Health Service Faces 'Extremely Difficult And Worsening' Situation

Northern Ireland's health and social care services are facing an extremely difficult and worsening" financial position, Health Minister Robin Swann has warned.

The minister made the warning in his keynote speech at the Royal College of General Practitioners (NI) in Ballymena. Minister Swann said the next year is largely going to be about "damage limitation" given the scale of the budgetary pressures.

Reflecting on his return as Minister, he said his main priorities include securing pay settlements, addressing waiting lists, and improving primary care and social care.

"I will want to push forward with improvements and innovations, as resources allow. However, much of the focus this year will inevitably be on stabilisation."

He also said: "The year ahead is largely going to be about damage limitation for health and social care. The main focus will be on preserving and protecting existing services, with all the limitations that they have. Even just to manage this, as a system, we are going to have to maximise efficiency, and improve performance. This will mean a continued focus on changing services, consolidating delivery and working collaboratively."

Pledging to push for the best possible funding settlement for health for 2024/25, he said NI is facing "the most challenging fiscal context in any period since the Belfast Agreement".

The Minister also told the event: "I believe we all have a duty to be honest with the public about what we see. The risks of service breakdown are real and growing in a range of areas – I do not say this to frighten people but to help build a shared understanding. We continue to have expectations and demands of health and social care that we cannot currently meet and on the current trajectory the situation is getting worse rather than better." He further said: "There's a huge mismatch between expectations and financial realities. Being in Government here is going to involve breaking a lot of bad funding news to a lot of people. In health, therefore, the Executive and I will not be able to come close to doing all the things we want to do."

Mr Swann emphasised that waiting lists cannot be fixed "in isolation from the wider health and social care system", saying this would be like "trying to repair the wing of a plane midflight while the engines are conking out".

"That's why the core health budget for next year will be so important. Funding for waiting list initiatives will have much more limited impact if the overall budget is far short of what the system requires."

Welcoming the decision by trade unions representing staff on Agenda for Change terms and conditions to ballot members on a proposed pay settlement, the Minister emphasised his limited options.

"The reality is that implementing the recommendations of independent pay review bodies or mirroring pay settlements in England is at the very limit of what can be afforded at this juncture.

"That does not address longer term grievances of below inflation pay awards over the past decade. That's an issue across the public sector, not just in Northern Ireland, but the whole of the UK. It was a direct consequence of the policy of austerity adopted in London.

"I don't think it's feasible to expect Executive Ministers to able to undo those consequences, given the resources we have at our disposal. The quarrel, the dispute, is national and if there is a solution it will have to come at a national level. I say this to colleagues in positions of leadership in the health service, who I hold in the highest regard. I have a track record of supporting and valuing staff. I will always be your champion. But I can't fix situations created over the course of many years by national government. You can fight me on that if you wish. But if I'd rather be fighting for you, than fighting with you."