Simon Hamilton announces 'biggest health system shake-up' in five years

Health Minister Simon Hamilton has rejected one of the key recommendations of the Donaldson report.

The report, which was published in January, proposed radical reforms to the health system in Northern Ireland.

On Wednesday, Mr Hamilton announced his changes to the way the system operates.

But he said he was "categorically ruling out" the report's recommendation that an international panel of experts be appointed to decide on the number of hospitals needed in Northern Ireland.

"I am not in public service to hand over lock, stock and barrel the future of health and social care in Northern Ireland entirely to outsiders to take decisions without any democratic fail-safe or local input." he said.

Instead, he proposed appointing experts from Northern Ireland who work inside the health care system to consider the future configuration of services.

The minister said he wants to abolish Northern Ireland's health and social care board. It currently decides where much of the budget is spent.

Mr Hamilton believes future financial decisions can be made by the department and the five health trusts.

Essentially the minister is removing a tier of administration. There will be some voluntary redundancies, while others working in the board will be moved to the department or trusts.

The move is unlikely to make big savings and it will not make any differences to services on the ground, but the aim is to improve efficiency and accountability.

The minister wants health trusts to be directly answerable to him.

He also plans to set up a panel to advise on more difficult decisions such as reducing the number of acute hospitals and regionalising services.

Mr Hamilton said he would retain a Public Health Agency "that renews its focus on early intervention and prevention and works more closely alongside the department in doing this essential work".

Among the other proposals are:

• Department of Health to take "firmer, strategic control of the health and social care system"

• Establish a panel of "local" experts to have a "clinically led conversation"

• Convene a health summit involving all parties to develop a consensus approach to a shared vision for transformed health and social care system.

• To pursue a significant increase in health spending in the next budget

• Create a transformation fund - a dedicated source of funding that supports innovation, collaboration and prevention.

A review of the health service said Northern Ireland had too many hospitals for its 1.8m population.

It was published in January by Sir Liam Donaldson, the former chief medical officer for England.

While agreeing with many of Sir Liam's recommendations, Mr Hamilton said he believed there were "ample experts from Northern Ireland who work inside our system and have a lot to offer any assessment of the future configuration of services here".

At present, the Department of Health is responsible for strategy and policy, while the Health and Social Care Board is in charge of "commissioning".

The trusts are then the service providers.

The Health and Social Care Board currently employs about 470 people, with an administration budget of £27m.

"My proposals would mean that many of the board's existing functions, and staff, would revert back to the department," Mr Hamilton said.

"Some would move to the new Public Health Agency. Whilst others, especially those in respect of planning for need, will move to our trusts.

"My vision is for greater operational freedom and flexibility for trusts. This is essential if they are to build on the huge innovative potential of staff across the sector.

"But with greater flexibility comes the need for sharper, and more rapid, accountability."

Dr Tony Stevens said it was an opportunity for health trusts to "start to think differently"

Responding to Mr Hamilton's announcement, Valerie Watts, chief executive of the Health and Social Care Board, said: "Our key focus has been and remains on improving the health and social care outcomes for everyone in Northern Ireland.

"We are fully committed to minimising any impact on staff and ensuring that we fully utilise their skills, expertise and commitment moving forward."

Dr Tony Stevens, of the Northern Health Trust, said: "I think the challenge for the trusts is to take the message and to start preparing - coming forward with plans and ideas about how we'll do transformational change.

"So I take today as the opportunity to start to think differently."

The Donaldson review highlighted unnecessary duplication between the department, the health board and the Public Health Agency.

The review also pointed to a report from 2011 called Transforming Your Care which had 99 recommendations.

Any move to restructure the management of the health service requires a public consultation and legislation, meaning it is unlikely to come into effect for between 18 months and two years.