Health Policy July 11, 2019
Political deadlock and top-down approach hindering reforms in Northern Ireland

By News Feature - Accountable Care Journal

A political vacuum and a culture of centralisation are impeding reform of the health and care system in Northern Ireland, says a new report from the Nuffield Trust.

The report, 'Change or collapse: Lessons from the drive to reform health and social care in Northern Ireland,' looks at which factors are helping or hindering change. It is based on interviews with health service leaders in Northern Ireland as well as outside experts and clinicians and acknowledges that although the civil service is doing its best to provide leadership in difficult times, the collapse of power-sharing is exacerbating already chronic problems in taking difficult decisions.

The report highlights a culture of centralisation and tight command and control at the heart of the health system, with both interviewees and academic literature suggesting such a top-down approach is not the way to make complicated reforms happen. The report also finds that a patient in Northern Ireland is nearly 50 times as likely to be waiting over a year for care than one in Wales, which is the next worst performer. Further to this, it argues that Northern Ireland is lagging behind on social care, despite being the only area of the UK with an integrated social care system.

The damning report reveals that historical failings in workforce planning for the health service in Northern Ireland are still prevalent, resulting in a shortage of important staff groups and a costly reliance on temporary workers.

Co-author and policy analyst at the Nuffield Trust, Mark Dayan, said: "There’s no doubt that the people we spoke to, from staff at the front line to top officials, were often genuinely 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 and working out new ideas. To keep on pushing from the top risks making things worse.

"Meanwhile the lack of political leadership makes difficult decisions hard to defend either morally or legally. We’re used to hearing Scottish and English healthcare leaders complaining about politics interfering in the NHS. But without elected leaders, it turns out things grind to a halt because officials don’t have the legitimacy to make tough calls."

Professor Deirdre Heenan, senior associate of the Nuffield Trust and co-author, said: "The spiralling waiting lists in Northern Ireland represent a major breach of public trust in the NHS. Longer waiting times can be deeply distressing for patients and their families and make no economic sense.

"The equivalent of one person in five is on a waiting list in Northern Ireland, with more than 120,000 people waiting over a year for treatment. A citizen of Northern Ireland 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 urgent action is taken?"

Full report can be read here.