Northern Ireland health and social care management costs too high

Northern Ireland Audit Office says that it expected greater savings in management and administration costs after 2008 reforms

Health and social care management costs in Northern Ireland have risen to £125m, 17% higher than five years ago, according to a report by the auditor general for Northern Ireland.

Kieran Donnelly, author of the report, said the findings were particularly surprising because costs had risen after a review of public administration reforms in 2008, which were meant to create greater savings in management and administration costs across the sector.

The report acknowledged that if the Department of Health, Social Services and Public Safety’s assertion that if 2006-07 management costs factor in inflation, pay modernisation and a change in the employer’s superannuation rate, then real-term savings on management costs of £17.3m would have been made, reducing the expenditure to £107.7m.

However, the auditor said that this was still £0.6m higher than the actual management costs of £107.1m recorded in 2006-07.

The reforms aimed to reduce costs, create better quality and a safer service through improved governance. Health and social care bodies were set a target of achieving £53m in efficiency savings by 2010-11 under the changes.

Under plans in the 2007 comprehensive spending review, the health and social care sector was required to deliver cumulative savings of £249m by the end of 2010-11, which was then increased by a further £105m. But the report acknowledged that Northern Ireland’s health bodies experienced considerable financial pressures in 2010-11.

The auditor goes on to highlight other issues. It says that compliance with prompt payment targets had been a “considerable challenge to health bodies”, and that performance against waiting time targets have declined considerably since March 2009.

“Key targets have not been achieved for inpatient treatment, outpatient appointments, diagnostic tests or emergency care during 2010-11,” it said.

At the end of March 2011, the operational performance showed that:

• Over 17,000 patients were waiting more than 13 weeks for inpatient treatment compared to over 3,000 at March 2010.

• 32,000 patients were waiting longer than the target of nine weeks for a first outpatient appointment.

• 12,000 patients were waiting longer than nine weeks for a diagnostic service or more than 13 weeks for a day case endoscopy.

However, the document goes onto say that the number of patients waiting more than 12 hours in an emergency care department had improved, with 850 waiting in 2010-11 compared to 1,239 12 months earlier.

The report also highlights other positive developments in the sector, which spends more than £4bn annually. It said that all health bodies in the country were able to break even in regards to the budget set for both 2009-10 and 2010-11, with the exception of the Northern Health and Social Care Trust, which required additional funding for both years and the Belfast Trust, which required additional funding for 2009-10.

The Health and Social Care Board, responsible for developing health and social care services across Northern Ireland, was allocated approximately £3.6bn for hospital, community health and personal social services’ expenditure – the equivalent to £10m a day.