What’s happening to our health service?

Director of Communications for the health and social care system David Gordon shares his thoughts after six months in the job

So where do you start when describing health and social care here?

Serious problems are in the news almost every day.

It would be wrong to ever downplay those problems.

And yet they are not the full story.

Great care is still being delivered by great staff every single day. The most recent Health Survey showed compliments from the public far outnumbering complaints.

That chimes with what we so often hear anecdotally – praise and gratitude regularly voiced after personal experiences.

The most pressing challenges facing the system can often involve delayed access to care rather than the quality of care received.

I’ve witnessed up close not just the dedication of staff, but an unwavering drive to innovate and find new and better ways to deliver services.

That’s right across the Health and Social Care (HSC) system – from those who deal directly with the public to those working behind the scenes.

Improvements in care keep coming too.

Yet alongside that, there are deep and worsening problems.

Far too many people are on unacceptably long waiting lists.

Emergency departments have been under severe stress for many months now.

Pressures are also faced by GPs, the ambulance service and in domiciliary care, while staffing gaps across the system are adding significantly to challenges.

None of this sadly should come as any surprise.

The Bengoa report – welcomed across the political spectrum – detailed how an outdated system would increasingly struggle with increasing demand. Professor Bengoa likened it to standing on a burning platform.

None of the serious problems should be seen in isolation. They are all symptoms of that underlying burning platform reality.

The Department of Health Twitter account – @healthdpt – will be highlighting some key statistics today and tomorrow. They illustrate both the growing pressures facing the HSC, and the increased activity rates that have still been achieved. Let’s not forget this has also occurred in a period of squeezed finances.

A lot of the growing demand for care is down to an amazing success story of health care – longer life expectancy.

That’s a huge reason to celebrate, but it brings some of the most significant long-term policy challenges facing society.

This is far from being a Northern Ireland only problem. Health systems are under serious stress in many countries.

The details are striking.

Older people are the main users of health and social care services here.

The Bengoa report noted bluntly: “In terms of costs, users aged over 65 account for more than two-fifths of HSC spending – 42%, compared to their population share of 14%. Whereas the average cost of treating a 55-59 year old stands at £1,970 per head, this rises to over £6,000 for 75-79 year olds and £14,000 for the over 85s.”
The challenge is really only just beginning. The number of people aged 85 and over here has quadrupled since 1971. It is projected to do something similar within the next half century.

Facing these and other issues, it is clear big conversations and big decisions are needed.

Happily, there is a way forward – summed up in the single word “transformation”.

That doesn’t just mean reshaping the organisation of hospital services. It also means an increasing focus on primary care – changing the face of your GP clinic, giving people more care close to or in their homes, helping them manage their conditions and offering alternatives to hospital referrals.

Initiatives are happening at ground level – we now need to extend them.

It’s not difficult to grow despondent about the position we’re in.

We could also get side-tracked by frustration and bouts of finger-pointing.

Yet there is hope and a clear route to making it better.

The full story of HSC includes both the ongoing great care and the deepening problems facing the system.

It has to also involve taking the transformation path.

That route won’t be quick and won’t always be easy.

The good news is we are already on it.

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