Transforming health in the age of COVID-19

It is no secret that Northern Ireland’s health service was in difficulty prior to COVID-19.

Chronic budget constraints, increasing demand, growing waiting lists and workforce pressures across the board are just some of the challenges, and these have been compounded by COVID-19.

Minister Swann himself has cited COVID-19 as the biggest challenge to the Health and Social Care system since its inception.

The health service, not to mention other sectors, is in desperate need of long-term investment. The past decade has seen NI government departments live on short-term year-to-year budgets, making long term investments, transformation and financial commitments difficult to say the least. This inevitably has a knock-on impact on strategy, vision and outcomes, and comes against a backdrop of several campaigns for fundamental reform of the system.

Treasury funding of around £5 billion was anticipated (but not promised) to support the New Decade, New Approach (NDNA) agreement back in January 2020. The Department of Health was expected to receive a sizeable chunk of this to drive the transformation agenda and tackle Northern Ireland’s ever growing waiting lists.

However, this level of funding was not forthcoming and NI received just £2 billion, dubbed “an act of bad faith” by Finance Minister Conor Murphy.

A move to multi-year budgeting - another key commitment in NDNA – is critical in health transformation, as it is across other sectors. However, Chancellor Rishi Sunak’s announcement that November’s Spending Review will be one for one year only instead of the anticipated three years, will see NI’s block grant set for the same period.

The combined impact of a lack of funding and long-term certainty, not to mention the unprecedented challenge that the pandemic has placed on the health service, presents huge challenges for our Executive. 

In February 2020, Minister Swann said that his Department required a £492 million increase on this year’s budget, just to meet the inescapable costs of maintaining existing service levels, with no growth in transformation, and to meet the Agenda for Change pay award and safe staffing costs.

He made no secret that this funding was to stand still, in his own words: “another year of frustration and falling short of public expectations – with gaps in provision and unmet need growing.”

An unenviable position, Minister Swann has, and continues to tackle, diverse and unprecedented challenges in his short tenure as Health Minister.

The core strategic driver for the Department of Health is, and will continue to be for some time, the transformation agenda.

Unfortunately at present, this has had to be put on the back burner whilst HSC resources need to be redirected to deal with coronavirus.

However, in spite of the magnitude of the challenge the pandemic presents to the health service, we may have already seen some transformation in the system take place.  But whilst many are supportive of moves to streamline services, some have expressed concern that we are  ‘drifting’ towards this, as opposed to in a managed and strategic way, with input from stakeholders.

This has included some unconventional practices, including consultation processes taking place concurrently with the planning and implementation phase. Perhaps understandably, this was to expedite the process and has been cited as “in the best interests of the public.” However, it certainly has raised some eyebrows.

Other decisions, such as the closure of A&E services in the Downe Hospital, have sparked a sharp response, with a lack of consultation with staff, patients, political representatives and constituents cited as key points of contention.

It is clear our health service will be tackling both the direct and indirect impacts of coronavirus for some time to come, with waiting lists - which were already unacceptably high - increasing in many service pathways such as elective surgery, diagnostic, screening and treatment services.

The pandemic has highlighted the enduring impact of poverty, inequality and isolation on the most vulnerable. We have also been reminded that serious diseases including cancer, heart disease and diabetes, to name a few, continue to claim lives. As we continue to manage the impacts of COVID-19, it is critical we have a system with capacity to care for everyone in society.

Our leaders are facing an immense challenge. Striking a fine balance between protecting our healthcare service and protecting our economy is vital and should not become a zero sum scenario.

Wellbeing, be that societal, physical, economic or environmental, is a combination of factors that ultimately must determine how our Executive manages its response and recovery in the months ahead.

A united front has never been more important.