By Moore Holmes
Health in Crisis as Stormont Stagnates
Proposals published by NI Health Trusts on how they are going to reduce spending in their department by £70million sent an anticipated shockwave throughout Northern Ireland.
What was presented at the HSC Trust’s consultation meetings were details about how exactly the Health Service intended to save £70 million and which services were going to feel the brunt of the blow.
The £70 million savings spread across five Health Trusts is the latest controversy in an extensive line of issues arising from Northern Ireland’s health service. Waiting lists are at an alarming high (worst in the UK) and show no sign of getting shorter. The Health Service needed a £60million injection from the Secretary of State in July, which only served as a sticking plaster covering a wound now reopened, with the newly proposed cuts.
It is reasonable to ask why the health service is spending over its allocated budget in the first place. But figures show that an ageing population, rise in healthcare demand, inflation and the increasing cost of high-level treatment means the health service needs to spend more just to keep up with itself. In fact, the health service currently requires an annual 6% funding increase to merely deliver the same service year on year.
This annual 6% increase is not financially sustainable. Yet despite both the DUP and Sinn Fein promising £1 billion to the Health Service in 2016, it cannot be done without raising taxes, reshuffling the budget, or making cuts – maybe even all three.
Even the much-discussed deal between the DUP and the Conservatives, which offers a £250 million parachute payment to health, will not be available year after year. The parachute cannot be stuffed back in the bag for next year once the cord has been pulled.
It seems that sooner or later the Department of Health is going to have to make some controversial cuts to rebalance and refocus their spending. The negative attention this will receive makes it somewhat of a poisoned chalice and it will be interesting to see what strategic vision the future Health Minister puts forward, whoever and whenever that is. In any case, I suspect it is just a matter of time before someone is forced to grasp the nettle.
What is happening in the short-term however is something of an ironic insult to the people of Northern Ireland. Those elected with the political power to immediately revoke such proposals have been outspoken in their criticism toward the cuts.
It somewhat cheapens the tone when MLA’s, who chose to resign from their position of legislative influence, begin criticising those who they imposed responsibility upon. You could be forgiven for getting the impression that politicians cannot do anything about the cuts – they can.
What we gain however with the outlined £70 million savings proposal is a detailed account of the damage ongoing deadlock at Stormont is causing. Public opinion and media outlets have been drowned with Irish language and Ulster Scots, legacy issues, gay marriage and the rest. Not enough attention has been given to the tangible impact the absence of government is having on departments such as education, justice and health.
The £70 million savings proposal will affect several services relied upon by thousands of people. The medical workforce is already too light and the reduction of agency nurses and locum doctors will only stretch it further. Waiting lists are going to get even longer by deferring specialised treatments.
Those seeking the 1st cycle of IVF via NHS will be deferred until next year.
New patients with Multiple Sclerosis, Inflammatory Bowel Disease and dermatology conditions will have their high-drug costing treatment deferred until next year. (Belfast Trust)
For every 3 clients who cease domiciliary care only 1 new client will receive the same treatment. (Belfast Trust)
For every 3 clients who cease residential housing packages only 1 new client will receive the same treatment. (Belfast Trust)
The reduction in agency staff and locum doctors, combined with the restricted accessibility of domiciliary care and residential housing will undoubtedly put more pressure on the Emergency Department waiting times also.
The Belfast Trust alone, responsible for saving £26.3 million, estimates the reduction of 95 beds (3-5 wards) and a savings plan which directly impacts around 3000 people.
The real impact however could not be more ominously put than in the NIHSC Trusts own statement.
“Delay in routine treatments may lead to patients requiring urgent care.”
The sober reality is in fact that these cuts put people’s lives at more risk than what they necessarily need to be. And it will be the most vulnerable in society that face the greatest risk. The clients less likely to receive residential care and domiciliary packages are mostly elderly or disabled. Thus, the most vulnerable are paying the price because of the political elite.
The insulting irony is that whilst the majority of MLA’s oppose the health cuts, at the same time they wield the power to reverse them. This only proves that political gamesmanship is preventing that outcome.
Regardless of who holds the largest share of the blame, the fact that the two largest parties cannot form an executive to provide the leadership and a vision for the Health Department is nothing other than a dereliction of duty.
Sinn Fein argue over legacy issues, an Irish language act and gay marriage. DUP respond with equal expectations for Ulster Scots and refuse to concede on gay marriage. Altogether forcing a deadlock at Stormont which has gone on for too long.
The public on the other hand is divided as they retreat to their traditional corners. Unionists criticise Sinn Fein for collapsing the government in the first place, and demonstrating little evidence that they sincerely want Stormont to function on anything other than the Republican party’s terms.
Alternatively, Nationalists blame the DUP for not giving Northern Ireland what they believe to be entitled marriage equality and native language acts.
Amidst the controversy, what is clear is that Sinn Fein is using its position as the largest Nationalist party, legislated by the Belfast Agreement to form a mandatory coalition with the largest Unionist party, as leverage for their manifesto aims.
It’s not to say that there is something objectively wrong with this. Its politics, and in order to achieve your aims and satisfy your electorate you have to use what advantages you can.
But you cannot expect to convince the public that what your holding out for is somehow more valuable than the lives at risk due to Stormont stagnation. In this regard Sinn Fein must be held accountable.
Although Sinn Fein reserve the right to hold out until Irish Language etc. is conceded, their case gets weaker with each consequence the absence of an executive causes in Northern Ireland. After all, their current demands did not stop them from forming previous governments with their Unionist counterparts. And more importantly, there is nothing to stop these issues being discussed in a working executive as opposed to being used as a bargaining chip in forming one.
At the same time, we must not exonerate the DUP from all responsibility. RHI, which seems to have become something of a story in the shadows of late, was gross incompetence on their part and whether agreeable or not, became the justification for collapsing Stormont.
The DUP also cut funding to Irish language in 2016, which can only be looked on now as a foolish decision. They went on to not only reverse the funding cut due to the backlash they received but also arm Sinn Fein with an example of DUP disregard for Nationalist values.
In any case, the longer this saga goes on you really do begin to wonder;
How long before DUP and Sinn Fein form an executive? What will it take for DUP to compromise on Sinn Fein’s demands? And if they don’t, will Sinn Fein put the needs of the people above the ambitions of the party? And still, if the two largest parties cannot form an executive, at what stage do we pursue Direct Rule as the best course of action for the sake of Northern Ireland?
As much as the “delay in routine treatments may lead to patients requiring urgent care,” the further delay of a functioning executive is leading to unnecessary cuts, people’s health facing greater risk with strains on numerous departments and an inevitable return to Direct Rule.
The biggest crisis this country currently faces is the absence of government.