The first cut isn't the deepest. What's coming next will go to the bone. The Western Health and Social Care Trust (WHSCT) has spelt out what services will have to be slashed if the "savings" demanded by the Department of Health are to be delivered.
The picture they paint is scary – especially if a member of your family is in need of special care.
The public service union Nipsa has called on the trust to refuse to implement the measures and on the Assembly's health committee to back the trust in saying no.
Nipsa says that it "will commence consultations with our members on the possibility of strike action to protect jobs and services". The scale of the contemplated cuts may prompt some who would normally shrink from the notion of industrial action to sing from a different song-sheet.
That, or come up with a better idea for saving the jobs of health professionals, maintaining an adequate supply of medical equipment and reassuring some of the most vulnerable among us that they are not about to be ditched.
In a letter to the Health and Social Care Board on August 23, the WHSCT's director of finance, Lesley Mitchell, disposed of the claim that making the "savings" would not necessarily damage frontline services. They will – and to an extent which has not yet become the focus debate. That is, the measures required would be so devastating they would have to be signed off by a body with a higher pay-grade than the trust.
The trust has identified the "potential measures" needed to find the specified £4.6m. Taken together, these would appear to be incompatible with the trust's duty to "directly provide services to people to ensure that these meet their needs... and to ensure all services are safe and sustainable".
How can that mission statement be reconciled with "reducing levels of respite provision for children with a disability"? This will have "a direct impact on the current population of service users," says the WHSCT.
Or with "progress[ing] the reform [sic] of statutory residential care and planned closure of homes".
Last week, Health Minister Edwin Poots (below) suggested that half of the North's 56 homes will have to be closed, which would involve losing 800 places over the next five years.
"Do not provide cover for 25% of medical vacancies, maternity and sick leave with agency locums ... Do not provide cover for 50% of AHP [allied health profession] vacancies, maternity and sick leave with agency staff."
This "will result in elective targets not being met... Nine-week waiting list will not be delivered... Quality of care will be compromised, including delays in discharging patients from acute hospital," says the WHSCT.
"Cap expenditure on lab chemicals/consumables": "Will result in delayed diagnosis which will impact on timely treatment."
"Cessation of generic family planning services ... Cease the provision of immunisations by health visitors ... Reduce beds in palliative care ... Reduc[e] unfunded nursing by 25%, including unfunded staff in wards and bank and agency cover ... Progress reform of mental health services and planned closure of Slievemore House [in Derry] ... Moratorium on [filling] new vacancies for admin and clerical posts."
Nipsa official Alan Law was hardly exaggerating when he said on Monday that the WHSCT estimation of the effect of the cuts "paints a very dire picture".
In announcing that the plan – Transforming Your Care – will be put out for a 12-week consultation, Edwin Poots told the Assembly that it offered "a vision of a new model of care... focused on ensuring that more services are provided in the community... prevention, earlier interventions, promoting health and well-being and having more personalised care that is planned and delivered around individual needs..."
The Health Minister maintained that the proposed changes were "not about cost-cutting, but were about improving service-delivery and making better use of resources".
This is the line that was spun by politicians and NHS chiefs across the water as they pushed for "reforms" of a similar nature and magnitude. This turned out to mean not only a reduction in services, but widespread privatisation – of homes for children and old people in need of care, for example – with the results that we are all now too familiar with.
The 12-week consultation period at least allows time for closer scrutiny of the Poots plan and the preparation of resistance.
It shouldn't be wasted.