A fresh start for health and social care across Northern Ireland?

Following weeks of campaigning, a 55% electoral turn-out on 5 May and several weeks of post-election negotiating, the shape and make-up of our new Executive was finally announced in Northern Ireland on 25 May.

Our First and Deputy First Ministers remain unchanged, reflecting our two largest political parties’ overall share of the vote. With 38 seats the Democratic Unionist Party (DUP) remains the largest party in the province and Arlene Foster continues as First Minister. Martin McGuinness continues in his role as deputy First Minister and his party, Sinn Fein, remains the second largest with 28 seats. However once we look beyond the Executive Office, it’s all change.

Our Executive is no longer an unhappy coalition of five parties. In a new departure, the smaller political parties have determined to go into opposition for this mandate. Our new Executive consists of the DUP and Sinn Fein only, with Claire Sugden an independent unionist taking on the key cross-community role of Minister for Justice.

Several ministries have changed hands from the previous Executive. DUP Ministers are now in charge in the Departments of Communities, the Economy and Education, while Sinn Fein Ministers lead the Departments of Finance, Health and Infrastructure. The new Ministerial Team appears young and keen to get on with the job.

So what does this new look Executive and a potentially fresh approach to the business of governing, mean for health and social care in Northern Ireland?

With an annual spend of around £4bn and health spend per person in NI in excess of £2000, almost half of our Executive’s budget is dedicated to providing health and social care. In the context of an ageing population, ever-increasing demands and an urgent need for structural reform both of the Executive parties have pledged to invest £1bn pounds in health and social care during this Assembly’s lifetime. As yet there is no flesh on the bones which will determine how we achieve this level of investment, where this money will come from, what it will be spent on, or indeed what this investment will mean for other parts of our public sector.

With both the DUP and Sinn Fein having signalled their pre-election commitment to reform of our current system, the new Executive will face the mighty challenge of agreeing and implementing new health and social care structures. This will not be a simple task. Professor Rafael Bengoa’s expert panel, appointed to help shape the future system, is expected to report shortly. There is broad agreement that the current system is unsustainable and change is needed. However time is in short supply. The Executive’s task will be to build a consensus around Bengoa’s recommendations, ensure decisions are made, momentum is generated and the much needed reforms are progressed.

The DUP’s election manifesto included a specific focus on tackling health inequalities, with the party emphasising their continuing commitment to a cross-departmental approach to implement Making Life Better, our population health strategy. As the Draft Programme for Government Framework was published on 27 May, it was encouraging to see that ‘improving wellbeing for all’ is one of the 14 strategic outcomes to be delivered during this Executive’s mandate. Our challenge will be to ensure we deliver meaningful improvements in our population’s health while significant structural reforms progress concurrently.

Our new Health Minister is Michelle O’Neill. A Sinn Fein assembly member, she has been an assembly member (MLA) since 2007, sat on the Education Committee and was her party’s spokesperson on health. She held the agriculture and rural development ministerial portfolio in the last Executive, 2011-16. Not surprisingly her in-tray is very full  - overflowing is probably a more accurate description.

However she has done two important things in her first days as Minister for Health.

Firstly she has taken time to acknowledge the enormous contribution of staff in the day-to-day delivery of our health and social care services. Secondly she has recommended, and the Executive has subsequently agreed, that the lifetime ban on blood donations from men who have sex with men should be lifted, in line with the rest of the UK.

With these early but encouraging steps, perhaps there is room for optimism that we are indeed experiencing a fresh start for health and social care across Northern Ireland?

Dr Lourda Georghegan is a Consultant in Public Health at the Public Health Agency, Belfast, and is a Health Foundation GenerationQ Fellow. You can follow Lourda on Twitter @doclourda