Deirdre Heenan: Is this Stormont executive up to the challenge of health and social care transformation?

Addressing workforce issues and a 10-year plan for transformation must be Robin Swann’s urgent priorities, says Deirdre Heenan

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.

Robin Swann was health minister during the Covid-19 pandemic
Robin Swann is back as health minister. Will he and the rest of the executive have the courage to drive the transformation our health and social care so urgently needs? (Oliver McVeigh/PA)

The dust has settled on the restoration of the devolved institutions, and attention has quickly turned to delivery and how this new administration plans to prioritise the plethora of issues in their in-tray.

While there are urgent challenges in education, the economy, the environment and policing, it is undoubtedly the crisis in health and social care that has attracted most public attention.

Spiralling waiting lists, ambulances queuing outside emergency departments, people being treated in hospital corridors, a depleted, exhausted workforce and the struggle to discharge medically fit patients are just some of the symptoms of a broken system.

People are spending their life savings on operations and many are relying on unpaid and overworked carers to provide essential services. The principle of universal, equitable, comprehensive health free at the point of delivery has been eroded.

This escalating crisis has been compounded by two years without a government; however, many of these issues have deep roots. Failures by previous executives to take tough decisions has destabilised the health and social care system.

Despite multiple high-profile reviews all pointing in the same direction of travel, transformation remains elusive. The failure to address long-term and systemic issues impacting the sustainability of health services in Northern Ireland is a chronic problem.

Will this administration be different, or can we simply expect more of the same? It is telling that despite extensive handwringing about health, neither Sinn Féin nor the DUP opted to take the most challenging portfolio, leaving it instead to the smallest party in the executive. For the new health minister there are two immediate priorities.

Firstly, the system must be stabilised and this means addressing the workforce issues. The haemorrhaging of the system’s most valuable assets must be addressed as a matter of urgency. Staff are burnt out, feel undervalued and leaving in their droves.

The biggest health board in Wales is still facing ‘fundamental challenges’ a year after it was put into special measures, a report has said
Health and social care staff are burned out (Peter Byrne/PA)

A fully funded, comprehensive, detailed workforce plan is required to address staff shortages and make health and social care an attractive, viable career option.

Secondly, there is a pressing need to produce a 10-year plan for transformation underpinned by a shared vision for change. This is required to create a sense of journey that everyone can buy-in to. It would also bring some much-needed unity of purpose. In the last decade we have lurched from one crisis to the next, fighting fires and papering over the cracks. There are no quick fixes. Bold leadership is required to rebuild the system.

It is telling that despite extensive handwringing about health, neither Sinn Féin nor the DUP opted to take the most challenging portfolio, leaving it instead to the smallest party in the executive

This detailed blueprint is required to guide decision-making and provide an overarching framework. The 2016 Bengoa plan set out the key principles for transformation such as prevention, early intervention, and empowerment. It was however short on detail. What will change actually mean for the people of Newry, Enniskillen or Coleraine? Where will specialisms be located?

The comprehensive plan must include robust targets, timescales, metrics and measures of success. Addressing inefficiencies in the system to maximise the quality and quantity of services is crucial.

In the last decade trust and confidence in those charged with managing the service has been severely damaged. Changes to provision have been short-sighted, counter-intuitive, leading to financially inefficient and fragmented delivery of care.

Communication to service users has been woefully inadequate. There should be consequences for poor performance, rather than management being a game of musical chairs into the next lucrative position.

The development of this strategic plan should be accompanied by a public information campaign designed to acknowledge, address and allay concerns. Eighty per cent of Northern Ireland’s landmass and 35% of the population are defined as being rural, any planned changes must take account of this reality.

The population of the north is similar in size to Manchester, but radically different in terms of culture, connectivity and infrastructure. One size does not fit all. What is the point of devolved government if policy does not reflect the needs of its citizens?

People in isolated communities are deeply concerned by the implications of reconfiguration on their access to healthcare. Rather than ignoring this reality, any regional plan must address the distinct challenges facing remote areas. How will gaps be filled? How will safe services be delivered?

Change is unavoidable. No more tinkering at the margins, it is time for a radical overhaul. A tall order, yes, but not impossible. Transformation is not for the faint hearted. Success depends on making some tough decisions and agreeing a credible long-term plan.

Getting from where we are now to a better future requires determination and an unrelenting focus on improvement. Are our politicians up to this challenge? Time will tell.