OPINION


SAVING OUR HEALTH SERVICE ONE MEETING AT A TIME


WhEn gErard grEEnE aSKEd If I WoUld BE onE of hIS fIvE SPEcIally-SElEctEd BElfaSt PharMacIStS to rEPrESEnt cPnI, hoW coUld I Say no? By Terry Maguire


B


eing picked for an important meeting to progress government policy brings a


certain warm feeling of purpose and usefulness. My professional career was not a waste I thought, as gerard popped the question. and so it was I arrived at the duncairn meeting prepared to change the world of pharmacy and the health service for the better and for ever.


to say the meeting was mortifyingly dull, absurdly pointless and incapacitatingly boring is to give an impression I enjoyed it more than I did. of all the hours I have lived so far, those three were the most excruciatingly painful. and I was not alone. Martin Ball, attending as an IcP pharmacist, visibly aged during the meeting. tara challener from Boots lost her indomitable chirpiness and aileen crossin – another cPnI special - had the good sense to make sure I was kept away from sharp- edged implements or fabrics that could be fashioned into a noose.


It wasn’t gerard’s fault - nor was it the fault of the department of health (doh) - who planned the meeting, rather it was yet one more attempt to bring together a roomful of coal-face


46 - PharMacy In focUS


healthcare professionals in the hope that they might magically come up with a sensible view on how our failing health service might be saved from implosion.


transforming your care was right back in 2011 when first published; it is right today but every opportunity to transform the health system has been blocked by those who fear change. the commissioning model was designed to buy services from five health trusts and primary care organisations in a change strategy that was to shift resources out of secondary care and into primary care.


But, in the end, the model failed. Sir liam donaldson was parachuted in to write the donaldson report, the right time, the right Place (Jan 2015) and recommended a review of the commissioning model. richard Pengelly, Permanent Secretary doh, headed this review that ultimately led to Professor Bengoa and his expert panel.


accepting that commissioning has failed, Professor Bengoa and his team were asked to come up with a new model – that was the accountable care System (acS), I think. But our politicians didn’t want experts telling them what to do, so Michelle o’neill,


then health Minister, published her own document health and Wellbeing 2026; delivering together, which reads remarkably like transforming your care but with acSs rather than commissioning.


commissioning failed because the structures it was based on were complex and, as a result, allowed too much interference 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. about absolutely everybody it seems - which is ironic - given that all recent reports claim we all want change.


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, Pathways for four clinical priorities; coPd, diabetes, frail Elderly and Stroke.


and yet I despair. co-production - design and development of services through patients working with


clinicians – is the ‘big idea in Michelle o’neill’s strategy and it fills me with dread. co-production is supposed to be ‘doing things with people’ rather than ‘doing things to people’.


newton Emerson, writing in the Sunday times some months back, suggested - and I agree with him - 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 resource will now be targeted at a mythical disease. But that’s real health politics.


at the duncairn meeting we were all at it again. allied health Professional (ahPs) got annoyed that no one mentioned them, and so we mentioned them. Pharmacy wasn’t mentioned until John Kelly – another cPnI special – commented articulately on pharmacy’s accessibility etc. etc. Sadly we miss the central point: the changes needed to save our health service need to be significant and - with significant changes - there will be losers.


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