Tag Archives: population health needs assessment

01.15.20
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NI Health Crisis – Cut in Specialist Acute Hospitals & their Uneven spread since 1995 is a major factor

Nurses and Health Workers in N. Ireland strike for pay parity, safe staffing levels Dec2019

2019 ended with Northern Ireland’s Health Care in crisis: Patient Waiting lists at record highs, healthcare workers on strike over pay and staffing levels, Nurses from the Royal College of Nursing on strike for the first time in its 103 year history. This ‘crisis’ is recognised by the Royal College of Surgeons, the Royal College of Nursing and Health Unions

NI Nurses and Health Workers province-wide strike January 2020

Health Care workers on strike here have been short changed in comparison with the rest of the UK, on pay and staffing levels. But in terms of Acute Hospital Care, are people in Northern Ireland being treated fairly in the number and location of specialist acute hospitals?

Before NI can start to fix the current Health Care Crisis –some background is necessary to find out how it got to this point.

There were 19 Acute hospitals in NI in 1995 as the map below, reproduced from The Department of Health’s Regional Strategy (1997 – 2002) shows.

Hospital map Northern Ireland with populations 1995 -shows acute hospitals.

According to the Department of Health:

“If the ratio of acute hospitals to population which currently obtains in England were applied to Northern Ireland (1,649,131 in 1995) there would be no more than 10 acute hospitals in NI. Thus many acute hospitals in NI serve much smaller populations than acute hospitals in England.”

Dept. of Health for Northern Ireland Regional Strategy (1997 – 2002)

Direct Rule Health Minister Mr Moss stated in a Hansard Report 5 March 1997:

“The Department’s Regional Strategy for 1997 to 2002 was published last year and envisaged specialised acute hospital services being built around the cornerstone of Northern Ireland’s six major hospitals- the Royal Victoria hospital, the Belfast City hospital, Craigavon, Antrim, Altnagelvin and the Ulster.”

It clearly states also that:

“While investment where appropriate will be made in other hospitals, it is expected that those SIX HOSPITALS will provide the main focus for FUTURE INVESTMENT in INPATIENT FACILITIES.”

Dept. of Health for Northern Ireland Regional Strategy (1997 – 2002) p65

These 6 hospitals out of 19 hospitals were envisaged as specialist acute hospitals, because of hospital size, NOT based on where the largest settlements of population lived, compared to England who the strategy stated would have 10 hospitals for a population the size of NI (1,649,131). The mid-year 1995 NISRA populations (Table) prove this.

They show that Daisy Hill acute Hospital, Newry & Mourne LGD – the FOURTH largest population (84,035) in NI, and Lisburn LGD (106,583), the SECOND Largest population in NI were COMPLETELY IGNORED for consideration as one of 6 major acute hospitals, while 3 other acute hospitals serving SMALLER populations in the local Government Districts of Craigavon, (population 77,689) Antrim (48,489), and Castlereagh (64,616) were listed for preservation.

investment in hospital buildings, acute specialist hospital services, hospital beds and specialist medical staff is needed in the Newry & Mourne area, in Daisy Hill Acute Hospital, including in the Emergency Department.
New investment in acute specialist hospital services, hospital beds and specialist medical staff is due in the Newry & Mourne area, in Daisy Hill Acute Hospital, including in the Emergency Department.
Doctor examining X-ray -Daisy Hill Acute Hospital Newry Imaging Consultation 2018

Accurate population demographics, as provided by NISRA must inform health planning and future investment in inpatient facilities across NI

This trend of ignoring population size has continued into the present (as the next post will show), so to truly combat the Northern Ireland wide health crisis – ACCURATE DEMOGRAPHICS provided by NI Statistics and Research Agency (NISRA) must inform health planning. This includes using these official statistics, as presented by NISRA to determine WHERE Specialist acute Hospitals and specialist inpatient and outpatient acute services are located.

Acute Hospital accommodation and services are paid for through Rates and Taxes by everyone, irrespective of where they live in NI – Urban or Rural, everyone is entitled to equality of access to Hospital Care.

Further posts will look at the present and future NI Demographics in relation to location of acute hospital provision.

Official statistics, as presented by NISRA must determine where Specialist acute Hospitals are located in NI.

BACKGROUND
A Short History – Pre Centralisation – In 1995 there were 19 ACUTE HOSPITALS in Northern Ireland. (See Map or Full List at End of post.)

1995: All NI population: 1,649,131*

1995: 15 LARGEST POPULATION SETTLEMENTS IN NORTHERN IRELAND (Statistics from NISRA*)

(1st) Belfast: 288,932; (2nd) Lisburn: 106,583; (3rd) Derry: 102,123; (4th) Newry & Mourne: 84,035 (5th) Newtownabbey: 78, 426; (6th) Craigavon: 77,689 (7th) North Down: 75,519 (8th) Ards: 68,462 (9th) Castlereagh: 64,616 (10th) Down: 61,441.
[(11th) Ballymena: 58,039 (12th) Fermanagh: 55,405 (13th) Coleraine: 54,176, (14th): Armagh: 52,675 (15th) Antrim: 48,809 [NISRA]*

19 ACUTE HOSPITALS IN 1995 NI (Alphabetical order)
Altnagelvin (Derry); Antrim; Ards; Banbridge; Causeway (Coleraine); City (Belfast); Craigavon; Daisy Hill (Newry); Downe; Erne (Enniskillen); Lagan Valley (Lisburn) ; Mater (Belfast); Mid-Ulster(Magherafelt); Route (Ballymoney); Royal Group (Belfast); South Tyrone; Tyrone County (Omagh); Ulster (Castlereagh); Whiteabbey (Newtownabbey).

Sources:
NI Regional Strategy for Health and Social Wellbeing (1997- 2002) ‘Health and Wellbeing into the Next Millennium’

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11.25.19
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NI Stroke Consultation: Call for Dept. of Health to Assess for Population Health and Rural Needs as Next phase of Work

NI Stroke Consultation -Call for Dept. of Health to Assess for population health and Rural Needs

Dept.of Health NI have stated in Hospital Reconfiguration Update Nov 2019 that 19,000 responses were submitted to NI ‘Reshaping Stroke Care’ Centralisation proposals and 4,500 responses received on proposed centralisation of NI Reshaping Breast Assessment Services.

The Department’s plans to proceed after these two consultations differ radically with a plan to carry out a Population Health Needs Assessment for BREAST ASSESSMENT but NOT FOR STROKE SERVICES.

The two statements on (1) Stroke and (2) Breast Assessment services appear below.
(1) Statement on ‘Reshaping Stroke Care’ services:

“A consultation on improving stroke services to improve outcomes launched in March 2019. The consultation document set out seven commitments to improve stroke care across the stroke pathway, alongside six potential options for the establishment of a hyperacute stroke network in Northern Ireland.
19,000 consultation responses were received. The Department is currently analysing consultation responses to inform the development of a preferred model for stroke care.”

Dept. of Health NI (DoH) 2019 Hospital Reconfiguration Update

(2) Statement on ‘Reshaping Breast Assessment Services’ :
“A consultation on proposals to improve breast assessment services ran from 25 March to 30 August 2019.
Over 4,500 responses have been received. The Department is currently analysing all responses. This will help to inform the next phase of work to review breast cancer treatment services which is commencing with a Population Needs Assessment. Further details will be announced in the weeks ahead.

Dept. of Health NI (DoH) 2019 Hospital Reconfiguration Update
Official statistics, as presented by NISRA must determine where Specialist acute Hospitals are located in NI.

POPULATION HEALTH NEEDS ASSESSMENT VITAL FOR BOTH STROKE SERVICES AND BREAST CANCER SERVICES.

The Department’s plan to carry out a “Population Health Needs Assessment” for Breast Cancer services as a next phase of work is a good proposal, but where is the plan to carry out a Population Health Needs Assessment for specialist emergency, inpatient, outpatient and rehabilitation treatment for Stroke Services covering the complete stroke pathway – across NI? THERE HAS NEVER BEEN ONE.

A failure to carry out accurate Population Needs Assessments for health services is a recurring theme in the Southern Trust area – NO NEEDS ASSESSMENT WAS UNDERTAKEN as part of the SOUTHERN TRUST STROKE CONSULTATION in 2014.

Despite this, the 2016 Full Bengoa Expert Panel Report used the controversial proposed removal of Specialist Acute Stroke services, and its specialist Acute Stroke staff, from Daisy Hill acute Hospital in Newry as the prime local Case Study for Centralising Stroke Services in NI.

The full Bengoa Report inappropriately promoted (quote below) the choice of Craigavon Hospital for a Specialist Stroke Unit, singled out ahead of all other NI hospitals, and WITH NO NEEDS ASSESSMENT.

This was proposed to make sure that Craigavon could have a 24/7 specialist Stroke Centre leaving Daisy Hill Newry without its existing life saving combined specialist Acute Rehabilitation Stroke Unit and its valuable specialist stroke staff.

“In 2014…, a decision was taken to create a single specialist stroke inpatient unit within the Southern Health and Social Care Trust, at Craigavon Area Hospital. The Trust is proposing to provide a consistent and specialist service 24/7 in one centre rather than spreading the specialist team of staff across four sites. Daisy Hill Hospital will continue to provide ongoing rehabilitation and support through community stroke teams working to a regionally agreed care model.”

Bengoa Expert Panel 2016 (Full Report) (pg 72/ 73).

WHY ASSESS NEED?

Population Needs Assessments are widely recognised as a statutory requirement for health commissioning across the UK to ensure fairness and to reduce inequalities. A Needs Assessment is absolutely vital to ensure that immediate access to stroke services is available for all NI stroke patients – not just those attending hospitals confirmed in all six options in the urban areas of in and around Belfast namely the Royal, Craigavon and Altnagelvin.

POPULATION NEEDS ASSESSMENT DATA MUST USE OFFICIAL NISRA STATISTICS

This Needs Assessment must be undertaken using accurate NISRA Local Government Districts Demographics – not by using (1) imaginary theoretical demand of 600 stroke patients to certain hospitals or (2) Integrated Care Partnerships (which vary across local government districts).

Neither is an accurate statistical representation of the POPULATION health needs of an area.

New investment in acute specialist hospital services, hospital beds and specialist medical staff is due in the Newry & Mourne area, in Daisy Hill Acute Hospital, including in the Emergency Department.

DEPT. OF HEALTH N.I. ARE FAILING TO ADDRESS THE HEALTH NEEDS OF NEWRY & MOURNE POPULATION

(1) Newry & Mourne LGD is consistently the HIGHEST POPULATION IN THE SOUTHERN TRUST OPERATIONAL AREA

(2) Newry & Mourne LGD is consistently the 4TH HIGHEST POPULATION IN NI -SINCE c1972

Newry and Mourne locality has always been the largest population of the 5 localities (LGDs) in the Southern Trust and must have investment for a Specialist Acute Hospital.

The DOH, PHA, HSCB and Commissioners need to take action to assess Population Health Needs and provide services for Newry & Mourne former LGD , (which includes South Armagh) both as:

(1) Newry & Mourne has been the consistently largest local government district that remains in the operational area of the Southern Trust since its inception in 2007. NISRA demographics confirm this.

Latest official population stats for the 5 LGDs in the operational area of the Southern Trust

(1)Newry & Mourne ( 105,693*); (2) Craigavon ( 101,489*); (3)Armagh(62,976*) (4) Dungannon (62,666*) and (5) Banbridge (50,717*) [ [2018* NISRA]. This has been consistently ignored by the Southern Trust since they came into operation in 2007.

(2) Newry &Mourne LGD has always been the 4th highest LGD population in NI since 1972 (for nearly 50 years) after only Belfast, Lisburn (Greater Belfast ) and Derry.

(3) NISRA demographics confirm the Newry & Mourne population is projected to be the 3rd HIGHEST LGD POPULATION IN THE WHOLE OF NI BY 2023 with 110,090 population after only (1st)Belfast (289,130) and (2nd) Lisburn (Greater Belfast): 133,106. Derry is projected to be the 4th highest population in NI with 110,028 (NISRA).

These demographics were not considered in the ‘Reshaping Stroke Care’ Consultation or by the Southern Trust. A population Health Needs Assessment using accurate statistics will show the DoH the population health needs within Newry & Mourne, including needs for specialist stroke services.

A Population Health Needs Assessment (at local Government District Level) using accurate NISRA demographics will show quite clearly the continued need for specialist Stroke staff in Daisy Hill acute Hospital combined Stroke Unit, in order to provide time crucial emergency, acute and rehabilitation stroke care for the Newry & Mourne population and further afield within the same time frame as in urban areas in NI.

Centralisation of stroke services to one area in Craigavon will not provide safe stroke care in Newry & Mourne and will cost lives.

Act FAST Stroke - HyperAcute Stroke Unit for Newry 2019

PHASE OF WORK REQUESTED:

CALL FOR THE DOH, PHA, HSCB and COMMISSIONERS TO:

1. Conduct a Full Population Health Needs Assessment at individual Local Government District level (not at Trust level) using official NISRA Statistics – not Administrative stats such as Integrated Care Partnerships or theoretical modelled hospital demand.
2. Carry out Full Rural Impact Assessment (Rural Needs Act 2016)
3. Carry out an Environmental Impact Assessment to assess the Carbon Footprint implications of Centralisation
Then
4. Rewrite the Stroke Consultation and Stroke Options following these assessments, based on population needs, along with the Consultation Responses.

WHY THE STROKE OPTIONS NEED TO BE RE-WRITTEN

Under “Change or Withdrawal of services” – ALL 8 existing specialist Acute Stroke Units (including Daisy Hill, Newry combined specialist Acute Stroke Rehabilitation Unit) , NOT JUST 6 STROKE UNITS are entitled to be included in an NI wide consultation questionnaire options for upgrading to Hyperacute stroke units and retained as Acute Stroke Units.

The finally selected options must ensure immediate access to Emergency and inpatient specialist stroke Care in a fair and regionally balanced way across NI

>>>>>BACKGROUND

Dept. of Health NI latest Update to NI 2019 ‘Reshaping Stroke Care’ Consultation can be seen at the following link:
https://www.health-ni.gov.uk/hrn-newsletter-edition1

For Bengoa Report: Systems not Structures: Changing Health & Social Care (FULL REPORT) (link Below) See pages 72/73
https://www.health-ni.gov.uk/topics/health-policy/systems-not-structures-changing-health-and-social-care

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