Health Care In Northern Ireland Research Articles

Who is Better Off: the Irish, the Northern Irish or the British? A Regional Economic Comparison

ABSTRACT: Debates around the constitutional future of Northern Ireland quite rightly consider the cost of living and quality of life compared to that in the Republic of Ireland. But there is no simple answer as to who is better off within the two jurisdictions, nor when comparing with Great Britain. Average pay is highest in Ireland and lowest in Northern Ireland, while living costs are higher in Ireland. Inflation has particularly hit people in Northern Ireland, with costs going up much faster than pay. Welfare benefits are more generous in Ireland than in the UK, including Northern Ireland. The quality of public service provision varies between the jurisdictions, with Ireland outperforming Northern Ireland in terms of education and skills. Long waiting lists and waiting times undermine the principle of free healthcare in Northern Ireland, while Ireland is reforming its health system to extend the provision of free care.

188 Structural differences in access to neurological healthcare in Northern Ireland: a neurodisparity index

Disparities in management of neurological patients should be minimal in a universal healthcare system. Northern Ireland has one neuroscience centre but no neurology centres. We have devised an easily- applied neurodisparity index (NDI) to measure population equity of neurological healthcare. NDI=number of patients managed per 105 population per Trust/number of patients managed per 105 population of the tertiary centre Trust. NDIs <0.75 and >1.25 were arbitrarily designated as neurodisparities.NDIs were calculated between 2013–2016 for intravenous thrombolysis (eight centres) or mechanical thrombectomy (one centre) for acute ischaemic stroke (AIS), disease modifying drug use for multiple sclerosis (>10 centres) and admissions to a neuroscience neurology ward (n=1) to determine the source and extent of neurodisparity.Amalgamated NDIs for non-tertiary centre trusts were: 0.36 for mechanical thrombectomy for AIS; 0.79 for intravenous thrombolysis for AIS; 1.1 for disease modifying treatment for multiple sclerosis and 0.48 for patient admissions to the tertiary neurology ward. Individual Trust data demonstrated a geographical gradient for mechanical thrombectomy and regional ward admissions.Neurodisparities in Northern Ireland are most marked for mechanical thrombectomy and regional neurology ward admissions. Commissioners should be aware that geography and time-dependent man- agement can exacerbate neurodisparities. Extra resources are required to address such neurodisparities.markmccarron@doctors.org.uk

Perinatal mental healthcare in Northern Ireland: challenges and opportunities.

Perinatal mental health is a vital component of public mental health. The perinatal period represents the time in a woman's life when she is at the highest risk of developing new-onset psychiatric disorders or relapse of an existing mental illness. Optimisation of maternal mental health in the perinatal period is associated with both short- and long-term benefits not only for the mother, but also for her infant and family. However, perinatal mental health service provision remains variable across the world. At present in Northern Ireland, 80% of women do not have access to specialist community perinatal mental health services, and without access to a mother and baby unit, mothers who require a psychiatric admission in the postnatal period are separated from their baby. However, following successful campaigns, funding for development of specialist perinatal mental health community teams has recently been approved. In this article, we discuss the importance of perinatal mental health from a public health perspective and explore challenges and opportunities in the ongoing journey of specialist service development in Northern Ireland.

‘We can help women stop a tragic cycle’

A nurse who has revolutionised women’s sexual healthcare in Northern Ireland has been named RCN Nurse of the Year 2021.

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways—intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32–0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38–0.66) for MT in AIS patients, 0.78 (95%CI 0.67–0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99–1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities.

Prison mental health care in Northern Ireland.

Prison mental health care in Northern Ireland.

Evaluating the impact of an Acute Care at Home service on acute hospital admissions

Introduction: Transforming Your Care (1) provided the blueprint for the future of Healthcare in Northern Ireland. It recognised some of the real challenges faced by Health Trusts and outlined the key areas for modernisation to enable services to meet the increasing demands from a growing and ageing population. Practice Change Implemented: In September 2014, the Southern Trust developed a consultant-led multidisciplinary team to deliver acute care to older people in their own home or in Nursing and Residential Homes. The service aimed to reduce pressure on emergency departments and acute hospital beds by preventing patients with non-critical care needs being admitted to hospital. Aim and Theory of Change: This study assessed the impact of access to a consultant led Acute Care At Home (ACAH) on unscheduled admissions to hospital. Timeline: Service evaluation took place from 1st September 2014 to 31st August 2015. Population of Focus: Over 75 year olds, Referred from 17 GP practices (100,000 population, 4,500 over 75 year olds). Innovations: Each patient received a comprehensive assessment by the ACAH team within 2 hours of being referred by their GP and had the same access to laboratory and diagnostic investigations as patients in an acute hospital ward. The service offers IV antibiotics, IV Diuretics, subcutaneous fluids and mobile ECG monitors, bladder scanners and blood testing in the patient’s own home. Impact and Outcomes: The service received a total of 358 referrals from GPs in the period from 1st September 2014 to 31st August 2015, 301 of these referrals were accepted onto the scheme. The GP practices which had access to the ACAH service had an increase in admissions for over 75 year olds from 186 to 197 per month (6% increase), compared to an increase of 525 to 609 per month (16% increase) from the GP practices which did not have access to the service. This reduction in admissions provided a saving in acute services of approximately £570,000. Service user feedback has been universally positive with one patient’s daughter writing, “The respect and courtesy given to my elderly mother by the team during this difficult time was nothing less than outstanding. This is an exceptional service and all those involved in the team should be extremely proud of it.” Comments on sustainability: The model has been demonstrated to be a cost effective alternative to acute hospital based cared and has other long terms effects in terms of requirements for ongoing care Comments on Transferability: The Southern Trust has extended the service to over 240,000 patients. Other Trusts in Northern Ireland have used the model as a blueprint for developing their ACAH service. Conclusion: The introduction of an ACAH service has reduced unscheduled care admissions for over 75 year olds. Lessons Learned: GPs are a key stakeholder in this service. A daily Multidisciplinary Team (MDT) meeting is essential to ensure this group of acutely unwell patients are cared for in a safe and effective manner with changes to treatment plans requiring consensus from the MDT and patient. Given the complexity and acuity of patients consultant oversight is important.

Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland

BackgroundIn May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services.MethodsWe analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system.ResultsNo evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups.ConclusionAlthough remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients.

073 Variations in the use of publicly funded oral care in Northern Ireland: results from an analysis of adolescents in the Northern Ireland Longitudinal Study

BackgroundA socio-economic gradient in use of health care has been observed in a number of situations. These have been used to assess the performance of systems as well as frame...

Fears over health care in Northern Ireland

Fears over health care in Northern Ireland

Addressing health care in Northern Ireland through collaborative peer education

This paper reports on an evaluation of a health education programme delivered through peer education methodologies to 16–18-year-olds in four community workshops in North and West Belfast. Qualitative approaches to evaluation were utilised in order to profile first hand testimony of the merits accrued by participants attending the programme. The findings clearly support the value of collaborative peer education for addressing health care among young adults.

RCN demands fair and equal access to health care in Northern Ireland

RCN demands fair and equal access to health care in Northern Ireland

NHS reforms: making it better.

Health care in northern Ireland is in a state of confusion. but, as Maura Thompson reports, a campaign calling for a common vision is underway

FACE‐ing up to Quality

Discusses, on the basis of existing quality initiatives, a systematic and integrated approach to mental health care in Northern Ireland. Utilizes two approaches: the Brunel Quality Management System and the FACE‐IQMS model.

Your good health: Access to health and health care in Northern Ireland

Hayes M. (1986) Your good health: access to health and health care in Northern Ireland, Reg. Studies 20, 493–504. The paper argues that health status must mean more than the availability of health care and that life style and environment are more important determinants of health than access to health facilities. A shift of resources is advocated from the acute hospital sector to primary care and prevention. The comparatively high provision of hospital beds in Northern Ireland is noted, also the high level of utilization and the relatively low threshold for admissions. Research in the USA and GB is drawn on to show that the main determinants of the rate of hospitalization is the number of beds available. It is suggested that the political argument about health provision has thus been wrongly focused.