Opinion

Peter Cardwell: Politicians must lead us towards a better health service

Stormont Minister for Health Robin Swann. Photo: Peter Morrison/PA Wire.
Stormont Minister for Health Robin Swann. Photo: Peter Morrison/PA Wire.

There’s not much that’s good about our health service in Northern Ireland at the minute, except that it can’t really get any worse.

Despite the heroic efforts of its dedicated staff, there is little doubt our health service has been truly broken by Covid.

In almost every way in which people engage with the health service, that engagement is well below the standard required. 999 response times are over 90 minutes for those having heart attacks and strokes, with one patient waiting six days - not six hours, that’s six days - last month in A&E before a bed became available.

And demand is higher than ever, with no fewer than 230,000 patients contacting their GPs last week and 20,000 face-to-face appointments each day, according to the Northern Ireland General Practitioners’ Committee.

With winter coming, there will be no respite. The prospect of a bad flu season and the continuance of Covid will heap yet more pressure on exhausted staff in an already-depleted workforce, doubling down on individual workers who have often been redeployed multiple times already.

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Yet there is hope. The principle of basic training in the army is that when something - or someone - is broken down, only then can it be properly built up again. And that is actually helping Northern Ireland’s health system as it deals with the current crisis, because already it is innovating to survive.

Without fanfare, changes to how healthcare staff work are happening, every day, and mainly through necessity. Crisis brings opportunity, and much-needed fresh thinking. Indeed, there has been an important change in the mindset of many of our senior clinicians, who, prior to the pandemic, often saw travel between hospitals as a waste of time. Yet it was expected that patients do the same for often a very short in-person meeting. Now it’s the norm for many of our doctors.

Zoom, and its equivalents, are an idea whose time has come. Face-to-face appointments will never disappear, nor should they, but virtual will become the norm for busier doctors and busier patients. Yes, it does carry some risk, but the benefits massively outweigh them, and as we get used to seeing our doctor on a computer or smart phone, more honest and useful conversations will ensue.

This week, English health secretary Sajid Javid welcomed billions from his Cabinet colleague, Chancellor Rishi Sunak, earmarked for digitalisation of the English NHS. Northern Ireland is actually ahead in this race, with electronic records from GP through to hospital discharge being used as yet another way our health service in Northern Ireland has innovated during Covid.

It is patently absurd to have five health trusts for a population of just 1.9m people. Yet the seeds of change for this deeply siloed system are there, too. It’s part of the process by which health leaders are facing up to the bizarre localistic fetish for lower-quality services on our doorsteps rather than regionalised excellence. The small sacrifice of longer journey times will, quite simply, equal better healthcare.

Politicians know this, and must lead, not crumble, in the face of emotional stories about local facilities, and simply cannot capitulate to intransigent, throwback union Trotskyists who fear reform. Do that, and we can kiss goodbye for another decade to the kind of much-needed transformation the Bengoa report advocated. It is time to lead.

And one shining example of that leadership is the current health minister, who somehow manages to be a Northern Ireland politician and yet apparently is largely free of cynicism. His continuation in office after an election is vital to this ambitious and essential project of health reform. Because rebuilding and transforming needs his kind of visionary, brave and sometimes quite subtle leadership. Yes, our healthcare system is in the ashes, but it doesn’t need a Phoenix in order to rise, rather the continuation of a Swann.

:: Peter Cardwell is the Political Editor of Talk Radio and a former special adviser to two Secretaries of State for Northern Ireland