A decade after a critical health service review, has there been any change?

A decade ago Northern Ireland's health service was likened to a "burning platform" - where there was such urgent pressure that "standing still is no longer a viable option".

The man who described it that way, Prof Raphael Bengoa, published a 2016 review that was supposed to change the way Northern Ireland does healthcare.

His proposition was practical but ambitious - that a system under relentless pressure could not simply treat more patients, run similar services in different hospitals and spend more money.

The name Bengoa came to represent something that Northern Ireland's health service desperately needed: the possibility of improvement and change.

A shift in emphasis was needed, he said, towards prevention, integration and keeping people well in the community, which would require the support of GPs.

But 10 years on, hospital waiting lists, access to GPs and the state of social care imply the job is far from finished.

While political parties say they continue to support the Bengoa ethos, with an election looming next year some actions suggest differently.

Speaking to BBC News NI, Bengoa said there was no reason why Stormont politicians could not embrace transformational change to bring about a world-leading health service.

"The most important green shoot 10 years ago was the political parties getting together and agreeing and putting a budget in place to support the plan.

"It would be great to see that consensus happening again with a budget that runs over three years to allow for long-term planning."

Bengoa also said GPs were key to prevention and reducing pressure on hospitals if the new neighbourhood health model is to be successful.

Notably his review tackled controversies that had been stifling transformation for years and, remarkably, it got five political parties to sign up and buy into making change happen.

Bengoa argued that the system was too focused on hospitals and buildings.

He said that Northern Ireland could not sustain every specialist service at every hospital and that some services should be consolidated into one hospital site.

A decade later, it is clear that the health service is finally moving some services around.

What is also visible is the degree of public and political concern that amalgamating certain services should not happen.

Politically, things have never been so toxic.

Intervention over emergency general surgery being consolidated in the Antrim Area Hospital and removed from Causeway Hospital triggered the resignation of former Health Minister Mike Nesbitt.

Other examples include moving services from South West Acute Hospital (SWAH) to Altnagelvin - and, more recently, potentially Daisy Hill's maternity services to Craigavon.

The public, especially in rural areas, have voiced their concerns that they are being short-changed and that lives are at risk. People power, as seen in recent weeks, is affecting decision making.

Without a doubt, the transformation has fallen well short of the ambition set out by Bengoa and, without a current budget, severe challenges remain.

Since 2016 Stormont has collapsed not once but twice and the Covid pandemic arrived, which overwhelmed an already strained system.

While the pandemic set the system back by three years, many argue that it was not the pandemic that hijacked progress, but instead politics and politicians.

An ageing population with increasingly serious health problems also means change is not straightforward.

However, there have been improvements in areas such as emergency department waits, and some elective waiting lists have begun to fall.

But overall Northern Ireland continues to have the worst hospital waiting lists and all the health trusts are still missing official waitingtime targets including in cancer.

The neighbourhood model scheme, which is just starting, has already seen about 2% of budget being moved from hospitals and shift into the community.

For instance, that funding will be felt in community palliative care services where people can die at home instead of in hospital.

According to health officials the single digital record system Encompass is making the system a lot more efficient when it comes to appointments and patient records.

Marie Holland is 69 and recently had her right hip replaced due to arthritis.

She was an urgent referral in 2025 and said compared to others she is lucky as fast treatment has made a fantastic difference to her life.

"Oh, it's brilliant. For the first week or so it was painful but after that I have been great - I have been on a cruise and more mobile.

"The only thing is I need the second hip done and that is holding me back. But this right hip is brilliant."

However, in simple terms, it is difficult to argue that Bengoa's transformation has delivered the health service envisaged in 2016.

The review's central diagnosis - that Northern Ireland needed fundamental reform to make healthcare sustainable - remains highly relevant, while implementation has been incomplete.

The department itself says the programme has made progress but significant work remains.

Bengoa argued that GPs should be integral to change, but Dr Ursula Mason from the Royal College of General Practitioners Northern Ireland said that can't happen without investment in more GPs.

"There is a simple equation, we have had falling number of GPs - in 2016 there were over 350 practices, now there are 305 and we have a rising patient population.

Mason said she supported the neighbourhood model.

"In order to take patients out of the hospital and move care into the community we need a workforce who can deliver that and that workforce is GPs."

Dr Alan Stout, who was a member of the expert panel behind the Bengoa report, said the health service is "undoubtedly in a worse place now" than it was 10 years ago.

"We haven't taken those actions and we haven't made those changes that are described," he said.

"We need to do so much more than waiting lists. They are really important. But actually they are a symptom of the wider problem."

Stout said the health service had instead seen "change by crisis", adding: "We see the pressures, we see collapse of service, usually dictated by workforce issues."

However, he said there was an opportunity to "move very quickly to a better place" through the neighbourhood health model.

The Health Minister, Robbie Butler, said that "without a shadow of a doubt" he supports the implementation of the Bengoa recommendations.

He described it as a "very valuable report" that "remains to be the cornerstone for transformation for our health and social care system".

And whilst he said things are "certainly not where they should be", he also said that there are reasons for this such as Stormont not sitting for five out of ten years and the Covid-19 pandemic.

Speaking on Good Morning Ulster, he also explained that "funding has been an issue for NI for many years across many of the executive departments".

But the health minister made clear that "health and social care are much too important to politic about".