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Published: 24/10/2002, Volume II2, No. 5828 Page 17 19

As consultation on service restructuring comes to a close, will the latest suspension of the Northern Ireland Assembly put decision-making in jeopardy? Jonathan Traynor reports

Last week, outgoing health minister Bairbre de Brun delivered one of her last speeches before devolution was suspended in Northern Ireland.

At a conference on cancer care, Ms de Brun was visibly emotional as she addressed the audience.

The former Sinn Fein minister has been at the centre of a storm of health controversies since taking up the post in the province's faltering administration, but said she would be 'very, very honoured' to take another shot at the portfolio should devolved powers return.

Her successor, Des Browne, faces a challenging brief.

He takes on a service which has the longest waiting lists in Europe, where re-structuring has long been stuck in consultation limbo and morale is crumbling.

Even a top-up of£43m recommended by the outgoing finance minister in Northern Ireland, Sean Farren, is unlikely to make much difference. Before the winter gets under way, local newspapers are already reporting dozens of trolley waits in Belfast hospitals.

Alan Gilbert, project consultant at the NHS Confederation in Northern Ireland, fears that suspension of devolved powers may mean that plans to reshape health services, on which consultation ends next week, could fall by the wayside. 'Under previous suspensions, work and any progress have ground to a halt. The secretary of state appears to have said that this will not happen this time.

'With that in mind, we will be pressing both the department and the new minister over the coming weeks to make sure that efforts under devolution are not lost.'

'The service has been grossly under-funded and it has been [the confederation's] position to make efforts on the resources issues among other key priorities.

'There was considerable success with devolved ministers and members of the legislative assembly in terms of their recognising the needs, but we also believe that the urgent structural issues need to be tackled as soon as possible'.

Inertia is also one of the greatest fears of the British Medical Association. Northern Ireland council chair Maurice Dunlop says: 'We are years behind the rest of the UK in terms of NHS reforms, and it is vitally important that the intense and various consultations carried out by the Department of Health Social Services and Public Safety during the past couple of years are not put on ice.

'We would hope that the incoming minister for health will meet with us early to take forward, as far as possible, current and outstanding issues in both general practice and hospital services.

'There is too much at stake for both doctors and patients in Northern Ireland to allow the inertia of the previous protracted suspension to prevail again.'

Indeed, just as the reality of suspension was dawning, all sectors connected with Northern Ireland's integrated health and personal social services were worried that local influence had disappeared.

The Independent Health and Care Providers Association (formerly the Registered Homes Confederation), which represents nursing and care-home owners, believes the current suspension of the assembly could halt the progress made since devolved powers were returned to Northern Ireland. Chair Janet Montgomery says the assembly had enabled healthcare providers to provide a real contribution to developing partnership in health and social services. 'Up until midnight on Monday 14 October, we had local ministers making local decisions.

Men and women who were accessible and understood local conditions and local priorities.

'The business, charities, church groups and voluntary organisations we represent were able to convey their views directly to ministers and ministers of the legislative assembly.'

She says that although the association will continue to lobby for improved conditions for residents and clients, the process will now be longer and less direct: 'We hope the new ministerial team will prove as open and able to respond as quickly as the ministers were able to under devolution.' l And now for the good news: successes under devolution Since devolution was returned to Northern Ireland four years ago, health and personal social services has been marked with what seems like a continual series of crises.

However, there have also been successes not as widely reported.

The province's cancer services, long lagging behind developments elsewhere, have been restructured, and this month work got underway on a new regional cancer centre at Belfast City Hospital.

Its neighbouring hospital, Royal Victoria, also opened a new wing, which modernises vast swathes of the care areas in the 19th century institution.

Official opening of the new wing coincided with a major cancer conference, drawing skills and expertise together from Northern Ireland, England, the Republic of Ireland and the US.

Steadily increased funding has also brought about some positive benefits, despite the waitinglist crises.

There has been a gradual development of service partnership with independent care providers, including the partial introduction of reduced nursing home fees for patients.

Ambulance services, long under-funded, also received a financial fillip, with the purchase of 45 new vehicles for a service operating with antiquated equipment.

Legislatively, health also saw the introduction of a bill establishing a Health and Personal Social Services Regulation and Improvement Authority, responsible for monitoring the quality of services delivered by health and personal social services by reviewing clinical and social care governance arrangements.Key features also included a new system of clinical and social care governance, making HPSS statutorily responsible for the quality of the services provided by their organisation and establishing a standards and guidelines unit within the department.

Bairbre de Brun bows out: 'Make your voices heard' Outgoing Northern Ireland health minister Bairbre de Brun believes her successor must tackle the urgent need for re-structuring the province's health and social services.

Over the weekend before suspension, Ms de Brun issued a forceful statement calling for careful consideration of new structures before consultation ends this month.

Ms de Brun said: 'This is not 'change for change's sake'but an important and serious restructuring which is necessary if we are to achieve the vision of a new health and social services which we wish to see.'

And she urged people to make their voices heard before consultation on the shape of the service closes on 31 October.

Developing Better Services: modernising hospitals and reforming structures, came in response to the Hayes Review of acute services, commissioned in July 2000.The latest setback adds to an already slow timetable.

Ms de Brun said the question now was how Northern Ireland's health and social services could 'create a new environment of partnership and co-operation'.

In the statement, she said: 'It is essential that the organisational structures support a partnership approach and reinforce the efficient and effective delivery of acute and other vital services. I therefore believe that we must think radically about the most appropriate organisational structure to achieve this.'

Among the proposals is the creation of one regional authority, which could raise question marks over the future of Northern Ireland's four health and social services boards and its 19 trusts.Ms de Brun said: 'These might be combined to produce a smaller number of trusts or they might be replaced altogether by having the local health and social care groups take on responsibility for both commissioning and providing services.

The former minister concluded her statement by backing key staff.

'There is, of course, an important human resources dimension to these issues and I will want to ensure a smooth transition for the staff concerned, ' she said.'Most of the functions currently being performed by boards and trusts will still have to be carried out under the new structural arrangements, and the skills and expertise of the staff in boards, trusts and the councils will not be lost during the migration to new organisational structures.'

Browne how: what the new minister must do

Cut waiting lists;

reform acute services and management structures;

reduce trolley waits;

reassure staff groups;

cut decline in staff numbers;

review mental health services;

revitalise community and primary care;

Protection of Children and Vulnerable Adults Bill.

Expanding CV: from the Scottish bar to Northern Ireland Des Browne was appointed junior minister at the Northern Ireland Office in June last year, with responsibility for criminal justice, victims and human rights.

The suspension of devolution on 15 October gives Mr Browne the additional portfolios of the Department for Social Development, the Department of Health Social Services and Public Safety, plus equality, human rights and community relations.

Before entering Parliament, he was a lawyer and was called to the Scottish Bar in 1993.

Mr Browne has been MP for Kilmarnock and Loudoun since 1997 and was previously parliamentary private secretary to the late Donald Dewar from 1998-99, and more recently to Adam Ingram.He is a former member of several select committees, including those on Northern Ireland and public administration.