The cross-border health report they didn’t want you to see

As a former journalist, I do relish getting hold of a government report that makes eminently sensible recommendations but which politicians for some obscure reason do not want the public to see. So I was delighted when earlier this month a copy of the North-South Feasibility Study compiled by the Irish Department of Health and Children and the Northern Ireland Department of Health, Social Services and Public Safety came across my desk.

This was the report, completed 18 months ago, that was meant to ‘develop a strategic framework for taking forward on a North-South basis future collaborative work in health and social care, and in planning and delivering health and social care services, as may be appropriate.’ As its authors, a group of officials from the two Departments, the Health Service Executive and the Cooperation and Working Together (CAWT) cross-border health authorities network, say in its executive summary: ’Through working together to address major health issues, significant additional benefits to the population of each jurisdiction can be achieved, which could not be achieved by each system working in isolation’.

They then go on to outline 37 recommendations. There is nothing here that is even the remotest bit radical or undermining of existing institutions in the two jurisdictions. The report suggests that 10 of the recommendations should be taken forward as a priority because they ‘offer the opportunity for a more immediate impact on patient and client care.’

These are that the two Departments and the relevant agencies should promote joint programmes and approaches to tackle obesity, positive mental health and suicide prevention (with the present All-Island Action Plan on Suicide Prevention being broadened to include mental health promotion).

A collaborative cross-border model of care for patients with paediatric and congenital cardiac conditions should be developed.  Radiotherapy capacity in Altnagelvin Hospital in Derry should be planned and developed to improve access to radiotherapy for patients in the whole north-west.

The two Departments and their agencies should ‘explore the potential to develop, on a joint basis, a service for those organ transplants which are less common and which may require the critical mass of a combined population to be sustainable.’

The two Departments and their agencies should ‘evaluate the effectiveness of the current alert systems for children at risk’ and should ‘continue to take forward measures to improve child protection.’ They should work to ‘progress and formalise cross-border foster care arrangements to deliver services which better meet the needs of children in border areas.’

There should also be formal exchange of information on existing standards, types of homes, staff training and therapeutic support to children in need of protection to assist the North South Ministerial Council’s North-South Child Protection Sub-Group on Information Sharing.

‘Is that it?’ you might ask. Is there the slightest hint of a controversial line anywhere in these priority recommendations?  Gentle reader, you may be forgiven for thinking that this is the stuff of eminently practical, common sense, cross-border cooperation at its most mutually beneficial: working together to help children with obesity problems; bringing cancer patients from Donegal to nearby Derry for radiotherapy rather than to faraway Dublin; moving towards a more sustainable all-island organ transplant system; and exchanging information about child protection. The North South Ministerial Council certainly believes so, having reported progress towards a new radiotherapy centre at Altnagelvin, all-island paediatric surgery services, a new North-South child protection website and other issues listed in the report at recent meetings.

However the Northern Minister of Health, Michael McGimpsey clearly differs. This formerly most sensible of unionist politicians has repeatedly refused requests that he should publish this report. In his most recent statement on the issue to the Northern Ireland Assembly, on 17 May 2010, he said he did not see any opportunities in the report for ‘cooperation that delivers practical results and benefits for the population of Northern Ireland.’

The Minister said the report ‘does not explain costs or benefits; it asks for further research, consideration, investigation and so on.’ He told a Sinn Fein MLA, John O’Dowd, that he would have an opportunity to read the report ‘in due course. My problem is that I do not see anything in the report to implement. It is long on discussion and on the need for further discussion, but I am looking for practical steps.’ He said his budget was ‘smaller than is required to run the Health Service in Northern Ireland, and I do not have money left over for extras unless I am certain they will deliver benefits.’

John O’Dowd thought the reasons for non-publication of the report were ‘political rather than financial.’ Is this another example of an Ulster Unionist politician trying to ‘out-unionist’ the DUP on an uncontroversial North-South cooperation issue?

Andy Pollak

P.S. Further to my May ‘Note’ wondering whether the Republic of Ireland now had a better welfare state than Northern Ireland, I heard Father Peter McVerry, the Dublin priest who champions the cause of homeless young people, arguing on RTE radio recently that a promised increase of 200 social workers would hardly touch the huge backlog of young people, poor people and others seeking help with their multiple problems in the Republic. He said that if the South wanted to be on a par with provision in the North, 2,000 new social workers would have to be appointed. The Health Service Executive spokesman on the programme did not disagree. So if you are young, poor or otherwise particularly vulnerable, you’re probably still better off in the remnant of the British welfare state that is Northern Ireland.

  • Reader

    Andy, on the basis of the recommendations you have summarised, McGimpsey’s comments seem fair and O’Dowd’s comments therefore seem to be mischievous. If there is any costed proposal in the report that offers an improvement in service without extra cost, or offers to maintain levels of service with a cost saving perhaps you could point it out? Otherwise, the report seems to propose lots more work for quangos and bureaucrats.
    Speaking of which, how much has this cost so far?
    And isn’t a north/south organ transplant proposal missing a trick – aren’t there already east-west arrangements that should be built upon?

  • Framer

    This is cross-borderism for the sake of cross-borderism. It smacks of civil servants meeting and desperately thrashing around for something, anything, to propose to please their masters in OFMDFM.

    When you read the text you realise its vacuity.

    On such reports, careers are made and advanced but do we really need a cross-border obesity strategy, or a strategy at all?

    The cost-no-object days are surely over. McGimpsey is to be praised for adopting such a sensible approach and saving money.

  • Watcher

    This is a major major and very real issue for people in the North West and border counties.

    It seems that McGimpsey is afraid of implementing anything that might have the involvement of the South.

    This report deals with something that can improve peoples’ health and welfare, yet it is swept under the carpet as if it is not valid – how pathetic it is that McGimpsey had not even bothered to read it.

    If Altnagelvin was receiving payments from the Dublin for every patient in Donegal it treated under these proposals, Mr McGimpsey would soon find much more money in his health budget.

    Reader – it would be much easier, quicker and cheaper to get vital organs from Belfast to Dublin and vice versa than traveling from/to Britain.

  • Drumlin Rock

    Andy, once again in trying to promote cross border issues you have hi-lighted the weakness outweigh the advantages, the most glaring of which in every instance is your total exclusion to any reference to the east-west relationships. Most of the points you raised seem to be administration and to be blunt paper chases, no doubt the cross-border dimension will complicate issues to a large enough extent to cancel out economies of scale, and the end result might not fit either system.
    The cross-border cancer treatment at Altnagelvin is common sense IF properly costed and sufficient capacity is assured, however it seems these are missing from the report. As for fostering, living only 3 miles from the border it would surely be exceptional circumstance where this comes into play, the different education systems if nothing else make it difficult.
    McGimpsey is well know to be practically minded, it seems the report groups have fallen far short of selling this to him to date, thankfully unlike Catrina & SF he dosn’t create white elephants like the Autism Centre at Middletown just for the sake of creating another cross border body.

  • barnshee

    “If Altnagelvin was receiving payments from the Dublin for every patient in Donegal it treated under these proposals, Mr McGimpsey would soon find much more money in his health budget.”

    I think that might be the issue-where s payment mentioned?

  • lamhdearg

    SAY NORTH SOUTH AGAIN, I DARE YOU SAY NORTH SOUTH AGAIN.

  • Reader

    Watcher: Reader – it would be much easier, quicker and cheaper to get vital organs from Belfast to Dublin and vice versa than traveling from/to Britain.
    But you have to wait 20 times as long for a match because we have only a fraction of the population.
    Watcher: how pathetic it is that McGimpsey had not even bothered to read it.
    I checked Andy’s link to Hansard – McGimpsey has read the report.
    Watcher: It seems that McGimpsey is afraid of implementing anything that might have the involvement of the South.
    I checked Andy’s link to Hansard – McGimpsey gave an excellent response to that charge, which both you and Andy have missed!

  • Would this discussion not make more sense if the minister actually published it so everyone can see what he is dismissing rather than defend (or attack) a report they haven’t seen? If it is 18 months since he received it and he sees no value in it – why keep it in his drawer (when 50% was funded by the public purse on either side of the border)? Is it any wonder people resort to FOI requests?

  • Turgon

    Reader,
    You are of course completely correct. Organ donation is done not merely on a UK and Ireland wide basis but on a European wide basis. My understanding is that the UK and Ireland function together for both donors and recipients. A North South donation system is simply nonsensical: there already is one as part of a British Isles and indeed Europe wide one.

    On the paediatric cardiac surgery issue it is interesting that the NHS is considering reducing the number of centres doing paediatric cardiac surgery by up to a half (from 11 as currently). Since there are 60 million people in the UK that suggests an optimal number for adequate throughput to maintain skills of approaching 10 million poplation per centre. Clearly that is greater than the whole population of Ireland (6 million). Hence, we should be thinking about whether or not both the NI and RoI paediatric cardiac surgery should be being sent to centres in the UK. This already happens for some very complex cases and there is a good case for exploring that option rather than an all Ireland option which may result in too small a patient pool to keep the outcomes of any putative all Ireland centre up to the standards of the very best centres.

  • Drumlin Rock

    Exactly Turgon, any issue that is significant enough to be covered on an All-Ireland basis is generally better considered on a British Isles wide basis, or at the least working with Scottish & Welsh partners, should the obesity and suicide prevention scheme not have included those areas as well?
    As for the local cross-border issues, the barriers have almost always come from the Republic, and the traffic has usually been one way with NI providing services to RoI residents, I don’t know how much it costs us, or if it is repaid in anyway by Dublin.
    Most Unionists would be happy enough to see practical cross border work develop, but It not if it is just paper exercises and publicity stunts, and it is properly costed and paid for fairly on both sides.

  • Drumlin Rock

    John, going by the miinister’s reply in Hansard it seems it was the south blocking publication.

  • Glencoppagagh

    “If Altnagelvin was receiving payments from the Dublin for every patient in Donegal it treated under these proposals”

    Aren’t they paying already? If not, why are the Irish being allowed to frreload like this?