In January 2020, the Northern Ireland (NI) Executive set out its priorities for health: an immediate settlement to the pay dispute; the introduction of a new action plan on waiting times; and to deliver reforms on health and social care (as set out in Health and Wellbeing 2026 Delivering Together (Department of Health (DH), 2019a and Power to People (Kelly and Kennedy, 2017).
These two reports seek to radically reform the way health and social care services are designed and delivered in NI, with a focus on person-centred care, rather than on buildings and structures. They also set out a clear case for change that focuses on the current system's inability to meet the pressures created by an ageing population, the stark differential in health and social care outcomes between the most and least deprived areas, the current service delivery model being no longer fit for purpose, and the challenges in attracting and retaining staff to deliver an outdated system.
Delivering Together is aligned with the aspirations set out in the NI Executive's draft Programme for Government (https://tinyurl.com/ybtr6r4v), to support people to lead long, healthy and active lives by:
Part of Delivering Together focuses on a reconfiguration of cancer services, inclusive of diagnostic pathways, treatment, prehabilitation, rehabilitation and living with and beyond cancer.
New treatment pathways are being developed, co-produced by involving those with lived experience of cancer services, and staff, to provide treatments closer to home where possible, and centralised where necessary. In future, patients will be able to have more systematic anti-cancer treatments delivered in their local cancer unit. To improve sustainability of services, work is ongoing to set out developments needed within the nursing, pharmacy, radiography and the medical physics workforce to enable them to contribute further to patient treatment pathways. This will result in shared models of care alongside medical staff to deliver different levels of treatments plans to patients. These developments will improve the access and experience of care for many patients, important when there is a predicted significant rise in the population who will experience cancer in the future (DH, 2019a).
In 2019, the DH also announced the development of a new cancer strategy for Northern Ireland, led by the Chief Nursing Officer, Professor Charlotte McArdle (DH, 2019b). The central goal is to identify new ways of working to secure further advances across cancer care, working with patients, staff and cancer charities. The strategy is central to the transformation agenda for health and social care and co-production plays a key role in its development. The strategy will help to direct the skilled workforce and resources most effectively.
Over the past year in NI, nurses have experienced industrial action and been instrumental in delivering services to patients during the COVID-19 pandemic, all of which has impacted on how services are delivered to patients. Nurses play a vital role in shaping future services. We have opportunities to embrace the successes of working virtually through COVID-19. Equally, nurses can share their experiences and knowledge of how services can be delivered and, in some cases, maintained during a second surge. Additionally, we have the opportunity to consider how the wellbeing of our self and others is embedded within our practice to support us during future challenges.
We look forward to a new era in cancer services that is based on co-production, advancing care provision and building a resilient workforce to meet the future demands of our population.