Northern Ireland

Health reform 'stifled' in Northern Ireland during political deadlock, think-tank warns

Professor Deirdre Heenan has co-authored a damning independent report into the Northern Ireland health service
Professor Deirdre Heenan has co-authored a damning independent report into the Northern Ireland health service Professor Deirdre Heenan has co-authored a damning independent report into the Northern Ireland health service

POLITICAL deadlock and a 'culture of fear' in the Northern Ireland health service is 'stifling' NHS reform, the author of a damning independent report has warned.

Influential think-tank, the Nuffield Trust, has also criticised the "tight command and control" at "the heart" of the north's health system that has led to the creation of a 'bunker mentality' discouraging openness about failings.

Interviews with frontline workers, clinicians and senior managers took place last year to inform the detailed research by the English body, which aims to improve healthcare across the UK and advise government on policy.

Co-author Professor Deirdre Heenan, who is based at Ulster University, was scathing in her assessment of the multi-layered bureaucracy in the north's health service - and said the "bottom line" was that patients were "languishing" on waiting lists.

Researchers discovered that a patient in Northern Ireland is nearly 50 times as likely to be waiting more than a year for care than one in Wales - the next worst performer.

It also concluded the north is "lagging behind" in delivering social care.

"We have been told in seven separate reports over the past decade that we are over-managed, over-administered and are on the verge of collapse," Professor Heenan said.

"Through our interviews we found that a tight 'command and control' style of management from the top has resulted in a lack of ambition, learning and working out new ideas...it is stifling progress.

"There is also a culture of fear that continues to exist with staff afraid to report problems...if we looking at other learning systems in the NHS such as Scotland we can see the progress, that is not happening here".

Professor Heenan, who is a senior associate at Nuffield, said spiralling waiting lists represent a "major breach of public trust".

"A citizen here is more than 3,000 times as likely as a citizen of England to have been waiting more than a year for healthcare..How bad does it have to get before action is taken," she added.

The report acknowledges that although the civil service is doing its best to provide leadership, the collapse of power-sharing is exacerbating chronic problems.

Three years after the Bengoa Report - which provided a blueprint to overhaul the north's health service - the research also identified serious failings in workforce planning over the past decade that had led to health trusts relying on costly agency staff.

Report co-author Mark Dayan, said: "There's no doubt that the people we spoke to were committed to changing to a health service that does a better job keeping people well. But this is colliding with a centralised culture that is exactly what you don't need for a process of experimentation.

"Meanwhile the lack of political leadership makes difficult decisions hard to defend either morally or legally...without elected leaders, it turns out things grind to a halt because officials don’t have the legitimacy to make tough calls."

The British Medical Association (BMA), the union representing doctors, said the Nuffield research highlighted the "scale of the challenge" to drive reform - and the urgent need for devolution to be restored.

"We do not have enough doctors in general practice or in our hospitals to deliver the services patients in Northern Ireland need," Dr Alan Stout of the BMA said.

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