John Compton: 'We must find a way forward or Northern Ireland health and social care system will simply decline'
Former health chief John Compton issues warning on the threat to services posed by Stormont stalemate
Whilst depressing for many, the recent political impasse poses a very real threat to the functioning of our health and social care service.
It faces an unprecedented financial challenge which threatens to undermine its ability to respond to our needs. There is no Executive in place to lead or take decisions, perhaps at this most difficult time for the service in the last 20 years.
The financial challenge for the year 2017/18 after the service makes its normal annual savings of £60m-£80m, which is no small task, will be over £300m. This is a huge overspend and an unsustainable financial position. We will all notice and bear the consequences if this is not resolved, yet not all of our politicians seem anxious.
Remember, we are told that the RHI scheme is costing over £20m per annum and it will take 20 years to cost over £400m, without action.
I draw on this example only by way of contrasting the political response. Without a very significant investment or curtailment of health and social care provision, spend in the incoming year will exceed £300m more than the budget, in one year! Yet there is no political noise about this fact.
Of course, it won't overspend, at least not to that level, because services will be rationed.
How will rationing show itself? It's really quite straightforward. We will all have to queue longer for services.
Waiting lists, already unacceptable, will get longer. The time we wait to see our GP will grow.
Those receiving community services will not be immune. Packages of care to older citizens will take longer to be in place and many community groups will see funding restricted. More and more service cracks will appear.
So how did we get into this mess? What seems complicated is in truth pretty straightforward. The Assembly began over the past few years to fund the financial debt in the service with short term money, coming from monitoring rounds.
For example, many politicians assertively lauded last June's monitoring contribution of £70m. What they omitted to say was that, come March 31, it would all be spent and the debt of £70m would reappear on April 1, plus additional debt to cover new demands. Exactly the same is true for money spent on waiting lists. It is like having no money left in your current account and using your credit card for regular family expenditure.
So before the service can draw breath, as it moves from one year to the next, it is £100m plus in debt and depending on this to deliver core services.
Add to this responsible but unstoppable uplifts in nursing home care at 4%, pay uplifts at 1%, and contributions to the new apprentice levy and soon we are at £200m.
Then there are new buildings opening, at the new Ulster Hospital and phase two of the cancer centre at Altnagelvin. The bill just keeps rising! Remember too, no money mentioned yet for new cancer drugs or the absolute necessity to be able to respond to the health and care issues posed by us all getting older, or those with mental health difficulties.
None of this should really be a surprise to our politicians, but there is real resistance to acknowledging the challenge or to have an honest public debate about where the financial challenge places the health and care service, recipients of it and those who work in it.
When, if ever, has there been a real debate about the fact that Northern Ireland has a more generous health and care system than England and Wales?
For example, there are no prescription charges and home care is not means tested, it is free. This is not to argue for charging, but it is surely right that there should be the endorsement and leadership by the political system to explain the choices and consequences, rather than consigning it all to the "too difficult box".
Turning to reform, everyone seems to agree we need reform and politically we seemed to have for the first time a consensus on the need to reform.
Our political impasse has poured cold water on that prospect, yet apart from generalities, there is no sense of a "burning platform" on the part of our political system as to the financial and service consequences for our health and care system.
Bengoa promises much, but the truth is our political crisis has cost us all a material time delay in reform. In the interim, the existing service model, which is not fit for purpose, soaks up more and more cash.
Perhaps just as crucially, it has left many working in the system feeling beleaguered and let down. Even if Bengoa gets back on track, have our politicians the courage to lead the change - or will they lead the protest to stop change?
In my experience, there are politicians who genuinely recognise the challenge the service faces and want to support it. However, this is far from a universal position.
There is a stark choice now facing us in the present political impasse. Find a way forward or accept that the health and social care system will decline and be consigned to the never ending task of wrestling with an insoluble financial conundrum, lurching from one short term solution to another - when its focus should be on prevention, and high quality care and treatment.
It employs directly or indirectly about one in nine of the working population.
The service spends nearly £15m every 24 hours and its ethos and value is subscribed to by all of the 1.8 million residents of Northern Ireland. Whatever the other problems, surely this must be motivation enough to find a constructive outcome to the current political stalemate.