Does the Executive have the will to make the tough decisions and face the consequences of real Health reform?

So after last year’s Donaldson report (saying clinicians should drive reforms and politicians take a back seat), we have this year’s Bengoa Report (commissioned by Simon Hamilton) along with the suggestion that the new SF Health Minister will do exactly that?

The report’s ten-year time span and lack of specific actions (costs would be both too great a fiction and scare too many skittish constituency horses to bear publication) gives report the minimum required verisimilitude.

Nolan has had great fun with the top priority this morning, which states “a short-term plan to tackle waiting lists to be drawn up by January” January is the next opportunity for the Minister to dip into the petty cash that may become available in the monitoring round.

According to Nolan, it appears that no such bid was received was forthcoming for the present monitoring round, and probably the last possible moment the Minister could realistically spend the money before the end of the year.

Leaving costs and lack of a bid for extra cash in spending rounds to one side, Rafael Bengoa is regarded as a world-wide expert in his field. It’s Donaldson with some practical outlines for what needs to happen.

None of it is news to anyone inside the NHS in Northern Ireland. Three major reports from 2001 until now have all recommended the same thing. The trouble is that no elected politician wants to be on watch when the big changes happen.

They can say what they like about clinician-led reform, their own voters are likely to take a very different view. Any politician anywhere near a decision to downgrade the new build Downe Hospital in Downpatrick faces huge agitation and most likely the chop.

Nigel Edwards head of the Nuffield Trust praised the Minister’s apparent willingness to step back from the management of health resources:

“It’s nice to see a minister with an appropriate sense of humility about their ability to do health care planning.”

In fact, this is a continuation of the DUP’s attempt to take politics out of health that I questioned the First Minister on in May…

The question hanging in the air is: do they have the nerve to press through, make the tough decisions and face the consequences to make it happen?

Mick is founding editor of Slugger. He has written papers on the impacts of the Internet on politics and the wider media and is a regular guest and speaking events across Ireland, the UK and Europe. Twitter: @MickFealty

  • chrisjones2

    Strangely too the Minister has stopped all spending outside the NHS to reduce waiting lists hasnt she. In E&W for example hearing aids, hips and knees etc can all be bought in from private suppliers but not in NI where we can now wait years. Why? Why cant the private sector be used to quickly remove the thousands on those lists leaving the NHS to focus on the rest

  • hgreen

    There was a plan to outsource hearing aids to the private sector as per GB however strangely this seems to have been kicked into touch. Not sure why hearing should be treated differently to eyesight and dentistry. Seems like a missed opportunity. Waiting 6 months to a year when you are in your 70s or 80s for a hearing aid is a big deal.

  • chrisjones2

    In Belfast its now about 1 year for an appointment I am told. Still it maintains the purtiy of SFs ideological stance and saves money if they ‘pop off’ while waiting

  • hgreen

    All over the UK we need to take politics out of healthcare and let the experts deal with it. Write and agree a cross party constitution or guiding principles for the NHS (free at the point of use etc.) and let the experts run it. The role of politicians should be oversight and budget only.

  • hgreen

    Well I’m no supporter of the privatisation of NHS services however in certain cases like hearing when the NHS is clearly failing alternative approaches should be considered.

  • murdockp


    They back down on everything in the end.

    The locals will gather with placards protesting to keep open facilities that that have no expert knowledge about.

    In northern Ireland people mistake healthcare as an industry that cares for people when the real way to look as it is a government body that provides well paid jobs.

    The protestors are always the people who stand to loose their jobs, never the patients.

  • murdockp

    rather than use the word privatisation, outsourcing to centres of excellence is a better way to look at it. If you have a centre that does nothing but dealing with cataracts, every day and employs the worlds best people and is super efficient, and does hundreds of operations per week, this is going to be far more economic than the NHS performing the same procedures.

    Who out there actually thinks politicians have any clue with to do healthcare.

  • Kevin Breslin

    In E&W for example hearing aids, hips and knees etc can all be bought in from private suppliers but not in NI where we can now wait years. Why? Why cant the private sector be used to quickly remove the thousands on those lists leaving the NHS to focus on the rest

    Perhaps those who don’t like waits but have the money could approach the private sector themselves.

    That’s what Gerry did.

  • Katyusha

    While I am personally a fan of such a technocracy, society and government in post-Brexit “we don’t need experts” Britain seems to be rapidly recoiling from it.

  • chrisjones2

    …but that was money from America (allegedly) and Gerry is too important to be made to wait

  • Kevin Breslin

    Not the party (allegedly) but America (allegedly) ?

  • Dan

    So, this Bengoa chap…..same chap involved in bringing about the expensive shambles that is Obamacare?

  • Declan Doyle

    Has any health minister anywhere ever managed to get to grips with their nations health service to the satisfaction of the people? Genuine question because it seems impossible. Here, the country’s two health service’s are in trouble, neither the Northern or Southern Dails have managed to develop a health service that is completely fit for purpose. Maybe the answer lies in creating one all Ireland Health service where the combined savings in staffing levels could be used to invest in better patient care addressing waiting lists and pack emergency rooms.

  • notimetoshine

    The hearing aid thing is a bloody disaster. I’m the primary carer for my grandmother who has advancing dementia, and waited over a year for a hearing aid assesment. It was shocking how much of an improvment we saw in her cognition and personal interactions after She finally got one. Hearing problrms can exacerbate dementia type illnesses and considering how much of a strain try can be on the nhs it’s shocking how poorly the services are resourced.

  • notimetoshine

    I doubt there will be any real systemic improvement. We’ve had numerous reports now, non of which have produced real improvements in services, mainly because the ability of our political class to implement their recommendations is lacking.

    It’s often said that NI politicians can’t do bread and butter politics, and given the state of health services in this country I’m inclined to agree.

    It’s shocking that the electorate seems incapable of demanding more frm te political classes here, beyond identity politics.

    Just more evidence (if more wAs needed) of the lack of competence shown by the DUP and SF.

  • Granni Trixie

    I don’t think an all Ireland remedy is the answer to the waiting lists in NI.

  • Declan Doyle


  • hgreen

    Indeed. It really is a disgrace that someone who’s paid tax all their lives has to wait a year for a hearing aid when the issue could be addressed within a week or less. Would you expect to wait a year for an eye test?

  • Vince

    The private sector generally fleeces the NHS. In the area in which I work mercenaries fly in from GB to do waiting list initiative clinics at the weekend, effectively earning several times the hourly rate in the NHS. Patients receive little or no follow-up and if you have a long term condition, forget it. Even worse, some local NHS clinicians sign up for private sector companies and start dealing with their own waiting lists – a huge conflict of interest, gaming the system – and remarkably they seem to be able to work much faster when working for the private company than when working for the NHS. Of course the contacts involve payment per patient rather than unit of time – funny that…..

  • notimetoshine

    In practical terms, it was harder to care for her and her care requirement actually went up while she waited yet went down after she was able to hear and follow instructions and answer questions. So in theory it actually cost the nhs more money.

    Though you raise an interesting point about her having paid taxes for years. Whn she was born her life expectancy was about 59 years. She has exceeded that by nearly 30, so in reality did she ever pay enough to cover the cost of her care and treatment? Not saying he shouldn’t have it of course, but shows how messed up our social care and health systems are. We still haven’t woken up to the fact that we aren’t paying enough. So when the boomers all retire I wonder how we will cope…

  • hgreen

    We clearly don’t pay enough when you consider what other nations pay. We expect the best healthcare in the world yet don’t seem prepared to pay for it.

  • Peter Moore

    I cannot find the link now (which is annoying). But I remember a report recently that stated to bring the NHS to the same level as the German health service, we would have to spend a billion more per annum (I think – it might even have been more per annum). But it shows we are woefully far behind. Other taxation models, especially those used by Scandinavian countries are, perhaps, needed here? It certainly wouldn’t be popular, but perhaps it should be examined.

  • Skibo

    Corporation tax rate in Germany is nearly 30%. We are at 20% and are looking to lower it to 12.5%! Taxation would have to go the other way to pay for more cover.