Northern Ireland’s healthcare needs Nye Bevan’s principles
Although Northern Ireland subscribed almost immediately post-War to the Bevan principles of a Health Service accessible by all regardless of means, it is an interesting quirk that officially Northern Ireland lacks an “NHS”. Joined together as much by accident as by design during a local government reform in the early 1970s, Northern Ireland in fact has an integrated Health and Social Care system (known as “HSC”), whose Chief Executive is also Permanent Secretary of the devolved Department of Health.
Clearly being a smaller jurisdiction of just under 2 million people and having an integrated system means that some aspects of the Northern Ireland Health and Social Care system are simpler. These advantages have led to some better outcomes, such as higher rates of cancer survival and dementia diagnosis. However, the smaller size also leads to some difficulties, such as the recent transfer of pathology services for Northern Ireland residents to the North West of England.
However, a combination of a refusal by the DUP/Sinn Fein-led Executive to implement reviews of the whole Healthcare system going back to 2001 and the failure to match budget allocations to Health in England since 2010 has led to an unreformed service being maintained on a comparatively lower budget for over a decade. The result has been catastrophic – waiting lists are now so long that many services are in effect not on offer, while at the same time people in Northern Ireland are unable to seek referrals for treatment elsewhere in the UK because officially the service is available.
The result, increasingly, is a two-tier service – people with means go private to skip the waiting lists, while people without them are stranded effectively without a service. For some conditions, waiting lists are now approaching three years. Even a diagnosis of Parkinson’s can be two.
Therefore, it is an old cliché, but things cannot simply continue as they are. Professor Rafael Bengoa was recruited to chair an expert panel on the reform of the Health Service in Northern Ireland, and this reported three years ago. The panel reported in 2016 and, even in the title of its review, emphasised that the Service consists of systems not structures; it was an appeal to recognise that the most important aspect of any healthcare system is the quality of the treatment and diagnosis it provides. The challenging reality of this is that it means provision of specialist services at fewer sites, but with greater immediate expertise available.
The Alliance Party’s vision for healthcare
The Alliance Party’s vision for the Health Service is, firstly, to align with the Bevan principles that no one should be disadvantaged because of their means; in general, this means a health and social care service free at point of access, although we do see the case for people with means paying towards certain aspects such as optical treatment (as has become the case over the past decades) and prescriptions (which became free in Northern Ireland just over a decade ago, but at greater cost than initially envisaged).
Secondly, we are broadly supportive of the “Bengoa principles” that it is essential to deliver high-quality regional specialist services, with a recognition that this will mean world-class provision in areas as wide-ranging as stroke to breast assessment.
Thirdly, we are also broadly supportive of the principle of “shift left” to ensure people are treated swiftly at point of access. Under the concept of “population health”, we are supportive of larger primary care centres providing not just GPs but other professionals across everything from physiotherapy to mental health. Fundamentally, the quickest way to bring down waiting lists is to put fewer people on to them in the first place by limiting referrals and instead providing immediate treatment and support. However, in the particular context of Northern Ireland, we do have some concerns about how pharmacy is being added to the mix here – even though they may be in a separate building from GPs, community pharmacies are a vital part of the service in Northern Ireland and we are supportive of greater investment in them.
Fourthly, we also have to invest far more in improving well-being more generally – both physically and mentally. We are supportive of an array of schemes with this objective, from increasing sport and physical activity in schools to enhancing mental health awareness.
Therefore, our vision ultimately is of a public Health Service everyone can use and rely one. That means a Service which is more responsive immediately to patients’ needs. The ultimate objective is that regional specialist services, wider treatment in primary care and improved public health overall will mean we can not just reduce waiting lists, but make them a thing of the past (as they are in other countries) and thus never again return to two-tier healthcare.
Paula Bradshaw MLA is a member of the Northern Ireland Assembly for Belfast South, and the Alliance Party’s spokesperson for health and social care.
With a General Election on the horizon, Bright Green is publishing a series of articles from progressive party spokespeople on how their policies would transform the country. This article is part of that series – all articles can be found here.