Reforms, review, consensus: What’s in store for health care in Northern Ireland?

Next week, on 5 May, Northern Ireland will elect their new Assembly to oversee its devolved functions. If you aren’t as up-to-date as you might like to be on how the system works in Northern Ireland, here is my starter for ten.

Responsibility for health has been devolved from Whitehall to the Northern Ireland Assembly since 1999 - although control was suspended between 2002 and 2007 - and the Department of Health, Social Services and Public Safety (DHSSPS) is the largest, in terms of budget, on the Northern Ireland Executive (the administrative branch of the Assembly). There are mandatory coalitions in Northern Ireland, so power is shared among many parties. This means the Minister overseeing DHSSPS may not be from the same party as the First Minister.

There have been a number of reforms as well as many inquiries and reviews of the NHS in Northern Ireland in recent years and there is scope for even more. The Donaldson review The Right Time, The Right Place which looked to ‘improve quality and safety of care in Northern Ireland’ recommended the establishment of an expert panel to look at the future shape of this system. With this now being led by Professor Rafael Bengoa from the Basque country in Spain, the system in Northern Ireland could begin to look very different in the near future.

With this in mind, there are many pledges and promises in all of the main five political parties’ manifestos. There are three key areas which they are all looking to tackle: primary care, mental health and cancer care.

Primary care

Many of the reforms to date, and those being proposed, centre on improving and expanding primary care.

According to the BMA, in 2014 there were just over 1,200 GPs in Northern Ireland (whose population is 1.86 million), and there is a push across the political parties to increase this number. The Democratic Unionist Party (DUP), Sinn Féin and the Social Democratic and Labour Party (SDLP) all pledge to increase the number of training places for general practice and the Ulster Unionist Party (UUP) hope to increase the number of full-time equivalent GPs by 400 by 2021. The Alliance Party don’t directly pledge to increase the number of GPs in their manifesto but do call for greater investment in general practice and more robust workforce planning.

Increased funding to primary care is also a common theme within these manifestos. Although in most cases, the intention appears to be to redistribute this money from the acute sector - which can be a challenge in itself when pressures on services mount.

Mental health

Mental health services in Northern Ireland have been under scrutiny in the last decade and this current election has arguably renewed the debate.

There is a keen focus on developing services around mental health trauma, which is partially in response to recent findings linking many cases of mental ill-health in Northern Ireland to the Troubles. There is also a push amongst many of the parties to try to reduce the number of suicides as the rate of suicide in Northern Ireland is the highest in the UK. Among the many promises relating to mental health, a number of parties pledge to appoint a mental health champion and also to increase funding.

Cancer care

The other clinical area which has been discussed a lot this election is cancer care. In general, waiting times are seen as a big problem in Northern Ireland. Along with dips in performance in other waiting times, the target that 95% of cancer patients should be treated within 62 days of referral has been consistently missed. In December 2015 only 72% of patients were treated in this timeframe.

A number of similar pledges to improve cancer care are made by multiple parties, including: developing a long-term cancer strategy, ensuring NICE approved drugs are adopted in Northern Ireland (and in some cases establishing a cancer drugs fund similar to that seen in England) and improving access to clinical nurse specialists.

Many of the parties also focus on prevention and detection too. The DUP pledge to ‘continue to promote awareness and prevention’, the SDLP call for a ‘tobacco-free Northern Ireland’, the Alliance Party support raising awareness of brain tumours, and the UUP want to ring-fence funding for awareness programmes.

What’s next?

It's clear there is a level of consensus seen on the main health care issues, though there's varying amount of detail in the main parties' manifestos. Having said that, the focus on improving performance – particularly around waiting times - means it is likely that whoever the next Minister of Health, Social Services and Public Safety is, there will be more reform, and probably more reviews, in the near future.

A full list of all Northern Ireland Assembly candidates and links to all the parties’ manifestos is available on the BBC website.

Hannah Butcher is a Policy Intern at the Health Foundation