Policy responses and statements
- Name of organisation:
- Department of Health, Social Services and Public Safety (DHSSPS)
- Name of policy document:
- Proposals for Health and Social Care Reform
- Deadline for response:
- 12 May 2008
Background: On 4 February 2008, Michael McGimpsey, Minister for Health, Social Services & Public Safety set out his proposals for the reform of the health and social care system. The Executive has now agreed that the proposals be consulted upon.
The main elements of the proposals are:
- a streamlined Regional Health and Social Care Board focused on commissioning, performance management and improvement and financial management which both encourages and ensures acess to quality services responsive to need;
- dynamic Local Commissioning Groups with active involvement of GPs, professionals within social work, public health, nursing and Allied Health Professionals; other primary care practitioners; and community representatives;
- a smaller Department more sharply focused on its responsibilities for serving devolved administration, bringing forward legislation, and determining and periodically reviewing policy, standards, priorities and targets;
- the establishment of a common services organisation to provide a broader range of support functions for the health and social care service;
- a new Regional Public Health Agency to create better inter-sectoral working to tackle health promotion and inequalities and help realise the shared goal of a better and healthier future for all, which would incorporate the functions of the existing Health Promotion Agency;
- action to reinforce the independence of the Health and Social Services Councils and strengthen the regional aspects of patients, client and carer representation while maintaining a strong local focus; and
- increased democratisation through local government representation on key bodies and improved partnership with local government and other stakeholders in the commissioning and delivery of health and social care.
While general comments are welcome, specific questions have been raised on each of the proposals.
COMMENTS ON
DEPARTMENT OF HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY (DHSSPS)
PROPOSALS FOR HEALTH AND SOCIAL CARE REFORM
The Royal College of Physicians of Edinburgh is pleased to respond to the DHSSPS on its consultation on Proposals for Health and Social Care Reform.
QUESTION 1
The Department is seeking your views on the functions, constitution and governance proposals for the new Regional Health and Social Care Board
The College broadly welcomes the new arrangements as outlined. There has been recognition for some time that, in a relatively small region, the number of organisations involved in both provision and commissioning of care was excessive. A single Regional Board should maintain equity and allow some efficiency saving.
It is worth emphasising here and elsewhere that structures in themselves will not guarantee success. The importance of effective relationships and communication systems within and between the organisations of the future is paramount. Only in this way can clinicians work effectively, with colleagues in team-based practice and with those responsible for management and policy development, to create and promote a culture of continuous development which is responsive to patient needs.
QUESTION 2
The Department is seeking your views on the functions, constitution and governance proposals for the Local Commissioning Groups, including membership
The relationship between the Local Commissioning Groups and Regional Health Boards needs to be more clearly defined. There should be an appropriate balance between local commissioning responsive to local needs and regional prioritisation to avoid inequity in the availability of care throughout Northern Ireland. There will be a range of more specialised services which need to be commissioned on a regional basis. These should still be sensitive to local needs, but require a coherent approach which can only be achieved through central commissioning. For many of these, clinical networks will be an important aspect of the delivery of a high quality service to patients and clients. The development of service frameworks can become an important supporting benchmark.
An obvious deficiency is in representatives from secondary care. There is no more reason for their exclusion on grounds of conflict of interest as Trust employees than any of the other representatives. The danger is that the Commissioning Groups may end up comprising those with no recent hands-on experience of health care.
QUESTION 3
The Department is seeking your views on the process for obtaining local government representation on the Boards of the Local Commissioning Groups
The role the elected representatives in the old Health and Social Services Boards was not an entirely happy one, and they were eventually dropped. A fear remains amongst health service workers that their reintroduction to Local Commissioning Groups might see a return to destructive criticism and the politics of perpetual opposition. Many believe it would be preferable that commissioning of services should be left to independent professionals. However, if democratic accountability is important then involving democratic representatives is a straightforward step to achieving it. Now that many local councillors belong to the same parties as those in regional government, it is to be hoped that some greater awareness of the overarching problems of Health and Social Care will be seen.
QUESTION 4
The Department is seeking your views on the functions, staffing and governance proposals for DHSSPS
Although it is proposed that the department will be smaller, it still needs to provide direction for commissioners. A key element of the Department’s work is in relation to the workforce, education and training. Our ability to provide high quality care in the future depends on the quality of education and training provided now. Northern Ireland needs to play its part in the UK context of developing models of professional education, training and work to meet the needs of patients and clients in the future.
The transfer of the R&D office to the Department is welcomed as providing an opportunity to ensure that locally based research is aligned with key health priorities.
QUESTION 5
The Department is seeking your views on the additional functions, staffing and governance proposals for the common services organisation
The College broadly welcomes the roles of the common services organisation as described. It is hoped that it will facilitate advances in the key area of information technology. Moves towards developing clinical networks are currently frustrated by inadequate communication between different health care locations, especially between General Practice and Secondary Care.
QUESTIONS 6-9
The College welcomes the establishment of the Regional Public Health Agency (RPHA) and the opportunity to bring together key public health constituencies and realise the goal of improving the health of the population in Northern Ireland.
The College would wish to see robust arrangements within which RPHA participates in commissioning services. As well as legislation to ensure advice is sought from the RHPA, it may be more important to put in place arrangements whereby the Regional Board and Local Commissioning Groups work collaboratively with RPHA on an ongoing basis.
QUESTION 10
The Department is seeking your views on the proposal to appoint the Chief Executive or a senior Executive of the Regional Public Health Agency as a non-Executive of the Board of the Regional Health and Social Care Board
This appears to be a sensible arrangement.
QUESTION 11
The Department is seeking your views on the proposal of how to make the work of the Regional Public Health Agency fully multi-professional
The proposals on how to make the RPHA fully multi-professional lack detail. Some of the ideas outlined in paragraph 7.17 might arguably be channelled directly to the Local Commissioning Groups. There is a danger that the views of frontline staff may not be heard.
QUESTION 12
The Department is seeking your views on the proposals for the Agencies referred to in Section 8
The College broadly welcomes the retention of a number of agencies within a new authority. The NI Medical and Dental Training Agency has achieved a great deal in its short life in taking forward current developments in education and training. It is essential that this work continues in line with initiatives throughout the United Kingdom. It will be important for links to be developed between the bodies responsible for education and training for the various Health and Social Care professional groups
We support the retention and enhancement of the Regulation and Quality Improvement Authority which has also begun important work in relation to patient safety and quality improvement. This needs to be closely integrated with commissioning and provision of services. The Authority will have an important future role in relation to relicensing and recertification for doctors.
QUESTIONS 13-14
The College supports the proposed functions, and believes that these could best be achieved for the relatively small population of Northern Ireland through option 1, i.e. a single independent regional body required by statute to establish 5 groups/committees coterminous with the integrated HSC Trusts. This would ensure local responsiveness within a regional approach and provide a stronger voice in influencing the Department and Regional Board.
QUESTION 15-20
The College recognises the importance of the human rights and equality issues raised in these questions.
GENERAL COMMENTS
The College welcomes the direction of change with the formation of a Regional Health and Social Care Board to replace the current 4 Health and Social Services Boards and the overall reduction in the number of structures involved in health and social care. The changes can provide a basis to provide both equity and efficiency in access to high quality services throughout Northern Ireland.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[12 May 2008] |
