Review of the Provision of Health and Social Care services in Northern Ireland


The Review should take account of:

  • the Minister’s statement of vision and strategy for the HSC;
  • the statutory duties on the HSC to improve the quality of services provided to individuals, and to seek to improve the health and social well-being of the population, and to reduce health inequalities;
  • all extant statements of policy and strategy approved by the Minister, and in particular the aims of improving public health, the prevention of illness, and of improving outcomes for patients and clients.  Other major themes of policy and strategy are the quest for better early intervention and chronic condition management, and the strategic shift of all suitable services towards a primary and community context;
  • the organisational structure of the HSC as established in the 2009 Reform Act, and in particular the responsibility to secure a clear focus on public health, and increasingly effective local commissioning of services and to exercise good governance and provide clear accountability – the Review will need to ensure that its analysis and recommendations are practical and applicable within this statutory framework;
  • the resources available in the Budget settlement for 2011-12 to 201415 approved by the Executive and the Assembly in March 2011, given the overriding obligation on all HSC bodies to manage services within the level of resources approved by the Assembly;
  • best practice guidance of regulatory and advisory bodies affecting the provision of safe and effective services, notably the National Institute for Health and Clinical Excellence, the Social Care Institute for Excellence and the Royal Colleges;
  • evidence of how arrangements for the delivery of health and social care in the Republic of Ireland and Great Britain and cooperation for mutual benefit with service providers there, might contribute to the objectives of the Review;
  • the established framework of terms and conditions for HSC staff including Agenda for Change and the Consultants’ Contract, and the contractual arrangements in respect of primary care;
  • recent previous studies and analysis of the HSC including the Appleby Reports of 2005 and 2011, the McKinsey Report of 2010 and the forthcoming PEDU Review; and
  • evidence-based good practice on the delivery of services from within Northern Ireland from elsewhere.


On that basis, the Review is asked to:

  • Provide a strategic independent assessment across all aspects of health and social care services on the present quality and accessibility of services, and the extent to which the needs of patients, clients, carers and communities are being met by existing arrangements, taking account of the issues of outcomes, accessibility, safety, standards , quality of services and Value For Money;
  • Undertake appropriate consultation and engagement on the way ahead with the public, political representatives (primarily through the Assembly Health Committee), HSC organisations, clinical and professional leaders within the HSC, staff representatives (through the Partnership Forum), and stakeholders in the voluntary, community, independent, private and local government sectors;
  • Make recommendations to the Minister on the future configuration and delivery of services in hospital, primary care, community or other settings.  The essential task of the Review is to set out a specific implementation plan for the changes that need to be made in the HSC in the context set out above, including proposals in relation to major sites and specialties;
  • To identify, at an early stage, potential areas of concern, specific priorities for Ministerial focus and potential issues of public/political/media concern;
  • To prepare a Report incorporating its analysis, findings and recommendations.


The new organisational structures within Health and Social Care have delivered major efficiencies already.  They are currently the subject of a further review as part of a wide ranging review by the Executive of all Arm’s Length Bodies and are outside the scope of this Review.


The issue of overall funding levels available to meet the needs of Health and Social Care now and in the years ahead is also outside the scope of this Review as that is a matter for the Executive collectively drawing on the advice of DFP.  The current PEDU review of the scope to make savings in the Health and Social Care sector is separate from the HSC Review and the development of an implementation plan to deliver savings will continue in parallel with this Review.


Where the Review finds major tension, or contradiction, between its emerging view of the best way ahead and the extant constraints listed at paragraph 1 above, this should be raised for consideration by the Department as soon as possible, so that the Minister can be advised of the issue and give a specific steer as to how the Review should proceed.


The Review should complete its Report by 30 November 2011.

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