Comment / Northern Ireland: making it work

Northern Ireland faces many of the same problems as health and care services in the rest of the UK – rising demand, an ageing population and staff recruitment and retention challenges – but, naturally, we have our own local twist.

The big difference with the rest of the UK is that we already have integrated health and care services. That doesn’t mean that work in this area is done. We are addressing issues of silo working to ensure professional boundaries are not barriers to giving patients the care they need. Multidisciplinary teams are key to this – planning and delivering care collaboratively and effectively.

Much has been said about the lack of an executive in Stormont – absent since January 2017 due to a dispute between the two main political parties. Without a minister, it would be easy to think that local health and personal social services (HPSS) are in limbo. That is not the case, with frontline staff, managers and senior civil servants working hard to deliver the best care to patients and clients. We have an ambitious plan to transform care, backed by a broad political consensus, and progress is being made.

But there are limits to the decisions that can be taken without a health minister, and something had to give. On 1 November, Royal Assent was received for legislation that gives senior civil servants greater powers while we wait for a new executive. This should help move plans forward.

With integration and transformation so high on our agenda, we are pleased to welcome Steve Wilson, the executive lead for finance and investment at Greater Manchester Health and Social Care Partnership, to the HFMA Northern Ireland branch annual conference on 23 November. He will share with us best practice from the Greater Manchester experience.

As with our colleagues in Scotland, Wales and England, finances are tight. Our local transformation work is being underpinned this year with a £100m fund (a further £100m is due to be available in 2019/20). Our overall budget was boosted in 2018/29 with a 2.6% uplift, which includes an extra £60m to address activity pressures and £10m for mental healthcare.

The Barnett consequentials of the £20bn five-year funding settlement for the NHS in England will be welcome – adding approximately £0.76bn to the Northern Ireland block grant by 2023/24. This was evidenced in the Chancellor’s Budget statement in November, setting out a £320m increase to the block grant in the next two years, of which health and social care should receive a significant share.

This additional money is crucial as we face major operational challenges. Our waiting times are some of the longest in the UK, with demand rising. The latest figures for all types of emergency departments show that in September 71.1% of patients were treated and discharged or admitted within four hours. This compares with 74.3% in September 2017, with attendances up almost 1%. At the end of the first quarter of this financial year, 21.6% of patients had waited longer than 52 weeks for an inpatient or day case admission.

Transformation will be the key to stemming this flow of demand, but recruitment will be too. HPSS leaders recently told the Commons Northern Ireland Affairs Committee that vacancies were running at just under 8% and the service must recruit 1,200 staff to deliver its transformation agenda.

Traditionally, there has been an outflow of staff, with people often undertaking medical and nursing training in other parts of the UK and in the Republic of Ireland. There have been appeals to this diaspora to come back, but this can be a difficult thing to sell. Pay uplifts in recent years have been less than those in other parts of the UK, which are themselves facing their own recruitment challenges. We will, however, be helped by receiving the Barnett consequentials of the Westminster government’s decision to fully fund the recent Agenda for Change pay award.

However, as well as porters, nurses, midwives and all the other staff who are on Agenda for Change pay scales in England, we also employ social care workers who are also on AFC terms and conditions. While their pay would also rise under any three-year pay settlement, funding will not be included in the Barnett consequentials arising from the deal in England.

Finding the money to, quite rightly, increase their pay will be tough, but they are also central to our transformation plans. The recruitment and retention of domiciliary staff, for example, is one of our greatest challenges. They are key to transforming care by providing support in the community for patients moving out of hospital.

We face a difficult agenda, but our finance community is strong and we are ready to face the challenge together.

For further details of the HFMA NI annual conference, click here