UUP leader Mike Nesbitt has been Stormont’s health minister since the end of last May, just over a month longer than Labour’s Wes Streeting has held the equivalent post in England.
This week, Streeting unveiled an NHS reform plan to cut hospital waiting times from 18 months to 18 weeks. Meanwhile, Nesbitt is still talking about reviews, strategies and consultations as Northern Ireland’s health service falls apart.
If this comparison seems unfair, it is mainly unfair to Streeting. He is dealing with a vastly larger system and his party only entered government last July after 14 years in opposition.
The UUP has controlled health for the past five years. Although this was interrupted by a two-year collapse of devolution that time could have been spent developing ideas, as Streeting did during his three years as shadow health secretary.
People are reluctant to criticise the UUP’s stewardship of health because it is seen to have taken on a job others refuse to do. Nesbitt’s predecessor, Robin Swann, is also felt to have conducted himself well during the pandemic.
Read more: Ambulance queues and overcrowded hospital wards a symptom of deeper malaise - The Irish News view
The UUP did not have to take health in the current or previous executives; other departments were available when the turn came to make its choice.
However, it has become clear the party’s priority when choosing health last February was to raise Swann’s profile for the Westminster election, making cynical use of his pandemic reputation.
That reputation is not above criticism. Of course, Covid dominated most of Swann’s first two years as minister. It forced him to operate within confines beyond his control and he was constantly undermined by Sinn Féin, which wanted everything synchronised with the Republic, although it was Dublin rather than Stormont that refused to coordinate plans.
Read more: Deirdre Heenan: Time to face up to hard truths of broken promises on health reform
But Swann still had time and scope to achieve more than managing the pandemic. The Bengoa report on health reform was on his desk from day one, officially adopted as executive policy. He did oversee major administrative reforms, most notably the merger of the Health and Social Care Board into the Department of Health between 2020 and 2022. Swann also found time for a political priority of his own, stalling the commissioning of abortion services by referring it to the whole executive.
Administrative reforms in line with Bengoa are still inching along in the background - new area planning boards have been rolling out since last year.
These bureaucratic reorganisations are important and Streeting’s plan involves similar changes to how parts of the health service work with each other. But in addition he has announced more straightforward reforms to how patients and NHS staff interact, improving communication and cutting out needless duplication and delay.
For example, GPs will be able to refer patients directly for a wider range of tests, rather than referring them to a specialist who will inevitably order the same set of tests.
Why can Stormont health ministers not drive through more of these type of reforms? Tackling ingrained working practices and professional gatekeeping can mean standing up to unions and professional bodies but if that is what leadership involves, so be it
Any management expert examining the NHS can immediately spot these glaring procedural inefficiencies. One reason they persist, surprisingly, may be too few managers - less than 4 per cent of staff, compared to 10 per cent for the UK workforce overall.
Time and motion studies, one of the oldest tools in management, have been shown to drastically improve hospital productivity. An example might be removing the bottleneck in discharging patients, where everyone has to wait on one doctor touring the wards. This is relevant to the winter bed crisis affecting Northern Ireland.
Why can Stormont health ministers not drive through more of these type of reforms?
Tackling ingrained working practices and professional gatekeeping can mean standing up to unions and professional bodies but if that is what leadership involves, so be it.
Nesbitt often insists he needs executive support, which may be true for budgets and anything considered significant, controversial or affecting multiple departments.
But the Department of Health should be free to streamline referral for tests, for example. If the health minister fears something this basic might be made controversial, or somehow obstructed by other ministers or the courts, he should demand a protocol defining exactly what he can do without requiring everyone else’s permission.
At the very least, this would address suspicions that seeking approval is an excuse for inaction or a way to spread blame. The executive approved a ‘Winter Preparedness Plan’ Nesbitt brought to it in November that has clearly failed, even by its own limited ambition.
We need to stop applauding the UUP for taking health on and confront the extent to which it is simply not getting the job done.
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