Change needs courage from all of us – Professor Bengoa

Date published: 10 April 2019

Update from Professor Rafael Bengoa, chair of the expert panel which produced the October 2016 report “Systems Not Structures – Changing Health and Social Care”

Professor Rafael Bengoa

It’s always good to be invited back to N Ireland, and this week provides a very timely opportunity to be updated on the latest health and social care developments.

It’s both a challenging and promising period – the pace of change has clearly been increased.

Reviews on key specialties have been advanced and concrete proposals in areas like stroke and breast assessment are now out for public consultation. Others will follow.

Change in health and social care can often prove difficult and controversial. It’s the same all over the world – and for good reason. We are dealing with vitally important and much valued services.

However, let’s always remember that avoiding change is not a safe or responsible course of action.

Without transformation, services will continue to deteriorate. More of the same means just that – longer waits for treatment, increasing pressure on staff.

If you want to build reliable health care for the future, the status quo is not an option.

That’s what our Expert Panel report made clear in its report “Systems Not Structures”. It’s why we used the phrase “burning platform” to graphically describe the unsustainable nature of the current situation.

Growing demand for services, increasing numbers of older citizens with complex care needs, technological advancements – they all point to the need to do things differently.

When our report was published, it was clear there was a widespread appetite for change. The consensus across different political parties and across the health and social care system was very encouraging. I hope that consensus can be sustained.

We have to keep reminding ourselves of the costs of avoiding change, of leaving the “burning platform” to blaze unchecked.

As our report said: “There is an unassailable case for change. If we do not change the way we provide health and social care, the situation will only continue to get worse – the demand will continue to increase, activity will remain static and waiting times will continue to lengthen.”

It's important to remember that there are two sides to the health transformation coin.

I have said before that in the face of increased specialisation and ever rising demand, it is not practical or desirable to try to deliver specialist services everywhere. For some specialist hospital treatments, it’s necessary to consolidate provision in regional centres of excellence. That helps secure improved outcomes for those accessing treatment as access to latest standards of care and sustainable staffing levels can be maintained.

At the same time, there are many services that can and will be decentralised – provided closer to people’s homes, in the likes of GP centres rather than in hospitals.

You can see that starting to take shape with the Multi-Disciplinary Teams initiative in NI – professionals like social workers, pharmacists, mental health professionals and physiotherapists working alongside GPs.

We need to help people look after their health and well-being in their own homes and communities, wherever possible. That means providing the right care in the right place at the right time.

Many other countries are facing the same challenges and choices.

Change is not easy. It requires us to give up what we have in exchange for something new. That needs a degree of courage from all of us.

However, there is widespread acceptance it is the right thing to do.

I wish you well as you continue to move forward."

*Professor Bengoa is in Northern Ireland this week participating in a health summit in the Western Trust

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