This is a public briefing on “Transforming Your Care” – more widely known as the Compton Review, which is central to Health reforms in Northern Ireland. It is designed not as a general overall briefing, but rather specifically for professionals seeking to influence public policy through the reforms.
The ultimate purpose of the Compton Review is to reform the Health Service to make it more cost-efficient. The reason for this – which is indisputable regardless of political philosophy – is that an ageing population would require ever-increasing amounts of money to deliver the same service to the same standard. This point applies in all jurisdictions of the UK.
|The National Health Service, when it was set up, accounted for 3% of the UK’s GDP. It now consumes close to 9%. Therefore, although some people refer to the purpose behind the reforms, in Northern Ireland as in England, as “just a money saving exercise”, they are necessary and they are more complex than merely cutting a few quid off the bottom line. Whether they are the right reforms is, of course, a matter of legitimate contention in both jurisdictions.
The Northern Ireland Health Service is regarded, narrowly, as the best performing in the UK, although it is noteworthy that is also enjoys a higher per capita spend. Outcomes in areas such as life expectancy are roughly on a par England/Wales (and markedly superior to Scotland); Northern Ireland performs comparatively well in areas such as cancer survival and dementia diagnosis, but poorly in areas such as heart disease.
More specific reasons for change are stated in the Review and elsewhere as:
- Improved prevention of ill health;
- More patient-centred approaches;
- Management of increasing demand across all programmes of care;
- Reduction in health inequalities;
- More evidence-based service delivery; and
- Support for the workforce in delivering change.
In addition to the reasons for the review, “guiding principles” were also agreed to meet these reasons for change.
- Individual-centred care (recognition that each individual’s precise needs differ) taking account also of family, and promoting independence and personalisation of care; and
- Providing right care in right place at right time (relevant both to “Get It On Time” and care services).
- Focus on prevention and tackling inequalities (not bad things in themselves perhaps, but not highly relevant to a condition which is not really preventable and can strike anyone anywhere); and
- Safeguarding the most vulnerable (again, fully understandable, but with Parkinson’s there are no particular “most vulnerable”).
As a result, the model envisaged by the Compton Review is:
- Individual at the centre and helped to make own decisions;
- Home as hub (support at or near home more common);
- Federations of GP practices and Integrated Care Partnerships to plan/coordinate care;
- “Responsible” access to emergency/specialist hospital care; and
- NI Health Service appropriately networked to Great Britain and Ireland.
“Community Care” is taken to include the normalisation of outpatient appointments in the community, minor surgery in smaller health centres, multi-disciplinary community teams, “telehealth” and ability of GP to admit to hospital (bypassing A&E).
The Compton Review leads to a focus on ten prime “programmes of care”:
- Population Health and Wellbeing
- Older People
- Long Term Conditions
- People with a Physical Disability
- Maternity and Child Health
- Family and Child Care
- People using Mental Health services
- Learning Disability
- Acute Care (including unscheduled care, urgent care, clear protocols for emergency care and planned care)
- Palliative/End-of-Life care.
The stand-out area here is “Long Term Conditions”, although in general “Older People” will also need some consideration in Parkinson’s UK campaigns.
The section on “Long Term Conditions” sets the objectives of:
- Home as hub of care and personalised care pathways;
- Early identification/diagnosis and as much self-management as possible;
- Support from GPs with a specialist interest, multi-disciplinary teams and community pharmacy;
- Partnership working towards greater self care;
- Continued use of Expert Patient Programme (led by users);
- Carers as “partners” in care;
- Named contacts in each GP surgery (for improved communication);
- Admission protocols between community and specialist secondary care staff;
- Maximising use of “telehealth”; and
- Improved data warehousing (to inform best practice).
The reforms may be read as an adaptation of those proposed by the Department of Health in England, and certainly there are parallels (most obviously Integrated Care Partnerships and the ultimate driving force of a more efficient service). However, some of the underlying motivations are different (and less obviously ideological).
The partisan political focus has been on the potential (and logically likely) closure of hospital A&E departments and, ultimately, hospitals. Around half of hospitals in Northern Ireland could face closure as a result and, although the reasoning for this (greater community care close to the home) is fairly well understood and supported within the Health Service itself, it will no doubt prove controversial with the public and be used (abused?) by some politicians for partisan ends.
Where this political debate will lead is uncertain – there is potential for the reforms to become badly stalled with serious financial consequences, but they are being well managed thus far.
Although some Unions have expressed concerns about the reforms, the focus of their argument has been on staff pay and pensions. Otherwise, the reforms seem to enjoy broad support from people working within the Health Service (notably those within Trusts).
However, there remain serious issues of “Change Management”, particularly with regard to the principle of patient-centred (personalised) care. In truth, this is the opposite of the current culture within the Service, and will prove a significant challenge to the success of the reforms.