Magazine article Public Finance

Review Sets out Reform of Northern Irish NHS

Magazine article Public Finance

Review Sets out Reform of Northern Irish NHS

Article excerpt

Northern Ireland's health service is set for major reorganisation, following the publication of its version of the Wanless review, conducted by Professor John Appleby, health economist at the King's Fund.

On a range of efficiency measures, Northern Ireland performs much worse than the UK average, with hospital activity per bed 26% lower than in England and unit prescribing costs nearly 30% higher. Waiting times are also much longer in Northern Ireland.

But Appleby found that while waiting lists were a severe problem, they were accounted for by a small number of trusts and specialities. Problems of weak performance, he recorded, resulted from inefficiency, not funding shortages.

Appleby made comprehensive recommendations for improvement. Performance monitoring should focus on outcomes, not just spending. More attention should be given to performance, using 'milestone' targets, with the adoption of incentives and penalties.

He suggested the introduction of a purchaser/provider split, along with activity-based reimbursement systems, which might include payment by results and tariff-setting for operations.

In addition, he proposed the modification of the existing system of integrated health and social service provision, with either the services separated or else social services given ringfenced budgets. …

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