Health reforms slowly being revealed

Slowly, almost painfully so, the health reforms are beginning to be revealed. The Compton Review stated that each of the Health and Social Care Trusts was to bring forward proposals for hospital services by June 2012. It is slightly unclear if that was to be the start or the end of this month: however, rumours of proposals have been circulating for some time with Marie Louise Connolly of the BBC providing most of the information:

The Royal Victoria Hospital is to become the main base for all emergency surgery within the Belfast Health Trust from 2012/13 with elective surgery remaining at the Belfast City and Mater Hospitals.

The Southern Trust plans a series of “treatment hubs” with GPs moving to larger centres and having additional resources in these centres. According to the BBC these changes might well result in services being moved out of Daisy Hill in Newry.

The most prominent recent issues have, however, been with the Northern Trust. Two reports into Antrim Area Hospital recently have been highly critical especially of the A+E department and subsequently reports of bullying have surfaced. Added to this is the suggestion that Causeway in Coleraine might lose 24 hour a day A+E. Indeed there have even been claims that the Northern Trust is even considering, in the longer term, abandoning Antrim and Causeway and building a single new facility in Ballymena.

Through these leaks and suggestions Edwin Poots and the Department of Health have remained fairly tight lipped. Poots did specifically say after Compton that each trust should draw up its own plans and present them. He did recently say that he would not make the same mistakes as were made in the past and allow the precipitate closure of hospitals resulting in A+E departments having to cope with much larger numbers than there were designed for – at its root the main cause for Antrim Area’s problems.

Poots also, however, reminded people that the longer term plan is for one acute hospital for 250,000 people. That practically inevitably comes back to the “gold five” of Royal/ City/ Mater; Ulster; Craigavon; Altnagelvin and Antrim (or its replacement).

The need to reduce the number of acute hospitals in order to optimise outcomes (ie minimise death and disability) is one which has been reiterated time and again: and all too often has been opposed by the very communities which would benefit most from such changes (aided and abetted by bandwagon jumping if not creating politicians).

Edwin Poots has tried to avoid being too prescriptive regarding the way forward in each Trust. However, changing services and closing hospitals even for completely appropriate reasons is always a deeply political decision. Trusts tend to be good at implementing changes but less good at long term strategic thinking. They also tend to be very adverse to the negative local headlines which service changes so often bring. Hence, it is probably necessary for Poots to give a pretty clear steer in public as well as privately that these changes are what is required (and what Compton proposed).

In turn then Poots needs to be given the political support of politicians who apparently all too often agree in private that changes to local services are necessary yet then denounce those self same changes publicly. Furthermore Poots should set out the longer term vision pretty clearly. The problems of Antrim for example (leaving aside the massive issue of its location) would have been nothing like as severe if previous health ministers had admitted that the Mid Ulster and Whiteabbey were going to close and had enlarged Antrim to cope. As it was by refusing to say that this would happen and refusing to enlarge Antrim, lest it become clear that the smaller hospitals were going: when the Mid Ulster and Whiteabbey closed, chaos ensued. That chaos has demolished public confidence in Antrim to the extent where it will be difficult to recover.

If indeed (and it is a big if) there is a plan to go for a single new hospital in Ballymena (Waveney mk2) then that plan should be stated publicly and a long term time frame, along with interim plans, should be made clear at the outset. In addition at the outset there should be a clear indication of the political will to drive such a plan through to conclusion. Short termism has always been one of the NHS in Northern Ireland’s greatest problems.

Poots has thus far done a genuinely good job with the very poor situation he inherited: certainly colossally better than the débâcles which were the tenures of his Stormont predecessors DeBrún and McGimpsey. As such Poots should receive the unequivocal backing of his party and leader. In a time of change the suggested handover of health to Jim Wells should be postponed indefinitely. Barring any unforeseen issues Poots should remain health minister until the end of this Stormont term of office and maybe even beyond: after one term, however, he might well want rid of the poisoned chalice he thus far has transformed, if not into wine, then at least into something less toxic than he first received.

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