Every so often it’s healthy to reflect on where things are and where they are going. At Northern Slant, we want to promote a conversation as to how Northern Ireland can ‘rethink‘ certain policy approaches. What can we do differently? What can we learn from elsewhere or from emerging research? In this article, Roger Greer considers how we can rethink aspects of healthcare.

There is a story of a man who visits a town in Ireland, and asks for directions from a local, who responds, “well, if I were you, I wouldn’t start from here.”

And a year ago, as our health and care system began to react to the impact of coronavirus, the feeling was that we would rather not be starting from here. 

The health and care system in Northern Ireland was already unsustainable. In dire need of systemic overhaul, it was at crisis point. The problems were well-discussed, with 5 formal reviews of the system in over the past 15 years telling us many of the same things about the way healthcare is configured across Northern Ireland, and the challenges we would face if we didn’t enact significant reform. And we didn’t act. 

This inaction was leading to worse outcomes for patients. None of our waiting time targets were being met. According to the Department of Health, in June 2019, almost 300,000 patients were waiting for a first consultant-led outpatient appointment. Over a third of patients were waiting more than a year for a first consultant-led outpatient appointment – 100 times that of England, whose population is 30 times greater than ours. Not 100 times as a proportion of the population – just 100 times larger.

Inequalities were being exacerbated, with men from the most deprived areas likely to live 7 years less on average than those in more affluent areas. Men and women from less well-off areas were expected to have 14 fewer years of healthy life than their better off counterparts.

This is despite Northern Ireland’s £6.1bn budget for health being more than the UK and English averages, and almost half of NI’s overall devolved budget of £12.3bn (2019-20).

It is within this challenging context that the health and care system has been tackling the impact of covid-19. Alongside the thousands of people who have contracted covid-19 and those who have sadly passed away due to the disease, we have also seen indirect impacts, such as an increased backlog of patients awaiting care which has been put off during the pandemic, as well as missed diagnoses for cancer and other serious conditions. 

We have also seen an increase in mental illness as a result of the pandemic, the associated lockdowns, increased isolation and inability to socialise normally.

The staff of the NHS and the care sector have performed acts of genuine heroism to keep the system on its feet during the pandemic, and now that we are well into our vaccination programme, it appears that there is light at the end of the tunnel. 

Data, tech and supporting the system 

That light has been further brightened by the rise in technology, data and digital solutions to support the health and care sector during the pandemic, and the possibilities which have been opened up to the health system due to their increased use over the past 12 months.

During this time, we have seen rapid adoption of technology to support the health and care system, which – in normal times – would have taken months, if not years to embed into the system. 

Through Chief Technology Officer for Northern Ireland’s health and care system, Dan West, the system’s response has included a greater emphasis on digital-first solutions, including things like the 111 helpline to answer citizens’ question on covid, as well as the increased use of telemedicine and remote care for care homes. These steps, may not seem ground-breaking, but they are effective innovations which have been adopted at an incredible rate, and with an acceptance from the public previously unthought of. 

The digital response has also included the development and deployment of a Covid-19 track and trace app well in advance of the NHS in England. 

Public opinion in relation to technology and data is clearly moving toward trust and acceptance at a greater rate than anticipated. A survey conducted by the National Data Guardian found: 

Looking ahead to how data sharing should take place after the pandemic… 60% agree that…organisations such as local authorities, university and hospital researchers, and private companies should be allowed to carry on using health and care data to improve care (for all people, not just coronavirus patients).

Seizing the opportunities for Northern Ireland 

Northern Ireland seems uniquely placed to take advantage of the advances of technology and data in healthcare to help support the system, drive better patient outcomes and to save money.

The Health and Social Care Board recently signed an agreement with Epic for the Empower Programme of introducing all electronic patient records across all of Northern Ireland’s Trusts. This will see NI become one of the first parts of the UK get a fully integrated electronic patient record, instead of a “patchwork of ageing legacy systems”, creating “a single digital care record for every citizen”, something which systems across the UK and the world have worked towards unsuccessfully for years.

Linking patient records like this is transformative for our health system by allowing increasing digitisation of records and reducing reliance on paper; fostering greater collaboration; and increasing efficiencies and supporting clinicians to care for patients.

Northern Ireland is also well-placed when it comes to supporting the Life Sciences and Diagnostics industries, and the goal of creating wealth from health.

For every £1 invested in health and social care Research and Development, over £4 is generated, and with the global market for digital health estimated to be worth over £150bn (2020), Northern Ireland’s ability to leverage its tech and R&D credentials to maximum effect could have a huge impact on the health of our citizens and on our economy. 

This is demonstrated best through the work undertaken in the Belfast City Region Deal Projects, including the Centre for Digital Healthcare Technology (CDHT), the work of the NI Connected Health Innovation Centre (CHIC) and the Health Innovation Research Alliance NI (HIRANI), all of which aim to bring together universities, health organisations and industry bodies to promote and foster growth in Northern Ireland’s vibrant Life and Health Sciences Sector, utilising our world-class ecosystem to boost productivity and support our economy.

Looking to the future

Harnessing tech and data is not a silver bullet, despite the positive impact it might have had during the pandemic. 

Wider problems will remain within the health and care system without proper reform, which has been held back through political inaction over many years. The status quo was unsustainable before the impact of coronavirus, and we will face even greater challenges over the next 5-10 years when we become aware of, and begin to manage, the after-effects of the pandemic and its indirect harms.

As well as questions about the configuration of our system, we also have major political and societal discussions to have on funding and care. 

It might not be an ideal starting point; but through the enhanced use of technology, digital advances and the use of data, Northern Ireland has a genuine opportunity to development and modernisation of our health service to support our clinicians, empower our citizens, and enhance patient outcomes.

At the same time, we can utilise our collaborative-clusters and world-leading R&D capabilities to support the Life and Health Sciences sectors, drive innovation, and provide a shot in the arm for our economy.

The views expressed in this article are those of the author alone, and are not official policy of any employer/s.