Health reforms and the budget…

Simon Hamilton is obviously being groomed as a rising media star, and the DUP’s point man on Health. In this set piece on the Politics Show with Patricia McKeown of Unison, the DUP criticism seems to revolve around the part of the Appleby report that calls for Health Service reforms. Professor Appleby also called for an increase in spending from £2.7 billion in 2002/3 to £6 billion by 2022/23, which appears not to have featured in the discussion. You can find Unison’s response here and that of the BMA.

  • the lad

    Why was the DUP Spokesperson for health not on the programme? Oh that’s right, because it’s Iris. Good move.

  • toodlepip

    Interesting that none of the DUP members of the health committee were deemed suitable to go on the Politics show, guess if ur Alex Easton or Thomas Buchanan you just don’t make the cut, for a party who apparently don’t subscribe to Darwinism they certainly seem practised in the use of it!

  • Hogan

    I would have thought the link provided on the BMA would have been better served as a response to Hamilton’s allegation that one of the key health stakeholders in Northern Ireland were dissatisfied with the minister’s performance! Rather than a two year-old press release.

    Can we have some evidence for that please?

  • sam
  • Turgon

    There is clearly significant inefficiency in the NI NHS. The Appleby report whilst it has significant flaws does make a number of very valid points; though some are quite arcane.

    It is also clear that McGimpsey is unable or unwilling to take significant decisions at this time if ever. The decision a have single health board would have been simple, would have led to savings and would have been relatively non controvertial. The DUP are quite correct to criticise him over it.

    McGimpsey is, however, correct that there are reasons for the need for greater funding in Northern Ireland.

    I am interested that the DUP talk about efficiency savings without mentioning the elephant in the room which is the number of acute hospitals. Appleby identifies this as a problem but I suspect he underestimates it. The whole issue becomes extremely complex but essentially very small hospitals are nolonger really very justifiable in the current age. In England, Wales and Scotland incidentally the small hospitals there are rows over saving are actually quite a lot bigger than the small hospitals here in Northern Ireland. Vast tracts of rural England and especially Wales and Scotland are much further from hospitals than anywhere in Northern Ireland and in some areas the rural road network is acutally worse.

    I suspect, however, the DUP are nowhere near brave enough to tell us which hospitals they would close. In fairness also one would need to increase the size of the bigger hospitals in order to then close smaller ones. This would: whilst in the long run saving money, result in increased up front spending.

    There are also cultural issues which create expense in our health care system. Remember the “You don’t need a pill for every ill” campaign. Look at the Appleby report and you will see that prescribing by GPs is more common than in GB. A GP friend of mine said when he started he tried to avoid giving out medicines too often. The patients, however, were not a bit pleased with this and in the end he was so fed up he gave them medicines.

    There are lots of other examples but whilst I think Iris Robinson would have been better than McGimpsey (so might my cat); I doubt the DUP are willing to talk about what actually might save serious money for fear of loosing votes.

  • Dan

    Some people may be interested in the presentations here, it is from a conference last week as part of the ongoing review in England.

    Many of the international speakers spoke both of things they had learned from us or examples of good practice they would take home.

    The direction of travel was more and more care did not need overnight stay so could be provided in buildings that may be open between 8 and 12 hours a day and 6-7 days a week, these are bigger than a GP practice but a lot smaller than a hospital. Polyclinics was the terminology used.

    Very specialist care which was hospital based benefits both from economy of scale in terms of bigger is cheaper and benefits of scale in quality , i.e. at the extreme in some conditions do 100 a year and cure most patients, do 1 a year the Dr is playing and the patient may well suffer.

    http://www.livegroup.co.uk/internationalclinicalsummit/index.php?view=venue

    The problem in a Northern Ireland context the catchment being pushed for the mega hospital end of the scale is bigger than the 5-800,000 traditional DGH’s in England, so in those terms all specialist services at a single mega-complex in Belfast.

    The polyclinic sized options talked about a prospective population of 50,000.
    If that is the route in England how many existing NI Hospitals would get replaced and how happy would the population be with negligible full hospital facilities outside Belfast.

  • Turgon

    Dan,

    There are also inefficiencies when hospitals get to big. However, there are clearly too many

    At a guess and it is only a guess.

    You could probably have the old “gold six” consisting of Royal Victoria, Belfast City, Ulster, Craigavon Area, Antrim Area, Altnagelvin Area. That leaves the Newry area a bit exposed, same with the South West and North Coast. As such have the six plus Causeway, Enniskillen, Newry.

    That is not that radical but imagine the wailing it would produce.

    Of course getting pretty seriously radical why not have:-

    Royal / City possibly on a new site

    Ulster a bit south and west of where it is now

    Craigavon Area moved to near the Ballygawley roundabout or even Augher. Then close CAH, Enniskillen and Tyrone County

    Altnagelvin where it is

    Newry where it is

    Antrim area moved to just the Ballymoney side of Ballymena

    Upgrade the relevant roads. The ambulance service would need improved but also would not waste as much time on endless interhospital transfers as it does now.

    Just a few thoughts

  • Dread Cthulhu

    Turgon: “I am interested that the DUP talk about efficiency savings without mentioning the elephant in the room which is the number of acute hospitals. Appleby identifies this as a problem but I suspect he underestimates it. The whole issue becomes extremely complex but essentially very small hospitals are nolonger really very justifiable in the current age.”

    Ah, but while people may agree that there may be too many hospital beds, or that there are too many small hospitals, no politician ever came out ahead by advocation, or even simply accepting, the closure of *THEIR* local hospital.

    And small hospitals have a place in the modern era, albeit a specialized place.

    Turgon: “I suspect, however, the DUP are nowhere near brave enough to tell us which hospitals they would close. In fairness also one would need to increase the size of the bigger hospitals in order to then close smaller ones. This would: whilst in the long run saving money, result in increased up front spending. ”

    Bravery has little to do with it — there is absolutely no political incentive to close those hospitals, particularly those hospitals in their areas, and nearly every incentive to keep them open.

    Turgon: “There are also cultural issues which create expense in our health care system. Remember the “You don’t need a pill for every ill” campaign. Look at the Appleby report and you will see that prescribing by GPs is more common than in GB. A GP friend of mine said when he started he tried to avoid giving out medicines too often. The patients, however, were not a bit pleased with this and in the end he was so fed up he gave them medicines. ”

    Medically short-sighted, leading to anti-biotic resistant strains, which, in turn, lead to even greater expense…

  • Turgon

    Dread,

    Yes I agree with all the above. My mate the GP tried really hard but said that eventually you get ground down. You exlplain and explain and they do not listen. Also of course if they make a complaint that is loads of hassel as well. I know GPs are really well paid now a days but to be honest they are welcome to it. It seems a lot of grief to me. Apparently they do not even get good toys from drug reps any more.

  • graduate

    Simon Hamilton appears to have a talent for self-promotion that’s typical of an ex-Ulster unionist. All style, no substance. there’s better men on the DUP benches