A non National Health Service

The National Health Service has now entered its sixty first year. Since devolution, however, the health service has been taking significantly different directions in terms of priorities and management structures within the four constituent parts of the United Kingdom.An interesting article by Nick Triggle on the BBC website analyses these differences between the health services in the UK. Whilst the Welsh have increased spending on public health, the Scottish executive have adopted a collectivist approach and the English have looked to competition to greatly reduce waiting times.

The article notes that Northern Ireland’s system is characterised by the politicians leaving the “front line” workers to “pursue their own direction”. It is also noted that the five new trusts control the social care for their area as well as health. This is suggested to prevent some of the arguments between councils and trusts regarding social care. Also vaunted is the creation of polyclinics with GPs, social workers and some hospital services.

This quite rosy picture is accurate up to a point. There is a considerable logic to trusts controlling social care as well as health (though I have argued before that there are now too few trusts). Despite this there are still some (thankfully fewer than there used to be) instances of bed blocking whereby patients who have recovered are unable to be discharged because there is no funding for a nursing home and not because of clinical need. This is an inordinately expensive problem due to the cost of hospital in patient care and also renders the patient at greater risk of hospital acquired infections.

In June of last year McGimpsey announced a significant reduction in waiting times though since almost all of this occurred during Direct Rule he cannot really claim credit for it. However, the targets for March 2008 are as follows:
• 13 weeks for a first outpatient appointment
• 13 weeks for a diagnostic test
• 21 weeks for surgery
These targets are somewhat less ambitious than those for England which are the 18 week “patient journey” going from presentation to GP to definitive hospital treatment (if appropriate) in 18 weeks, this to be delivered by the end of 2008. It is also unclear whether or not our less ambitious targets will be met.

What is most worrying for the future, however, is the apparent lack of strategic planning and the inability of McGimpsey to take any decisions. I have previously noted the problem regarding the number of hospitals, something which would take decision making skills in a different league to those thus far evidenced by McGimpsey. His other problem is his need for more money though I note that he has scaled down his demands somewhat. McGimpsey feels that his department will be able to make efficiency savings; this claim must be seen in the context of the man who has put out for review the decision to reduce the number of health boards.

I suppose if the March 2008 targets are met Mr. McGimpsey will hail them and his role is bringing them about (exactly what that role will have been is unclear). Presumably, however, if they are not delivered he will blame horrible Mr. Robinson for not giving him money and so causing this failure.

So the BBC health correspondent is quite correct that we have some significant advantages such as health and social care trusts but there are significant structural problems and significant challenges ahead. With a leader such as we have at the helm, I for one, am very doubtful whether or not we are adequately equipped to meet them.