healthcare in Northern Ireland
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Health and Social Care (HSC) ( ga, Sláinte agus Cúram Sóisialta, ) is the publicly funded healthcare system in
Northern Ireland Northern Ireland ( ga, Tuaisceart Éireann ; sco, label= Ulster-Scots, Norlin Airlann) is a part of the United Kingdom, situated in the north-east of the island of Ireland, that is variously described as a country, province or region. Nort ...
. Although having been created separately to the
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS), it is nonetheless considered a part of the overall national health service in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...
. The
Northern Ireland Executive The Northern Ireland Executive is the devolved government of Northern Ireland, an administrative branch of the legislature – the Northern Ireland Assembly. It is answerable to the assembly and was initially established according to the ...
through its
Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
is responsible for its funding, while the Public Health Agency is the executive agency responsible for the provision of
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
and social care services across Northern Ireland. It is free of charge to all citizens of Northern Ireland and the rest of the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...
. For services such as A&E, patients simply walk in, state their name and date of birth, are given treatment and then leave. Patients are unaware of costs incurred by them using the service. It is sometimes called the "
NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
", as in
England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
,
Scotland Scotland (, ) is a Countries of the United Kingdom, country that is part of the United Kingdom. Covering the northern third of the island of Great Britain, mainland Scotland has a Anglo-Scottish border, border with England to the southeast ...
and
Wales Wales ( cy, Cymru ) is a country that is part of the United Kingdom. It is bordered by England to the east, the Irish Sea to the north and west, the Celtic Sea to the south west and the Bristol Channel to the south. It had a population in ...
, but differs from the NHS in
England and Wales England and Wales () is one of the three legal jurisdictions of the United Kingdom. It covers the constituent countries England and Wales and was formed by the Laws in Wales Acts 1535 and 1542. The substantive law of the jurisdiction is Eng ...
in that it provides not only health care but
social care Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social wor ...
too (
NHS Scotland NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, ...
also includes social care). Social services are provided by local councils. The Health and Social Care service was created by the
Parliament of Northern Ireland The Parliament of Northern Ireland was the home rule legislature of Northern Ireland, created under the Government of Ireland Act 1920, which sat from 7 June 1921 to 30 March 1972, when it was suspended because of its inability to restore ord ...
in 1948 after the
Beveridge Report The Beveridge Report, officially entitled ''Social Insurance and Allied Services'' (Command paper, Cmd. 6404), is a government report, published in November 1942, influential in the founding of the welfare state in the United Kingdom. It was draft ...
.


Organisation

Hospitals in the region were managed by the Northern Ireland Hospitals Authority and
hospital management committee From the founding of the National Health Service of the United Kingdom in 1948 until the reorganisation in 1974 the hospital management committee was the main instrument of local management. There were originally 377 committees which were answerabl ...
s from 1948 to 1974, and then transferred to four health and social services boards, along with responsibility for social care. The pattern of local government in the region was of 26 single-tier local authorities which, apart from
Belfast Belfast ( , ; from ga, Béal Feirste , meaning 'mouth of the sand-bank ford') is the capital and largest city of Northern Ireland, standing on the banks of the River Lagan on the east coast. It is the 12th-largest city in the United Kingdom ...
, covered small populations ranging from 13,000 to 90,000 and were not considered an adequate base for the provision of personal social services. The Health and Social Care (Reform) Act (Northern Ireland) 2009 led to a reorganisation of health and social care delivery in Northern Ireland, reducing the number of organisations involved. This Act established the
Health and Social Care Board The Health and Social Care Board is an organisation responsible for the commissioning of health services for the people of Northern Ireland. Its current chief executive is Ms. Valerie Watts. Creation The Health and Social Care (Reform) Act (Nor ...
and five Health and Social Care Trusts which are responsible for the delivery of primary, secondary and community health care. The act also established five local commissioning groups which work in parallel with the health and social care trusts. The Department of Health is now organised under a Permanent Secretary into several groups and one agency. These are the Planning and Resources Group, Strategic Planning and Modernisation Group and Primary, Secondary and Community Care Group and the five professional groups. The department's executive agency responsible for the oversight, coordination and overall provision of health and social care services is the Public Health Agency. The five professional groups are: *Medical and Allied Services *Social Services Inspectorate *Nursing and Midwifery Advisory Group *Dental Services *Pharmaceutical Advice and Services


Information technology

The Northern Ireland Electronic Care Record, developed from 2013, was extended to community optometrists in July 2019. Cloud21 (British) and Tegria (American) were engaged in 2022 to deliver the Encompass programme which will have a fully-integrated electronic health and care record across acute physical services, mental health, community care, and social services. This is the second such system in Western Europe.


Trusts

Trusts are the statutory bodies responsible for the management of staff, health and social care services on the ground and have control their own budgets. The 19 health and social services trusts were merged into six health and social care trusts which became operational on 1 April 2007. The six trusts are: *
Belfast Health and Social Care Trust The Belfast Health and Social Care Trust (BHSCT) is a health organisation covering Belfast, Northern Ireland. The trust is one of five new trusts which were created on 1 April 2007 by the then Department of Health, Social Services and Public Safe ...
*
Northern Health and Social Care Trust The Northern Health and Social Care Trust is a health and social care trust in Northern Ireland, responsible for providing services at various health facilities including Antrim Area Hospital The Antrim Area Hospital is a general hospital in A ...
* Northern Ireland Ambulance Service Health and Social Care Trust *
South Eastern Health and Social Care Trust The South Eastern Health and Social Care Trust (SEHSCT) is a health organisation in Northern Ireland Northern Ireland ( ga, Tuaisceart Éireann ; sco, label=Ulster Scots dialect, Ulster-Scots, Norlin Airlann) is a part of the United Kin ...
*
Southern Health and Social Care Trust The Southern Health and Social Care Trust (Irish language, Irish: ) provides health and social care services in Northern Ireland. It runs Craigavon Area Hospital, Daisy Hill Hospital in Newry, Lurgan Hospital and South Tyrone Hospital as well a ...
*
Western Health and Social Care Trust The Western Health and Social Care Trust is a health organisation in Northern Ireland. Hospitals served by the Trust include Altnagelvin Area Hospital Altnagelvin Area Hospital is the main hospital for the North West of Northern Ireland. It ...


Primary care

There are about 350 GP Practices in the region. In 2016
Michelle O'Neill Michelle O'Neill (née Doris; born 10 January 1977) is an Irish politician who served as deputy First Minister of Northern Ireland between 2020 and 2022. She has been serving as Vice President of Sinn Féin since 2018 and is the Member of the ...
produced a plan to install a named district nurse, health visitor and social worker in every practice. 54 pharmacists are to start in practices in December 2016 with one in every practice by 2021. The number of GP training places is to increase to 111. The British Medical Association voted to start collecting undated resignations from Northern Ireland GPs in January 2017 in protest against the underfunding of general practice in the province. Less than 60% were collected. There was a decline in partners take-home pay in 2016/17, to £90,500. An investment package of £22 million was announced in 2018. £12.3 million is for pharmacists in practices. In May 2018 a £100 million Health and Social Care transformation funding package was announced, including £5 million for Multi Disciplinary Teams in two areas initially, each of about 100,000 people, which will involve the establishment of practice-based physiotherapists, mental health specialists and social workers working alongside doctors and nurses. The first community hub for primary care in the province is to be established in Cookstown, in 2018, backed by four local GP practices and the health board. It is to incorporate scanning facilities, a minor surgery suite, a pharmacy, out-of-hours consultations and community healthcare partnerships, with the possibility of developing supported living accommodation for older people. In 2019 a £26,760,000 increase in funding for GPs was provided under the new contract. which is to support the recruitment of advanced nurse practitioners, practice-based pharmacists and other staff to support GPs.


Pay parity

In November 2019
Unison In music, unison is two or more musical parts that sound either the same pitch or pitches separated by intervals of one or more octaves, usually at the same time. ''Rhythmic unison'' is another term for homorhythm. Definition Unison or per ...
members began industrial action in
Belfast City Hospital The Belfast City Hospital ( ga, Ospidéal Chathair Bhéal Feirste) in Belfast, Northern Ireland, is a 900-bed modern university teaching hospital providing local acute services and key regional specialities. Its distinctive orange tower block d ...
, Craigavon, Musgrave Park and Omagh Hospitals over unsafe staffing levels and the lack of pay parity with NHS staff in the rest of the UK. The
Royal College of Nursing The Royal College of Nursing (RCN) is a registered trade union in the United Kingdom for those in the profession of nursing. It was founded in 1916, receiving its royal charter in 1928. Queen Elizabeth II was the patron until her death in 2022. ...
is also planning industrial action.


Prescription charges

On 29 September 2008, Michael McGimpsey, the then Minister of Health, Social Services and Public Safety, announced that
Prescription charges Charges for prescriptions for medicines and some medical appliances are payable by adults in England under the age of 60. However, people may be exempt from charges in various exemption categories. Charges were abolished by NHS Wales in 2007, Hea ...
were to be phased out by April 2010, being first reduced to £3.00 in January 2009. This was widely accepted by the four main parties of the Northern Ireland Executive plus the
Alliance Party of Northern Ireland The Alliance Party of Northern Ireland (APNI), or simply Alliance, is a liberal and centrist political party in Northern Ireland. As of the 2022 Northern Ireland Assembly election, it is the third-largest party in the Northern Ireland Assembl ...
. The move brought Northern Ireland in line with the Scottish and Welsh systems which had already abolished charges.


Performance

In Northern Ireland, health and social care have been part of the same structure since 1974; however, according to Terry Bamford, "integration has failed to address a reliance on hospitals and institutional care which is significantly greater than elsewhere in the UK." He says that there are various reasons for this. It is difficult to get resources out of acute care without closing buildings, which is a political problem particularly in rural areas. Information technology systems may not be compatible and patient confidentiality hinders the sharing of information. Health services are free but social care is means tested. But, he says, "the greatest difficulties lie in the different cultures and values of health and social care." Until 2014, the Kingsbridge Private Hospital in
Belfast Belfast ( , ; from ga, Béal Feirste , meaning 'mouth of the sand-bank ford') is the capital and largest city of Northern Ireland, standing on the banks of the River Lagan on the east coast. It is the 12th-largest city in the United Kingdom ...
was used to reduce waiting lists for routine surgery. In September 2015 the Northern Ireland Health and Social Care Board admitted that waiting lists for surgery had grown and that they did not have the money to pay either NHS providers or the private sector to bring them down. The NHS waiting list target in Northern Ireland is 52 weeks, not 18 as in England, and it isn't met. 10% of healthcare provided in the region is paid for privately. A report by the
Nuffield Trust The Nuffield Trust, formerly the Nuffield Provincial Hospitals Trust, is a charitable trust with the mission of improving health care in the UK through evidence and analysis. The Nuffield Trust is registered with the Charity Commission as char ...
in 2017 showed that though spending per head in the province at £2,200 a year was much the same as the rest of the UK the performance of the system was much worse. Using the NHS targets more than 20% of patients waited more than 4 hours in A&E departments, and sometimes 30%. About 16% of the population were on a waiting list, compared with around 7% for the rest of the UK. More than 64,000 of them, around a quarter, had been waiting over a year for their first outpatient appointment. In the last 16 years there had been 7 government reports calling for a move to more stress on prevention and away from hospital based care. In 2018 hospital performance in the province was worse than the rest of the United Kingdom. All the five trusts failed their targets for A&E, cancer and routine operations for the whole of 2017–18. The Northern Ireland Audit Office reported in December 2018 that "the health and social care system, as currently configured, is simply unable to cope with the demands being placed on it." There is a deficit of £160 million and waiting times were unacceptable. None of the NHS targets have been met since 2015. 204 patients died in hospital in 2018 while waiting to be discharged largely because of a lack of domiciliary care packages. The BBC reported the case of a woman with multiple health problems who moved from County Armagh to Swansea and said the doctor she encountered in Bristol "was shocked" at the standard of medical care she had received from the
Southern Health and Social Care Trust The Southern Health and Social Care Trust (Irish language, Irish: ) provides health and social care services in Northern Ireland. It runs Craigavon Area Hospital, Daisy Hill Hospital in Newry, Lurgan Hospital and South Tyrone Hospital as well a ...
. 205 homeless people in Northern Ireland died in an 18-month period, according to the
Bureau of Investigative Journalism The Bureau of Investigative Journalism (typically abbreviated to TBIJ or "the Bureau") is a nonprofit news organisation based in London. It was founded in 2010 to pursue "public interest" investigations. Macmillan Cancer Support described the statistics as, "shocking and extremely worrying". Monteverde said emergency departments are unable to give the highly specialised care cancer patients need and added just 55% of Northern Irish cancer patients begin treatment within the 62-day target, and the number was, "deteriorating month-by-month". Cancer patients presenting via emergency departments have the lowest survival rates. 74% of the 4316 patients who died from cancer in 2015 were admitted to emergency departments during the last year of their lives. Only 85.6% of suspected breast cancer patients were seen within the target period of a fortnight. In May 2022 waiting times for outpatient appointments, hospital procedures, emergency care, GPs and community health services reached record levels. Tom Black chair of the British Medical Association Northern Ireland said the crisis boiled down to "workload and workforce" issues. Nearly one-in-five of the total population were on hospital waiting lists. For a hip replacement patients can wait between five or six years to be assessed, and up to another five years for the operation. In February 2022, 16.3% of attendees spent more than 12 hours in an emergency department.


See also

* Healthcare in the United Kingdom * Health & Social Care Business Services Organisation * List of government departments, their agencies and their ministers in Northern Ireland *
List of hospitals in Northern Ireland The following is a list of currently operating hospitals in Northern Ireland. County Antrim Belfast *Belfast City Hospital *Knockbracken Healthcare Park *Mater Infirmorum Hospital *Musgrave Park Hospital *Royal Belfast Hospital for Sick Children ...


References


External links

* {{Health and Social Care (Northern Ireland) Healthcare in Northern Ireland