Devolution was restored in January because the health service was in crisis, with one fifth of Northern Ireland’s population on a waiting list, half of them for over a year.
Coronavirus will obviously make this worse, both from the temporary interruption to the NHS and the long-term burden of infection control.
Voters forced Sinn Féin and the DUP back to Stormont to solve the crisis, yet voters dislike the solution of centralising health services, as recommended by every report commissioned on the issue for the past three decades, most recently the 2016 Bengoa Report.
Sinn Féin and the DUP signalled their intent on this conundrum by refusing to choose the health portfolio in January, leaving it to a plainly surprised UUP.
Other parties are as bad. Late last year, they all objected to moving breast cancer services away from Craigavon, although this is part of the Bengoa policy they have all endorsed.
Coronavirus is not going to make this any better. Last week, UUP health minister Robin Swann said Stormont had let the NHS down over the past decade as “difficult choices were ducked”.
Although this statement was incontestably true and covered a period of DUP, Sinn Féin and UUP health ministers, Sinn Féin still flew into a rage, insisting “the Tories” were solely responsible, while the DUP remained conspicuously silent.
The executive’s coronavirus truce applies between the big two parties only, both of whom are clearly itching to get stuck back into their sacrificial Swann.
It is time to admit the executive is not up to delivering the necessary change and the task must be taken out of political hands.
There is no shame in this, or abandonment of democracy. Every political system struggles with such complex, contentious decisions and delegating them to an independent body is a conventional, accountable response.
Stormont had a debate on this in 2014, when a previous report on NHS reform advised that recommendations be binding on the executive.
The author of that report, Professor Liam Donaldson, blamed parish pump politics and media populism for blocking difficult decisions.
The health minister at the time, the DUP’s Edwin Poots, baulked at committing Stormont to doing whatever the experts said and instead commissioned another expert report, from Professor Rafael Bengoa. If Northern Ireland’s health service is circling the drain, this is the circle.
Stormont has an unfortunate history with binding reports - that is how the University of Ulster ended up at Coleraine.
Stormont has a more successful recent history of going the whole hog and removing ministerial control.
The clearest example is policing, where the PSNI has full operational independence and the justice minister has no policy or even oversight role, unlike with justice ministers in Dublin or home secretaries in London.
A chief constable may be summoned before politicians on the Policing Board to explain the closure of small rural police stations, for example.
That explanation needs to show how closure serves the PSNI’s top-level mission of upholding law and order within the confines of available resources. The parties that make the laws and allocate the resources can then complain about the consequences. So the job gets done and everyone is happy, or blamelessly unhappy, which for a politician is even better.
A key service does not have to be as politically loaded as post-Troubles policing to receive the same treatment. Public transport has been largely self-governing in Northern Ireland since 1967, with the law only permitting ministers to “from time to time give directions”.
Operational independence for the NHS is a mainstream debate in Britain, inspired by comparable models in Scandinavia.
The Conservatives toyed with the idea when they were last in opposition but ended up merely adding more layers of bureaucracy.
Labour’s last health minister, Andy Burnham, proposed an ‘NHS constitution’, similar to the BBC charter and renewed every 10 years, to take most decisions out of ministerial hands.
Gordon Brown reportedly considered an independent NHS board, modelled on his creation of an independent Bank of England. Setting interest rates had been one of the ultimate political powers.
Surrendering power is difficult for politicians, even if they dread using it. However, creating an independent NHS in Northern Ireland would be a remarkably easy act of administration: we already have a single Health and Social Care Board that could simply be cut loose from the Department of Health.
Stormont can either do that, or cause and preside over the collapse of public healthcare. Those appear to be its choices.
