NHS 75 - Director of Communications blog

The thoughts of David Gordon, DoH Director of Communications, on the need for informed debate on the long-term future of health and social care.

Calling out the supersized clichés

Avoid clichés like the plague.

It’s a pretty lame joke.

But it keeps coming into my head in relation to public debate about health and social care.

There are some clichés that just keep on circulating. And we need to question them for the sake of better, more informed conversations.

Here are my top two.

* Things are so bad because we have not transformed the health service.

Don’t get me wrong. Reforming health and social care is a vital priority.

But there’s a danger of oversimplifying the position, and giving the impression that there’s a single, magic solution for all our problems.

Two things can be true at the same time. Reform is essential, but it’s not a panacea.

In addition, people do not always define what they mean by health transformation.

Too often, it’s a phrase that gets scattered about like confetti whenever health service pressures are discussed.

Health reform is not a single measure.

It’s actually a range of different policies. These include reshaping hospital services, with a greater focus on specialisation and moving away from the idea that every hospital can provide every service.

It is also about what’s called a population health approach – designing services to reduce the occurrence of ill health and improve outcomes across the population.

All this is easier said than done, and requires detailed, painstaking planning. It may also mean different things for different sectors and medical specialties.

It’s not always about saving money either. In some cases, reform will yield major efficiency gains. In others, it will require additional investment.

One example of the latter is the expansion of the MDT (Multi-Disciplinary Team) initiative in general practice.

This involves physiotherapists, social workers, mental health workers and practice-based pharmacists working together alongside GPs.

This is a big part of the reform agenda and it requires significant, sustained funding.

Which brings me to another supersized cliché:

* Slashing waste is the answer for health, not more money.

It hardly needs to be stressed that reducing waste and inefficiency is essential.

With funding under growing pressure across the public sector, there is a responsibility to ensure value for money for taxpayers.

But bearing down on inefficiency is not a one-off event. Nor should it be imagined that there are countless billions just waiting to be uncovered and banked at once. Squeezing out efficiency savings is a relentless slog, requiring constant vigilance and attention.

Even on big-ticket items like reducing agency staff expenditure, it’s not that straightforward.

Quite rightly, there is a lot of media interest in the eye-watering costs incurred on agency nurses in our hospitals.

Sadly, that’s not a tap that can be fully turned off straightaway. Agency nurses help maintain existing services. Stopping their use overnight would lead to some hospital provision collapsing.

A longer-term solution is needed, including building up the health service workforce and cutting out those agencies which charge the highest rates.

 Reconfiguration of services is also part of the answer, as too many staffing teams are currently stretched over too many sites.

All this has to be done. But that doesn’t mean it will yield game-changing savings immediately.

The reality is that greater efficiency by itself will not come close to providing the additional funding health and social care is going to require.

There are three separate financial tidal waves heading our way. The first is the prospect of an extremely tight budget for all parts of government here in 2023/24.

The next is the projected longer-term squeeze on Northern Ireland’s funding, as helpfully detailed in a report last September by the NI Fiscal Council. 

Finally, and most significantly, comes the impact of our ageing population.

NISRA has projected that about a quarter of the NI population (24.8%) will be 65 and over by 2045. That compares to 16.9% in 2020.

That will inevitably mean a massive increase in demand for health and social care. And it will pose fundamental questions for the whole of society.

Facing up to these challenges requires open and honest conversations, as we celebrate the 75th birthday of the NHS.

Binning the clichés will help.

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