Expert says NI health service has tools to reform amid warning over current model

Northern Ireland has all the tools to reform its health and social care service, an international expert has said.

Professor Rafael Bengoa warned that staying with the current model will see the service swallowing up all the public money in 15 years.

He returned to Northern Ireland this week, eight years after his major blueprint for reforming health services in the region.

Recommendations from the 2016 report, Systems, Not Structures: Changing Health And Social Care by a panel headed by Prof Bengoa, were never fully implemented amid the collapse of two assemblies and the Covid-19 pandemic.

Addressing a conference at La Mon Hotel on the outskirts of Belfast on Wednesday, Prof Bengoa said the principles in the report are still valid.

First Minister Michelle O’Neill, deputy First Minister Emma Little-Pengelly, Health Minister Mike Nesbitt and Agriculture and Environment Minister Andrew Muir were among those in attendance along with health service workers.

Prof Bengoa said there needs to be a management system for change, plans and clarity.

He said that technology, including AI, will help in some aspects but said there may need to be a tough decision around hospital expenditure.

“Nobody really knows how to do that so people are exploring how to do that sort of decision, but if we stay with the previous model we are going to be using all the public money in 15 years,” he said.

“It’s better to start taking, slowly and incrementally, decisions in relation to where the finances go.”

Prof Bengoa said a strong centre is needed, but “not micro-managing”.

“People in my country, in Spain, are having a really hard time doing that because you think you are going to lose budget control, but actually people below identify much better solutions than you above, so little by little you start learning from the local successes,” he said.

He insisted Northern Ireland has the tools and the political leadership to carry out reform.

“The leadership is there, there is a sense of direction and why not then take this moment to develop this for more rapid change,” he added.

Mr Nesbitt said he believes Prof Bengoa’s visit will make a real impact and welcomed that ministers representing all the Executive parties attended the event.

He is set to publish a plan around health and social care reform in the coming weeks.

“Prof Bengoa’s analysis hasn’t really changed and it’s still valid, he gave us principles to work to that he would still recommend,” he said.

“It’s not as if the report has sat on a shelf for eight years gathering dust but it is a question of saying, we’ve done some good things, let’s now finish the deal.”

Mr Nesbitt said he will not shy away from making difficult decisions.

“I understand people like their local facility to be able to offer every health service procedure they want,” he said.

“I can be as guilty of that as anybody having grown up most of my life in the shadow of the Ulster Hospital, but we have to start thinking of our hospitals as a network and that means not every hospital will offer every procedure but the benefit of that is that if you go to a hospital that does offer the procedure you need, you are likely to be going to a centre of excellence.

“My priority is to do the right thing as the minister for health, if that should damage me in the court of public opinion, I’m afraid so be it. I’m going to do the right thing and I’m going to be clinician-led in terms of the advice that I bring to communities, including my own community around Newtownards and further afield in Strangford.”

Ms O’Neill pledged her support for reform, adding it will be a collective effort by the Executive.

“I don’t think anyone can dispute the fact we need to fix our health service. I think we have the blueprint in the professor’s work eight years ago and now I hope we can get on in earnest as a new four party Executive and make it happen,” she said.

“This is a collective effort. We need to work on this together. This is not going to fall, I believe, on the shoulder of one minister.

“I am the First Minister of the Executive and I’ll work with every other Executive colleague. I want us to fix our health service, I want us to invest in our workers, they’re the backbone that keeps the health service running.”

Ms Little-Pengelly said the Executive “has been very clear thus far, we want to see that necessary transformation of the health service”.

“We know that people are waiting much too long in terms of the waiting lists, we know that people aren’t getting the care when they need it and where they need it, so of course that requires investment, it requires transformation and that will require the health minister getting the support he needs in terms of driving that forward,” she said.

Prof Bengoa has worked for the World Health Organisation in Copenhagen and Geneva and co-authored numerous healthcare policy documents in Spain and internationally.

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