title: United Kingdom (Northern Ireland): Health system review.
abstract: The political context within which Northern Irelands integrated health and social care system operates has changed since the establishment of a devolved administration (the Northern Ireland Assembly, set up in 1998 but suspended between 2002 and 2007). A locally elected Health Minister now leads the publicly financed system and has considerable power to set policy and, in principle, to determine the operation of other health and social care bodies. The system underwent major reform following the passing of the Health and Social Care (Reform) Act (Northern Ireland) in 2009. The reform maintained the quasi purchaser provider split already in place but reduced the number and increased the size of many of the bodies involved in purchasing (known locally as commissioning) and delivering services. Government policy has generally placed greater emphasis on consultation and cooperation among health and social care bodies (including the department, commissioners and care providers) than on competition. The small size of the population (1.8 million) and Northern Irelands geographical isolation from the rest of the United Kingdom provide a rationale for eschewing a more competitive model. Without competition, effective control over the system requires information and transparency to ensure provider challenge, and a body outside the system to hold it to account. The restoration of the locally elected Assembly in 2007 has created such a body, but it remains to be seen how effectively it will exercise accountability.
authors.affiliation: NUI Galway.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.forename: Pat
authors.initials: P
authors.lastname: McGregor
authors.forename: Sherry
authors.initials: S
authors.lastname: Merkur
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D058005:General Practitioners / Q000458:organization & administration / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000458:organization & administration; D005102:Health Expenditures / Q000706:statistics & numerical data; D006298:Health Services Administration; D006304:Health Status; D006280:Health Workforce / Q000458:organization & administration / Q000706:statistics & numerical data; D061889:Healthcare Financing; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D009660:Northern Ireland; D057766:Policy; D011057:Politics; D011635:Public Health Administration / Q000706:statistics & numerical data; D012946:Social Welfare; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*