Change for the better
In the last in our present series of Policy in Focus, we examine the reforms in Northern Ireland. Reports and research by Matthew Limb
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- What’s happening and why?
- What does it mean for physiotherapy?
- What are the opportunities?
- What are the concerns?
- Further information
What’s happening and why?
In 2002, the Northern Ireland Executive set up a major review of the way public services were run with the aim of putting in place ‘modern, accountable and effective arrangements’ for the delivery of services.
Social well-being is a priority in Northern IrelandThe review of public administration has led to big changes in the organisations running health and social care and an extensive programme of modernisation.
The RPA aims to put patients and carers at the heart of services, provide ‘streamlined’ health and social care, improve accountability, enhance local government involvement and ensure better joint working between all agencies.
The Department of Health, Social Services and Public Safety has itself been slimmed down. The changes put fresh emphasis on raising standards while delivering better value for money within tight financial controls.
The government says the reforms, which were implemented in phases, will improve health and social well-being, reduce
health inequalities and promote more innovative, seamless and accessible services. By 2007, the number of integrated health and social care trusts had been reduced from 19 to five.
The main changes since 1 April this year are:
a single regional board for health and social care responsible for commissioning and performance management (replacing four separate health and social care boards)
- a new public health agency to drive the agenda
- five local commissioning groupsto take on the commissioning functions of the four defunct HSC boards
- a new Patient and Client Council to represent the public
- a Business Services Agency to provide common support functions for health and social care.
In terms of commissioning, Northern Ireland is now moving along the same path as England, if lagging slightly behind. In the foreseeable future, it is unlikely to go as far as large-scale competitive tendering or contracting out of services because the independent sector is not as developed as in England. However, the province has been a trailblazer in other respects; for example, health and social services have been integrated since 1972.
What does it mean for physiotherapy?
Commissioning is intended to be more coherent and integrated, and to benefit from more local decision-making. The new commissioning arrangements are expected to give frontline staff more of a say in shaping services and delivering healthcare objectives.
Most, if not all, LCG boards will have their own allied health professional member sitting alongside GP, nurse
and lay representatives and those from social services and local government.
Despite some delays and uncertainties - the new bodies are still filling posts, the LCGs’ powers and resources
are yet to be finalised and it is unclear if commissioning bodies will have to meet specific or ‘aspirational’
targets - the promotion of health and well-being should come to the fore in commissioning and in the new public health agency. This will give AHPs more chance to use their skills to prevent sickness and improve the health of the population.
As the new system has had little time to bed down, much will depend on how the new organisations perform in their own right and work together as a whole. Some commentators, while welcoming the reforms in principle, see a lack of clarity in the plans and are concerned about how the changes will work in practice in the current financial climate.
At a national level, the Department of Health, Social Services and Public Safety now has a lead AHP officer, Patricia Blackburn, tasked with developing an AHP strategy for Northern Ireland.
What are the opportunities?
The reforms should mean more recognition for the profession’s role in integrating services and helping to deliver packages of care.
Local authority involvement in commissioning could see more multi-professional services being developed that cross organisational boundaries, possibly with more roles for AHPs in settings such as schools and leisure centres.
CSP policy officer for Northern Ireland Tom Sullivan says a key aim of the reforms, as in other parts of the UK, is to shift the centre of gravity away from big acute centres towards more locally provided and locally responsive services that reduce hospital admissions and allow more people to live independently. ‘Physiotherapy is well positioned to do that as long as it’s given the opportunity within the new arrangements,’ he says.
What are the concerns?
The RPA is being implemented against a challenging backdrop. Some individual physiotherapists have faced uncertainty around Agenda for Change re-grading appeals, while physio services are unlikely to be exempt from the general drive for health service efficiencies.
Critics say there is a danger that NHS staff will feel swamped by the combined effects of AfC, the review of public administration and the spending review. Th CSP is working with the Irish Congress of Trade Unions to campaign against the cuts and the impact of the spending review.Restructuring has led to a number of senior physiotherapy managers being made redundant and there are fears that this loss of expertise will not help the reforms to bed in. Northern Ireland has comparatively high numbers of vacant posts for senior physios and the UK’s highest rate of graduate physiotherapy unemployment.
The CSP has called for more clarity on how responsibilities for commissioning will be divided between the new bodies and for details of how much of the healthcare budget will be devolved to the new LCGs.
Further information
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