At the beginning of the term, the Executive outlined a goal to revitalise the health service we all depend on within the Programme for Government. For the past few decades, the problems facing the service have only increased and compounded. Take waiting lists. In England, Scotland, and Wales, one might reasonably expect to be admitted to a hospital much faster than here. The latest data from the Department of Health show that over 80% of patients on the waiting list have waited for over 13 weeks. Unacceptably, over half have been waiting for well over a year. In Great Britain, no matter the health service, the percentage of such patients lies within the single-digits. This is the latest data point on a trend which health experts have observed and predicted would worsen for decades, and other aspects of the health service have been suffering likewise. This, of course, has the greatest health impact on the most vulnerable and those who cannot easily turn to private health cover; it worsens the deep injustice we see with health inequalities. Given the under-allocation of key health services, surgeries being the plurality, the status quo has an unacceptable cost in human life and well-being.

With this context in place, I am proud to announce measures to tackle multiple problems facing the HSC and to deliver a better quality service for future generations.

Rationalisation

Some fundamental problems in the health service are not necessarily those of funding. Historically, patients in the HSC have had similar per-head funding compared to their counterparts in the English, Welsh, or Scottish health services, yet the disparities have only widened massively over the past two decades. This variation is fundamentally too large for the issues to be solely grounded in funding differences, though, to be clear, an appropriately funded health service is a key priority for the Executive. Instead, the issue lies with the organisation of service provision within the HSC. In 2001, the Hayes report called for rationalisation of inpatient services to avoid substantial harm to health and further assessments in 2011, 2014, and, most recently with Bengoa, 2016 have outlined similar recommendations. As time has gone on we also see the added acknowledgement that, as society is ageing, the way care is delivered will need to evolve.

HSC services are currently poorly organised and allocated throughout the North. One of the most durable claims over the years across reviews has been the over-abundance of acute hospitals and the under-delivery of home care and smaller-scale community care facilities. E-health and the delivery of certain simple services within pharmacies have also become newer areas which have the potential to massively improve the level and standard of care to fit the circumstances of more people. With so much attention on acute hospitals rather than better-suited structures and facilities, the HSC can only deliver healthcare services through these less flexible, more easily-crowded spaces. This is a huge source of the present waitlist crisis in our health system, and it is necessary to change this orientation by scaling down the number of acute hospitals and consolidating specialist services at these sites.

As such, the HSC Board will be directed to reduce the number of acute hospital facilities by half by 2026, consolidating the number of services at the remaining sites. The figure derives from recommendations of earlier reviews on the health service and is seen to be appropriate for our population and service needs. I will also establish a new non-statutory task force within the Department of Health to provide oversight over this sensitive, but crucial goal as it needs to be handled carefully and with the patient in mind.

Re-investment

The long-term savings from the rationalisation measures will be substantial, but it has to be accompanied with substantive re-investment into community and home-based service provision if we are to genuinely improve the patient’s quality and standard of care. Savings from the aforementioned measures will be dedicated towards the provision of home care, mobile rural health needs, new e-health capability, and smaller clinics interspersed throughout the community, including those in partnership with our registered community pharmacists and chemists. This will be a vital decentralisation which will cut waitlists at our acute hospitals and better meet the needs of those seeking care with our ageing, more rural population. The HSC Board will be directed to achieve this aim in tandem with its rationalisation measures. Making the change to establish these services in the transitional period will require additional funding in the realm of £200 million over each of the next five years, which the Executive’s budget will deliver. If this funding is not secured, the services will not be in place for patients to use. This is an outcome we will take all steps to avoid.

The need for a wider range of services must be underpinned by local intelligence and professional knowledge. The Accountable Care Systems approach outlined in the Bengoa Review is one to be followed, and in order to make it a full reality within our health system the local and professional networks we already have must be enhanced further. We will, in this transitional process, direct the HSC Board to enhance support for the GP Federations and Integrated Care Partnerships to ensure that local population needs can be better planned and addressed in matters relating to budgeting and service provision.

Alongside these measures, the workforce of the health service needs to be equipped and prepared for the future of the service. The HSC Board will be directed to continue its important work in facilitating the appropriate integration and recognition of qualifications between the health and social care sectors. With an ageing society and the extension of home and residential care, it becomes more important to have greater capacity to move qualified professionals between roles and meet the needs of patients. The Department will work with its counterparts in the Irish Government to aim to facilitate the retention of mutually-recognised qualifications in our post-Brexit landscape given the mutual need to facilitate effective cross-border labour mobility within the health systems in both jurisdictions on this island. Finally, to ensure that talent is retained within our health service, we will be making the requisite investments in the health service to ensure that our health professionals retain pay parity with England. New incentives will be established to support those who seek to provide health services in rural, underserved areas coming to a total cost of £120 million.

Conclusion

These changes will not be easy, but they remain necessary. The health service is at a point where it must evolve to meet our collective future needs. As put starkly in the Bengoa Review itself, the choice is not between ‘change’ or ‘no change’, but instead ‘change on our terms’ and ‘change in the face of crisis’. I believe firmly in managing this transition effectively to secure the best outcomes for our community. This work will, of course, need to be underpinned by a genuine commitment to see the goals achieved as well as broader attention paid to promoting better health outside of the health service’s own remit; future work in improving public health trends more generally remains an important goal that is far greater than what I have outlined here.

Minister of Health - u/SoSaturnistic CT MLA