Human Rights Commission report: Transforming Your Care

Last month the Human Rights Commission released a report into A&E services in Northern Ireland, detailing a number of individual cases that amounted in inhumane and degrading treatment.

However the HRC determined that there is no pattern of substandard care that would amount to “systemic violations of human rights”.

The details of some of the individual cases listed are galling. However, from a policy perspective, the biggest red flag concerned Transforming Your Care, and its subsequent bedfellow from earlier this year, the Donaldson report.

“The Northern Ireland Executive has committed itself to implementing Transforming Your Care (TYC) by allocating funding to enable the transition from hospital to community based services to relieve pressures on emergency departments and other hospital services.

“During the course of our Inquiry we learned that less funding than was recommended has been provided for the transition to implement TYC. Moreover, while the monies allocated were used for many valuable purposes, much of it was not what the TYC transition funding was designed to achieve.

“In effect, the TYC proposals have been parked and emergency care departments have continued to struggle to meet the demands placed on them. One of our key recommendations matching that of Sir Liam Donaldson’s recent review is that the DHSSPS should urgently revise and implement Transforming Your Care.”

This month Scope features an update on TYC, providing some detail on the extent to which it is not happening. This article concerns one of the major stumbling blocks: communications.

The silent problem

TYC, as well as Donaldson, outlines clear aims. From these aims, there are some obvious and necessary messaging requirements. It goes like this:

1. HSC reform is necessary, and moreover the changes required are clear and specific.
2. Central to all this is a major restructuring of our healthcare model, including seismic measures such as significantly reducing the number of local hospitals (and a profile change for other valued provision)
3. As things stand, these changes would be profoundly unpopular with the general public
4. Therefore, a bold (and necessarily unified) communications drive is needed to explain the rationale behind the restructuring – and, crucially, that these changes will be for the benefit of everyone in Northern Ireland

If this does not happen then TYC will fail and all the stresses and strains that ultimately provided the headlines for the HRC report will get worse and worse.

Scope has written about similar issues numerous times over the past few months. It might seem strange to continually hammer politicians and health officials for their comms – but rarely has it been so important.

Factors including an ageing population and, not unrelated, significant increases in the number of people living with long-term complications mean demand is rising at a rate far beyond that of available finances.

The current model will, therefore, become steadily less fit for purpose over time. The HRC paper, and other reports over recent years, indicate some of the consequences of this growing pressure.

Transforming Your Care, Donaldson, and now the HRC report all say the same things. The requirements for getting the most out of our health and social care service are clear.

The only two stumbling blocks are financial – and lack of funding is no small issue – and securing public support.

Money is tight but, while TYC will have necessary and substantial one-time costs, ultimately it will provide a cheaper service. Balancing the books will not be easy, but finger-in-the-dam measures such as those mentioned in the HRC paper represent a holding pattern.

Speaking up

There has been a distinct lack of bravery when it comes to talking about Transforming Your Care. This might continue as long as the relevant people – politicians, senior health executives, and communications staff – think all the difficult stuff can be left for someone else, sometime in the future.

Our current trajectory is one that will only change when we reach some threshold of very bad things happening too frequently.

In the meantime a lot of well-remunerated people will have continued to do very well for themselves whilst avoiding their most important duties.

Health Minister Simon Hamilton now just about has his feet under the desk at DHSSPS. So far he has been frank in his support of TYC.

But discussions in the chamber are not the same as speaking with the public. Asserting support for TYC is not the same as laying out, in the full view of people across Northern Ireland, precisely what that means, knowing what the initial reaction will be and being prepared to confront that reaction.

None of this will be easy. Trying to bring along a populace sensitive to the realities of stretched public services by pushing the counterintuitive fact that, for example, closing hospitals will be better for everyone is an extremely demanding task.

Some efforts have been made to get the message across, and credit is deserved for speaking so plainly. However, the importance and radical nature of TYC are both so extreme that what is needed is an entire public information campaign – something massive, blunt and unavoidable. And, even then, those in power should prepare for a backlash.

Just because something is very difficult to do does not mean you should avoid trying.