Fix the NHS

There are many areas within our health system requiring change, and we have engaged with health professionals, service users and the wider community throughout the current mandate of the Northern Ireland Assembly to understand where change and modernisation are required.

The DUP will support

• Full implementation of the Systems not Structures report by Prof Rafael Bengoa.
• The Executive Covid Taskforce being repurposed into a Transformation Taskforce.
  
• Transformation being clinically led with frontline professionals empowered to lead the change.
  
• Extending and expanding the Transformation Fund, which originated from the DUP Confidence and Supply Agreement, allocating it a further one-quarter of a billion pounds over the course of the Assembly term.
• Investing an additional £2billion in Health above baseline over the next three years.
  
• Refocusing resources into the community and primary care, including more new health and care centres.
  
• Rolling out fully Province-wide additional multidiciplinary primary care teams as piloted through DUP Confidence and Supply funding in Belfast, Down and Londonderry.
  
• Emergency Departments being for Emergencies - i.e. ambulance arrivals and those referred by doctor. Urgent and ambulatory care, and rapid assessment services to be co-located with EDs, and Acute Care and Home expanded.
  
• A new approach to service planning with the Health and Social Care Board abolished, and reinforcing a culture of innovation and improvement.
• Maximising the opportunities offered from healthcare data in predictive analytics, research and the evolution of personalised medicine.
  
• Increase the proportion of spend on prevention, health improvement and early intervention.
  
• Initiate a new focus on tackling key population health challenges such as obesity and diabetes, substance misuse and self-harm.
  
• Implementing a new cancer strategy, offering more chemotherapy and other treatments at local units.
  
• Prioiritise the acquisition of resilience and coping skills from an early age.
  
• Dramatically improving access to talking therapies and deliver a world-leading physchological trauma service.
  
• Access to timely specialist treatment for all patients presenting with eating disorders.
  

Staff are at the heart of our health service, and they have excelled during the recent pandemic. We are determined to ensure they are well supported and that the sector is attractive to those who might consider working in healthcare.

The DUP will support.

• Enthusing and motivating staff, and ensuring fair pay and safe-staffing levels.
  
• Increasing the number of health professional training places in line with the HSC workforce strategy and Medical Student Places Review.
  

• Incentivising the retention and return of staff financially and/or through support for training, freedom to pursue professional development areas of interest, long-term rostering or guaranteed leave, in areas such as domiciliary care, ICU or general practice, allowing a reduction in locum and agency spend.

• The workforce being rebalanced towards community and primary care, and a gradual reduction in the boundaries between professions with the expansion of new roles such as physician associate and community paramedic

• Resolving the pension accrual issue which is perversely limiting the activity of senior clinicians.

• Providing indemnity for primary care as in other parts of the UK.
  

Technology is key to modern health provision and we see the results regularly with improved diagnosis and treatment rates, aided with the latest health care innovations.

The DUP will support:

• Every citizen to have access to, and the ability to input into, their medical data online during the next Assembly mandate.
  

• Using digital health technologies to drive improvement through high quality, targeted and co-ordinated care, access to specialist expertise, patient engagement, system learning and resource management.

• All community-based staff to have mobile access to health and care systems as we progress towards a paper-free service.
  
• Establishing a Digital Health Technology Hub to enable universities, business and clinicians to accelerate the development of medical technology devices and diagnostics.
  
• Maximising the benefits from technology, data and artificial intelligence, and through the opportunities offered in life sciences and genomics.

Despite the myriad of challenges there are many things we do in Northern Ireland exceptionally well. We have a great opportunity to make Northern Ireland a leader in high quality healthcare.

The DUP will support:

• Embedding Northern Ireland as a global centre of excellence in e-health.
  
• Building on current strengths to be a leader in precision medicine.
  

• Establishing a Clinical Research Centre of Excellence bringing together the NHS, industry and researchers, transforming our capacity to trial drugs and medical technology.

The DUP wants to transform Northern Ireland’s intolerable waiting lists from the worst in the UK to the best by 2030, investing an extra £1 billion to deliver full NHS capacity plus an additional 750,000 hospital assessments and procedures.

This will include £700m more over the course of the next Assembly term to guarantee an additional 650,000 hospital assessments and procedures over and above the regular everyday service by 2027, and seeing the full £1 billion invested by 2030.

Continuing in the same way as before with small contracts with local providers will not have the necessary impact. We will seek to partner on a much larger scale with a national or global independent/non-profit provider organisation who can work alongside us and provide the additional skilled staff required in the short term as we enhance our own capacity.

We will separate planned surgery away from emergency care designating an increased number of sites as specialist centres for planned surgery with seven-day theatre schedules, multidisciplinary mega-clinics, and establishing regional endoscopy and diagnostics centres.

The DUP can point to having made a positive impact on waiting lists when previously in charge of the Health Ministry. Prior to the Northern Ireland Executive having to surrender £200m in welfare fines to the Treasury, significant progress had been made on waiting lists.

The number waiting on outpatient appointments had been decreased by more than 31,000 (or 24%) to under 100,000 from a then-high of 130,783 just after the DUP inherited the Health Department in 2011. Also, within two years, the number waiting on admission for treatment was decreased by 10,000 (or 17%).

Within Emergency Departments the DUP Minister managed to achieve consecutive months with 76 and 77 twelve-hour waits in Emergency Departments across Northern Ireland compared with more than 1,500 each in January and February during the first winter after inheriting the post. The number waiting longer than 12 hours to be assessed, treated and discharged from Emergency Departments was slashed by 44%.

Making progress on waiting times is painstaking and slow but slides back extremely quickly, and unfortunately the protracted refusal of other parties to act to reform welfare put paid to that hard-earned progress.

We recognise that additional money alone is far from the answer, as Northern Ireland already has the highest spend per capita of all of the UK.

We must maximise the outcomes from additional investment.

We want to see services and waiting lists organised on a regional Northern Ireland-wide basis to permit same-time access regardless of where anyone lives.

A rapid review team should be tasked with exploring whether the direct payments model in social care could be extended across into areas of healthcare too.

Huge resources are squandered through patients fit for discharge requiring extended stays in hospital, awaiting confirmation of community care arrangements.

We are proposing a powerful new unit to minimise delayed transfers from hospital and the consequent bed days lost, driven from the Department and operating cross-system and across Northern Ireland.

The DUP will support:

• Investment of an additional £700m to tackle waiting lists over the next Assembly term.
• Exploring partnering on a much larger scale with national or international independent/ non-profit providers who can work alongside us and deliver the additional skilled staff required in the short term as we enhance our own capacity.
• Maximising existing capacity through designating more sites as dedicated elective centres, seven-day theatre schedules, multidisciplinary mega-clinics, and establishing regional endoscopy and rapid diagnostics centres.
• Organising services and waiting lists on a regional Northern Ireland-wide basis to permit same-time access regardless of where anyone lives.
  
• Rapid review team to consider whether the direct payments model in social care could be extended across into areas of healthcare.
  
• Powerful new unit to minimise delayed transfers from hospital and the consequent bed days lost, driven from the Department and operating cross-system and across Northern Ireland.

It is clear that general practice is not working and needs fixed.

Patients aren’t being assessed in a timely manner, the workload is continually expanding and there aren’t sufficient staff to run the service optimally.

90% of all contacts within the NHS occur with a GP, and the number of patients with multiple long-term conditions is rising with people living longer with illness. On average each person is consulting their GP more often.

The DUP wants to see resources redirected into primary and community care, and the number of doctors, and subsequently general practitioners, trained increase substantially following the HSC workforce strategy and Medical Student Places Review. In advance of that however we also need to look at all the other factors contributing to the present situation including the system and structures.

Practices have historically operated as a small business, providing services as a private contractor. However the composition of the primary care workforce has changed, and less trained GPs want to take on a partner role in that type of business model.

We need to explore alternative models, which could still permit those who wish to remain partners to do so. Any new system should be designed in such a manner that existing practice arrangements could remain, particularly since individual GPs may have invested substantial sums in them doing so.

More GPs have been retiring and reducing hours than could be balanced by those newly qualified, increasing the pressure on those they leave behind. Doctors have been abandoning the salaried GP role in practices too, leaving a large cohort of trained GPs in Northern Ireland who are choosing not to work in primary care, or only working very limited hours. There is justification for a bold substantive offer that could transform work-life balance in order to incentivise the return of some of this readily available valuable existing resource.

Indemnity should be provided for primary care as is the case in other parts of the UK, and pay and conditions must enthuse and motivate staff. As well as any financial incentivisation, support for training, freedom to pursue professional development areas of interest, long-term rostering or guaranteed leave are elements that can be employed in a range of different specialisms where there are workforce gaps.

Working as part of a much larger team is attractive to many doctors. It means, in simple examples such as arranging annual leave or if a colleague is off sick, there is a much broader group to carry the burden rather than just one or two colleagues.

Having larger groups of GPs and multidisciplinary staff also provides the scope for additional services to be offered, innovations and enhanced integration with secondary care, the community/voluntary sector and local government through area-integrated partnerships.

Examples for alternative larger or medium-sized employer models might include via a trust or a not-for-profit organisation for instance. There are already seventeen GP Federations set up as community interest companies covering the entire Northern Ireland population. Doctors and other staffcould be employed in a manner more akin to their counterparts in health and social care trusts.

Much of the present primary care estate is no longer fit for purpose. The Primary Care Infrastructure Development programme which aims to roll out new Primary and Community Care centres in a number of our larger towns should be reinvigorated and accelerated.

Technology needs to be embraced and better utilised. The morning rush to obtain an appointment by phoning the practice is utterly unacceptable for a modern service, and new ways need to be provided. This will include the ability to seek assistance and obtain an appointment online via your mobile phone. There is no reason why primary care and public services should be any less equipped for modern communications than business and retail for instance, and individuals should have digital access to their medical information.

While many patients will continue to prefer a face-to-face consultation, YouGov found patients would prefer a same day video consultation by 61% to 21% over waiting longer to be seen face to face.

It is essential that continuity of care and the longstanding personal patient- GP relationship is retained. GPs need to be free to operate at the level they have been trained for, with members of the multidisciplinary team providing appropriate support within their competencies where medical attention is not required.

The multidisciplinary primary care teams including social workers, physiotherapists and mental health practitioners, piloted through DUP Confidence and Supply funding in Down, Londonderry and Belfast should be rolled out fully Province-wide.

Democratic Unionist Party proposals for General Practice include:

• a new Health Minister should quickly establish a working group involving clinicians, service users and officials, to consider an alternative employer model which could co-exist alongside traditional small-scale partner-run practices.
• refocusing resources into primary and community care.
  
• increasing year on year the number of GPs trained.
  
• incentivising GPs currently not working or working limited hours back into general practice.
  
• providing indemnity for primary care.
  
• reinvigorating the Primary Care Infrastructure Development programme with locations for the next phase of new Primary and Community Care centres announced as one of the early decisions of a new Health Minister.
  
• progress on technology in primary care including access to an electronic health and care record for every Northern Ireland citizen, and the ability to arrange appointments that suit the individual.
  
• full rollout of multidisciplinary primary care teams across Northern Ireland.

Fundamental reform of social care in Northern Ireland is needed. Such reform must place a greater focus on the needs of individuals.

The DUP will support:

• The Executive legislating for a fair, sustainable model for adult social care, including a cost cap for individuals.

• Implementing the Transforming your Care recommendation for a policy review to determine the potential benefits of independent price regulation within the care sector.

• Permitting care home operators in Northern Ireland to reclaim VAT to the same extent as other parts of the UK through the updating of Health Trust contracts, making additional resources available to reinvest back into our care home network.

• Anticipatory care plans and regular multidisciplinary reviews for all care home residents to monitor needs and aid earlier intervention.

• Concerted action to strengthen our domiciliary and social care workforce, making it a more attractive profession by improving working conditions, establishing clear career pathways and providing support for staff. Mandatory training and professional development should be introduced, with pay and progression linked to skills, experience and qualifications.

• Significantly reducing the bureaucratic burden which accompanies working in social care services