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Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
Ciaran O'Neill on NHS reform - a Northern Irish perspective
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Ciaran O'Neill on NHS reform - a Northern Irish perspective

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Professor Ciaran O'Neill, School of Business and Economics, NUI Galway, gives his perspective on the proposed NHS refoms and outlines the health care system in Northern Ireland.

Professor Ciaran O'Neill, School of Business and Economics, NUI Galway, gives his perspective on the proposed NHS refoms and outlines the health care system in Northern Ireland.

Published in: Health & Medicine
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  • 1. Reflections on Reform in England: A Northern Irish Perspective Professor Ciaran O’Neill School of Business and Economics NUI Galway
  • 2. <ul><li>Elements of the reforms </li></ul><ul><ul><li>Increased role for GP commissioning </li></ul></ul><ul><ul><li>Increased role for provision from outside the NHS, voluntary and private sector </li></ul></ul><ul><ul><li>Increased role for Monitor in governance </li></ul></ul><ul><ul><li>Increased integration between health and social care </li></ul></ul>
  • 3. Structures in Northern Ireland DHSSPSNI Health and Social Care Board (est 1/4/09) HSC Trusts Belfast Northern South Eastern Southern Western LCGs Belfast Northern South Eastern Southern Western GPs 350 practices, (1160 GPs) 10 acute hospitals General dental practitioners (760) Community pharmacies (560) Agencies (BSO, GA etc.)
  • 4. Management and support staff per 1000 of population Source: Funding and performance of healthcare systems in the four countries of the UK before and after devolution. Sheelah Connolly, Gwyn Bevan and Nicholas Mays. Nuffield Trust 2010.
  • 5. <ul><li>Increased role for GPs in commissioning </li></ul><ul><ul><li>Past experience </li></ul></ul><ul><ul><ul><li>Sporadic uptake </li></ul></ul></ul><ul><ul><ul><li>Efficiencies achieved in prescribing </li></ul></ul></ul><ul><ul><ul><li>Issues flagged with respect to de-selection of patients </li></ul></ul></ul><ul><ul><li>Likely future prospects for enhanced commissioning </li></ul></ul><ul><ul><ul><li>In principle welcomed </li></ul></ul></ul><ul><ul><ul><li>Compulsion could be problematic </li></ul></ul></ul><ul><ul><ul><li>Governance may be an issue </li></ul></ul></ul>
  • 6. <ul><li>Increased role for non-NHS provision </li></ul><ul><ul><li>Past experience </li></ul></ul><ul><ul><ul><li>Evidence on quality mixed between government, for profit and voluntary sectors – suggests that a one size fits all model is perhaps not appropriate </li></ul></ul></ul><ul><ul><li>Potential conflicts of interest among commissioners and providers </li></ul></ul><ul><ul><li>The capacity and stability of the voluntary sector (in NI) </li></ul></ul>
  • 7. <ul><li>Increased demands on Monitor </li></ul><ul><ul><li>Information infrastructure exists </li></ul></ul><ul><ul><li>Issues relate to </li></ul></ul><ul><ul><ul><li>Linking information sources </li></ul></ul></ul><ul><ul><ul><li>Interpreting information </li></ul></ul></ul><ul><ul><ul><li>Acting on information in a timely and commensurate fashion </li></ul></ul></ul>
  • 8. Staff per 1000 of population in 2006; England = 100 Source: Funding and performance of healthcare systems in the four countries of the UK before and after devolution. Sheelah Connolly, Gwyn Bevan and Nicholas Mays. Nuffield Trust 2010.
  • 9. Aspects of performance Source: Funding and performance of healthcare systems in the four countries of the UK before and after devolution. Sheelah Connolly, Gwyn Bevan and Nicholas Mays. Nuffield Trust 2010.
  • 10. Percentage of the population reporting illness Reported illness
  • 11. <ul><li>Increased role of integration </li></ul><ul><ul><li>NI experience </li></ul></ul><ul><ul><ul><li>It exists more in theory than practice </li></ul></ul></ul><ul><ul><ul><li>Where there is integration in the absence of clear priorities there may be threats to social services </li></ul></ul></ul>
  • 12. <ul><li>Conclusions </li></ul><ul><ul><li>GP commissioning should improve services but robust systems of governance with commensurate sanctions must exist </li></ul></ul><ul><ul><li>In small areas some trusts may remain “too big to fail”, even when other providers can compete </li></ul></ul><ul><ul><li>While working with the voluntary sector can be beneficial, small local charities may not always be as stable as one would like </li></ul></ul><ul><ul><li>For the benefits of integration to be attained, integration must be more than the integration of budgets </li></ul></ul>

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