A lack of politicians might seem superficially attractive but while the Northern Ireland Assembly has lain dormant, the pressures on doctors have mounted. Jennifer Trueland reports
We are standing in the chamber at Stormont, home of the Northern Ireland Assembly.
It is empty of politicians, of course; it’s more than two years since the Members of the Legislative Assembly sat in its fine leather-backed seats.
A chirpy and enthusiastic guide is telling an assorted group of tourists that one advantage of the political situation is that tours can venture into the chamber itself. Otherwise, she says, we would be crammed into the public gallery.
This attempt at finding a silver lining might be admirable but it cuts no ice with Northern Ireland’s doctors. Medics across the area are tired of the political failure to restore devolution and bring back much-needed ministerial decision-making power.
For some, the idea of living without a legislative assembly might seem like a dream come true. Health so often becomes a political football that the thought of just being able to get on with it could appear refreshing, and rather appealing. However, the fact of the matter is that the power vacuum is already causing problems for important areas such as health and care, according to doctors in the region.
‘The lack of government over the past two years has had a real impact,’ says BMA Northern Ireland council chair Tom Black (pictured below), a GP in Derry.
‘There are areas where we have been able to make some progress but there are some policy decisions which need ministerial sign-off. That means, compared with the rest of the UK, Northern Ireland’s health and social care services have been at a real disadvantage.’
The delay in establishing a new medical school is a case in point, Dr Black says. Queen’s University, Belfast, is the only place to study medicine in Northern Ireland – and it’s accepted that medical graduates tend to stay and work near to where they trained.
This means that not only is there a shortage of doctors in Northern Ireland as a whole but the distribution is such that some parts are hit harder than others.
Although plans to establish a graduate-only medical school at Ulster University’s Magee campus are well under way, as things stand they cannot be fulfilled without ministerial approval.
‘There’s a real workforce crisis in general practice and hospitals in the north, west and south of Northern Ireland,’ says Dr Black. ‘We really need a second medical school. At the moment we have one medical school for two million patients, while there are six in the Republic of Ireland. But it takes a long time to train doctors, and even if the new school is signed off soon, we’re still talking about losing two or three years.’
The workforce crisis is making itself felt in primary and secondary care, he adds, and this is only likely to become worse as the medical profession continues to age, and the incumbents (40 per cent of whom are over the age of 55) retire. GP practices are already closing, creating pressure on those that remain, as well as giving patients a raw deal.
‘Some people are having to make a 25-mile round trip just to get a dressing done,’ warns Dr Black. ‘It’s simply not good enough.’
Secondary care is seeing rota gaps which are not only generating massive bills for locum cover (where available) but are contributing to Northern Ireland’s dire performance figures, which make the rest of the UK look positively efficient. For example, by March 2019, more than 97,000 people were waiting more than 52 weeks for a first outpatient appointment (yes, that’s more than a year) in Northern Ireland, compared with less than 0.1 per cent in England.
Plans on hold
Dr Black is quick to point out that there has been some progress. Primary care has implemented ways of working to make much better use of the wider health professional team, for example, with enhanced roles for nurses, pharmacists and allied health professionals such as physiotherapists.
But, he adds, there’s a crying need to make progress with radical transformation plans, largely put on hold with the suspension of devolution.
‘Like the rest of the UK, Northern Ireland has people who are living longer and with more complex conditions. Successive reviews have shown that we spread our resources too thinly – we need to rationalise services to make them fit for the future, but the authority to take these decisions lies with ministers.’
BMA Northern Ireland consultants committee chair Anne Carson is equally frustrated. ‘Significant investment is needed to move forward effectively with transformation but that can’t happen unless there is a minister in place and the legislation to support change can’t be introduced without a legislative assembly,’ she says.
Dr Carson (pictured below), a consultant radiologist, says that urgent efforts are needed to attract and retain doctors – and that the longer the country is without a functioning government, the worse the situation will become.
‘We’re losing our young doctors to the Republic [of Ireland], Australia and North America. Northern Ireland even lags behind the rest of the UK in terms of pay, and clinical excellence awards have been frozen since 2010.’
Doctors in Northern Ireland are not immune to factors affecting their peers in the rest of the UK – such as punitive changes to pension arrangements – which only makes action more necessary. ‘We need an active Government to make the change and improvements that are so necessary for the people of Northern Ireland,’ she says.
Richard Pengelly, the permanent secretary in the Department of Health, has some decision-making power, and has signalled his commitment to transformation and recently blogged about why he felt it was necessary.
He also outlined some areas where work was continuing, even in the absence of the legislative assembly. This includes consultation on stroke services, and on breast-assessment services. Again, however, under the current arrangements, ministerial approval will be needed before real action is taken.
Waiting times rise
Mr Pengelly has also previously announced extra resources for general practice. While this investment has been welcomed, GPs fear it is not enough.
Alan Stout (pictured below), who chairs the BMA Northern Ireland GPs committee, paints a picture of a health and care service under huge pressure, with GP practices on the front line.
Lengthy waiting times have an effect across the service, he says. ‘If someone is having to wait longer than a year, it’s not a service,’ he says.
‘Obviously it’s dreadful for patients, but it’s also intensely frustrating for doctors. We see our patients living in pain and they can’t get the operations they need. It also has an impact on social care.’
There is some hope. Following the death of journalist Lyra McKee in April, politicians in Northern Ireland agreed to get round the table for talks again in the hope of breaking the impasse. Doctors – and patients – will be hoping they succeed.
Why (political) inactivity is bad for your health
The wellbeing of the population of Northern Ireland lags behind the rest of the UK while the political vacuum persists
Measures to improve public health have been another casualty of the political impasse in Northern Ireland.
While the rest of the UK has been pressing ahead with legislation on, for example, protecting children from cigarette smoke, the lack of a government at Stormont has meant that Northern Ireland is lagging behind.
Assurances given by a previous health minister that Northern Ireland would follow Scotland and Wales in introducing minimum unit pricing for alcohol have not been fulfilled, in part at least because of the absence of a Government.
Similarly, Northern Ireland is now the only part of the UK that does not ban smoking in cars with children. Although legislation to do this was passed in 2016, without a functioning Assembly, regulations to enact it cannot be laid.
Northern Ireland is also being left behind on organ donation. While the other three countries have introduced steps to move to an ‘opt-out’ system of presumed consent, or are in the process of doing so, this is not the case in Northern Ireland.
People in the region are also potentially losing out on money intended to counteract childhood obesity and increase awareness and education around nutrition.
While the money from the UK-wide sugar tax is supposed to be ring-fenced to tackle these things, in the absence of devolution, the proceeds go directly into the total Northern Ireland budget pot.
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