The health system in Northern Ireland: How is it structured and who makes decisions about COVID-19?
This article explains how the health system in Northern Ireland is structured, and who is responsible for COVID-19 planning and decision making.
[This article is part of the COVID-19 Information Dissemination (COVID-19 ID) Project — a partnership between Community Development and Health Network (CDHN) and FactCheckNI. Its aim is to improve people’s health literacy about COVID-19 by providing accurate and up-to-date information which will increase knowledge, understanding and confidence and enable people to make good health decisions.]
There is a huge amount of collaboration between health bodies around COVID-19 in Northern Ireland. But the division of responsibilities can be understood as follows:
- Health policy is devolved to Northern Ireland, but there is a focus on coordination with the wider UK and the Republic of Ireland.
- The Northern Ireland Executive is responsible for coordinating the overall response.
- The Department of Health sets COVID-19 policy, regulations and health strategy.
- The Health and Social Care Board (HSCB) commissions services.
- The Public Health Authority (PHA) collects information, issues advice and communicates key messages.
- Health Trusts manage the day to day running of hospitals, health centres, residential homes and other health and social care facilities. The Northern Ambulance Service is also a Trust.
The health system in Northern Ireland
The Health and Social Care Board (HSCB) is the body in charge of commissioning health and social services in Northern Ireland. It deploys and manages money from the Department of Health, and oversees the work of six Health Trusts.
Health Trusts are responsible for the day to day running of hospitals, health centres, residential homes, day centres, other health and social care facilities: the Northern Trust, the South Eastern Trust, the Southern Trust, the Western Trust, the Belfast Trust and the Northern Ireland Ambulance Service Trust.
Devolution and health systems in the UK
The UK has four health systems.
Health policy has been devolved to the executives and governments of Northern Ireland, Scotland and Wales, while the central UK government is responsible for the health system in England.
Since devolution in the late 1990s, the four health systems have diverged significantly. Health and social care are provided as an integrated service in Northern Ireland and Scotland, whereas in England and Wales, social care is provided by local authorities. There is more private sector involvement in England than in the other nations.
Who is responsible for decisions with regard to COVID-19 in Northern Ireland?
The Institute of Government has a useful explainer on COVID-19 and devolution. They underline that while most public services impacted by the pandemic are the responsibility of respective devolved administrations (e.g. health and education), there is a strong emphasis on regional coordination across the UK.
Emergency UK-wide COBRA meetings are attended by the First Minister, the Deputy First Minister, the Health Minister and other Ministers where relevant. Northern Ireland Executive Ministers are also in close contact with their counterparts in the Irish Government, both informally and through the North-South Ministerial Council.
The Department of Health (DoH) sets policy and regulations for COVID-19 in Northern Ireland.
The DoH sets COVID-19 testing policy. It is responsible for The Health Protection (Coronavirus, Restrictions) (Northern Ireland) Regulations 2020. While many Northern Ireland regulations are coordinated with the wider UK, the DoH issues Northern Ireland-specific advice.
The DoH works with other Executive Departments, for example with the Department of Finance in sourcing PPE. While there is a four nations PPE oversight board, each devolved administration has their own supply chain operation and is responsible for distribution.
The DoH also leads on COVID-19 strategic organisation. For example, it set up a COVID-19 information app and website, launched an HSC workforce appeal, and oversaw the establishment of Belfast’s first Nightingale Hospital.
The Chief Medical Officer (CMO) and the Chief Scientific Officer (CSO) from the DoH work with their UK counterparts to provide coordinated advice across the four regions. CMOs from Northern Ireland and Ireland are also in regular contact and have developed a Memorandum of Understanding.
The Public Health Agency (PHA) gathers information and communicates advice about COVID-19 in Northern Ireland.
The PHA is responsible for monitoring COVID-19 trends. It publishes daily surveillance bulletins with information on testing, numbers of confirmed cases and COVID-19 positive deaths. It has undertaken contact tracing. It also monitors the impact of public health measures to reduce virus transmission.
The PHA sends out public health messages such as #StayAtHomeSaveLives. It also issues wider general health advice during the pandemic, regarding for example pregnant people, stress, sick children and household accidents.
The Health and Social Care Board commissions services, and plays a logistical and coordinating role.
For example, the HSCB has made arrangements with independent hospitals to treat non-COVID-19 patients and has helped GPs, pharmacists, dentists and optometrists to restructure services. The HSCB also liaises with counterparts in the Health Service Executive in the Republic of Ireland to make the best use of collective resources.
Health Trusts ensure service delivery on the ground.
The Trusts are focusing on service delivery throughout the pandemic, from social work through to medical care. With regard to COVID-19, Health Trusts, for example, worked with the DoH to reconfigure hospital provision. They recruit staff, in conjunction with the DoH’s HSE workforce appeal. They have worked with the PHA to establish testing centres for healthcare staff in the SSE Arena car park and some MOT centres.
The Trusts deliver social care in nursing and residential homes as well as domiciliary care, adapting services for COVID-19. They also work with the independent care sector to ensure appropriate COVID-19 measures are in place. The pandemic has seen Trusts play additional emergency roles, for example the South Eastern Trust established a PPE delivery service for domiciliary care workers.