Edwin Poots has said that Northern Ireland's health service could be thrown into a "major crisis" by a regular outbreak of flu.
The Health Minister issued the stark warning in a letter to his Executive colleagues that revealed how a £140 million shortfall for his department would devastate services here.
As well as cuts to key services, Mr Poots warned of the potential for industrial action by health care workers.
In a grim prediction, he claimed lives could be at risk, and there would be delays in new drugs for cancer patients. And thousands of people would be left waiting even longer for surgery.
The DUP minister said that the cuts would have a severe impact on every area of the health and social care service, particularly on the "most vulnerable in our society" over the next six months.
As he threw down the gauntlet to the Executive, Mr Poots challenged ministers to either choose where to make the cuts or to give him an extra £80m to "avoid the most devastating impacts of the proposals on the public".
He condemned the magnitude of the reductions he was being asked to implement, saying: "The consequences and implications are wholly unacceptable and, indeed, indefensible.
"Squeezing to this degree will have a detrimental effect on nursing care and will have a profound impact on patient care and experience.
"It is likely that outbreaks such as flu or winter vomiting bugs could not be contained and could cause a major crisis for the health service."
Among the worst-affected will be the frail and elderly, the sick with long-term conditions and young vulnerable children requiring social care, Mr Poots added.
His department's proposals for additional savings include:
- Imposing pay freezes on all health and social care employees, including salaried doctors and dentists, which would achieve a £14.9m saving.
- Saving £18m on reviewing the money spent on pharmacy services in hospitals and by doctors, restricting certain drugs and encouraging the use of generic drugs.
- Saving £7.5m by reducing the use of agency nurses over the next six months.
- Saving £3.5m by reducing home care packages by 4% and leaving the frail elderly with shorter visits and fewer visits per day and week.
- Saving £12.6m in running costs expenditure.
Where the axe could fall: The cuts detailed in Health Minister's letter
Pay restraint across the board. This would mean that doctors' and dentists' pay would mirror proposals for health staff in England in 2014/15 - although the plan carries with it the very real possibility of industrial action.
Spending on agency and locum hospital doctors would be cut by half for six months.
However, the impact would be significant on all Trust areas. It would mean Emergency Departments not being able to meet targets, with breaches of waiting time standards inevitable. Patient-flow through the hospital system would be severely impacted, particularly on elective and unscheduled care services in the South West, Causeway, Daisy Hill, Lagan Valley and Downe hospitals.
Spending on agency nurses and social workers cut by half for six months. Several specialist wards would close and hospitals would be expected to have severe problems with emergency admissions. District nursing in the community would not be able to cope with the demand for services such as IV antibiotics and blood transfusions as this would affect hospital, community, mental health and children's services. No new graduate nurses could be employed and any reduction in social work capacity would lead to an increase in unallocated child care cases.
Spending on home care packages cut by 4% for six months. This would hit our frailest and elderly patients the hardest. It could make their stay in hospital even longer and reduce the time allocated to each homecare visit, with reduced regular visits and a longer time taken for the award of new packages. The knock-on effect would be increased GP visits to the person's home and/or emergency admissions to hospital, as well as increased delays in discharges and an increase in Emergency Department breaches of the four and 12 hour waiting time standards.
A review of pharmacy services would lead to a reduction in the amount of money spent in hospitals and by GPs. However, it is likely to lead to restrictions in the availability of certain drugs, an increased use of generic drugs and a review of expenditure in community pharmacies.
Cuts of 2.5% to Health Department agencies. External bodies – such as the Regulation and Quality Improvement Agency, which inspects health and social services – face a mid-year cut. But this measure would also have a "substantial impact"on the Fire and Rescue Service, leaving it with a "significant challenge to maintain a safe level of service provision".
Some elective care is under threat, including operations and procedures in general surgery, orthopedics, ear nose and throat, gynaecology, urology and neurology. The likely impact over the next six months is a delay in patient assessment. The number waiting more than 15 weeks for assessment is expected to increase by 20,000 and the number waiting for 26 weeks will increase by 7,000. There would also be protracted waits for patients requiring investigation for cancers and eye disease.
Progress on the 'Transforming Your Care' reforms would be substantially delayed under the proposals by the minister. Only two out of the five health trusts would be able to roll out all-new Northern Ireland-wide services for the frail, elderly, and patients with respiratory problems, diabetes and strokes. The planned introduction of a irregular pulse detection service for all over-65s and 'at risk' patients under 65 who would be receiving the flu vaccine from next month would not proceed. That would affect some 238,000 patients.
Drug therapies could be delayed. This would mean patients waiting up to seven months for new treatments for cancer and hepatitis. Also, more than 400 patients with rheumatoid arthritis, psoriasis, multiple sclerosis, inflammatory bowel disease and HIV would have their treatment delayed.
Organ transplants could be affected from October.
Couples trying to get pregnant on the NHS using IVF treatment may find themselves no longer eligible.