Health and Social Care (Northern Ireland)

Health and Social Care (HSC) is the publicly funded healthcare system in Northern Ireland, and one of the four systems which make up the National Health Service in the United Kingdom. The Northern Ireland Executive through its Department of Health is responsible for its funding, while the Public Health Agency is the executive agency responsible for the provision of public health and social care services across Northern Ireland. It is free of charge to all citizens of Northern Ireland and the rest of the United Kingdom.

Health and Social Care
TypePublicly funded service
PurposeAdministration of the public health and other social care services
Region
Northern Ireland
Parent organisation
Department of Health
Websiteonline.hscni.net
For the NHS in the UK as a whole see National Health Service.

For services such as A&E, patients simply walk in, state their name and date of birth, are given treatment and then leave. Patients are unaware of costs incurred by them using the service. It is sometimes called the "NHS", as in England, Scotland and Wales, but differs from the NHS in England and Wales in that it provides not only health care but social care too (the NHS in Scotland also includes social care). Social services are provided by local councils. The Health and Social Care service was created by the Parliament of Northern Ireland in 1948 after the Beveridge Report.

Organisation

Hospitals in the region were managed by the Northern Ireland Hospitals Authority and hospital management committees from 1948 to 1974, and then transferred to four health and social services boards, along with responsibility for social care. The pattern of local government in the region was of 26 single-tier local authorities which, apart from Belfast, covered small populations ranging from 13,000 to 90,000 and were not considered an adequate base for the provision of personal social services.[1]

The Health and Social Care (Reform) Act (Northern Ireland) 2009[2] led to a reorganisation of health and social care delivery in Northern Ireland, reducing the number of organisations involved. This Act established the Health and Social Care Board and five Health and Social Care Trusts which are responsible for the delivery of primary, secondary and community health care. The act also established five local commissioning groups which work in parallel with the health and social care trusts.

The Department of Health is now organised under a Permanent Secretary into several groups and one agency. These are the Planning and Resources Group, Strategic Planning and Modernisation Group and Primary, Secondary and Community Care Group and the five professional groups. The department's executive agency responsible for the oversight, coordination and overall provision of health and social care services is the Public Health Agency.[3][4]

The five professional groups are

  • Medical and Allied Services[5]
  • Social Services Inspectorate[6]
  • Nursing and Midwifery Advisory Group[7]
  • Dental Services[8]
  • Pharmaceutical Advice and Services[9]

Information technology

The Northern Ireland Electronic Care Record, developed from 2013 was extended to community optometrists in July 2019.[10]

Trusts

Trusts are the statutory bodies responsible for the management of staff, health and social care services on the ground and have control their own budgets. The 19 health and social services trusts were merged into six health and social care trusts which became operational on 1 April 2007.

The six trusts are:[11]

Primary care

There are about 350 GP Practices in the region.[12]

In 2016 Michelle O'Neill produced a plan to install a named district nurse, health visitor and social worker in every practice. 54 pharmacists are to start in practices in December 2016 with one in every practice by 2021. The number of GP training places is to increase to 111.[13]

The British Medical Association voted to start collecting undated resignations from Northern Ireland GPs in January 2017 in protest against the underfunding of general practice in the province. Less than 60% were collected. There was a decline in partners take-home pay in 2016/17, to £90,500. An investment package of £22 million was announced in 2018. £12.3 million is for pharmacists in practices.[14] In May 2018 a £100 million Health and Social Care transformation funding package was announced, including £5 million for Multi Disciplinary Teams in two areas initially, each of about 100,000 people, which will involve the establishment of practice-based physiotherapists, mental health specialists and social workers working alongside doctors and nurses.[15]

The first community hub for primary care in the province is to be established in Cookstown, in 2018, backed by four local GP practices and the health board. It is to incorporate scanning facilities, a minor surgery suite, a pharmacy, out-of-hours consultations and community healthcare partnerships, with the possibility of developing supported living accommodation for older people.[16]

In 2019 a £26,760,000 increase in funding for GPs was provided under the new contract. which is to support the recruitment of advanced nurse practitioners, practice-based pharmacists and other staff to support GPs.[17]

Pay parity

In November 2019 Unison members began industrial action in Belfast City Hospital, Craigavon, Musgrave Park and Omagh Hospitals over unsafe staffing levels and the lack of pay parity with NHS staff in the rest of the UK.[18] The Royal College of Nursing is also planning industrial action.[19]

Prescription charges

On 29 September 2008 Health minister Michael McGimpsey announced that Prescription charges were to be phased out by April 2010, being first reduced to £3.00 in January 2009.[20] This was widely accepted by the four main parties of the Northern Ireland Executive plus the Alliance Party of Northern Ireland. The move brought Northern Ireland in line with the Scottish and Welsh systems which had already abolished charges.

Performance

In Northern Ireland health and social care have been part of the same structure since 1974 but according to Terry Bamford "integration has failed to address a reliance on hospitals and institutional care which is significantly greater than elsewhere in the UK." He says that there are various reasons for this. It is difficult to get resources out of acute care without closing buildings, which is a political problem particularly in rural areas. Information technology systems may not be compatible and patient confidentiality hinders the sharing of information. Health services are free but social care is means tested. But, he says, "the greatest difficulties lie in the different cultures and values of health and social care." [21]

Until 2014 the Kingsbridge private hospital in Belfast was used to reduce waiting lists for routine surgery. In September 2015 the Northern Ireland Health and Social Care Board admitted that waiting lists for surgery had grown and that they did not have the money to pay either NHS providers or the private sector to bring them down.[22]

The NHS waiting list target in Northern Ireland is 52 weeks, not 18 as in England, and it isn't met. 10% of healthcare provided in the region is paid for privately.[23]

A report by the Nuffield Trust in 2017 showed that though spending per head in the province at £2,200 a year was much the same as the rest of the UK the performance of the system was much worse. Using the NHS targets more than 20% of patients waited more than 4 hours in A&E departments, and sometimes 30%. About 16% of the population were on a waiting list, compared with around 7% for the rest of the UK. More than 64,000 of them, around a quarter, had been waiting over a year for their first outpatient appointment. In the last 16 years there had been 7 government reports calling for a move to more stress on prevention and away from hospital based care.[24]

In 2018 hospital performance in the province was worse than the rest of the United Kingdom. All the five trusts failed their targets for A&E, cancer and routine operations for the whole of 2017–18.[25] The Northern Ireland Audit Office reported in December 2018 that "the health and social care system, as currently configured, is simply unable to cope with the demands being placed on it." There is a deficit of £160 million and waiting times were unacceptable. None of the NHS targets have been met since 2015.[26] 204 patients died in hospital in 2018 while waiting to be discharged largely because of a lack of domiciliary care packages.[27]

The BBC reported the case of a woman with multiple health problems who moved from County Armagh to Swansea and said the doctor she encountered in Bristol "was shocked" at the standard of medical care she had received from the Southern Health and Social Care Trust.[28]

205 homeless people in Northern Ireland died in an 18-month period, according to the Bureau of Investigative Journalism accounting for more than 25% of the 800 homeless deaths in the UK. Northern Ireland's population of 1.9 million is 2.8% of the UK total.[29]

One in five Northern Irish cancer patients get their cancer diagnosis while attending an emergency department. This happens because some patients wait too long on hospital lists and get taken to an emergency department instead. Heather Monteverde of Macmillan Cancer Support described the statistics as, "shocking and extremely worrying". Monteverde said emergency departments are unable to give the highly specialised care cancer patients need and added just 55% of Northern Irish cancer patients begin treatment within the 62-day target, and the number was, "deteriorating month-by-month". Cancer patients presenting via emergency departments have the lowest survival rates. 74% of the 4316 patients who died from cancer in 2015 were admitted to emergency departments during the last year of their lives. Only 85.6% of supected breast cancer patients were seen within the target period of a fortnight.[30]

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See also

References
  1. Royal Commission on the NHS. HMSO. 1979. ISBN 0 10 176150 3. Retrieved 12 June 2015.
  2. "Health and Social Care (Reform) Act (Northern Ireland) 2009". Retrieved 10 June 2016.
  3. Public Health Service home page. Retrieved 27 August 2016
  4. "Northern Ireland Health and Social Services Estates Agency". Dhsspsni.gov.uk. 2009-02-06. Retrieved 2010-07-11.
  5. "Northern Ireland - Department of Health, Social Services and Public Safety". Dhsspsni.gov.uk. Retrieved 2010-07-11.
  6. "Northern Ireland - Department of Health, Social Services and Public Safety". Dhsspsni.gov.uk. Retrieved 2010-07-11.
  7. "Northern Ireland - Department of Health, Social Services and Public Safety". Dhsspsni.gov.uk. Retrieved 2010-07-11.
  8. "Chief Dental Officer | DHSSPS (NI)". Dhsspsni.gov.uk. 2009-02-06. Retrieved 2010-07-11.
  9. "Northern Ireland - Department of Health, Social Services and Public Safety". Dhsspsni.gov.uk. Retrieved 2010-07-11.
  10. "Expansion of Northern Ireland electronic care record sees improvement in eye care". Building Better Healthcare. 29 July 2019. Retrieved 4 September 2019.
  11. "Health and Social Care Trusts". NI Direct. Retrieved 4 August 2014.
  12. "The National Health Service (NHS) Updated October 2012" (PDF). Association of the British Pharmaceutical Industry. Retrieved 20 May 2015.
  13. "Health plan aimed to help service 'at breaking point'". Commissioning Review. 26 October 2016. Retrieved 29 October 2016.
  14. "BMA may call off mass resignation plans after GP investment". Pulse. 12 September 2018. Retrieved 13 September 2018.
  15. "GP practices set to benefit as part of £100m boost for health services". Belfast Telegraph. 9 May 2018. Retrieved 25 May 2018.
  16. "£8m health village plan 'well advanced'". Mid Ulster Mail. 9 May 2018. Retrieved 25 May 2018.
  17. "Northern Ireland unveils £27m GP funding boost for 2019/20". GP Online. 23 September 2019. Retrieved 19 November 2019.
  18. "Members of Unison begin strike action at Northern Ireland hospitals". Belfast Telegraph. 28 November 2019. Retrieved 29 November 2019.
  19. "NI Civil Service 'regret' as Unison healthcare workers strike". BBC. 25 November 2019. Retrieved 29 November 2019.
  20. "UK | Northern Ireland | NI to scrap prescription charges". BBC News. 2008-09-29. Retrieved 2010-07-11.
  21. Bamford, Terry (30 April 2015). "Integration is not a cure-all for health and care – look at Northern Ireland". Guardian. Retrieved 3 May 2015.
  22. "End to private contracts 'helped fuel NHS waiting crisis'". BBC News. 21 September 2015. Retrieved 21 September 2015.
  23. "Mark Regan: 'There's huge health inequality between Northern Ireland and England'". Belfast Telegraph. 17 August 2015. Retrieved 21 September 2015.
  24. Heenan, Deirdre; Appleby, John (17 October 2017). "Health and social care in Northern Ireland: critical care?". Nuffield Trust. Retrieved 24 December 2017.
  25. "The hospitals that fail to treat patients on time". BBC. 20 November 2018. Retrieved 20 November 2018.
  26. "Northern Ireland NHS 'simply unable to cope with the demands placed on it': report". Belfast Telegraph. 18 December 2018. Retrieved 20 December 2018.
  27. "More than 200 patients 'ready to go home' die in hospital in 2018". Homecare Insight. 16 April 2019. Retrieved 20 May 2019.
  28. "Waiting lists: NI woman's 'life changed' by move to Wales". BBC. 12 July 2019. Retrieved 12 July 2019.
  29. "Northern Ireland homeless deaths account for quarter of UK figures". Belfast Telegraph. 29 October 2019. Retrieved 3 November 2019.
  30. Cancer: One in five cancer diagnoses 'in Emergency Departments' BBC
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