of reaching 13 per cent in the long-term. (Paragraph 119)

12.In the absence of a mental health strategy measures should be taken to ensure that Confidence and Supply funding ring-fenced for mental health is being used as effectively as possible. The Committee recommends that the Department consult widely with professionals, service users, staff, and the community and voluntary sectors on where funds would be most effectively deployed and to make this information clearly available to the public so that decisions can be properly scrutinised. Furthermore, the Department’s decision to use funding to maintain existing services raises the prospect of what will happen once the deal expires. The Department should set out how it will respond to the exhaustion of additional funds for those programmes supported by the Agreement in 2018–19 and 2019–20. (Paragraph 125)

13.Mental health services in Northern Ireland are not delivering the model of care that Bamford envisaged. In the absence of clear lines of decision-making in mental health, Northern Ireland is in need of a comprehensive, up-to-date mental health strategy that will provide the direction necessary for developing collaborative partnerships and services that are capable of meeting the dynamic needs of service users. The Committee recommends that the Department publish the latest Bamford evaluation and use this as a first step to begin work on the mental health strategy for Northern Ireland in collaboration with the HSC Trusts, professionals, service users, staff, and the community and voluntary sectors. (Paragraph 135)

14.The dominant themes of the evidence we heard on Children and Adolescent Mental Health Services were of underfunding and fragmentation. The acknowledged funding gap must be closed by the Health and Social Care Board. We recommend that spending on CAMHS is brought into line with the HSCB’s own recommendation of 10 per cent of the mental health budget. To ensure that funding is deployed strategically measures should be taken to better integrate the commissioning of services and develop a culture of multi-disciplinary and multi-sectoral team working. The recent review into CAMHS conducted by the Northern Ireland Commissioner for Children and Young People contained a number of recommendations based on wide-ranging consultations with key stakeholders. We agree with the Commissioner’s recommendation that a long term and sustainable ‘funding and practice partnership’ model be established for driving change which takes account of the investment required across all key services and sectors included in the stepped care model. (Paragraph 142)

15.Urgent action must be taken to bring down suicide rates in Northern Ireland. The comprehensive measures set out in Protect Life 2 are evidence-based and would provide clear direction and focus for tackling Northern Ireland’s suicide epidemic. The Committee recommends that the Department implement the Protect Life 2 strategy as soon as the next budget is agreed. (Paragraph 147)

Oral health

16.Northern Ireland has some of the poorest oral health outcomes in the United Kingdom. The current oral health strategy is based on obsolete data from 2003 and does not contain any up-to-date targets for optimising services and improving outcomes. Fresh direction and impetus are needed to improve Northern Ireland’s oral health. This will not be achieved with a piecemeal approach but requires an overarching, evidence-based strategy with associated targets to work towards. The Committee recommend that the Department commit to developing a new oral health strategy for Northern Ireland in collaboration with the dental profession to be published in draft by early 2021. (Paragraph 157)

Community pharmacy

17.Community pharmacies are a valuable healthcare resource and highly rated by the communities they serve—including some of the most deprived and rural communities in Northern Ireland—and uniquely placed to play a proactive role in the prevention and management of long-term conditions, promote wellbeing, deliver community-based healthcare and reduce pressures on General Practice. While securing a GP appointment may take days and sometimes weeks for many, community pharmacies are not appointment-led and able to provide a uniquely accessible service. Yet many are struggling to survive in the face of prolonged underfunding. The Committee recommends that the Department agree a sustainable funding package for community pharmacy based on the findings of its own Cost of Service Investigation and implement a Drug Tariff based on Northern Ireland’s unique set of circumstances. (Paragraph 173)





Published: 2 November 2019