Northern Ireland

Northern Ireland health review says there are too many hospitals

Sir Liam Donaldson
Image caption Sir Liam Donaldson is the former Chief Medical Officer of England

A review into Northern Ireland's health service has said there are too many hospitals for the 1.8 million population.

The review was led by the former chief medical officer of England, Sir Liam Donaldson.

The review makes a total of 10 recommendations.

Sir Liam was asked to look at just how effectively the Department of Health (NI) and the health trusts have been performing.

He has also reviewed the care of patients and management of staff.

He said the fact there are too many hospitals does not allow the public to receive the best healthcare.

As a result, expertise was being too thinly spread.

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Media captionHealth Minister Jim Wells said difficult choices had to be made in regards closing hospitals

Sir Liam said that the Transforming Your Care programme established that elsewhere in the UK, a population of 1.8 million people would likely be served by four acute hospitals - not the 10 that Northern Ireland has.

"Past analysts and observers have pointed to the current level and citing of provision not being in keeping with maintaining high standards of care," the review said.

"Some populations are just too small to warrant full-blown general hospital facilities yet they are kept in place because of public and political pressure.

"Amongst those who work within the system, there is deep frustration that the public are not properly informed about the higher risks of smaller hospitals and that the misapprehension that alternative forms of provision are in some way inferior to a hospital."

His report also found that some diseases like cancer and diabetes got priority.

Sir Liam's 10 recommendations

  • Close local hospitals that cannot provide level of care needed 24/7.
  • Strengthen commissioning - system needs redesigned to make it simpler and capable of reshaping services for future
  • Transforming Your Care - action not words. Need new costed timetabled implementation plan that includes expanded role for pharmacists and paramedics in pre-hospital care.
  • Self-management of chronic disease. Establish programme to give people with long-term illnesses the skills to manage their own conditions
  • Better regulation - unannounced routine inspections should take place. Consider outsourcing role of Regulation and Quality Improvement Authority (possibly to Scottish regulator). RQIA to review current policy on whistle blowing
  • Making incident reports really count. The system of serious adverse incident and adverse incident reporting to be modified - currently falling well below its potential.
  • Make patient safety a beacon of excellence. Establish a NI Institute for Patient Safety.
  • System-wide data and goals. NI health and social care system has no consistent method for the regular assessment of its performance. Recommend establishing new measures for benchmarking service in areas of safety, quality and patient experience.
  • Technology - establish a technology hub to identify best innovations for quality and safety of care internationally, and look at adapting them to NI.
  • Stronger patient voice. More independents in complaints process, more independent Patients and Client Council.

He said provision for other conditions was "inadequate and fragmented".

Panel of experts

He says people with long-term illnesses should be trained to manage their own conditions.

Sir Liam recommends that an international panel of experts is set up to redesign some health and social care facilities.

The review also suggests that politicians and the public should agree in advance to accept whatever is proposed, including closing some hospitals.

The far-reaching report concludes that Northern Ireland's health system is no more or less safe than any other part of the UK.

However, it criticises the implementation of the Transforming Your Care programme, which he said required a "rocket buster" to implement it.

He also suggested that the Patient and Client Council needed to become independent from the health department in order to best represent the interests of patients.

The former chief medical officer of England said that senior executives in the Northern Ireland health service were paid much less than those elsewhere in the UK and described the salary pressure as "penny-wise and pound-foolish".

Sir Liam said political pressure and media interest has prevented the salaries of top managers from being raised too substantially.

Image caption The review was ordered in April last year by the then health minister, Edwin Poots

"The public would be better served if their care system could compete to attract the very best managerial talent," he said.

On the issue of regulation, he recommended that the regulating body the RQIA, could be outsourced so it can make more of an impact.

The RQIA is to begin a series of unannounced inspections of acute hospitals in April.

There will also be a review of legislation to strengthen regulation of acute health care providers and also changes to the current system of regulation of non-acute services.


The review was ordered in April last year by the then health minister, Edwin Poots.

Sir Liam, once England's most senior doctor, led a team of experts.

His remit included examining whether the health service supports a culture of openness, learning and making amends.

Addressing the assembly, Health Minister Jim Wells said: "There are a number of recommendations that should be progressed and I am determined that this should happen as quickly as possible, particularly those which point to opportunities to improve the quality and safety of our services.

"A key point made by Sir Liam, both in Northern Ireland and the broader UK context, is that the health and social care system we have is not the one we need."

Image caption Jim Wells told the assembly he hoped to progress a number of the recommendations as quickly as possible

He added: "In light of the challenges posed in the report, we must all contemplate the tough choices to improve health and social care facing the executive. I propose to ask Sir Liam to return next year to advise me on his view of progress made.

"I want to conclude by highlighting another quote from Sir Liam's report: 'The leaders of the Northern Ireland Health and Social Care System should be clear in their ambition, which in our view is realistic, of making Northern Ireland a world leader in the quality and safety of its care. Northern Ireland is the right place for such a transformation, and now is the right time.'"


Last year's major incident at the Royal Victoria Hospital's Emergency department was a turning point in the local health service.

It highlighted a system in crisis and that intervention was long overdue.

The regulators, the RQIA, published its own report and recommendations, as did the College of Emergency Medicine.

However, what makes this review different from others is that it explores governance issues within the department of health.

It also considers if there is unnecessary duplication between the department, the health board and the public agency.

Its remit was to investigate if these bodies could be operating more effectively.

Some critics would argue that Northern Ireland does not need another review - instead, what is more critical for going forward is strong leadership.

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