Travel further to be seen faster, says healthcare report

A major report into the future of healthcare in Northern Ireland has recommended retaining all five area hospitals and investing in regional centres of excellence for specific medical treatments.

Hospitals - Creating a Network for Better Outcomes also says there should be a drive toward separating emergency cases and planned procedures at different locations.

It says patients may have to travel further for certain types of care but would be seen faster.

The report pinpoints staff shortages and an adequate transport system as key challenges in making any new hospital network workable.

The framework commissioned by the Department of Health says previous reports had outlined why the system required change, while this framework was designed to deliver it.

With the region still experiencing the worst health waiting lists in the UK, the report says Northern Ireland must act.

“Waiting for a long time means that patients are living with problems that can and should be treated sooner than they are...this is unacceptable,” says the report.

It suggests excessive waiting times for routine surgery need to be addressed and recommends establishing an additional elective care centre at the Causeway Hospital in Coleraine.

The report says on the subject of hospital closures, “the reality is that we will continue to need every square inch of our acute hospital capacity.

The five area hospitals providing acute care are:

• Craigavon Area Hospital
• Antrim Area Hospital
• Altnagelvin Area Hospital
• Ulster Hospital
• Belfast Hospitals Campus

The Department of Health said the framework was not about cost-cutting or closing hospitals but about effectively using existing resources.

It does not provide details on budgets and the precise costs of implementing the recommendations, but says “in some cases reconfiguration will require additional money to deliver”.

The framework says that with fewer hospital services stretched across multiple sites, the need for locums and agency staff should lessen.

Reducing health inequalities and increasing cooperation with services in the Republic of Ireland and the rest of the UK are also key targets.

The report says Northern Ireland’s 13 local hospitals are important hubs for community and social care services, with many having “developed niche roles that have made them more resilient”.

The local hospitals are:

• Ards Hospital
• Bangor Hospital
• Dalriada Hospital in Ballycastle
• Downe Hospital in Downpatrick
• Lagan Vally in Lisburn
• Lurgan Hospital
• Mid-Ulster Hospital in Magherafelt
• Moyle Hospital
• Omagh Hospital
• Robinson Hospital in Ballymoney
• South Tyrone Hospital in Dungannon
• Waterside Hospital in Londonderry
• Whiteabbey Hospital

The framework says it is important to avoid duplicating services and competing for resources among the 13 hospitals.

NI’s three General Hospitals are the most vulnerable to unplanned change in service, and issues over their geographical locations and rotas are major challenges, says the framework.

The general hospitals are:

• South West Acute Hospital in Enniskillen
• Daisy Hill Hospital in Newry
• Causeway Hospital in Coleraine

An “achievable and sustainable solution that ensures the future of these hospitals is critical to developing a successful hospital network”, says the report.

We first started talking about a new hospital landscape for Northern Ireland back in 2001 - 23 years later and the Department of Health has published the latest document which brings the argument bang up to date.

The timing is not a coincidence - with the arrival of Professor Rafael Bengoa next week - health officials are keen to show they’re still in the business of reforming our fragile services.

Since the turn of the century, all four of NI’s government commissioned health reviews have suggested cutting or changing the number of acute hospitals - those providing ED services and emergency surgery.

While that's been happening in piecemeal fashion, the landscape is slowly showing glimpses of change.

This plan explains why the system must change, but what we don't know and what hasn't been explained or budgeted for is patients having to travel to centres of excellence, how infrastructure will be improved to facilitate that and how the workforce will migrate.

What patients will say is that they need to see action at a much greater speed.

While it's good to see the former health minister on a return visit, perhaps next time he’ll be proved right when he said: “Northern Ireland is more than capable of delivering.”

Maurice Hayes Review:

Published in June 2001. It recommended reducing the hospitals, amalgamating health boards into one, integrating health and social care, removing accident and emergency services from five of NI's smallest acute hospitals.

Donaldson Report:

Published on 27 January 2014. The main point was there were too many hospitals and expertise was being too thinly spread. The review made 10 recommendations including closing local hospitals and self-management of chronic disease.

Bengoa Report:

The report was on the basis of a 10-year plan introduced by the then Health Minister Michelle O’Neill on 25 October 2016. It laid out a ten-year plan which aimed to improve services, cut waiting list times and improve care for an ageing population. It laid out 18 time-specific action points.

Compton Review:

Reported in December 2011, publishing ‘Transforming Your Care: A Review of Health and Social Care in Northern Ireland’. It made 99 proposals for change across a range of health and social care services, including cutting the number of acute hospitals from 10 to five. And led to the opening of new health and care centres in Banbridge, Ballymena and Omagh.