Ministerial priorities for the health reform jigsaw
Minister of Health Mike Nesbitt MLA has outlined his primary policy pieces to complete the health reform jigsaw, the details of which have been met with some scepticism by Executive partners and opposition colleagues alike.
In July 2024, the Health Minister issued a Written Ministerial Statement to update MLAs on his policy priorities. In a previous speech, his first to the Assembly since assuming the portfolio in May, Nesbitt identified health inequalities as his predominant focus.
Outlining his intention to “reboot the public conversation about health reform”, the Minister announced his intention to publish two associated documents:
1. a draft hospital reconfiguration framework; and
2. a three-year strategic plan for health and social care focusing on stabilisation, reform, and delivery, with an overriding objective of producing better outcomes for patients.
Furthermore, the Basque public health and management specialist, Rafael Bengoa was invited by the Minister to return to Northern Ireland where he was the keynote guest speaker at the October 2024 ‘Health and Social Care Reform: Accelerating Change’ conference.
Bengoa return
Speaking ahead of the conference, Bengoa said: “The analysis in Systems Not Structures [the Bengoa report] is just as valid today as when it was published. The need for transformation, backed by sustained resources, is ever more pressing.”
After eight years, Bengoa’s one-day return was showcased as a significant component of the health reform “reboot”.
Draft reconfiguration framework
In the same month, the Health Minister published Hospitals: Creating a Network for Better Outcome, a draft reconfiguration framework for hospitals which outlines the principles informing the creation of an interdependent hospital network. The foremost principle of the draft framework is that while all existing hospitals will have a role to play, they cannot provide all services.
With modern medicine driving increasing clinical specialisation and subspecialisation, change, Nesbitt argues, is inevitable. As such, while stressing that “no acute hospitals will close”, he asserts that not every hospital can provide every service, and the roles of specific hospitals must change.
The Minister said: “We need to see each of our hospitals as part of something bigger and wider – fitting into a network in which each plays a key part. This is essential if we are to deliver better outcomes for patients and staff.”
Referencing Bengoa’s 2016 report, Systems, Not Structures: Changing Health and Social Care and the 10-year plan produced in response, Health and Wellbeing 2026: Delivering Together, the draft framework places acute hospitals into four main categories within a wider network.
1. Local: delivering primary, secondary, and community care services in support of general and area hospitals. This includes Ards Hospital, Bangor Hospital, Dalriada Hospital, Downe Hospital, Lagan Valley Hospital, Lurgan Hospital, Mid-Ulster Hospital, Moyle Hospital, Omagh Hospital and Primary Care Complex, Robinson Hospital (Ballymoney), South Tyrone Hospital, Waterside Hospital, and Whiteabbey Hospital.
2. General: delivering defined secondary care services, including the delivery of some unscheduled care alongside elective care for a specific geographic location. This includes Causeway Hospital, Daisy Hill Hospital, and Southwest Acute Hospital.
3. Area: delivering a full range of secondary care services within a geographic area defined by the five health and social care trusts. This includes Altnagelvin Hospital, Antrim Area Hospital, Craigavon Area Hospital, Belfast Hospitals Campus, and Ulster Hospital.
4. Regional: delivering specialist inpatient services for the entire population. This includes: Altnagelvin North West Cancer Centre, Belfast City Hospital including the Cancer Centre, Musgrave Park Hospital, Royal Belfast Hospital for Sick Children, Royal Jubilee Maternity hospital, Royal Victoria Hospital, and Ulster Hospital Regional Centre for Plastic Surgery and Maxillofacial Surgery.
“Reconfiguring hospital services remains an important part of the overall jigsaw.”
Minister of Health, Mike Nesbitt MLA
Furthermore the draft framework establishes five enablers and 13 actions to support the delivery of a connected hospital network.
The five enablers are: workforce, funding, communities and people, digital solutions, and cross-HSC trust collaboration, while actions include consideration of:
- available travel supports;
- maintaining core general hospital services in the short to medium term;
- moving specific activities out of specialist regional centres into area hospitals;
- aligning clinical training with projected population health demand;
- reviewing how vulnerable specialist services might be consolidated via closer collaboration with Britain and the Republic.
- The draft was opened to public consultation on 2 October 2024 and closes on 22 January 2025.
Three-year plan
In a letter addressed to all MLAs on 30 September 2024, the Minister promised MLAs that his department would publish the three-year plan determining the health and social care strategy for the Assembly’s remaining mandate within weeks of Bengoa’s departure. At the time of writing, this document has yet to be published.
In the same letter, Nesbitt warned: “The current financial position makes progress all the more difficult… While the Programme for Government sets out the limits that the present budgetary situation places on efforts to reduce waiting lists, I will continue to make the case for significantly more funding for health.
“I have no time for the argument that money alone is the solution to the health service’s ills. Equally, anyone who suggests it is not part of the answer is sadly mistaken.”
As such, the public now awaits the publication of the three-year plan as the final piece of the health reform jigsaw, and its subsequent implementation alongside the hospital reconfiguration.
In the meantime, considering the one element of reform that has been published to date – the draft hospital reconfiguration framework – the response of the Minister’s Assembly and Executive colleagues has been less than positive.
From an opposition perspective, the SDLP’s health spokesperson Colin McGrath MLA commented on the proposed reconfiguration saying: “We cannot escape the fact that there is very little detail in the Minister’s statement today about what transformation will look like or what form it will take.”
Likewise, while welcoming the announcement, Alliance Health spokesperson Danny Donnelly MLA asserted: “We do not need more reviews and frameworks… We need decisions now. There is some concern around the lack of detail on how this will work in practice.”
At the same time, Sinn Féin MLA Liz Kimmins insisted: “Consideration must also be given to ensure those in more rural areas are able to access hospital services in a timely manner when they need to.”
