Reducing the issue of providing better health services to the simple question "do we need 11 health boards?" misses the point altogether, argues Michael Lyons
It is regrettable that there is a potentially divisive debate ongoing about the health services, and in particular about the various personnel who deliver, manage and plan these services. I am referring to the vitriol that is being currently poured on those people in the health services outside the nursing and medical grades.
This debate is all the more regrettable - and I would argue, unnecessary - in this era of partnership in the health services, the ethos of which is that the work of each and every member of the health service is mutually valued and respected within a shared objective of providing a high-quality and fair health service.
These comments are even more damaging because sectional interests, politicians and the usual health service commentators are choosing to ignore the basic facts to pursue their own agendas. It would be much more useful if the positions being taken were based on fact in order to generate a calmer, more dignified and productive debate.
Let me take the question of administration in the health services. It has become fashionable selectively to attribute the term "administration" to those people outside the nursing and medical categories. This is completely misleading and factually incorrect. In this flawed analysis, where are the ambulance personnel, social workers, childcare staff, community welfare officers, environmental health officers or clinical support staff, for example? All of these health workers are categorised as clerical/administrative, but all of them deliver frontline health and personal social services. In fact, two thirds of those categorised as clerical/administrative staff are actually delivering frontline services.
This is a fact that most of those contributing to the current debate are very well aware of but choose to ignore.
While I am on the subject of the frontline role of the majority of the clerical/administrative category of the health services staff, I find it incredible that an ESRI official could conclude recently that, of the new staff approved in recent years, only one in 13 were service providers.
In fact, of the new staff approved, 73 per cent are involved in frontline service delivery, as follows:
Staff Increases (1999-2001)
Health & social care professionals 13.00%
Medical/dental 5.23%
Nursing 16.18%
Other patient/client care 24.00% Management/admin dealing with patient care 15.06%
Total 73.47%
The argument has also been put that the health services have not kept pace with the growth in staff numbers, again implying that this growth has not provided value for money. While undoubtedly there are issues to be addressed, the range of health services has expanded and an increasing number of patients and clients are being treated in the system, year after year.
This applies to all care groups - primary care, acute hospitals, care of older persons, physical, sensory and intellectual disabilities, childcare and mental health.
This is against a background of a growing and ageing population with changing health and social needs and high public expectations. In addition, the high quality of the services has been demonstrated through independent patient/client surveys, the most recent of which (ERHA, August 2002) demonstrated, for example, an 89 per cent satisfaction level from people who had care and treatment in a public hospital.
It must be remembered that this care is delivered by a range of disciplines - nursing, medical, dental, paramedical, administrative and support staff, all of whom work together, "on the ground", in the interests of providing high-quality healthcare in a collaborative manner.
This teamwork, ironically, is not reflected in the statements uttered by some of their national representatives.
Another feature of the current debate is the organisation and structure of the health system.
Regrettably, this is reduced to the basic question of "do we need 11 health boards?" While keeping the organisational issue at this very simplistic level might serve a particular agenda, it misses the point altogether.
No health administration appears to have come up with the ideal organisational arrangement.
For instance, New Zealand has gone from four health authorities to 21 district health boards. Scotland has 14 health authorities, the province of Saskatchewan in Canada has 10 and Greater Manchester has one! Clearly there is no consensus on an appropriate number of health boards.
The Government health strategy "Quality and Fairness" correctly acknowledges the complex web of inter-dependencies which currently exist and which need to be addressed in order to achieve its objectives. These issues include the current capacity constraints, functional supports (such as information technology needs), strategic human resources issues, the consultants' common contract and other medical manpower issues, as well as the need for an appropriate organisational structure to plan, finance and deliver on the strategy.
The health boards, the Eastern Regional Health Authority and the health boards' executives recognise the fact that, after 30 years in existence, there is a need for a fundamental review of the present structures.
We have been centrally involved in, and have supported, all of the organisational changes in the health system throughout the years and are fully supportive of the present audit of structures being carried out by the Department of Health and Children.
But the issue is not the number of health boards, or for that matter the number of regulatory and other agencies which make up the health system - all of which inter-relate to each other, and are dependent on each other, in terms of the rapidity of decision-making and ultimately, the effective delivery of patient care.
It is far more important that all organisations in the system function appropriately, interact appropriately and effectively with each other, that unnecessary overlaps and duplication are removed and that clear governance and accountability arrangements are in place. It is also about how people, within and between health service organisations, co-operate and collaborate with each other in the interests of patient care.
It is also crucial that other obstacles to the achievement of a high- quality, fair and equitable health service are addressed so that any new organisational structures put in place can contribute effectively to the ideal that we all continue to strive for - the care of our patients and clients. Structural change in itself will not be sufficient.
Michael Lyons is chief executive officer, East Coast Area Health Board, and chairman of the health boards' chief executive officers' group