Northern Ireland's top doctor has delivered a stark warning about a growing gap in the care received by patients in Northern Ireland and the rest of the UK.
The First and Deputy First Minister were told that planned health cuts next year could result in the health service breaking the law by failing to provide minimum standards of service, as well as failing to meet key targets in the Programme for Government.
The stark predictions are contained in a presentation made to the two political leaders in April by Michael McBride, the Chief Medical Officer, and Julie Thompson, the senior finance director of the Department of Health. The briefing document was used at a presentation by Dr McBride and Ms Thompson on April 2.
The meeting was referred to by the DUP last week in a challenge to Martin McGuinness, the Deputy First Minister.
"Did Martin McGuinness just not listen to the Chief Medical Officer at his last briefing in April or did he choose to ignore what he was told by Michael McBride some months ago?" Gordon Dunne, a party spokesman asked.
Mr McGuinness last night held an urgent meeting with Dr McBride in Londonderry to review the funding crisis in health. Neither commented afterwards.
The issue is a bone of contention between the two biggest parties because the DUP has claimed that the Executive cannot adequately fund health or other departments because of the refusal of Sinn Fein to implement welfare reform. This has resulted in reductions in Northern Ireland's block grant from Westminster.
The document, a copy of which has been obtained by the Belfast Telegraph, spells out the implications and states that an additional £160m is needed to fill the funding gap in health next year. The alternative, it warns, involves compromising patient safety and allowing our standards of care to fall below the rest of the UK.
Under the heading 'Impact of budget allocation: 2014/15' the presentation lists:
- Deterioration in waiting times for elective services.
- Compromising the safety and quality of services.
- Compromising the delivery of statutory requirements.
- A growing parity gap between Northern Ireland and the rest of the UK.
It notes that £492m has already been delivered in savings since 2011.
It lists a number of unpalatable choices for the Executive if it wishes to make further savings instead of increasing spending.
These included "constraining pay for HSC staff", an option which has led to staff balloting for strike action. Other options involve "reducing the range and/or standard of services offered" and imposing charges on patients for the health service. This could include introducing prescription charges or charges to use some services such as accident and emergency.
Westminster has introduced welfare reforms which will reduce benefit spending. Up to now Sinn Fein and the SDLP have vetoed the reforms at Stormont because of their impact on claimants.
As a result we are overspending on benefits and Westminster is reducing our block grant by £87m this year; it was already reduced by £13m last year. Edwin Poots, the DUP Health Minister, has said that he cannot implement the savings that will have to be made in the health budget as a result.