Leading article

Minister deserves fair wind to address complex challenges

The Bengoa Review, published yesterday, is a cautionary tale about the need for change in the health service, rather than a detailed plan on how that service might be improved.

While it contains 18 recommendations, most of them tend to be un-costed aspirations in terms of bringing forward proposals, developing designs or embarking on consultations.

This does not render the review any less valuable as a signpost on the road to health service reform, but its emphasis on the general rather than the specific makes it difficult for politicians and the public to formulate a response at this early stage.

Certainly, there appears to be little in its content with which anyone might reasonably disagree, but the real challenge will come when theory turns into hard reality.

Minister Michelle O'Neill has pointed out that while health now absorbs almost half of Stormont's budget, that figure will rise to 90 per cent within the next 10 years.

She has therefore presented a compelling argument for immediate change, but it is disappointing that the review has not indicated by how much the proposed reforms might reduce overall health expenditure.

Until that figure is available, it is difficult to fully evaluate the cost of the review's proposals against their likely benefits and to assess the full worth of these latest recommendations

One way in which the minister might attempt to reduce costs is to think beyond the border.

While we cannot be sure what type of border we will have 10 years from now, Stormont could be expected to examine economies of scale by exploring an enhanced system of north-south co-operation on health care provision.

The present flow of people across the border for health and dental care suggests that Ireland has the potential for a shared public health system, in terms of strategic planning and practical provision. This is particularly relevant in view of the common challenges currently facing both health systems.

It may prove more difficult to introduce a shared provision after a post-Brexit border has been fixed in place.

While the Bengoa Review has established a theoretical foundation for implementing health service reform, in medical terms the patient might be diagnosed as suffering from too many reports and not enough medicine.

Since this is the twelfth attempt to reform health and social care provision since 1973, it is difficult to congratulate the minister for having taken a useful first step.

However, if she can transform the ideas in this report into an improved service, she will have taken a useful final step. For that reason, she deserves a fair wind to address the complex challenges which our health service now faces.

Leading article

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