Northern Ireland

Citation

(2006), "Northern Ireland", International Journal of Health Care Quality Assurance, Vol. 19 No. 4. https://doi.org/10.1108/ijhcqa.2006.06219dab.005

Northern Ireland

Health and social service reforms

Keywords: Healthcare economy, Partnership working, Patient led healthcare

In pledging to put patients first, Shaun Woodward has unveiled radical plans to strip bureaucracy and waste in the health service and redirect millions of pounds into front line services. Core structures will move from 47 to 18 organisations. The plans include: a considerably smaller government department; one strategic health and social services authority to replace the four boards and take on some functions currently with the department; 18 trusts reduced to five by April 2007 (the ambulance service remains as a separate trust); seven local commissioning bodies, demand led by patients and driven by GPs and primary care professionals, taking on some roles from the four boards and some roles from the 15 local health and social care groups, which will be abolished; and one patient and client council replacing the existing four health and social services councils.

Shaun Woodward said: “If there is a continuing theme to everything I am trying to achieve in health and social services, it is to ensure we put patients first. I have elsewhere signalled my concerns that the current organisation of health and social services is too cumbersome, too bureaucratic, and inefficient. The case for reform is very strong – Faster and better treatment; Efficiency in the service; Greater patient safety; Removing inequality.”

“Why do we need 19 Trusts? Why four Boards? Well the total management cost of running existing bodies, including Boards and Trusts, is £155 million every year. If I could take just one million out of that, I could put every MS patient-now on a waiting list for drugs-off that list.”

“So my proposals are designed to ensure that the patient comes first. The patient will drive demand in the system. Fundamentally I want to see GPs, nurses and other primary care professionals commission services on the patients’ behalf, from those delivering the services. Demand led by patients. Driven by GPs and primary care professionals.”

“I envisage a health system where commissioning of services is structured by a partnership between a single Strategic Health and Social Services Authority and doctors and other primary care professionals, organised into seven Local Commissioning Groups. And these Commissioning Groups should map against the proposed areas of the seven district Councils announced in today’s RPA statement.”

“Eighteen of the Trusts will be replaced by five with the Ambulance Service continuing as a separate Trust. The new Trusts will be established to promote links between hospitals and community based services. Larger Trusts will promote integration within and across Trusts. Integration across professional groupings. Integration across geographical areas. Integration between the health and social services. For example, we need to make sure that people who suffer from a long term mental condition receive a joined up service in which their social worker, GP pharmacist and community psychiatric nurse, can work effectively together to manage their illness.”

“An effective system must ensure that the voice of the patient can be heard. The four Health and Social Services Councils will be replaced by a powerful single healthcare user’s body. A Patient and Client Council (PCC). In this re-organisation I want to drive down on the bureaucracy, which too easily can end up watching over the shoulders of everyone doing the work. The system must be efficient but we should trust the doctors and health staff who we employ to look after patients. Therefore, I envisage a considerably smaller Government Department. To develop policy. And rightly set targets. And critically to lead the drive for better performance and efficiency. Under the Permanent Secretary I will from January 1 2006 establish a Reconfiguration Programme Board. It will first establish in principle and then recruit to the new Strategic Authority a Project Board.”

“We should also guard against the presumption that all our main bodies should have to be in Belfast. Does the new Strategic Authority have to be in the centre of Belfast? Why not say in Portadown or Antrim? Or why couldn’t the headquarters of the new PCC be located, for instance, in Omagh or Derry? No matter where the new bodies will be located, my objective will remain the same-putting patients first.”

For more information: www.dhsspsni.gov.uk