Healthcare transformation in NI urgently needed: Bengoa
Northern Ireland’s healthcare transformation: Can leadership deliver where it matters most?
By Dr Richard Dune
Image by Wavebreakmedia via Envato Elements
Eight years ago, Professor Raphael Bengoa delivered a comprehensive plan to overhaul Northern Ireland’s struggling healthcare system. His 2016 report, ’Systems, Not Structures,’ called for a radical rethinking of health and social care delivery across the region. The focus was clear: shift from hospital-centred treatment to community-based care, prevention, and better management of chronic conditions. It was a visionary blueprint, yet here we are in 2024, and the promised transformation remains slow, fragmented, and stagnant in many areas.
As Professor Bengoa returned to Northern Ireland for one day last week, hopes were rekindled that his presence might reignite the critical debate surrounding healthcare reform. Accompanied by Stormont Health Minister Mike Nesbitt, the event marked a crucial moment for Northern Ireland’s health system. Can the lessons learned and promises made in 2016 finally lead to the radical changes so desperately needed?
Image by Prostock-studio via Envato Elements
The urgent need for change
Professor Bengoa returns to Northern Ireland when the need for health transformation is more urgent than ever. Bengoa stated that healthcare reform must now be "backed by sustained budgets" to succeed. His message was clear: Northern Ireland’s healthcare system is at a breaking point. Short-term pressures such as growing demand, an ageing population, and the increased complexity of patient needs are putting unprecedented strain on hospitals and services. And while these challenges are by no means unique to Northern Ireland, their impact has been compounded by the COVID-19 pandemic and the stop-start nature of NI government.
The conference underscored that Northern Ireland is not alone in its struggles. As Bengoa highlighted, health services across Europe grapple with similar issues: balancing short-term pressures with long-term reform needs. His remarks came just as the Department of Health in Northern Ireland published a long-awaited report on hospital reform, offering new plans for rebooting health services. Yet, as with any healthcare system, reforms on paper are one thing, and translating them into real-world results is the challenge.
A glimpse of progress, but is it enough?
There has been some progress since the 2016 report. The publication of significant studies around general emergency surgery led to the separation of planned from emergency surgery, a step that has allowed surgical hubs to be created. These hubs, located on some hospital sites, have helped tackle the backlog of waiting lists, providing some measure of relief for overburdened hospitals. However, general practice funding cuts and the closure of some practices have continued to plague the system. Social care, often called the "poor relation," remains underfunded and under-prioritised.
What’s clear is that much more needs to be done. Speaking at the conference, Nesbitt acknowledged that reconfiguring hospital services remains one of the final pieces in this complex jigsaw. However, critics argue that the government’s current plan, "Hospitals - Creating a Network for Better Outcomes", now out for public consultation, lacks the necessary detail and doesn’t go far enough to reduce the sprawling hospital network.
Nesbitt’s reluctance to close hospitals may be politically savvy, but the alternative of centralising services at single locations has caused accessibility issues. Patients are now required to travel further for surgery, undermining the core goal of bringing care closer to communities.
Image by wirestock via Envato Elements
Image by YuriArcursPeopleimages via Envato Elements
Leadership and legacy - Will Nesbitt and Bengoa deliver?
The big question remains: Can Northern Ireland’s leaders transform the healthcare system when all services, including those in hospitals, are stretched and budgets are tight? Professor Bengoa's return brings renewed energy to the conversation, but as he has acknowledged, the transformation ahead is the work of a generation. Short-term wins are insufficient to repair a system that has been neglected for years.
Nesbitt has expressed his desire to be the minister who makes the “difficult calls”. He has committed to holding himself accountable when he steps down in 2027, setting the stage for a potential legacy of real change. But as Bengoa’s visit this week demonstrated, leaving a lasting legacy requires more than just bold words. It requires decisive action and long-term vision.
Pay deals are slowly being resolved, and there are signs of more joined-up thinking between health trusts, offering some hope that healthcare services are becoming more coordinated. Yet, as Nesbitt himself pointed out, Wednesday’s conference was not a time for self-congratulation. It was a reality check - a moment to assess how far Northern Ireland still has to go.
Systems, Not Structures - The long road to transformation
At the heart of Bengoa’s 2016 report was a simple but profound concept: "Systems, Not Structures". The idea was to move beyond simply building more hospitals and focus instead on rebalancing care to better serve communities. Bengoa argued that by delivering more care at the community level and focusing on prevention rather than treatment, the health service could help people manage their conditions and live longer and healthier lives. Yet, achieving this shift is proving to be the challenge of a generation.
Nesbitt acknowledged this, stating, "Achieving this shift is the work of a generation." With health inequalities rising and community care systems under strain, it’s clear that this problem cannot be solved overnight. However, it is also clear that without radical reform, Northern Ireland’s healthcare system will continue to struggle to meet the needs of its population.
Image by Wavebreakmedia via Envato Elements
Image by halfpoint via Envato Elements
The path forward - A call for action
Ultimately, the future of Northern Ireland’s healthcare system rests on the shoulders of its leaders. Professor Bengoa and Minister Nesbitt have the expertise, vision, and authority to deliver real change, but will they? As the professor said, rebalancing the system requires sustained budgets, bold decision-making, and an unwavering commitment to tackling the problems that have plagued the region’s health services for decades.
Wednesday’s conference may not have provided all the answers, but it reignited a critical debate. More than ever, Northern Ireland’s health service needs strong leadership to navigate the challenges ahead. The stakes are high, and time is running out for meaningful change.
Meet regulatory requirements with ComplyPlus™
Get in touch today to learn how ComplyPlus™ helps health and social care providers in Northern Ireland meet regulatory compliance efficiently and stay ahead of legislative demands.
The urgent need for change
Image by Prostock-studio via Envato Elements
Professor Bengoa returns to Northern Ireland when the need for health transformation is more urgent than ever. Bengoa stated that healthcare reform must now be "backed by sustained budgets" to succeed. His message was clear: Northern Ireland’s healthcare system is at a breaking point. Short-term pressures such as growing demand, an ageing population, and the increased complexity of patient needs are putting unprecedented strain on hospitals and services. And while these challenges are by no means unique to Northern Ireland, their impact has been compounded by the COVID-19 pandemic and the stop-start nature of NI government.
The conference underscored that Northern Ireland is not alone in its struggles. As Bengoa highlighted, health services across Europe grapple with similar issues: balancing short-term pressures with long-term reform needs. His remarks came just as the Department of Health in Northern Ireland published a long-awaited report on hospital reform, offering new plans for rebooting health services. Yet, as with any healthcare system, reforms on paper are one thing, and translating them into real-world results is the challenge.
A glimpse of progress, but is it enough?
Image by wirestock via Envato Elements
There has been some progress since the 2016 report. The publication of significant studies around general emergency surgery led to the separation of planned from emergency surgery, a step that has allowed surgical hubs to be created. These hubs, located on some hospital sites, have helped tackle the backlog of waiting lists, providing some measure of relief for overburdened hospitals. However, general practice funding cuts and the closure of some practices have continued to plague the system. Social care, often called the "poor relation," remains underfunded and under-prioritised.
What’s clear is that much more needs to be done. Speaking at the conference, Nesbitt acknowledged that reconfiguring hospital services remains one of the final pieces in this complex jigsaw. However, critics argue that the government’s current plan, "Hospitals - Creating a Network for Better Outcomes", now out for public consultation, lacks the necessary detail and doesn’t go far enough to reduce the sprawling hospital network.
Nesbitt’s reluctance to close hospitals may be politically savvy, but the alternative of centralising services at single locations has caused accessibility issues. Patients are now required to travel further for surgery, undermining the core goal of bringing care closer to communities.
Leadership and legacy - Will Nesbitt and Bengoa deliver?
Image by YuriArcursPeopleimages via Envato Elements
The big question remains: Can Northern Ireland’s leaders transform the healthcare system when all services, including those in hospitals, are stretched and budgets are tight? Professor Bengoa's return brings renewed energy to the conversation, but as he has acknowledged, the transformation ahead is the work of a generation. Short-term wins are insufficient to repair a system that has been neglected for years.
Nesbitt has expressed his desire to be the minister who makes the “difficult calls”. He has committed to holding himself accountable when he steps down in 2027, setting the stage for a potential legacy of real change. But as Bengoa’s visit this week demonstrated, leaving a lasting legacy requires more than just bold words. It requires decisive action and long-term vision.
Pay deals are slowly being resolved, and there are signs of more joined-up thinking between health trusts, offering some hope that healthcare services are becoming more coordinated. Yet, as Nesbitt himself pointed out, Wednesday’s conference was not a time for self-congratulation. It was a reality check - a moment to assess how far Northern Ireland still has to go.
Systems, Not Structures - The long road to transformation
Image by Wavebreakmedia via Envato Elements
At the heart of Bengoa’s 2016 report was a simple but profound concept: "Systems, Not Structures". The idea was to move beyond simply building more hospitals and focus instead on rebalancing care to better serve communities. Bengoa argued that by delivering more care at the community level and focusing on prevention rather than treatment, the health service could help people manage their conditions and live longer and healthier lives. Yet, achieving this shift is proving to be the challenge of a generation.
Nesbitt acknowledged this, stating, "Achieving this shift is the work of a generation." With health inequalities rising and community care systems under strain, it’s clear that this problem cannot be solved overnight. However, it is also clear that without radical reform, Northern Ireland’s healthcare system will continue to struggle to meet the needs of its population.
The path forward - A call for action
Image by halfpoint via Envato Elements
Ultimately, the future of Northern Ireland’s healthcare system rests on the shoulders of its leaders. Professor Bengoa and Minister Nesbitt have the expertise, vision, and authority to deliver real change, but will they? As the professor said, rebalancing the system requires sustained budgets, bold decision-making, and an unwavering commitment to tackling the problems that have plagued the region’s health services for decades.
Wednesday’s conference may not have provided all the answers, but it reignited a critical debate. More than ever, Northern Ireland’s health service needs strong leadership to navigate the challenges ahead. The stakes are high, and time is running out for meaningful change.
Meet regulatory requirements with ComplyPlus™
Get in touch today to learn how ComplyPlus™ helps health and social care providers in Northern Ireland meet regulatory compliance efficiently and stay ahead of legislative demands.
About the author
Dr Richard Dune
With over 20 years of experience, Richard blends a rich background in NHS, the private sector, academia, and research settings. His forte lies in clinical R&D, advancing healthcare tech, workforce development and governance. His leadership ensures regulatory compliance and innovation align seamlessly.
About the author
Dr Richard Dune
With over 20 years of experience, Richard blends a rich background in NHS, the private sector, academia, and research settings. His forte lies in clinical R&D, advancing healthcare tech, workforce development and governance. His leadership ensures regulatory compliance and innovation align seamlessly.
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