SHOULD the good people of Causeway have the right to dictate health policy for all of us and in so doing damage our Health and Social Care system? Under our unusual form of government it seems they do.
A public meeting about a local issue has not only secured the removal of the Health Minister but makes it likely his replacement, who we now know, will reverse the policy direction of the Department of Health because the new Health Minister’s boss, an unelected MLA, opposes the transformation of the Service.
I, like so many, ask why does Stormont fail to deliver? I am grateful to John Burrows for answering this question. Real politicians make hard choices on behalf of us all. Populist politicians go with the crowd on parish pump issues. Our unusual form of democracy turns most of our politicians into populists and for this reason the system fails.
It has been widely agreed for at least two decades that shifting more care into primary and community settings and out of hospital (shifting left) is essential for the sustainable future of health and social care systems in developed countries. This means making hospitals more efficient.
When people receive earlier support closer to home, outcomes improve, reliance on hospitals decreases, and quality of life is enhanced. Preventing avoidable deterioration is not only better for individuals, but also critical to managing the pressures facing the entire system. An attractive proposition for anyone leading a struggling and failing health system, such as Mike Nesbitt.
Until Wednesday last that is. The loss of Mike Nesbitt’s leadership in Health and Social Care is certainly serious, maybe devastating, perhaps catastrophic, and will have significant consequences for us all.
In Health, shifting-left is never an easy thing to do. The North has tried it before and these efforts largely came to nothing, not because it wouldn’t work but because the Department failed to show the necessary leadership, commitment and resolve and caved into too many vested interests: Comfortable consultants, an indifferent public and politicians with myopia for the next election.
Local politicians are the most vocal opponents to any shift left when a local hospital needs transformed, downgraded or closed. This was the core of Mike Nesbitt’s problem. He is a mature, intelligent and visionary politician worthy of a Westminster or Dáil role but he has been brought down by those who find difficulty seeing beyond the bottom of their street.
Transforming Your Care (TYC), published as far back as 2011 called for shift-left changes but it was never delivered. Mike Nesbitt was delivering.
Dr Terry Maguire
Systems not Structures (the Bengoa Report), published in 2016, (Bengoa was TYC for slow learners) called for a similar model. But the model never found traction with communities, was starved of funding that didn’t shift left out of hospital budgets, gained little political support and was largely ignored by Health Trusts and GPs.
The Health Service continued to deteriorate as the status quo showed off its impressive talent for maintaining itself.
Mike Nesbitt was defying the usual narrow path. He was getting on with a vision – the neighbourhood model – that would shift-left and he was delivering.
So a party leader undermining one of his ministers on a local issue in Coleraine means that the many other changes across health care here as part to the shifting left policy are now in question. The only outcome will be the Health Services getting worse as Trust are forced to try to do more will less and less money.
Dr Terry Maguire, Maguire's Pharmacy, Beechmount Avenue
