Assessing Health Services in Northern Ireland


To help the OECD understand key elements of health and social care commissioning in Northern Ireland, researchers assessed key informant perceptions of how effectively the population's needs are being met, the use of strategic planning, and how well the system incentivises high quality, value for money service provision.

The front entrance of Northern Ireland's Craigavon Area Hospital

Northern Ireland's Craigavon Area Hospital

Photo by Dean Molyneaux/CC BY-SA 2.0


Across industrialised countries the cost of healthcare is increasing - driven upwards by increases in the costs of providing care, medical advances and demographic changes. In Northern Ireland (NI) the situation is no different. For the 2014/15 budget the Department of Health, Social Services and Public Safety (DHSSPS) identified that it required an additional £420 million to meet the costs of all existing policies and expectations. Taking into account planned increases to the DHSSPS budget of £90 million and savings of £170 million, the DHSSPS predicted the funding gap would be about £160 million. Given these financial constraints, the DHSSPS needs to ensure that available resources are used to increase access to services and improve the health of the population in the most efficient and sustainable way.

The OECD was asked to conduct a case study on the key elements of Health and Social Care commissioning in NI. This study provides recommendations for potential ways to improve the effectiveness of the delivery of health and social care (HSC) services through better commissioning in NI.


The project team considered the following three aspects of the review of commissioning arrangements:

  1. How effectively the health and social wellbeing needs of the population of NI are assessed.
  2. The use of strategic planning to prioritise those assessed needs within available resources.
  3. How well the system incentivises high quality, value for money service provision to meet the assessed and prioritised needs of the population.


The project team made several findings, based on interviews with key informants:

  • The ability of the Health and Social Care Board to conduct needs assessment was perceived to be hampered by a lack of capacity, and while specialist knowledge was available it was poorly articulated in decision making.
  • The commissioning process was characterised as reactive and not producing the long-term transformation in care needed to address the increasing demand for services, and for developing new models of care to meet complex conditions.
  • The commissioning process was reported to create incentives to deliver activities rather than health and wellbeing outcomes. Payments were perceived to be linked to the volume of activity and not the outcomes achieved.
  • The role of competition was acknowledged to be limited by the size of the system. However, there was a perception that resources are allocated on the basis of existing provider power rather than efficiency and there were opportunities to introduce more contestability and managed competition.


The project team recommended that policymakers should:

  • Build political engagement and a new consensus around commissioning to meet the long term health and social care needs of people in Northern Ireland.
  • Build greater transparency into commissioning decision-making.
  • Balance the focus on acute care with greater collaboration from the full range of providers to develop effective, sustainable and integrated care pathways.
  • Join up with other parts of the system and integrate work force planning.