In a crucially important Population Plan Table*, created in 2013 for the influential ‘Transforming Your Care’ Health Review – Newry & Mourne Local Government District was made to look like the smallest population in Southern Trust area when it was really the largest.

This misinformation was used to plan future Acute Hospital services for the Southern Trust area and the rest of NI and is still being used today – so this error is why Newry & Mourne LGD and Daisy Hill Acute Hospital have been placed at the back of the queue for hospital buildings and specialist acute inpatient services for years, despite Newry & Mourne LGD being the HIGHEST LGD population in the Southern Trust area since it was formed in 2007.

WHAT IS WRONG WITH THIS TABLE?

This population plan table (shown in the graphic) implies that Newry & Mourne local government district (LGD) has the smallest Locality population in the Southern Trust area.  But this is wrong because Newry & Mourne was NOT the smallest population – it was the LARGEST (and still is).

Whoever compiled this Southern Locality Population Plan Table* incorrectly displayed the standardised NISRA population figures of the Southern Trust area and by doing this –masked the true population sizes of the five Localities / LGDs in the Southern Trust area. The effects of this misinformation are still being felt today.

WHERE DID THIS TABLE COME FROM? 

In 2011/12 as Part of the Transforming Your Care (TYC) Health Review and Consultation, the Health Minister asked the 5 NI Local Commissioning Groups for Draft Population Plans for each of their areas to assess the population in each Local Government District (LGD or locality) across NI to reflect local needs. “Population planning and local commissioning to be the central approach for organising services and delivering change.” (p8 TYC).

This Table is reproduced from the Southern Local Commissioning Group Locality -Population Plan ‘Changing For A Better Future’ 2013 Report on p18.* (A copy is available to download from the References section at the end of the article)

The Southern Local Commissioning Group (SLCG) created this Population Plan Report in conjunction with the Southern Trust which outlined how they jointly intended to commission and provide health and social care services in the Southern Trust area.

This information in this Population Plan was used for decision making in the Public Consultation on Transforming Your Care (TYC) Health Review.

EXPLAINING THIS POPULATION PLAN TABLE AND WHY IT IS SO IMPORTANT TODAY

The Table* shown from the 2013 Population Plan Report presents the Population sizes of all 5 local government districts in the Southern Trust in a very distorted way. There are FIVE Localities or local government district LGDs named in the Southern Trust area, they are:

(1) Newry & Mourne LGD, (2) Banbridge LGD; (3) Dungannon LGD; (4)Craigavon LGD and (5) Armagh LGD.

WHAT IS WRONG WITH THIS TABLE?

This population plan table (reproduced in the graphic) implies that Newry & Mourne local government district (LGD) has the SMALLEST locality population in the Southern Trust area.  But this is wrong because Newry & Mourne was NOT the smallest population – it was the LARGEST (99,900) in the table (and still is the largest today with a population of 106,813 people in 2020).

So whoever compiled this Southern Locality Population Plan Table incorrectly displayed the standardised NISRA population figures of the Southern Trust area and by doing this – masked the true population sizes.

MASKING OF TRUE POPULATION SIZES

To understand this distortion of locality/LGD  population size as displayed in the reproduced Table, please look at the BRIGHT BLUE ROW OF HEADINGS shown on the Graphic.

First start with the first column named:

YEAR– then > go along to the Next Column: ARMAGH/DUNGANNON >then next Column: CRAIGAVON/BANBRIDGE then > next column: NEWRY/MOURNE. 

These Headings are misleading as the places named are TWO local government districts grouped and added together in one column – that is until you get to the fourth column which instead displays only one local government District instead of two LGDs like the other columns before it.  

So the grouped double LGDs are compared against one single LGD. This single LGD is Newry & Mourne LGD which is being compared inaccurately and misrepresented so it appears as the smallest population.

IN DETAIL

The second column in the Table adds the population of the 2 local government districts of Armagh LGD and Dungannon LGD together in one column to form a higher combined population total (117,100) than the Newry & Mourne LGD population which appears as one LGD on its own in the third column. (99,900)

Armagh LGD + Dungannon LGD =117,100

Compared against

Newry & Mourne LGD = 99,900

The third column again adds TWO LGD populations together – it adds Craigavon LGD and Banbridge LGD together in one column to give a COMBINED population Total (141,600) and then this Total figure is then compared alongside the single local government district of Newry & Mourne population, (99,900) which appears again on its own as ONE LGD.

Craigavon LGD + Banbridge LGD =141,600

Compared against

Newry & Mourne LGD = 99,900

Of course 2 local government district populations added together are likely to be much higher than one single LGD even if the single LGD is the largest population, but this is not a fair use or acceptable standardised practice, and Newry & Mourne is losing out because of it.

The former 26 Councils or Local Government Districts (LGDS) or localities are still named in legislation and remain as the Operational area of NI Health Trusts (Establishment Order 2006) and Commissioning Groups. In the Southern Trust area. (See Background and References for more information)

The Graphic titled FACT below shows how the populations of the 5 LGDs in the Southern Trust should have been shown if represented fairly and accurately: it is obvious from this accurate representation using the official standardised NISRA statistics that Newry & Mourne LGD is the largest Locality population in the operational area of the Southern Health and Social Care Trust.

THERE ARE FIVE LOCALITIES OR LOCAL GOVERNMENT DISTRICT LGDS NAMED IN THE SOUTHERN TRUST AREA NOT THREE!

The original Population Plan Table* from the Southern Local Commissioning Group Locality -Population Plan Report also gave the impression that there are only THREE localities or local Government Districts in the Southern Trust/Commissioning area and wrongly implies Newry & Mourne Local Government District has the least need, instead of correctly stating that there are FIVE localities in the Southern Trust with Newry & Mourne being largest population with greatest need.

This misinformation about the size of the Newry & Mourne LGD and the other LGDs in the Southern Trust area was presented to the decision makers in charge of planning future hospital services in the Transforming Your Care Review.

This TYC Review made it clear that there should only be 5-7 Acute Hospital networks for the entire population of NI. This Review knew there would be a huge interest in Acute Hospital sites and their future role and outlined that the final functionality of each of the (hospital) facilities will be based on POPULATION NEED and the principles set out in the report. (p116 TYC).

The Transforming Your Care Health Review was a population based planning of Services which then formed the foundation for many future Health Reviews which followed including Delivering Together, Donaldson, and the Bengoa Report.

WHAT CAN BE DONE? – POPULATION NEEDS ASSESSMENTS AND HOSPITAL FUNDING

This misinformation as presented in the table* was used to plan the current Acute Hospital services in the Southern Trust area and the rest of NI and is still used today.

This error will have been a major reason why Newry & Mourne LGD and Daisy Hill Acute Hospital have been placed at the back of the queue for hospital buildings and specialist acute inpatient services for many years, despite Newry & Mourne LGD being the HIGHEST LGD population in the Southern Trust area since it was formed in 2007, and the fourth Highest Locality (LGD) population in all of NI since 1971 with Belfast, Lisburn (Greater Belfast) and Derry.

This injustice must be rectified now by the DOH as discussions take place about the future Hospitals services here.

ACTION NEEDED TO REPAIR THE DAMAGE DONE BY POPULATION PLANNING MISINFORMATION 

Newry & Mourne Acute Area Hospital at Daisy Hill needs re-imbursement for the years of lost funding (when they were placed bottom of the Queue) and return of inpatient beds and specialist services, in a fully functioning Major Acute Specialist Hospital (as designated by Government in 2003 and again earmarked for a major new acute hospital in 2005) which has still not been delivered by the Southern Trust and Department of Health 18 years later.

The Population Plan Table* – which in effect was a population needs assessment reveals why Daisy Hill is being wrongly treated as a ‘small local’ hospital today.   

ACTIONS NEEDED

As verified by official NISRA statistics, for over 50 YEARS since 1971, Newry & Mourne LGD has ranked in the TOP 4 HIGHEST POPULATIONS in NI with Belfast, Lisburn (Greater Belfast) and Derry.  

The number of people living within a locality (LGD) is supposed to be the primary factor when commissioning health Services so the misrepresentation of population sizes which continues today in population planning in Southern Trust must be corrected urgently.  

So, in order to repair the damage done by this misinformation in 2013, which made Newry & Mourne LGD appear wrongly as the smallest LGD instead of the largest in the Southern Trust area there are two actions needed:

1. The Southern Trust and Southern Local Commissioning Group must stop putting forward the misleading idea that there are 3 localities in the Southern Trust when we know there are really 5 localities (LGDs). The population sizes of the Southern Trust area must be presented accurately acknowledging that Newry & Moure (single LGD) is the largest LGD/locality of the FIVE localities in the Southern Trust.

2. All Public Consultations (at both Regional and at Southern Trust level) must be based on accurate population size and accurately assessed population need. All Consultations (including the EQIA) must be population evidence based including for Emergency services (Emergency Surgery, Stroke, specialist acute services and reduction in status to a Regional elective Centre).

This should be organised by the Department of Health, The Strategic Planning and Performance Group, Public Health Agency and Southern Trust in the spending of scarce capital resources and decisions on spending on Hospitals (which have been paid for with public money). The public should have right to reply and challenge centralisation of services and when their hospital is used as a case study for closure.

Newry Mourne & Down Council, MPS, MLAs and the community all can be confident in the knowledge that Newry & Mourne LGD has been short changed and is long overdue the required investment in a major Specialist Acute Hospital in Newry City instead being bartered off with a Regional Elective centre or privatised Community Health Centre instead of a Major Specialist Acute hospital with a 24/7 Consultant- Led Type 1 Emergency Department & Consultant- Led Maternity.

BACKGROUND AND REFERENCES

THE ORGANISATION OF NI HEALTH CARE IS STILL UNDER THE 26 COUNCIL MODEL

Operational areas in Health trusts still remain under the 26 council model.

The former 26 Councils or Local Government Districts (LGDS) or localities are still named in legislation and remain as the Operational area of NI Health Trusts (Establishment Order 2006) and Commissioning Groups. In the Southern Trust area.

The Five LGDs in Southern Trust in consistent order of size since Establishment of the Southern Trust on 1st April 2007 according to NISRA are:

>1st Newry & Mourne;

>2nd Craigavon;

>3rd Armagh:

>4th Dungannon:

>5th Banbridge

NEWRY & MOURNE LGD POPULATION

As verified by official NISRA statistics, for over 50 YEARS since 1971, Newry & Mourne LGD has ranked in the TOP 4 HIGHEST POPULATIONS in NI with Belfast, Lisburn (Greater Belfast) and Derry.

Based on population size, Daisy Hill should have a major Hospital the same size as Altnagelvin as its population size is very similar, and based on both population size, number of patients on GP Registers (c161,000)  and on its location -Daisy Hill should have a larger Specialist Acute hospital than Antrim, Craigavon, or Ulster Hospitals. Why? Because Newry & Mourne LGD has a population bigger than Antrim LGD, Castlereagh LGD, and also Craigavon LGD, who all have major acute hospitals already.

The Newry & Mourne LGD and Daisy Hill acute Hospital cannot be ignored any longer as there are many factors which require proper hospital services funding and commissioning in this area (1) it has the large population, (2) the highest number of births, (3) the Location

REFERENCES

*Main Reference: This Table comes from the Southern Local Commissioning Group Locality -Population Plan ‘Changing For A Better Future’ 2013 Report on p18.* Also see p2 for important information in the Foreword. To Download a copy, please see the Download button below

Other References

Transforming Your Care : https://www.health-ni.gov.uk/topics/health-policy/transforming-your-care#toc-0

Transforming Your Care (TYC):  Vision to Action. A Consultation Document 9^th Oct 2012 to 15^th Jan 2013.

Transforming Your Care (TYC) : Vision to Action – A post Consultation Report  March – 2013 

The TYC Consultation Document ‘ Vision to Action’ was “based on the draft Population Plans which have been developed by Local Commissioning Groups with input from HSC Trusts, to reflect local needs and a Draft Strategic Implementation Plan which gives a wider NI overview.” (p3 Vision to Action. A Consultation Document 9^th Oct 2012 to 15^th Jan 2013).

“Population planning and local commissioning to be the central approach for organising services and delivering change.” (p8 TYC)

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You may also be interested in other posts on Daisy Hill Acute Hospital, Newry city, like: https://savedaisyhillhospital.com/2022/02/28/daisy-hill-hospital-newry-is-one-of-the-nine-major-acute-hospitals-in-the-regional-network-designated-in-2003-like-antrim-ulster-etc/

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