By Lisa Smyth
April 11 2019
The health service in Northern Ireland is at a crossroads. People can expect to wait up to four years for a first outpatient appointment and the outcomes for emergency care can vary depending on the time of the day, or week, or even which hospital, a patient goes to.
It’s not the kind of NHS the public wants. And it’s certainly not the service that health professionals want to deliver. Successive expert reports and reviews have been clear: the NHS cannot continue to function in its current format.
The most recent of these, the Bengoa report, made a series of recommendations for the future of the health service, including centralisation of services to make the best use of over-stretched resources.
The idea behind the restructuring of the health service is to make best use of limited resources to improve the patient journey and, ultimately, save lives.
So, it is little wonder that, when it was published to much fanfare in October 2016, the document had cross-party support and was welcomed by professional bodies as having the potential to help their members deliver the best service possible to patients.
The then First Minister, Arlene Foster, said: “We either try and manage the change, or we manage the chaos that would come if we didn’t tackle the huge issues that there are.”
Meanwhile, her deputy, the late Martin McGuinness, said: “Change has to happen and the only question is whether it will happen in a controlled, planned fashion, or unfold out of control. There is only one responsible choice to make.”
Of course, when the report was launched, no one could have known that, within a few months, the Assembly would collapse.
And while the political stalemate has not stopped health officials pressing ahead with implementing change, there is no doubt that the momentum for change has somewhat stalled as a result.
So, it is to be welcomed that the Department of Health has, in recent weeks, launched public consultations that will change the way cancer and stroke services are delivered In both cases, patients are currently being failed.
As it stands, health trusts are struggling to meet the 14-day government target for patients referred with suspected breast cancer.
Meanwhile, the fate of someone who has a stroke depends on the time and day they fall ill and which hospital they attend.
The fact is, resources are currently spread too thinly across too many sites and smaller and less-busy centres will always find it difficult to attract and retain the expertise they need to deliver world-class care.
This is being exacerbated further by the uncertainty that comes with Brexit and the shortage of doctors and nurses available to run clinics, wards and theatre lists. Without changes to the NHS, you can expect to see more services collapsing at short notice and the chaos that ensues as a result.
So, whether you like it or not, the argument for transformation – properly planned, managed and resourced – still stands as strong, if not stronger, than it did when the case was made in 2016.
Despite all of this, it wasn’t exactly surprising that politicians have been less than enthusiastic about the proposed changes to stroke and breast assessment services.
After all, supporting the closure of a service in your constituency is never going to be a vote-winner.
UUP MLA Roy Beggs said he does not believe centralising services will produce better clinical outcomes, while SDLP MLA Justin McNulty said the proposals relating to breast cancer assessment services are “deeply disappointing”.
The changes will mean patients from the Southern Trust with suspected breast cancer having to travel to Belfast, Antrim, or even as far away as Londonderry. But if it’s a choice between having to travel for a few hours to be seen within a fortnight, or going to a hospital appointment five minutes down the road and waiting months to be seen, surely there is no choice?
A case in point is my own personal experience. Just a few weeks ago, my young son, Ethan, became unwell.
While I live a stone’s throw away from an acute hospital, my first and only instinct was to take him to the emergency department at the Royal Belfast Hospital for Sick Children.
It meant a longer journey to get him in front of a doctor, but I knew that, once we were there, he would be seen by someone who is an experienced paediatric doctor. It was a no-brainer to me.
Of course, it is understandable that, if you live in a remote and rural location, you would be less than happy about the prospect of having emergency services, such as stroke treatment, removed from your local hospital.
The Northern Ireland Ambulance Service is already struggling to cope with demand without being expected to transport patients further for life-saving treatment.
In the absence of a radical overhaul of Northern Ireland’s infrastructure, which is never going to happen in the current financial climate, the air ambulance will have to play an even greater role in ensuring patients get the care they need as quickly as possible.
These are issues that health bosses will have to consider when pressing ahead with any changes.
The real problem here is that people want the NHS to continue to be free at the point of delivery and for it to be delivered on their doorstep.
There is an automatic fear of change, as though any change from the norm will result in disaster.
However, as it was warned in 2016, the health service cannot continue to operate under the status quo – staying the same will result in disaster.
A serious and mature conversation is required and the public voice should be included in the debate. But one thing is clear: we can no longer afford to bury our heads in the sand.
The question is not whether change should happen, but, rather, what can we do to support the health service to deliver and grow?
Lisa Smyth is a freelance journalist specialising in health issues
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