Health service overhaul 'has been limited,' says report
A lack of planning and funding has meant the biggest overhaul of the health service in Northern Ireland for decades has not had the expected impact.
Transforming Your Care (TYC) was a plan to change how services are delivered.
But the programme has only realised £28m of the £130m saving anticipated.
In a report the Auditor General, Kieran Donnelly, said the pace of change is not what was envisaged.
This is the first time officials have commented on the management and delivery of the programme, which was published in 2011.
While acknowledging it was an ambitious shared vision, Mr Donnelly said the programme has so far not achieved what it set out to do.
"The impact of TYC has been much more limited than expected and the hoped-for shift of services from hospitals into people's own homes has not happened as rapidly as had been intended," he said.
The message "could do better" rings loud and clear from the report.
It is the first official confirmation of what many health professionals have been saying for some time about TYC.
According to Mr Donnelly, that is because there was no action plan, funding or leadership to help deliver it.
"A precise action plan had not been established at the outset of the programme setting out clear, measurable aims and objectives together with an appropriate set of performance indicators for assessing its performance," he said.
However, the auditor also stresses the importance of having leadership to drive the process forward. In fact, the report says "leadership of the highest order will be vital in moving the reform process forward".
The core objective of TYC was to shift the delivery of services away from hospitals and into the community to allow more people to be cared for in the community and at home.
It would also allow for funding to be transferred from hospital to community care.
But that clearly has not happened.
While the plan was to reallocate £83m of resources from secondary care to primary/community by March 2016 - instead that figure has been closer to £65m.
There are huge obstacles in the way of delivering health and social care and that is also acknowledged by the Auditor General.
Mr Donnelly said the scale and complexity of the task TYC set itself is not to be underestimated.
"In addition to funding constraints and the need to satisfy a growing demand for health and social care, the challenges these relationships present to health and social care leaders have also been exacerbated by other initiatives in the sector for example the constant and immediate pressure health trusts face to meet waiting-time targets and to manage their finances," he said.
The report also notes there have been some positive changes including fewer hospital beds required for stroke rehabilitation, more money for domiciliary care and mental health care provision.
It says the use of re-ablement services which encourages independence among older people, has allowed £7m to be redirected to support the management of demand for domiciliary care services.
In a statement, the the Health and Social Care Board (HSCB) said it welcomed the report, and would give it detailed consideration.
"Whilst the HSCB accepts the report's findings that the overall impact of TYC was more limited than originally expected, the report also highlights that TYC has brought about notable achievements in the development of care for patients, and service users, and has laid a solid foundation for future reforms to be built upon.
"The report acknowledges that reforms could not have been accomplished without the commitment and effort of many health and social care staff, supported by the department and the Health and Social Care Board."
However, John Compton, the former chief executive of the health board may find the report somewhat frustrating.