VIEWPOINT


REAl hEAlth PolItIcS PREfER thE StAtUS qUo by terry maguire t


he media hype over our latest could-do-better health Service report Systems not Structures:


changing health and Social care, was more positive than I expected.


BBc wheeled out the usual pundits. the interminably monotonal John compton welcomed the report, saying it was good to say things over and over again until the public finally hears the message. I don’t disagree, John, but it might be an idea to brighten the tonal palate now and again!


the famously bald dr george o’Neill was unusually positive, but that seems to be because his Accountable care System (AcS) approach got a good airing. At least george understands AcSs, which is more than can be said for the rest of us, but, with no experience of how AcSs might work in a nationally- funded public healthcare system such as ours, it is a bit of a gamble - to say the least.


the Report’s author, Professor Rafael Bengoa, the genial Spanish academic, who was parachuted into Northern Ireland to save our health service, has done his work, smiled for the cameras, spoken to the Assembly and flown home. he leaves behind a report full of jargon which most struggle to understand. he tells us our health service must transform, become fit for purpose, more responsive, more efficient. Rafael, Rafael, you are speaking to the converted!


But the good professor and his Expert Panel will not be allowed a final say on the direction of our health service. minister michelle o’Neill wants to meddle and has issued her own take


on Rafael’s recommendations in her policy paper health and Wellbeing 2026:delivering together.


Unsurprisingly, she agrees we need to change and transform. ministerial meddling is a feature of Northern Ireland politics. When he was health minister, Simon hamilton refused to allow clinical experts to define and implement the necessary transformation. But since health ministers seldom plank their behinds into the hot seat long enough to bring it to normal temperature, it’s no wonder the health service is in such a mess.


were asked to come up with a new model – which was, I think, the AcS.


So, why did the commissioning model fail? the simple answer is that the structures created were too complex and - as a result - allowed too much interference, with decision making by a coalition of those who wanted the unnecessary and unobtainable, and those who much preferred the status quo.


In this coalition we find: patient groups, the media, politicians, healthcare professionals and the unions. Absolutely everybody it seems


“thE loBBYIStS hAvE WoN ANd lotS


of vAlUABlE RESoURcES WIll NoW BE tARgEtEd At A mYthIcAl dISEASE. BUt thAt’S REAl hEAlth PolItIcS”


We have just wasted ten years of transformation. the commissioning model was designed to buy services from five health trusts and primary care organisations in the context of a change strategy, transforming Your care (tYc). But in the end this model was deemed to have failed by liam donaldson – another expert parachuted in – and, on the foot of his report, the department of health (doh) did away with the health Board, which will cease functioning in march 2017.


the donaldson Report, the Right time, the Right Place (Jan 2015) recommended a review of the commissioning model and this review, which was headed up by Richard Pengelly, Permanent Secretary doh, ultimately led to Professor Bengoa.


Accepting that commissioning has failed, Professor Bengoa and his team


- which is ironic given that all recent reports claim we all want change.


commissioning is simple: identify the health needs of the population, develop and implement services to address these needs. then work out if the services are effective. If they are, continue to fund them. If not, decommission them.


like our new health minister’s party, health commissioning bodies weren’t good at decommissioning. Without decommissioning, things jammed up and transformation fails to materialise.


Sir liam's donaldson's report suggested local commissioning was merely tinkering with a few well- meaning projects. But under the commissioning model there were successes: percutaneous cardiac intervention, stroke services,


re-ablement, glaucoma services, mental health hubs, and pathways for four clinical priorities: coPd, diabetes, frail elderly and stroke. But the hScB was unnecessarily fragmented and there seemed to be no clear plan that one group owned.


As the next model of healthcare for Northern Ireland becomes clearer – and it might be an AcS model - I hope that some lessons have been learnt. the lobby groups and the status quo groups are much more powerful than we appreciate.


In fact, we might be part of them from time to time. Rather than simply repeating the message that we must change, we need to actively counter these vested interests if we are to succeed.


Yet I despair. the concept of co-production - design and development of services through patients working with clinicians - features strongly in michelle o’Neill’s strategy and it fills me with dread.


Writing in the Sunday times, Newton Emerson suggested that co-production only encourages the lobbyists and those with vested interest.


co-production has given us a Northern Ireland pathway for fibromyalgia. fibromyalgia is not a physical disease, but a form of depression. People who are unhappy with their lot are people who suffer from fibromyalgia.


But the lobbyists have won and lots of valuable resources will now be targeted at a mythical disease. But that’s real health politics. •


PhARmAcY IN focUS - 49


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