Response to the consultation document, “Hospitals -Creating A Network for Better Outcomes” by the Workers Party
The document lays the foundation for ongoing and continuing reconfiguration of services and is heavily weighted towards the needs of medical staff as opposed to patients.
The Workers Party is not opposed to change within the Health Service. In fact, we have been demanding changes for well over a decade. The Party believes we should use all new technological advances at our disposal for the benefit of patients and service users, and we have no difficulty with regional specialist services which currently operate and deliver medical treatment across a range of medical conditions.
We do have a problem with a number of the proposed changes and the very confused messages in the two documents, “The Health and Social Care NI - Three Year Plan” and “Hospitals -Creating A Network for Better Outcomes” (henceforth Better Outcomes). In the former there is a heavy emphasis on the use of the Third Sector and huge efficiency savings totalling £400 million, with anticipated savings coming through charging for prescription and home care services. We note, for example, that the Three Year Plan expects what it terms “independent sector in-sourcing”, i.e., outsourcing, to relieve pressure on breast cancer services, while more generally, the independent sector is described as being one of the “key partners” in the planning and delivery of social care and mental health services.
Better Outcomes claims to be designed to meet the ambition of delivering better clinical outcomes for patients and service users. It must be clear that there is a contradiction in this position and the ‘efficiency savings’ and private sector ‘ins-sourcing’ proposed in the Three Year Plan. Research shows that the erosion of the principle of a NHS free at the point of demand through charging, outsourcing, and privatisation leads to poorer outcomes for NHS patients and even to the death of patients.
The Workers Party acknowledges that health and social care practices have evolved over the years, but we would question whether those practices and changes have always been in the best interest of service users and patients. The privatisation and fragmentation of home care and residential care has caused enormous damage to those services. Public money has been wasted, and a lower quality of service has been delivered to those in need. It would seem that no lessons have been learnt from past reforms and that the same rationales are being used to spearhead the reforms outlined in Better Outcomes, namely, affordability and career progression.
Despite what Better Outcomes says about the delivery of services locally, the trend towards centralisation is confirmed in the document. The Minister and the Department and our politicians are aware of the anger in local communities about being unable to access GP appointments yet cutting back on GP services delivering services locally and possibly at home forms a part of the proposed change process. If patients cannot access their GPs at their surgeries through the current procedure, there is little chance of GPs seeing them in their own homes, regardless of what these proposals say.
The Workers Party would agree that the regional infrastructure is not fit for purpose and never was. The whole rationale behind the creation of Health and Social care Trusts was to facilitate the introduction of the internal market, and the framework was designed to create competition not co-operation and to force Trusts to bid against each other to deliver not better but cheaper services. The Workers Party is wholly opposed to the so-called ‘purchaser/provider split’, in which an internal market has been created in the NHS with the result that the health service (the purchaser) has to contract with other parts of the NHS or independent sector organisations (the providers) to supply patients with services. Scotland and Wales run all their healthcare services directly, having abolished this split model in 2004 and 2009, respectively, and the Workers Party calls on NI to follow suit.
The Minister and the department have ignored the opportunity to look at the health infrastructure in NI and to provide an analysis of the costs related to maintaining six Trusts each with its own senior and middle management structures and Trust Boards, six LCGs, and all of the other structures and Agencies, too numerous to mention, which draw financial support away from direct patient care. We note that the number of available hospital beds in Northern Ireland has fallen precipitously since 2009, a fact not acknowledged or dealt with in Better Outcomes. The system cannot “collectively prioritise timely flow through …[hospital] beds” if there simply aren’t enough of them.
Better Outcomes also provides a blanket cover for future changes and reconfiguration and allows for trusts to make the decision on what services they will provide in the future. This scenario cannot be in the best interest of patients and service users. The document creates an impression of our National Health Service in a continuous state of instability.
The document talks a great deal about pathways for citizens to access hospital services and flags up travel as an issue. What it does not do is offer any solutions or remedies to what is a major issue for many of our citizens especially those in rural areas. This document is laying the foundation for ongoing and continuing reconfiguration of services and is heavily weighted on the needs of medical staff as
opposed to patients. Whilst the Workers Party would agree that our citizens are entitled to high quality services and medical treatment, we do not see this process of endless reform as the means of delivering high quality clinical outcomes for those most in need.
We are in agreement that the health service should be effective, efficient and maximise productivity and make the best use of the workforce. We have major concerns about how this can be achieved in the absence of a credible workforce planning strategy.
Health inequalities are a major problem across many areas of Northern Ireland. They go hand in hand with poverty, multiple deprivations, unemployment, substandard housing. Yet that the only solution offered to deal with the systemic neglect which creates these inequalities is to suggest that patients might have to travel further to access care shows a lack of detailed understanding of health inequalities and related causes.
The Workers Party is concerned that with the widespread use of the private sector. The Better Outcomes document is silent on this issue, but, as we have noted, other documents explicitly describe a role for private provision. We are currently operating a two-tier health system which flies in the face of the founding principles of the National Health Service.
The document also flags up concerns with the conceptual outline of three different tiers of hospitals and how those impact on delivering stainable services. The document goes into quite substantial detail on critical mass and its effectiveness for delivering services and the training and learning opportunities for medical professionals and other staff. This argument is not new, in fact it has been mentioned in each restructuring and every health report and proposals for change for decades.
"Public money has been wasted, and a lower quality of service has been delivered to those in need. It would seem that no lessons have been learnt from past reforms and that the same rationales are being used to spearhead the reforms outlined in Better Outcomes, namely, affordability and career progression."
The document also mentions that there are some hospitals that medical staff do not want to work in. We are aware that this is also currently the case and has been the case for many years. How can this unwillingness on the part of professionals to work in certain contexts be balanced against the proposed changes that would require patients to travel to receive the necessary care?
There are also concerns around creating a three-tier system and what impact centralisation would have for securing doctors for Local and General Hospitals. If these hospitals lose their teaching hospital status do junior and other grades of medical staff no longer go on rotation to these sites?
The Workers Party supports sharing best practice across hospitals and the cross-border sharing of services. What we do have is a strong opposition to NHS patients having to follow clinicians and the other proposals within Bengoa, which suggests additional payments to medical and senior managers when consultants already receive merit payments and senior managers receive performance related pay. While recognising the importance of adequate remuneration and career progression, the only ‘vested interest’ in the NHS should be the patients.
