Services are struggling to meet the needs of an aging population with chronic, complex conditions and are lacking adequate financial support or strategic guidance. Recently, the Department of Health's Permanent Secretary, Richard Pengelly, spoke about the intense pressure the health and social care service is under.
The report finds that key services, in particular cancer, social care and mental health, lack comprehensive strategies to guide their future direction. The Department of Health must do more to demonstrate its commitment to developing long-term strategies for these services. The Committee finds that it must also take immediate action to tackle acute issues facing the health service including cancer waiting times, shortages in social care staffing and inadequate mental health funding.
The Committee emphasises that decisions over health services in Northern Ireland are the responsibility of the Minister of Health in the Northern Ireland Executive. However, if the Northern Ireland Assembly has not formed by the end of the year, the UK Government will need to take action to address unsustainable pressures across the service.
Chair of the Northern Ireland Affairs Committee, Simon Hoare MP said:
"The stark reality is that the Northern Ireland health service is falling behind the rest of the UK. An approach to funding that simply keeps things ticking over, and an absence of over-arching strategy in key areas, has left services at breaking point and this situation must end as soon as possible.
Health services need the funding and long-term security necessary to allow them to transform and innovate, to truly address the short and long term pressures they will face. We have called for the Government to end the insecurity and set three-year minimum budget allocations to give vital services the space to breath and look ahead. We also expect more regular updates on the progress in developing strategies in key areas, particularly cancer services and mental health.
The UK Government must also accept that, while decisions over the direction of Northern Ireland health services should be taken by the Executive, delay is no longer an option. Should Stormont not form this year, they must take action in the interim otherwise vital services will only deteriorate further".
Transformation of Northern Ireland's health and social care services is long overdue. The recommendations of the Bengoa Report and Delivering Together are needed urgently if services are to keep pace with the increasingly complex and evolving needs of an aging population. While ring-fenced funding is welcome, the current model of non-recurrent funding over a two year period is not conducive to delivering the sustained change needed. Successive one year budgets are impeding planning and investment in Northern Ireland's health and social care services and without a long-term approach the measures needed for improving outcomes and delivering value for money cannot be taken.
- If the Northern Ireland Executive is not in place by the end of this year, the UK Government must work with the Department of Health and Department of Finance to secure a multi-year ring-fenced funding settlement for transformation. The UK Government should also work with the Department of Health and Department of Finance to produce three-year minimum budget allocations.
Cancer incidence increases with age and demand is likely to rise as the population gets older. At present, Northern Ireland is alone in the UK in lacking an up-to-date cancer strategy. Without this integrated, long-term vision for cancer care, cancer services will continue to struggle to keep pace with demand. The Committee therefore welcomes the announcement that a new cancer strategy is in development. However, work will also be needed to arrest the growing waiting times to access services.
- The Department of Health should commit to a baseline assessment to identify where gaps in the Health and Social Care workforce are contributing to delays in the diagnostic pathway for cancer patients. The Department should bring forward a strategy for closing those gaps through the recruitment and retention of an adequate workforce alongside innovations in technology and service delivery, to be published in draft by summer 2020.
- The Department of Health should set out clear timescales for its programme of work in developing a new cancer strategy and provide regular updates on progress. This timescale should include the key milestones where Ministerial decisions need to be made.
- The Committee welcomes the announcement that FIT testing will be adopted as the primary screening device for bowel cancer. However, the Committee recommends that the Government consider extending the programme to cover men and women over the age of fifty, in line with the recommendations of the UK National Screening Committee.
- Ongoing work to explore a managed strategy for introducing HPV testing as the primary test for cervical screening is welcome. The Department of Health should provide an update on what progress has been made so far and continue to do so until primary HPV testing is rolled out fully.
Access to innovative treatments
The Committee welcomes the Department for Health's moves to place Northern Ireland on an equal footing with the rest of the UK in opening up patient access to innovative new treatments. However, there remains a lack of updates on progress made in realising the full raft of changes announced in 2018.
- The Department of Health should update the Committee on what progress has been made so far and provide regular updates on further progress until the pledged changes have been fully rolled out.
Short term budgets are restricting the ability of providers to plan for the future and develop service innovations. There are also particular challenges in the independent sector, which plays a vital role in providing effective and efficient social care but struggles from competition from the low wage sector and statutory social care providers. High quality care requires a skilled and valued workforce and action must be taken to ensure it is an attractive career choice.
- Three-year minimum budget allocations are needed for social care services to facilitate the move towards a minimum five-year partnership model with community and voluntary providers in which commissioning and investment are based on progress towards agreed outcomes.
- A review of social care roles in the independent and statutory sector should be conducted to identify inconsistencies in roles, responsibilities and salaries in order to improve consolidation of the social care workforce. This should be completed by summer 2020. The Department of Health should also set out what steps it has taken to progress proposals to equalise pay and conditions set out in the Power to People report.
Mental health services
Despite high demand on services, mental health funding comprises a comparatively small percentage of the Department of Health budget in Northern Ireland, 5.2% in 2016-17 compared to 13.3% in England. Northern Ireland lacks a comprehensive, up-to-date mental health strategy that is needed to provide services capable of meeting the needs of service users.
- The Department of Health should increase the level of investment in mental health as a share of the overall health budget in line with recent increases in other UK jurisdictions, with the aim of reaching 13 per cent in the long-term.
- The Department of Health should consult widely with professionals, service users, staff and the voluntary sector on where funds would be most effectively deployed. The decision to use Confidence and Supply funding to maintain existing services raises the question of what will happen once this deal expires. The Department must set out how it plans to support services in 2018-19 and 2019-20.
- Spending on Children and Adolescent Mental Health Services should be brought into line with the Child and Adolescent Mental Health Services recommendations of 10 per cent of the mental health budget. Funding should be deployed strategically to ensure better integration of commissioning services and develop a culture of multi-disciplinary and multi-sectoral team working.
- Urgent action must be taken to bring down suicide rates in Northern Ireland. The comprehensive measures set out in Protect Life 2 are evidence based and would provide clear direction and focus for tackling Northern Ireland’s suicide epidemic. The Department of Health should implement the Protect Life 2 strategy as soon as the next budget is agreed.