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Tackling challenges in Health and Social Care – Telling the full story

Department of Health’s Director of Communications, David Gordon gives an insight into the problems faced by the health and social care system in Northern Ireland and outlines how transformation is assisting in tackling these issues.

"So where do you start when describing health and social care here?

Serious problems are in the news almost every day. It would be wrong to ever downplay those problems. And yet they are not the full story.

Great care is still being delivered by great staff every single day. The most recent Health Survey showed compliments from the public far outnumbering complaints.  That chimes with what we so often hear anecdotally – praise and gratitude regularly voiced after personal experiences.

The most pressing challenges facing the system can often involve delayed access to care rather than the quality of care received.

I've witnessed up close not just the dedication of staff, but an unwavering drive to innovate and find new and better ways to deliver services.

That's right across the Health and Social Care (HSC) system - from those who deal directly with the public to those working behind the scenes.

Improvements in care keep coming too.

Yet alongside that, there are deep and worsening problems.

Far too many people are on unacceptably long waiting lists.

Emergency departments have been under severe stress for many months now.

Pressures are also faced by GPs, the ambulance service and in domiciliary care, while staffing gaps across the system are adding significantly to challenges.

None of this sadly should come as any surprise.

The Bengoa report - welcomed across the political spectrum - detailed how an outdated system would increasingly struggle with increasing demand. Professor Bengoa likened it to standing on a burning platform.

None of the serious problems should be seen in isolation. They are all symptoms of that underlying burning platform reality.

The Department of Health Twitter account has been highlighting some key statistics and they illustrate both the growing pressures facing the HSC, and the increased activity rates that have still been achieved. Let’s not forget this has also occurred in a period of squeezed finances.

A lot of the growing demand for care is down to an amazing success story of health care - longer life expectancy.

That's a huge reason to celebrate, but it brings some of the most significant long-term policy challenges facing society.

This is far from being a Northern Ireland only problem. Health systems are under serious stress in many countries.

The details are striking.

Older people are the main users of health and social care services here.

The Bengoa report noted bluntly: “In terms of costs, users aged over 65 account for more than two-fifths of HSC spending – 42%, compared to their population share of 14%. Whereas the average cost of treating a 55-59 year old stands at £1,970 per head, this rises to over £6,000 for 75-79 year olds and £14,000 for the over 85s.”

The challenge is really only just beginning. The number of people aged 85 and over here has quadrupled since 1971. It is projected to do something similar within the next half century.

Facing these and other issues, it is clear big conversations and big decisions are needed.

Happily, there is a way forward - summed up in the single word “transformation”.

That doesn't just mean reshaping the organisation of hospital services. It also means an increasing focus on primary care - changing the face of your GP clinic, giving people more care close to or in their homes, helping them manage their conditions and offering alternatives to hospital referrals.

Initiatives are happening at ground level - we now need to extend them.

It's not difficult to grow despondent about the position we’re in.

We could also get side-tracked by frustration and bouts of finger-pointing.

Yet there is hope and a clear route to making it better.

The full story of HSC includes both the ongoing great care and the deepening problems facing the system.

It has to also involve taking the transformation path.

That route won’t be quick and won’t always be easy.

The good news is we are already on it."

How do you think the Department of Health could involve people as they try to address growing demand for Health and Social Care services?


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Previous comments ...

Doreen Patton 28-Apr-2018 at 19:14 hrs

Nothing new in this! What does Mr. Gordon mean by "involve people", user input and influence or toe the line? If something is not done very soon to resuscitate our NHS in Northern Ireland more and more people will have to dip into their savings to access timely treatment via the private health care route. A cost most of us will struggle with. We hear repeatedly about the importance of user involvement etc etc but could the service provider please tell the public what has gone wrong for NHS to have got into this state. NHS spokespersons place the majority of the blame on the elderly but more openness and honestly would prevent or reduce the amount of frustration and bouts of finger pointing Mr Gordon refers to. Agree transformation is needed but a wide spread review is needed of recent changes that have been made eg. specialist nurses workload and outcomes v value for money, the lengthy referral route for investigation and pain management and the effects this has on the demand for GP appointments and increased prescriptions, access to GP appointments, has there been an increase in the number of employees on Band 6 and above with a review of these posts especially band 8, etc. etc. I am not sure if user influence will have any impact on the health policy makers here in Northern Ireland. If one listens to the comments of top managers when in the media spotlight when something has gone wrong eg no beds available, they will waffle on and on about the increase in the elderly population, increase in chronic illnesses, inappropriate attenders, increase in the use of alcohol and drugs etc. The ordinary man in the street could have forecast this but did our strategic planners in the NHS plan for them? Teaching the public about the health services to ensure they are using the appropriate service at any given time could improve waiting times. The present ad to use OOH, pharmacy etc is totally misleading as it does not take into consideration of what services are not available at different times of the day. Don't tell the public what an emergency department is not for without telling them what a minor injuries unit is for and where they are. Try to reach more ordinary people during consultation periods by use of local newspapers, local groups, radio and TV and better questionnaires for reply. Stop the use of ALL abbreviations and jargon in ALL documents for the public domain and meetings that the public are attending. Most people in Northern Ireland call a spade a spade but our NHS appear to have a great need to call projects, groups etc by a name/title that means absolutely nothing to the man on the street. Use of plain English would encourage more user involvement and interest.


Cathy Malcolm 21-Apr-2018 at 00:17 hrs

Department of Health can engage and involve people through

They need to consult with young people our future generations through Youth workers which I am one

Focus groups in gp surgeries

Patient client feedback groups there is currently one within the Western Trust whereby feedback is currently being captured

Repeat the 1000 voices imitative last yr July 17 on people's experiences of A and E and get feedback on gp's, mental health services and waiting lists

PR campaign

People need to see outcomes very quickly after consultation so you need directors of services involved in the engagement with people to hear what is being said and can then response initially and then put actions and changes into place

I am happy to help with any of the above


Peter Martin 20-Apr-2018 at 17:37 hrs

This news item tells me absolutely nothing new I need someone to explain to me why after being on a waiting list for 12 months and have now been told it is a two year waiting list, if they are carrying out the procedure that I am waiting for I should be further up the list not have to wait another 12 months and possibly when I phone up again it might be even longer.


Hannah Jaminson 20-Apr-2018 at 16:50 hrs

Mr Gordon has only told us what we already know!
We all agree there are ‘deep and worsening problems...far too many people on unacceptable waiting lists!’
Transforming your Care is not a new concept!
How far along that ‘Transformation Road’ are we?
As for involving people - many patients have told their stories of pain, frustration and utter despair while on waiting lists.
They are listened to and sympathised with BUT nothing changes!
The waiting lists get LONGER.
Some borrow money to have surgeries and procedures done privately.
So, Mr Gordon,
It is not platitudes or promises we want to hear about- but PROGRESS.