This study investigated the impact of the Troubles and the potential ‘additional’ costs associated with the delivery of health and social care in North and West Belfast. A variety of research methods were implemented. Initially, two sets of data collected by the Cost of the Troubles Study (1999) were re-analysed. The first was a data set of deaths related to the Troubles and the second was data generated by a survey, which aimed to ascertain the overall impact of political violence on the Northern Ireland population. Existing data was also collected from the Eastern Health and Social Services Board, North and West Trust and South and East Trust. Data was also obtained from the Northern Ireland Housing Executive. Focus group discussions and in-depth individual interviews were conducted with North and West Trust workers.

The aims were to:-

Those living in areas with a greater exposure to political violence and particularly those with extreme experiences of the Troubles report negative effects upon their health. Deaths in the Troubles were overwhelmingly concentrated in Belfast with 40 per cent of deaths occurring within the city. North and West Belfast in particular experienced the greatest number of deaths (75 per cent of deaths within Belfast).

Residents reported experiencing the effects of violence to a greater extent than residents in other areas of Northern Ireland. Furthermore, more people from North and West Belfast also classified their health as being poor (11.2 per cent compared to 6.3 per cent in the rest of Northern Ireland). Over 70 per cent of those reporting poor health also reported a lot or quite a lot of experience of the Troubles.

These figures indicate that the level of need for health and social care among residents of North and West Belfast is higher. The focus group discussions and in-depth individual interviews also confirmed this high level of need.

This report makes 12 recommendations in relation to Troubles related need and provision. These are:

1. Financial Allocation
The impact of the Troubles on health status should be recognised in the financial allocation of resources to Health and Social Services Trusts, not through the modification of the regional capitation formula, but rather by reallocation from the general budget, which could be bid for by Trusts to support projects designed to compensate for Troubles-related effects. Historic exposure to Troubles-related incidents should be used as an indicator of need in this allocation.

2. Data Collection within Trusts
Existing provision for the collection of data within Trusts should be reviewed, to ensure that data is collected to facilitate the monitoring and analysis of the impact of the Troubles in the future. Data should focus on the impact of the Troubles on levels of need, and should include detailed records of untoward incidents due to the Troubles. This will foster the conditions under which a transparent discussion about such issues can take place in the future.

3. A Data Handbook
An audit of existing data held by the North & West Belfast Trusts, and the production of a data handbook should be undertaken.

4. Dedicated Research
Dedicated research should be undertaken to more definitively test the impact of the Troubles on levels of need.

5. An Initiative on Social and Psychological Reconstruction
Consideration should be given to the establishment and provision of a dedicated facility or multi-disciplinary initiative for the reconstruction of communities affected by the Troubles in North and West Belfast.

6. Location of Other Future Regional Facilities
Careful consideration should be given to the location of other future regional facilities within the Board area. Location within North and West should be considered a priority.

7. Solving Accessibility Problem in Segregated Settings
The method of location of Trust facilities should take account of recent developments along peace-lines such as North City Business Centre, located on the ‘no-man’s-land’ of a peace-line, and which offers access to both communities.

8. Review of Up-Take of Staff Care Packages
It is recommended that a review of current uptake of the staff care package be conducted.

9. Staff Debriefing and In-House Support and Training
Consideration should be given to the possible need for specific tailor-made debriefing and training programme for fieldwork staff in North and West Belfast.

10. Mainstreaming the Troubles as an Issue for Health and Social Service Providers
The challenges involved in delivering health and social services in communities affected by the Troubles must be seen to become a mainstream concern, and should be mainstreamed in Board training programmes and on other programmes which should endeavour to ensure that Troubles-related issues are seriously addressed.

11. Rotation of Staff
Consideration should be given to the rotation of staff between North and West and other trusts, so that staff are not expected to serve long periods of time in particularly stressful or embattled communities.

12. Recognition for Outstanding Service
Some method of formal recognition for professionals both at fieldwork and management levels who have worked in Troubles-affected communities, and whose service has been exemplary should be developed.

For details of the published report please click here.