Debate contribution: Health Service Transformation: Funding

Debate contribution by Ms Liz Kimmins on 17 September 2024.

MLA

Ms Liz Kimmins

Party at the time

Sinn Féin

Date

17 September 2024

Type

Debate contribution

Business

Private Members' Business

Heading

Health Service Transformation: Funding

Assembly identifier

Official Report component 4536997

Read the official Assembly record

Text

I support the motion and the amendment. Eight years ago, Professor Bengoa launched his report 'Systems, Not Structures', which signified a turning point in the Assembly's intent to transform our health and social care system, with a clear focus on creating a safe, high-quality and sustainable service for people across the North of Ireland. I recently refreshed myself on the findings and the content of that report, particularly as I know that Professor Bengoa is due to visit here again next month. Despite almost a decade having passed since the report's publication, it could have been written yesterday, except that the key challenges have significantly worsened. We are now in a situation where our health service is undoubtedly in a fragile state. Had the transformation been implemented as outlined in the Bengoa report and, indeed, in 'Delivering Together', which was introduced by my colleague the First Minister and then Health Minister, Michelle O'Neill, we would not be witnessing the impact of the "burning platform" that Professor Bengoa rightly predicted in 2016. We have not moved on from the reactive, acute-centred model of delivery that was operating back then, and that is clearly not delivering for patients and service users. In fact, it is contributing to increasingly higher costs, with an over-reliance on short-term solutions, including expensive agency and locum staff, not just in secondary and tertiary care but in primary care, as we continue to struggle to attract GPs into our local surgeries. We are at a point where this is no longer a tenable position, and maintaining those existing models is having increasingly negative impacts on the quality and experience of care for patients and service users. Over the last decade, we have seen the symptoms of inaction, which, the wider public have often felt, was what was meant by "transformation", but let us be clear: the removal of services, such as emergency surgery from Daisy Hill and the South West Acute Hospital (SWAH), is not transformation; it is service collapse.

I thank the Member for her intervention. That is an important point, and I will discuss that in more detail later. We cannot impose decisions on the community, our staff or all the sectors that are critical components of our health and social care service. We must do it in genuine partnership and with co-design and co-production. The only way that we will deliver is by listening to the people who use the services and to those who deliver the services every day and know what the changes have been, whether they were societal changes or changes in the needs of patients. That leads into my next point, which is the importance of proper workforce planning. We talked about service collapse, and my colleague will be aware of the impact of that in the SWAH. In order to avoid further such service collapse, we need to ensure that we have proper workforce planning, because we have seen that, where that has not happened, our highly skilled workforce has continued to see diminution and dilution as a result. That must be a starting point, and that is inevitably our biggest challenge if we want to see the proper transformation that, we all agree, is required. In this year alone, we have seen some of the dire consequences of a failure to invest in our workforce, and that is failing all our citizens. 'Delivering Together' envisioned the health and social care system as an attractive employer and one that enables staff to develop their skills in a working environment that allows them to do what they do best, and that needs to be our focus now. Staff are burnt out, and they are prevented from doing the job that they want to do by the constant firefighting and crisis management that they are required to do every day. In 2016, Bengoa also highlighted the disproportionately high use of emergency and urgent care by people in the North, and that has undoubtedly increased significantly, as we see week in, week out the huge pressures on our emergency departments, with, as others said, some the longest waiting lists in western Europe and extremely long waits for access to GP services and treatment. That points to the need to turn the ship around from a focus on the latter stages of a patient's journey in acute or emergency care to a strong focus on primary care and early intervention where preventative and proactive care will ensure that our population will not only live longer but live a healthier and more active life with better outcomes. Primary care is undoubtedly the bedrock of a properly functioning health and social care system, and we therefore need to see concerted efforts to tackle the existing challenges across primary care so that patients can see the right person at the right time. As others have said, that work cannot occur in isolation. We need to see deliverable actions to tackle our waiting lists. That is not an easy task, given the current financial climate, but that does not mean that we should do nothing.

Those are just some elements of what we need to do to transform our health service. I am under no illusion that many components are required to fully deliver what was envisioned by 'Delivering Together' and the Bengoa report. We have seen chinks of light with the implementation of elective care hubs and the partial roll-out of multidisciplinary teams (MDTs), but we have some way to go. As others have said, we cannot do it without genuine partnership working, co-production and co-design with the people who use the services and those who deliver them. Our communities are anxious and fearful that they will lose services and that things are being removed. We cannot do business like that any more. Staff must not be the last to know about service changes. We must work together, and we are committed to working with the Minister to ensure that that happens in the time ahead.

999 words. Text as published by the Northern Ireland Assembly.

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