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The Review of Public Administration (RPA) in Northern Ireland was launched by the Northern Ireland Executive in June 2002. The final outcome was announced by the Secretary of State in November 2005.

History

The purpose of the RPA was to review Northern Ireland's system of public administration with a view to putting in place modern, accountable and effective arrangements for public service delivery in Northern Ireland. It allowed for joined up thinking and the promotion of key cross cutting values such as efficiency, equality, accountability and co-terminosity.

On 22 November 2005 the then Minister for Health, Social Services & Public Safety announced the reorganisation of Northern Ireland's health and social services as part of the RPA. The result was to be significantly fewer health and social services organisations, including:

• a reduction from 19 existing Health & Social Services (HSS) HSC Trusts to 6
• the abolition of HSS Boards and replacing them with the establishment of a single Health & Social Services Authority with seven LCGs to replace the current 15 Local Health and Social Care Groups
• the establishment of one Patient and Client Council to replace the existing four Health and Social Services Councils

A further announcement was made on 21 March 2006 about non-departmental public bodies and agencies, which abolished seven agencies and their functions, staff, assets and liabilities would be transferred to other HPSS bodies, including the proposed new Authority, HSC Trusts, and the Regulation and Quality Improvement Authority.

There were two major phases for implementation of the RPA within health and social care:

• the first phase involved the establishment of the 5 new integrated HSC Trusts and the retention of the NI Ambulance Trust with effect from 1 April 2007.
• the second phase was scheduled for completion by April 2008 and included establishing new organisational arrangements to replace the present four HSS Boards, four Health and Social Services Councils and a number of Agencies.

Following a change in Minister, it was decided to go back to first principles in order to have clarity about potential benefits as well as the essential attributes of any new structure. To that end, guiding principles and criteria were developed which were used to assess prospective organisational models including ensuring that any potential model would support democratisation within the system and enable enhanced involvement of local government in the delivery of health and social care.

Key guiding principles

The original RPA proposals have been re-examined by the Department and a set of key guiding principles agreed as follows:

• The service must be centred on the needs of patients, clients and carers.
• Services must be efficient, with fair but challenging savings targets and all unnecessary waste and duplication eliminated. Value for money is crucial and therefore the delivery of services and all the supporting activities must be focussed on maximising benefits to patients, clients and carers.
• Forward looking, innovative health and social care organisations will be encouraged delivering the services that they are commissioned to provide, adhering to priorities, meeting targets and ensuring that performance is always being improved.
• Patients, clients and carers must be given the opportunity to voice their concerns and be sure that they are being listened to - dignity, respect, equality and fairness for patients, relatives and staff are at the core of the health and social care system.
• Quality and standards will continually be driven up without compromise.

In addition, account has been taken of other models in England, Scotland and Wales, the Republic of Ireland (ROI), who have faced similar issues of reform.

Consultation response

Proposals for the latest consultation on restructuring of health and social care services were issued by the Minister for Health on the 13th February. The Minister met with the CSP and other unions at the Staff Side Partnership Forum on 6th March to outline his proposals. The Minister has held a series of workshops across the five trusts in order to hear the views of staff and "significant others" on the proposals contained within the consultation.

AHP Policy Officers representing Physiotherapy, Podiatry, Speech & Language, Occupational Therapists, Radiographers and Dieticians have drafted a joint submission to go to the Department.

The final response and accompanying letter can be found on our news item: Review of Public Administration in Northern Ireland

The Health and Social Care (Reform) Bill

The Health and Social Care (Reform) Bill will provide the statutory authority to implement the RPA proposals. Copies of the Health & Social Care Reform Bill can be accessed via the Department website: www.dhsspsni.gov.uk

The Assembly Health Committee began its scrutiny of the Northern Ireland Health & Social Care Reform Bill on 11th September. On the 2nd October the CSP Policy Officer for Northern Ireland and the Chair of the CSP UK Council presented the case for AHPs in Northern Ireland as part of the AHP NI Federations' submission to the formal evidence session. The evidence session also included evidence from the BMA and the RCN.

During the evidence session the following issues were addressed:

• The management structures at Departmental, Regional Board, Trust and Commissioning level including adequate representation for AHPs
• The current arrangements at the Department for AHPs and the absence of an adequate support structure for our professions.
• Health and Social Care Trusts responsibility to develop community initiatives to reduce inequalities and enhance the health of the local population.
• AHPs support for the role of local government in the delivery of health messages to the public.
• Support for the broad concept of commissioning as the means by which to secure the best possible health and wellbeing outcomes for service users.
• Support for the establishment of five Local Commissioning Groups (LCG's) coterminous with the exiting five Health and Social Care Trusts.
• The fact that previous structures failed to sufficiently engage the full range of professionals in the planning and commissioning of services to meet the needs of users requiring therapeutic interventions.
• Clarification of the mechanisms and extent of financial control to be devolved to Local Commissioning Groups and clear direction on what is commissioned regionally and locally with as much commissioning as possible done at a local LCG level.
• Adequate resources and financial controls should be devolved to these groups to ensure that commissioning is effective.
• The requirement for a high level of professional support, including input from public health, social services, nursing, allied health professionals, planning, finance and information.
• Concern that the current arrangements within the RQIA do not allow for the full participation of allied health professionals in relation to the monitoring and regulation of the quality of health and social care services provided in Northern Ireland.

Further details

Please contact Tom Sullivan, Policy Officer for Northern Ireland either by phone on 028 9050 1803 or email sullivant@csp.org.uk.