Last week the new health minister Robin Swann gave a keynote address to the Royal College of GPs. The health and social care system is in turmoil, staff are burnt out, demoralised and the public are in despair. What was needed was a rousing, electrifying, visionary address.
What we got instead was a mixture of deflection, a rehashing of tired excuses and some deeply worrying fatalistic language. There is an escalating crisis in health and social care, with waiting lists that look set to reach 500,000 people, unprecedented workforce vacancy rates, increasing demand, a crumbling healthcare estate and a hugely challenging financial landscape.
All of these issues require urgent attention, to stabilise the system and ensure a sustainable model fit for the future.
The Ulster Unionist MLA said he wanted to build a “shared understanding” about the risk of “service breakdown”. He also warned of a “huge mismatch between expectations and financial realities”. The minister stressed the need to push back against any notion that there is “a magic reform fairy who can wave a wand, save us billions, transform services overnight and turn grey skies blue”.
It is difficult to know where to start with this. Firstly, the huge mismatch between expectation and reality. What exactly is this referring to? Expectations here could hardly be any lower. We have resigned ourselves to broken promises, platitudes, inefficiencies and appalling outcomes. Accessing health services in a timely fashion is now beyond the reach of most people.
The long-suffering public in Northern Ireland has been asked to accept the longest waiting lists in the UK - and amongst some of the worst in Europe - for well over a decade. In England waits of two years have been largely eliminated.
Simply lamenting the finances does not cut it. Despite the minister’s claims, money is not the issue, or at least not the only issue. We spend more per head of population on health of any UK region but have the worst outcomes. Is Robin Swann seriously suggesting that he controls approximately £7 billion but has no agency? No ability to fix things? If so, then why is he in government?
Meanwhile, waits of six years and longer have become commonplace here. Orthopaedics, rheumatology and neurology are effectively closed to new patients. In some trust areas children are waiting over two years for a first appointment to mental health services. These delays have implications for financial security, physical and mental wellbeing but are a fact of life here.
Targets associated with elective care have all been missed, despite them becoming less stringent in recent years. Targets for a first outpatient appointment have rarely been met since 2006.
Secondly, the notion that reform can happen overnight and save us billions? Who in Northern Ireland could possibly be labouring under this illusion? It is simply not credible.
We have been talking about transformation for well over a decade with a clutch of expert reports pointing to the need for fundamental change. How does the health minister imagine that this dirge will inspire loyalty, trust and galvanise shared commitment to change?
Transformation is not easy, but no-one ever said that it was. According to Swann, “Reforming, reconfiguring, transforming health care is a slog, it’s a grind”; actually it is a privilege to be charged with leading a change programme that has the potential to radically enhance lives and communities.
Undoubtedly, we are in a mess. But simply lamenting the finances does not cut it. Despite the minister’s claims, money is not the issue, or at least not the only issue. We spend more per head of population on health of any UK region but have the worst outcomes.
Is the minister seriously suggesting that he controls over half the block grant, approximately £7 billion, but has no agency? No ability to fix things? If so, then why is he in government?
The recent Stormont impasse has not helped, but it alone is not a plausible explanation for this omnishambles. Decisions here have been delayed; counter-intuitive actions taken for short-term savings have plagued the healthcare system.
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Inefficiencies and ineffectiveness exist at every level. Since 2016, unit costs of hospital care have risen by around 28% in Northern Ireland, as opposed to 7-8% in England.
In a recent example of a nonsensical, economically illiterate decision, in October 2023, without consultation, funding for GP clinics which were taking pressure off waiting lists was either halved or stopped completely. GPs had undergone training and accreditation to carry out this work, but it was decimated to make short-term savings. Who thought this was a good idea?
Swann’s speech - in its tone, language, paternalism, patronising assertions and handwringing - demonstrates a malaise that runs deep in Northern Ireland and feeds off itself. It speaks of a poverty of ambition, a lack of vision and inability to engender a sense of collective purpose.
We needed a cheerleader. We got a funeral director.
