You’re right Robin, it’s not about you. But it is about us, and our health is being failed yet again - Deirdre Heenan

Last Thursday the Ulster Unionist Party and its executive minister Robin Swann voted against the Northern Ireland Executive budget.

The health minister claimed that this was a financial settlement that would lead to harm. He lamented, “Not only is this a budget that doesn’t prioritise health, this is a budget that actually removes funding from the health service in Northern Ireland.”

We currently spend over half of the block grant on health and social care. How much would be enough? Sixty per cent? Seventy per cent? How realistic is it to continually ask for more?

The nature of the devolved settlement means that the money that comes here from Westminster is in many respects akin to a cake which is sliced up between the government departments. Without any additional revenue raising measures more money for health inevitably means less cash for other priorities such as schools, justice or infrastructure.

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Where should the axe fall? On our schools, where teachers are already in despair? On our infrastructure, notwithstanding the appalling state of our roads and public transport system? Also, health is a cross-cutting issue that is too important to be left to one department. The social determinants of health illustrate that housing conditions, educational outcomes and environmental factors, to name but a few, have a crucial impact on overall wellbeing.

The fundamental issue here is that any ask for additional funding rings very hollow if it is not accompanied by a detailed plan, blueprint or strategy. This plan of action should set out key priorities such as primary care, social care and waiting lists. It should be framed around key themes, for example early intervention and prevention.

All proposals should be evidence-based, demonstrating how policies and interventions will address longstanding issues. It should be fully costed with timescales, targets and key objectives.

Robin Swann claims that he needs an additional £1 billion to fix the system. A convenient round number, but what is this actually based on? The back of envelope for all we know.

Leadership is about prioritising and not grandstanding. It is concerning that the health minister warned that this budget will result in cuts across domiciliary care, across elective care and waiting list initiatives. Why? Aren’t these the very things that he should be protecting from cuts?

Any reduction in domiciliary care packages will inevitably lead to further delayed discharges and additional stress on hospitals already under severe pressure. Longer hospital stays increase the risk of hospital-acquired infections, patients risk losing mobility and cognitive function. They may also lose confidence and find it difficult to regain their independence after leaving hospital.

It is concerning that the health minister warned that this budget will result in cuts across domiciliary care, across elective care and waiting list initiatives. Why? Aren’t these the very things that he should be protecting from cuts?

Why not attempt to address the shortfall by addressing unnecessary bureaucracy, fragmentation, duplication, poor productivity and inefficiencies?

Last week in this paper Newton Emerson highlighted the nonsensical counterintuitive plans to create a completely new layer of administration within the health and social care system. The Integrated Care System is being sold as a new way of doing area-based planning.

It will include new boards made up of a range of representatives including local councillors, healthcare professionals, service users and representatives from the community and voluntary sector. They will liaise with the Department of Health through a regional forum.

Seriously? This is utter madness. These proposed area integrated planning boards have no powers, no budget, no ability to take decisions, no ability to commission services. Their ideas and recommendations can be ignored by officials in the department.

They are, in fact, glorified talking shops that serve no useful purpose. What bright spark thought that this was a good idea?

Needless to say, they will come at a significant cost. How much? I’ve no idea, nor it seems has anyone else.

These boards were piloted in the Southern Trust, but the report of this trial run is suspiciously hard to access. The department has not exactly been crowing about the success of this scheme.

By no stretch of the imagination can it be assumed ICS represents improvement. So why not just scrap it? As far as I can see these boards are neither use nor ornament.

Also, why has the Northern Trust’s surgery merger to make one emergency site and increase the number of elective cases been delayed? What is holding up the obstetric move from Coleraine to Antrim? Where is the elective care strategy? When can we expect to see the full rollout of primary care multi-disciplinary teams?

The health minister has warned of “dire consequences” if health did not get the financial allocation he demanded. This looks like a blatant attempt to deflect away from inaction and a refusal to reform.

Following the announcement of the budget he stated that he did feel let down, but “it’s not about me”. Correct. It is, though, about us, all the citizens of the north.

We have been repeatedly let down with one fiasco after another. We have been failed by those unwilling or unable to make hard decisions.