Michelle O’Neill sets out vision for North’s health service overhaul

Health will eat up 90 per cent of the Northern Ireland Executive budget if action is not taken to overhaul the North's health service, the Sinn Féin Minister for Health Michelle O'Neill has warned.

Ms O’Neill issued her warning on Tuesday after she launched her 10-year “vision” for a “radical transformation” of the current health and social care system which she said is now at “breaking point”.

Ms O'Neill told Assembly members how her plan, "Health and Wellbeing 2026: Delivering Together", is based on the 10-year "roadmap" proposed by an expert panel led by former Basque Country minister for health Prof Rafael Bengoa.

The Bengoa report, Systems, Not Structures: Changing Health and Social Care, also published on Tuesday, sets out broad principles on how the North's health service could be transformed over the next 10 years.

Prof Bengoa in his report pointed out how health costs £4.6 billion annually, or 46 per cent of the Executive budget. By 2026, the budget is predicted to double to more than £9 billion which, according to Prof Bengoa and Ms O’Neill, would be “unsustainable”.

Vulnerable services

Prof Bengoa added that many services are vulnerable and struggling to recruit and retain staff. “Some of these are very close to collapse,” he said.

Prof Bengoa said the service faced a stark choice. “It can either resist change and see services deteriorate to the point of collapse over time, or embrace transformation and work to create a modern sustainable service that is properly equipped to help people stay as healthy as possible and to provide them with the right type of care when they need it,” he said.

His report is not costed and does not make any specific calls for hospital closures or other particular cutbacks but rather calls for a “fundamental” change in the health service and a “new model of care designed to meet the needs and challenges of today and this century”.

He said his report presented “an opportunity for transformation that must be seized and acted upon”.

Health officials said the proposals need not necessarily necessitate the closure of hospitals but rather adapting particular buildings for particular services, which could involve scaling down current hospital services in certain areas.

Ms O’Neill said: “It follows that the nature and focus of our acute hospitals will change. As well as enhancing the support received in primary care we need to reform and reconfigure our hospital services.”

Clear goals

It will be for the department and health service to set out clear goals over the 10 years of the Bengoa plan. The professor did, however, set out some goals for next year that include the reduction of hospital waiting lists and improving pathology, diabetes, paediatric and stroke services.

Also among his recommendations are the appointment of a senior health “leader” to drive forward the transformation; “accountable care systems” to integrate services; greater investment in and rationalisation of services.

He said the service must work to the “triple aim” of improving patient care, improving the general health of the population, and reducing the cost of health care.

Ms O’Neill said her plan and the report had the full support of the DUP/Sinn Féin-dominated Executive. She said she would report to the Assembly every six months on how the 10-year “roadmap” was being implemented. “This is a positive day, this is a fresh start for health,” she said.

“My vision for health and social care is ambitious. It will require whole system transformation across primary, secondary and community care and a radical change to the way we access services,” said Ms O’Neill.

“We need to reduce bureaucracy, to make the decision-making process more streamlined and importantly to plan and manage services in a way that promotes collaboration, integration and improvement in service delivery,” she added.

The Minister said the cost of the transformation would be significant. “But standing still is not an option – there are consequences if we don’t deliver planned and managed change in our health and social care system”.