Dear Mike Farrar
Congratulations on being appointed as the new interim permanent secretary of the Department of Health.
We have had many false starts, but there is optimism that you can lead us from intentions to actions.
Unprecedented financial challenges, a workforce stretched to breaking point, spiralling waiting lists and increasing demand from a sicker and older population are issues across the UK. However, chronic inertia is unique to Northern Ireland.
We have a policy landscape littered by broken promises, reforms that never happened, hand-wringing, short-termism, buck-passing and the ducking of difficult decisions.
For decades we have been fed a steady diet of empty rhetoric, spin, hollow words and meaningless pronouncements. It is time to think and act differently.
We have had our fill of activity disguised as movement. Paying lip service to the idea of reform is one of the few issues that unites our political leaders. The public have wearily accepted what amounts to a denial of service.
The task is a daunting one, and with this in mind, it may be constructive to highlight a number of key priorities which are crucial to transforming healthcare delivery and restoring public confidence in the service.
Firstly, articulate a vision for the future of health and social care supported by a compelling case for change.
Not another broad-brush review, but a comprehensive, detailed assessment of what success will look like. What are your objectives?
This blueprint must be underpinned by a detailed, evidence-based financial strategy which is data-driven and addresses productivity, value for money, timelines, economies of scale, incentives, accountability, transparency, priorities and scrutiny. Please, no more wish lists of totally implausible outcomes.
Addressing the conundrum of keeping a system running whilst simultaneously building a better one for the future is complex and complicated. It requires sophisticated systems thinking, a well-developed, coherent infrastructure and robust management.
Secondly, be honest and transparent with the public.
There are no easy solutions – we are in a downward spiral and faced with a series of difficult choices.
Most people here are acutely aware of the pressures in the system. We are in what feels like a permanent state of crisis - the colossal waiting lists for hospital treatment are rarely out of the headlines.
Better to be straightforwardly upfront about the reality and highlight the risks in the system. No-one believes that there is a silver bullet to solve our problems.
Last week, in response to the suggestion that AI should be considered to tackle waiting lists, the health minister responded by asserting that Northern Ireland was “helping” to lead the way in digital health solutions. Righto. A perfect example of utterly meaningless spin.
Documents with unrealistic aspirations, no timelines, no funding streams, dependent on huge financial cash injections, not grounded in the internal and external environment, without specific measurable, achievable goals, and devoid of meaningful content, are not strategies.
What is entirely absent is anything approaching an intellectual analysis of the health and social care system. No substance, no analysis. Just a lot of magical thinking with tenuous links to reality.
A fluffy aspiration statement about “eliminating long waits by March 2026”, if we are given a shed-load of cash, is not a credible strategy.
Thirdly, there is an urgent need to change the culture within the health and social care system.
A toxic culture of defensiveness and hostility pervades and despite many inquiries, little has fundamentally changed.
Many experts agree that there is a blame culture which is deeply ingrained. Fear discourages staff from reporting problems and is often linked to bullying and high levels of dissatisfaction.
It is encouraging to note that in previous roles, you have repeatedly stressed the importance of being a learning organisation which engages and empowers staff and patients.
This culture change must begin with the Department of Health. Research undertaken by the Nuffield Trust highlighted a corrosive, defensive culture. Participants referred to a command-and-control culture where leadership was hierarchical.
A ‘them and us’ attitude created a climate of fear and mistrust, rather than openness and transparency. A new style of distributed, collaborative leadership is urgently required.
Finally, the good news is that there is no shortage of innovative thinkers who are willing and able to work collaboratively to address the systemic issues.
The paralysis that has led us to this point can be overcome by galvanising the right people.
We need to stop going around in circles, delaying, denying and dithering, and finally embark on a long overdue journey of transformation.