SDLP representatives will not lobby against health service reorganisation in their constituencies if changes have been recommended by experts.
So pledged Colum Eastwood on BBC’s The View last week.
The SDLP leader qualified this by adding reforms must be “sensible” and involve travel times of no more than an hour for treatment.
However, he was unusually direct by the standards of this issue, saying he will tell party colleagues they must “absolutely support… the hard decisions [that] will be required”.
Eastwood also volunteered the point that lack of reform rather than lack of money is the basic problem.
Colleagues might feel all this is easy for the MP for Foyle to say. There will be no downgrading of services at Derry’s Altnagelvin hospital - restructuring would almost certainly see it grow and acquire new regional specialist centres. But in North Belfast, SDLP deputy leader Nichola Mallon might have to ‘absolutely support’ downgrades at the Mater Hospital; in South Down, an SDLP revival is tied to the fortunes of Downpatrick’s small general hospital.
It is inconceivable that SDLP politicians would go along with an A&E closure in their area, for example, let alone actively advocate it. Other parties are no different. In 2019, all five executive parties turned up to a meeting in Lurgan to object to centralising breast cancer services away from Craigavon Hospital, although the move was in accordance with the 2016 Bengoa report that all five had adopted as executive policy.
Northern Ireland’s inability to modernise healthcare is hardly a unique failing: democratic politics everywhere struggles with the same task. We are merely gathered around a smaller parish pump. In theory, mandatory coalition should be an advantage in making hard decisions as it gives every party a reason, or at least an excuse, to stick with an unpopular consensus. In practice, a decision as emotive as a hospital closure will always see one or more parties break ranks, perhaps especially from the forced and unwieldy partnership of a Stormont executive.
The effective collapse of many NHS services, with waiting lists stretched out to five or six years, might once have been expected to shock parties into action, yet that disaster has arrived without provoking fresh urgency.
Parties were shocked into bringing Stormont back 18 months ago when voters rebelled over waiting lists. Health reform is the “immediate” top priority under New Decade, New Approach. Despite that, and Covid since making waiting lists even worse, the executive is settling back into torpor on the issue. This may simply be a challenge elected representatives cannot tackle head-on.
The conventional solution to such a democratic deadlock is to commission a binding expert report, with parties promising in advance to implement whatever it proposes.
Bengoa made only outline recommendations so there is scope for a detailed follow-up report. However, this would still be repeating earlier, more specific reports on rationalising the hospital estate - there have been half a dozen by some counts over the past 25 years. It is unconscionable to waste another two or three years reinventing the wheel for a political backside-covering exercise that is not even guaranteed to work. Would any report ever be ‘binding’ enough to prevent another farce like the Lurgan meeting?
The MP for Foyle might recall an unfortunate historical precedent. Bringing in outside experts for a binding report was how the new University of Ulster ended up in Coleraine.
A more sustainable approach to delivering reform would be introducing the model in parts of Europe, where public healthcare has operational independence. Although ministers still set budgets and objectives, deciding what facilities go where falls entirely to managers.
Health charity the Nuffield Trust has proposed operational independence for the NHS in England, with various options for how this could be delivered. One would be a “BBC model”, with an NHS Corporation accountable to ministers and parliament but managing itself under a charter.
Delightfully, Derry provides another precedent. The Londonderry Development Commission, set up to replace the gerrymandered council in 1968, is remembered today - when it is remembered at all - for failing to prevent the Troubles. However, its Stormont-appointed panel of experts succeeded in a hugely ambitious house-building and infrastructure programme before handing power back to an elected council in 1973, as planned.
Something similar is needed for the NHS in Northern Ireland, either as an interim measure to deliver reform and tackle waiting lists, or as a permanent solution.
Then everyone we elect can protest against it to their heart’s content.
