Health Service Revamp Is Sure To Be A Bitter Pill

Our Health Service faces a time of unpopular but necessary restructuring – some of which will be left to the new Assembly. Claire Regan reports on the task ahead for our new Health Minister and MLAs.

The road to completely transforming how our health system is run will be a long and rocky one. While many controversial and difficult decisions have to made on how best to streamline management – not least the loss of hundreds of jobs – there is no doubt its aim is to have a better funded and more efficient front-line service for patients.

Ask any member of the public, especially one waiting for a vital operation or suffering a serious illness, if there’s a need for more secretaries or more doctors and we know what the reply would be. That’s not to detract in any way from the key contribution administrative and managerial staff make. They are the people who drive the service, provide leadership and make the decisions which impact directly on important issues, such as slashing hospital waiting lists.

Department of Health Permanent Secretary Andrew McCormick told the Belfast Telegraph last month that current estimates will see 1,700 clerical, managerial and executive jobs go over the next four years – more than double original estimates.

Since the Government’s announcement on how the Review of Public Administration would re-shape the Health Service in November 2005, no-one has been in any doubt that it would lead to job losses. After all, the whole point of RPA is to cut back on cash spent on bureaucracy and re-invest it where it is most needed by the public, in areas such as health and education.

No front-line jobs, such as doctors and nurses, are to be hit by the cuts. In fact, the £50m it has been estimated the cuts will save each year will be ploughed back in to social care and front-line services. And the cash boost should see a welcome increase in employment at the chalk face.

The Department stressed that it has no plans for compulsory redundancies, yet cannot rule them out. The in-coming and yet to be named Ulster Unionist Health Minister has a difficult task ahead. No politician will want to be seen as the man who signed off tens of hundreds of Health Service jobs, regardless of the intentions behind the cuts. And if the prospect of compulsory redundancies rears its head, then the high-profile post will be all the more controversial.

The first step on the road of restructuring was taken at the start of this month when our 18 health trusts merged into five. The four health boards are also to be replaced by an over-arching body.

There currently isn’t a huge difference in the day-to-day running of the new organisations but there are other sensitive decisions ahead for MLAs in the four year period it is estimated RPA will take to complete.

It’s easy to see how problems can arise when you think of how, for example, 18 trust managers of various departments or 18 headquarters have to be whittled down to five.

The new Stormont ministers are to be more accountable to MLAs than in the previous Assembly. As such, members will have more influence on major decisions being taken. Stormont politicians will be in charge when it comes to looking at where the permanent headquarters of each of the new trusts will be based – something that might prove sticky, depending on where their constituency is.

While the Belfast Health and Social Care Trust is the biggest body of its kind in the UK, it is not as geographically big as the Western trust which stretches from Limavady in north Londonderry, as far as south Fermanagh.

Any MLA serving as health minister or lobbying from the health committee who stands in, for example, the north west, may be keener to see the Western HQ set up in Derry rather than Fermanagh. To be seen to be behind a decision that would remove key HQ services and possibly employment from their own constituency is not something any MLA would want.

With this in mind, our new Assembly members will have to pull off a delicate balancing act when it comes to deciding on such emotive issues. They must act in favour of the long term interests of our Health Service and patients – but will no doubt be keeping an eye on individual interests unpopular with voters.