Deirdre Heenan: A bunker mentality in the department of health won't cure the problems in our hospitals or build public confidence

Deirdre Heenan

Deirdre Heenan

Deirdre is a columnist for The Irish News specialising in health and social care and politics. A Professor of Social Policy at Ulster University, she co-founded the Northern Ireland Life and Times Survey.

Protests such as those held this summer in Newry in support of Daisy Hill Hospital reflect genuine public concern over the future of health services in their areas. Picture by Jonathan Porter/Press Eye
Protests such as those held this summer in Newry in support of Daisy Hill Hospital reflect genuine public concern over the future of health services in their areas. Picture by Jonathan Porter/Press Eye

In a highly unusual move, last week the Department of Health published a blog penned by its director of communications, David Gordon.

Rather than using this platform to outline how the department intends to address the current chaos engulfing health and social care, he instead embarks on a jaw dropping exercise in deflection and displacement of blame.

Reading this, one might be forgiven for thinking that the Department of Health was merely an interested bystander, powerless to address some of the systemic issues which have left us teetering on a cliff edge.

Gordon stresses that there are "actual" serious threats to the future of our hospitals but that they are "not what you might think". According to him the "conspiracy theories" are undermining the stability of the system and jeopardising the wellbeing of citizens.

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He notes that when changes to hospital services are announced, they are often accompanied by negative press. High profile claims that proposed changes are part of a secret plot to close local services are amplified by the media. This becomes the focus of debate about the future of healthcare.

He bemoans the fact that no matter how many times officials deny these allegations they still have legs. Changes are not embraced as part of transformation but instead are depicted in negative and damaging terms.

At no point in his blog does the author stop to reflect why these "rumours" gain traction. Could it be that the public are genuinely worried and alarmed when they see their local services get to a state of collapse? Might they not wonder who is in charge? Or ask who is responsible for this omnishambles?

In case it has slipped the mind of the director of communications, the department is responsible for formulating policy and setting the strategic direction.

If the public are convinced that there is a Machiavellian plot to close smaller hospitals, who is responsible for this? Could it be that misinformation, a lack of transparency, doublespeak, group-think and the absence of an overarching strategic plan for health and social care cause genuine concern and distress?

Transformation of healthcare is necessary and long overdue; as Bengoa stressed, if change is not embraced or properly managed, collapse is inevitable.

It is deeply patronising to note that changes to health services often "cause concern" in local communities. You don't say. The public are naturally vexed by what they view as the downgrading of services that is happening in a haphazard, unplanned way.

Being told one week that a local hospital's future has never been brighter and then questioning its viability weeks later is hardly conducive to instilling confidence. Instead of stating that "simply opposing change won't stop it happening", it might be better to focus on being open and honest with people and attempting to rebuild trust.

Local hospitals play a key role in the delivery of services. As Gordon rightly notes, the days of every hospital providing every service are over. Why, then, is it so difficult to say, 'This is what we have planned for Daisy Hill', or, 'This is what we have planned for Causeway'? Why can't the department publish what services will be delivered, where and why? Surely expecting the department to produce a blueprint for the future, based on robust evidence on outcomes, is not beyond the pale.

The central thrust of the blog is that rumours about the viability of a hospital can essentially become self-fulfilling prophecies. For example, a consultant thinking of taking a job might read speculation about the hospital's future and decide to go elsewhere.

Indeed, this may be the case, but doesn't this scenario actually highlight the need to provide a strategic long-term plan for health care which details the role played by all hospitals and service providers?

Additionally, the blog ignores that fact that a failure to plan has left Northern Ireland as the least attractive area of the UK to work as a consultant. Alongside this, the Northern Ireland workforce is being hollowed out by the Republic of Ireland. Sláintecare has already denuded border areas of consultant staff and will eventually have a similar impact on GPs.

The suboptimal terms and conditions for staff in Northern Ireland means that they are leaving in their droves. What is the department doing to counter this? How can it address serious issues in both recruitment and retention?

A key part of the department's role is to anticipate the future and ensure that measures are in place to safeguard the delivery of safe, sustainable services. The political vacuum in Northern Ireland is exacerbating chronic problems in taking difficult decisions, but a bunker mentality is not the answer.

As we face into a gruelling winter, stubbornly high inflation and intense labour market pressures, the public and the beleaguered health and social care workforce are crying out for leadership.

The most effective way to counter the “threats” presented by conspiracy theories is to address the information vacuum by providing transparent, robust, realistic, long-term plans for reform.