Godot arrives: Compton Review delivers

Last week I suggested that Northern Ireland health reform was like waiting for Godot. Now Godot has arrived, told us he is sorting out major changes and that he will be back soon.

The Compton Review (pdf) is a large and highly impressive document. Despite having been carried out in only a few months it has clearly been well researched with examples taken from best practice throughout the UK. There are twenty one chapters which detail everything from maternity to palliative care and specific mention is made of the proposed future overall model and the implications for the current service. Much is made of the need to proceed to more patient centred care and attempts to keep patients in their own homes. That sounds uncontroversial but keeping patients in their own homes would reduce the need for acute beds and acute hospitals. The relevant quote is here:

A bed utilisation audit of 2011 showed
that, on the day in question, up to 42% of
the inpatients reviewed should not have
been in hospital.

The headlines noted by the BBC, UTV and Belfast Telegraph all centre on the number of acute hospitals. The suggestion is that the number of acute hospitals be reduced from 10 to 5-7: the hospitals which are to become non acute may still have a role providing other forms of care.

The review proposes the reduction in numbers of hospitals over the next five years. It does not appear to specify its preferred number of hospitals (5, 6 or 7) nor does it specify which ones that includes. Most can work out which hospitals would be the five (Royal / City, Antrim, Altnagelvin, Craigavon, Ulster) and most health analysts have suggested that those five would be the correct ones to keep. The arguments are clearly going to be whether there should be another two and if so which ones: the most likely would probably be Erne and Causeway (in that order of likelihood of survival). Politicians will no doubt acquiesce to the closure of any hospital apart from the one in their own constituency, which in contrast they will fight for tooth and nail.

When the Compton review team went to the Health Committee a large amount of the time was spend by local MLAs trying to defend Daisy Hill in Newry (H/T to tinman for link). That is most likely the picture of things to come with each locality fighting to save its own hospital with shroud waving politicians and crowds claiming that “People will die” if their local hospital is closed and that their road links / traffic congestion make them a special case.
The report attempts to answer these issues with the patient observation:

The Rural Trauma Outcome Study in
Scotland (84) showed that longer prehospital
travel times did not increase
mortality or length of stay.

Such reports are unlikely, however, to assuage the shroud waving and no doubt some pseudo reason will be presented showing that in the parallel universe of Northern Ireland distances are much greater than those in the geographically vastly larger area of rural Scotland.

I observed previously that Comtpon might bottle the review: he and his group clearly have not; though they have fought shy of stating which acute hospitals should be closed which is much the most controversial issue. To be fair the issue of which hospitals should be downgraded is a political one which probably requires a decision at ministerial level. The problem is that although it requires a political decision it is still fundamentally a health care issue. Furthermore the review proposes a time scale of up to five years to implement the changes. This again is probably fair at one level (changes cannot be implemented instantly) but it does mean that we will have more delay before we can begin to try to catch up with the rest of the UK in terms of health care provision. Furthermore it potentially allows more time for campaigns and fighting to try to prevent the changes happening. It also means that Poots will have to hold his nerve for longer and if Robinson does replace Poots with Jim Wells there is a danger that some of the changes will be reversed / watered down. As I observed previously there was a proposal to have six acute hospitals as long ago as 1966.

Edwin Poots has demonstrated that he is probably made of stern enough stuff to push the changes through: today he has made it pretty clear that he is going to reintroduce prescription charges and one of his first actions was to permit the reduction of A+E hours in Lagan Valley in his own constituency. Considering the enormity of the challenges facing the NI NHS and the fact that Edwin Poots seems thus far willing and able to make the necessary changes it might be wise for Peter Robinson to keep Poots where he is for the duration of this Stormont term and make a clear announcement to that effect. Given time and stability Godot might well deliver.

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