Nearing good health
After coping with outbreaks of C.difficile in 2008, the Northern Ireland Health Service is getting better, but there is still some way to go.
With an increasingly ageing population and the cost of chronic illness accounting for an increasing share of spending, the Public Accounts Committee says that it is time the Health Service made “significant progress” in prevention and promotion.
The committee advocates a more “invest to- save” culture, with the aim of “investing in return for savings and/or reform”. However, taking a more individualist approach, the report states that people should take more responsibility for their own health – calling on them to “understand the impact of their actions on the health system”, pointing to chronic illnesses such as diabetes, cancer and cardiovascular disease.
Health promotion, however, does not rest solely with DHSSPS but rather on a whole-of-government basis, recognising which departments and agencies have a role. DCAL, for example, could promote participation in sport, while DRD often advocates taking the bike to work. But while both could be advantageous, if they are to lead to long-term changes in individuals’ minds then they need to be “paired with other interventions” like individual programmes.
The big problem the committee found is that there are still inequalities in health between more affluent areas and more disadvantaged parts of the province.
Obesity also remains a problem, most especially for young people, which is “storing up health problems for the future”. Consequently, the committee recommends the department should invest in “interventions that will at least pay for themselves”, i.e. stem the problems which could arise in the future.
The school nursing service can play a part in that. While there is already a process of collecting BMI measurements of eight and nine year olds, the committee recommends, that this should be extended to younger children whose physical activity can still be influenced.
Cancer targets remain high on the list of PAC targets and it says that more effort should be made to use comparative data on survival rates to benchmark the ‘performance’ here.
Diabetes is an altogether more difficult illness to benchmark. The committee accepts that there is little any health organisation can do about the genetic form of the illness. It does, though, say that the department should consider implementing targets on type 2 diabetes, specifically reducing the risk of people progressing to that stage, the number of undiagnosed people and the proportion of avoidable hospital admissions.
In spite of a reduction, smoking levels in Northern Ireland are still high and the DHSSPS should, in the committee’s view, provide an effective smoking prevention strategy as well as a service to help smokers quit. It is recommended the latter service should be pharmacy-based.
Underage smoking also remains a problem as children are very likely to continue smoking into adulthood. Although the department agrees, it does point out that the figure has fallen from 14.5 per cent in 2000 to 8.8 per cent in 2007.
Sixty-eight GP surgeries have yet to receive depression-awareness training, the report says. That deficit should be urgently remedied. By extension the committee also says that the department should tackle the problem of suicide by “ensuring that the most appropriate preventative services … are in place.”
The rise of the independent medicine sector could, the committee says, have implications for value for money. It is the department’s duty, according to the report, to monitor the cost of the treatment given and how it compares to NHS fees. Those figures should be regularly reviewed.
There is, though, some good news for the committee to report. There has been “significant” progress on reducing waiting times for primary and secondary care. Death rates from what the committee calls “big killers” such as those illnesses above, also continue to improve.
