The health and social care (HSC) sector in Northern Ireland spends more than £4 billion each year. Today, John Dowdall CB, Comptroller and Auditor General (C&AG) for Northern Ireland published a report to the Northern Ireland Assembly, which considers the progress being made throughout health boards, trusts and agencies in delivering improved health and social services.
The report reflects a number of successes:
- the maintenance of financial balance in the new merged health and social care trusts in 2007-08;
- the further embedding of good corporate governance;
- the delivering of better healthcare; and
- the implementation of a number of major change initiatives – such as new national contracts for medical consultants, general practitioners and other staff – throughout the health and social care sector.
The report, however, also highlights a number of challenges:
- financial stability is key, with a number of bodies facing significant spending pressures which could jeopardise their overall financial positions;
- managing the major capital redevelopment programme in the HSC sector, which is expected to cost over £1 billion over the next few years, is a significant test; and
- whilst there have been improvements in waiting times and appointments in hospitals, and fewer people are dying from cancer and coronary heart disease, further progress is still necessary to effect other improvements on people’s health in Northern Ireland, for example, in reducing the current levels of smoking and obesity.
Most fundamental is the need to press ahead with the major change programmes of recent years. Some of these remain ongoing, such as the second phase of structural reorganisation arising from the Review of Public Administration (RPA). Recently, this involved the dissolution of the four health and social service boards and several other agencies and the creation of a single health and social care board and other regional bodies, together with the merger of some agencies, which took place from April 2009. The report showed that up to the end of March 2008, £16 million had been spent on compensating HSC staff for the loss of their posts during the reconfiguration of health trusts. This sum will increase in order to meet the total redundancy and early retirement costs of the RPA in health. The benefits of RPA will inevitably take time to emerge.
Other changes, such as new employment contracts, are well established. Completing and embedding these changes is central to delivering the vision for better health and social care. It will also be important to determine the benefits of these changes to patients and the wider public, given the considerable investment in them. In addition to determining whether the benefits have outweighed the costs to the health and social care sector, this should also inform future change planning in other parts of the public sector.
The report reviewed the system of governance embedded throughout health bodies, particularly looking at the governance framework. The results reflect sound progress in most bodies, though the Audit Office warned against complacency. More needs to be achieved, particularly in the areas of emergency planning, records management and environmental cleanliness.
The report highlighted the qualification given by Mr Dowdall on the 2007-08 accounts of the Western HSC Trust on two grounds:
- payments for management consultancy under a contract awarded by the former Sperrin Lakeland Trust, totalling £129k which did not adhere to guidance; and
- expenditure of £2.4 million on specialists on capital projects, which were deemed to be outside the approved business case.
The report recognised that the these problems were largely beyond the control of the Western Trust, reflecting decisions made by the former Sperrin Lakeland Trust. Finally, the Audit Office review considered the progress that has been made on the prevention and detection of fraud within the health and social care sector, but it pointed to:
- the estimated loss of £9.9 million from the continuing problem of patients fraudulently claiming exemption from having to pay prescription and other charges;
- the investigations into fraud by a small minority of pharmacists, opticians, dentists and GPs, resulting in savings to the public purse of more than £1.4 million;
- recoveries of over £2.2 million in settlements following an investigation into the alleged operation of a price-fixing cartel by a number of pharmaceutical manufacturers; and
- the recovery of nearly £280k following the fraud perpetrated on a number of health bodies over eight years.
Notes for Editors
- The Comptroller and Auditor General is Head of the Northern Ireland Audit Office (the Audit Office). He and the NIAO are totally independent of Government. He certifies the accounts of Government Departments and a range of other public sector bodies. He has statutory authority to report to the Assembly on the economy, efficiency and effectiveness with which departments and public bodies use their resources. His reports are published as Assembly papers.
- The Comptroller and Auditor General's report, “General Report on the Health and Social Care Sector – 2008” is published as NIA 132/08-09 of Session 2008-09. It is available from the Stationery Office throughout the United Kingdom. It is also available on the Audit Office website at www.niauditoffice.gov.uk. The report is embargoed until 00.01 hrs on 10 June 2009.
- Background briefing can be obtained from the Audit Office by contacting Terry Woodhouse (028 9025 1074) or Neil Gray (028 9025 4345).