ST7, Royal Victoria Hospital, Belfast
Co-opted Council Member representing RCoA Board for Northern Ireland,
Consultant, Antrim Area Hospital, Northern Health and Social Care Trust
With the 25th anniversary of the Good Friday Agreement (GFA) not long passed, the eyes of the world recently focused in on Northern Ireland (NI). The political stalemate currently ongoing has garnered world-wide attention. As a result of the political leadership vacuum in NI, healthcare in the province is being greatly impacted.
Since 2017, there have only been two years of limited functioning government due to political impasses, the first in 2017 and again in 2020. Seismic elections in May 2022 resulted in Sinn Fein becoming the majority party for the first time in NI's history. However, NI's devolved government remains suspended.
Healthcare in NI is primarily led by the Department of Health (DoH), a devolved government department responsible for health and social care. The DoH sets policies, allocates funding, and oversees the healthcare system in the region. It is headed by the Minister of Health, a member of the Northern Ireland Executive.
Under the DoH's guidance, healthcare is delivered through five Health and Social Care Trusts, each responsible for providing services in specific geographic areas. These trusts operate hospitals, clinics, and community services, ensuring access to a wide range of medical care.
General practitioners play a central role as primary care providers, offering initial diagnoses and referrals to specialists. Dentistry, optometry, and pharmacy services are also integrated into the healthcare system.
Healthcare professionals, including doctors, nurses, and allied health staff, work collaboratively to provide patient-centred care. Medical education and training are overseen by Queen's University Belfast and Ulster University.
Additionally, various regulatory bodies, such as the Regulation and Quality Improvement Authority (RQIA), ensure that healthcare services meet established standards and maintain quality. Public involvement and consultation are encouraged through mechanisms like the Health and Social Care Board and patient advocacy groups. An electronic healthcare record joins up patient care throughout the province, making patient records accessible to healthcare professionals in all hospitals and GP practices.
However, with no local ministers in place the burden of governance has fallen upon civil servants, hampering the ability to address critical healthcare challenges effectively. Any solutions offered by these well-meaning but unelected civil servants are at best short-term and temporary. Healthcare professionals are increasingly finding themselves unable to enact positive change due to their lack of authority to make policy decisions.
There are more than 300,000 people waiting for a first consultant-led outpatient appointment, with nearly half of those waiting more than 52 weeks for a first outpatient appointment.2 This is in addition to the 125,000 already waiting for inpatient or day-case treatment, many of whom will require anaesthetic services.
Healthcare leadership in NI faces unique regional challenges. The ongoing uncertainty surrounding Brexit contributes to the struggle within the healthcare sector. Leaving the European Union represents a threat to longstanding collaboration with the Republic of Ireland: cooperative medical research and surgery partnerships, and shared knowledge and skills are vital to the long-term wellbeing of our patients in NI, including services such as organ donation, paediatric cardiac and neonatal care.
Northern Ireland’s healthcare system faces formidable hurdles. Its leadership must not only navigate these intricate regional challenges but also strive to ensure that the healthcare system remains robust, accessible, and responsive to the needs of its people, and uphold the ethical principle of justice. As the province faces this pivotal moment, the world watches, hoping for a brighter, healthier future for all in NI.
Box 1 provides a brief explanation of political power sharing in NI since the GFA.
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Box 1 The Northern Ireland Assembly – or Parliament – was established as part of the Belfast Agreement (also known as the ‘Good Friday Agreement’) in 1998, and is responsible for devolved matters. Instead of Members of Parliament (MPs) in Westminster, local politicians make key decisions on how NI is governed. The UK government remains responsible for national policy on matters that have not been devolved. Within the UK government, the Secretary of State for Northern Ireland is responsible for the Northern Ireland Office. The Assembly is composed of political representatives who debate and pass laws. It is made up of 90 representatives, known as ‘Members of the Legislative Assembly’ (MLAs), who come from different political parties, and a small number of independent MLAs. Each MLA must identify as 'Unionist', 'Nationalist' or 'Other'. An MLA represents the electorate in 1 of 18 constituencies. Each constituency elects 5 MLAs, making a total of 90 MLAs. Each constituency also elects one MP to Westminster. The Northern Ireland Executive Committee runs the devolved government on behalf of the Assembly. It is made up of the First Minister and Deputy First Minister (who are joint chairs), eight other ministers (seven of whom are nominated by the political parties in the Assembly through a procedure known as d’Hondt), and the Minister of Justice (who is appointed through a cross-community vote in the Assembly). Each minister is nominated to take charge of a particular department. The number of ministerial posts that any party can have is determined by the number of MLAs they have in the Assembly, which is determined by the public voting them in. The First Minister and Deputy First Minister are nominated by the largest and second-largest political parties respectively, and act as joint chairs of the Executive. Thus, opposing parties work together via mandatory coalition. Mandatory coalition refers to the requirement that the government be formed by a power-sharing agreement between political parties representing both the nationalist and unionist communities to ensure that there is cross-community consent in the governing of the province. |
References
- Your MLAs. Northern Ireland Assembly.
- Waiting list statistics, December 2022. Department of Health.
- Thousands of NHS doctors considering emigration to Australia as strikes continue. The Telegraph, 15 April 2023.
- Manifesto from RCPCH Northern Ireland - health and wellbeing of children and young people: 2022. Royal College of Paediatrics and Child Health.