Michael McGimpsey: 'I don't want to say I told you so but all I predicted has happened'
Lisa Smyth talks to former health minister Michael McGimpsey about the future of the NHS, his proudest moment in the job and why he is still opposed to same-sex marriage.
Q. Is the UUP interested in taking back the health portfolio after the next Assembly election?
A. We still have to have that discussion. I had no involvement with health at all until I became the minister, and it proved to be a difficult department to run. It was very, very difficult.
It really took a huge effort on my part and the part of others, so whether the party is up for that depends on the budget.
If the budget is reasonable, you can do a reasonable job, but if it's a bad budget, then you're going to do a bad job.
Q. The budget shortfalls you experienced when you were health minister were well-documented at the time. How did they affect your ability to deliver in the job?
A. Any time I stood up in the Assembly, there was a hysterical reaction from the DUP, firstly from Iris Robinson and then Jim Wells, and then Sinn Fein and Alliance joined in.
It became very personal. Some of the comments were very personal, very vicious, nasty, uncharitable, not Christian. It didn't bother me because I knew I had a job to do, but it bothered my mother significantly.
In my final year as minister, the finances rocked a bit because Sammy Wilson, who was finance minister at the time, appeared one day at the Executive and said he had a £300m black hole and that everyone was going to have to contribute pro rata, which meant the health service had to provide £150m.
In the same year, we also had to deal with swine flu. I needed £55m to cover me for my costs for buying Tamiflu and getting the capacity in place. There were some seriously ill patients, although mortality didn't go as bad as expected.
At one point, we were advised of the possibility of 15,000 premature deaths, which is a massive amount, so I prepared for that but only got £5m and had to find the other £50m.
The thing that kept us going was the staff who stretched themselves because they understood the situation.
There was an anticipation that once there was a new health minister in place, they would get a sufficient budget and everything would be okay.
That actually never happened - the DUP believed their own propaganda and they put through a budget that effectively regularised the poor situation, and that is where we are still at today.
So, I have to say I found the last year difficult because I felt we let the patients down and we were letting ourselves down as we weren't giving the doctors or nurses the support they needed.
Q. Do you believe the excessive waiting times facing patients across Northern Ireland could have been prevented?
A. I don't want to say 'I told you so', but what I said would happen has happened and it breaks my heart.
I feel we were on a fairly even keel and addressing issues such as waiting times until about 2010, when we rocked a wee bit.
I could have kept the show on the road if I had been given an extra £200m. Without it I said that waiting times would spiral and there would be staff vacancies, issues around drugs and not being able to supply the latest drugs and a deterioration in services. All of that has come to pass.
In 2011, Peter Robinson was saying it would be obscene to give the health service any more money. Simon Hamilton talked about the health service being fed billions over the years, and when Poots arrived, his first line was "I don't need another penny, there isn't another penny, we're going to make this work". Yet six weeks later he was saying that he needed a quick £300m to keep the show on the road.
I believe the problems we face now can be fixed, but it is going to take investment, and Simon [Hamilton] is going to have to go to the Executive and make that case. And I believe that the other departments are going to have to find the money to do that. Balancing the books isn't exactly rocket science - you know how many hip operations you're going to need, how many care packages you're going to need, so you add that all up and that's your budget.
I wasn't looking for an infinite budget when I was minister, just the money we needed to meet demand.
Q. What do you regard as your greatest achievement as health minister?
A. That is a difficult question to answer because I believe that we did so much. We made so many policy changes, such as introducing free prescriptions and the thrombolysis service. We also increased the age for breast screening.
However, I suppose the most important thing we did was setting up the Public Health Agency (PHA), which was very much about engaging the population about their own health.
I suppose the PHA encapsulates where we were coming from because unless the population is engaged, you are fighting a losing battle.
The problem is, health outcomes in poorer areas are so relentlessly poor, with incidents of smoking and poor lifestyle choices, so I believe that the health service will only function properly when the PHA fully delivers its promise.
It is asking a huge amount of the PHA, but I believe that it can deliver if it is given the right support and resources. I think that if it is done properly, when you look back in 10 or 20 years, you will say that the PHA saved so much money and so much pain and stress for patients.
Of course, I didn't achieve anything on my own when I was minister - I had an awful lot of help and advice, and I have to acknowledge that.
Q. You also established the Health and Social Care Board, which Simon Hamilton has just announced is to be abolished. What is your reaction to this?
A. The idea behind the board was to have a lean and professional organisation which would commission the trust to deliver treatments. When it started, I said there should be a maximum of 250 staff, but after a lot of crying and wailing that they couldn't do it with that number of people, I allowed it to go to 350. When I left there was 335.
The last time I checked, about six months ago, there were 525 employees, which is a 40% increase, so it is clear that it has become bloated. I believe that they have spent money on bureaucrats and administration.
The job will still have to be done, so I think you will see an awful lot of the same people going back into the department and doing the same job, only under a different umbrella.
Q. It appears as though more change is on the horizon for the health service. Will Northern Ireland's politicians support the more radical proposals, which could see services moved and hospitals losing their acute status?
A. I don't think there is the political maturity [to do that]. I understand that from very bitter experience.
When it comes to changing the way services are delivered, I don't think there is a mature approach. There is a 'not in my back yard' stance, although in saying that I do think there has to be a coherent plan in order to win support.
For example, Simon [Hamilton] closed beds in Bangor hospital. They were step-down beds - exactly the sort you need. They take patients out of acute beds in the Ulster Hospital and put them in a nursing ward setting where you don't have the acute medicine but the patients are managed by GPs.
Simon shut them because he worked out he could get them cheaper in a nursing home, but the problem with that is the patients are cared for by care workers supervised by a nurse.
There is a world of difference in the provision of care, and it wasn't a logical decision. I believe that if you don't have a coherent and sensible plan, you are never going to get a mature response.
Unfortunately, this is the sort of thing that we need to happen, otherwise the health service is going to break down.
Q. What is your position on the ongoing ban on gay men donating blood?
A. I think it is a nonsense. For a start, there is no such thing as bad blood - it is either safe or unsafe. We have very safe blood, and decisions about donation are governed by protocols set by an advisory committee.
I followed their advice, and when I was minister, their advice was not to accept blood from gay men. But that advice has changed, and I would have no problem with them. I think the current position here is a mistake.
We don't produce enough blood here - we rely upon and take top-ups from England, which will contain blood from gay donors, so it is a nonsense. I say stick to the science and that a change in policy is safe.
Q. And what is your position on gay adoption?
A. It is a nonsense to say that same-sex couples can't provide properly for children. The key thing is giving the child support and a warm, loving, caring environment. I believe that same-sex couples are perfectly capable of providing that.
I had legislation on adoption going through when I was minister, but it was stalled at OFMDFM for nine months. Martin McGuinness told me it was the DUP stopping it.
As far as I am concerned, children living in a family with same-sex parents do just as well as heterosexual parents. If they are fit and appropriate to provide the support the child requires, that is what you go for.
Q. Given your position on gay adoption, how did you vote when the issue of same-sex marriage came up?
A. I voted against it. I have no issues or qualms about civil partnerships and same-sex couples giving blood, but my view is that marriage is defined as between a man and a woman, and that is what I believe.
It is not an equality issue. I don't believe same-sex couples are disadvantaged in any way. My concern, frankly, is that we will end up in a situation if it becomes law where we will have churches being targeted inappropriately by the Equality Commission.
I voted against it on the last four occasions. I gave it serious thought and I consulted my conscience, as they say, but in the end I still believe marriage is between a man and a woman. It is a heterosexual concept.
Q. Can you explain the rationale behind your decision to abolish prescription charges?
A. When I started as health minister, 90% of all prescriptions were issued free, but patients not included in exemptions included patients with cancer, heart disease, asthma, stroke, osteoporosis, kidney disease and arthritis.
There was a huge number of people not benefiting, so we looked at making them exempt, but we still would have had the administrative charges to cover.
There was also £7m fraud in the system, with people getting prescriptions they should have been paying for.
And there was clear evidence to show that people were not taking their medicines because it was costing them money, so unless it was the right time of the month or week, they were deferring buying their medication so that they could spend the money on other things.
Ultimately, this was costing the health service money, so getting rid of prescription charges was cost-neutral.
I actually funded it myself because it wasn't costing the department anything.
There was always the risk there would be a surge in demand once free prescriptions came in, but we followed Scotland and Wales. It didn't happen there and neither did it happen here.
Q. Do you believe prescription charges should be reintroduced, as suggested by former health minister Jim Wells, in order to fund a specialist drug fund?
A. I believe that healthcare should be free at the point of delivery, so people should not be asked to pay for their prescriptions.
If you go into hospital and the doctor writes a prescription, you get it for free, but as soon as you walk out the door, you start to pay for it. That is irrational.
You want people to take their medicine when they need it, as prescribed by the clinicians, and I think charging for mediation goes against the ethos of the NHS.
I nearly think it is a perverse approach to charge patients for prescriptions for a drugs fund. We can't have a situation where we start taxing the sick to pay for the sick.
There has also been a suggestion that there should be a universal charge, but does that mean a six-month-old baby is going to have to pay? Or an elderly person with dementia? Or someone who is not fit to work? If you are talking about an elderly person paying, then they may be making a decision between a bag of coal or some gas and their medication.
As far as I am concerned, the logic behind this idea is to bring in an escalating charge. They will start small but build it up, and I think we are headed to paying £10 for a prescription. I think there is an awful lot of dishonesty about the proposal.
They would need Executive approval to get it through, however, and, fortunately, I think Sinn Fein have said that they won't support it.
I regard the idea as taxing the sick, who are by definition the most vulnerable in society.
Look at Sinn Fein's position on welfare, which is all about protecting needy and the vulnerable people. You simply don't get any more needy or vulnerable than sick people.
Q. You have cited the introduction of free prescriptions as one of the positives in your time as health minister. What was your lowest point?
A. I think it would have to be the way the other parties played politics with the health service. They clearly didn't want me to deliver for fear of me getting a political advantage.
I kept saying it wasn't about politics, but in the end they withheld money for the cancer centre at Altnagelvin, and then I was heavily criticised when I made the announcement that it couldn't go ahead without more funding. It all became very personal. Martin McGuinness called me sectarian, although I think that says more about Martin than it does about me because he clearly believes Altnagelvin is a Catholic hospital for Catholic people.
The thing is, over the past four years, I had spent £110m on Altnagelvin, and when it came to the radiotherapy centre I had used £28m of my capital budget, with another £14m coming from the Irish Republic. But we still needed £12m for training of staff because without staff you just have a building.
I submitted a business case in the October, and by the following March I still hadn't heard anything back and I couldn't get an answer out of the Department of Finance and Personnel. Sammy Wilson wouldn't even respond to me.
I could have been disingenuous and made the announcement that the centre would go ahead as planned, but I felt it was better to be honest. I was given a very hard time as a result.
I felt like even after everything I had achieved over those four years, the other parties were still playing stupid games, which was difficult to accept.
Q. So is the health portfolio a poisoned chalice?
A. No, I don't think so. Politically, it may be, but in reality it is a rare privilege and a rare position to be in as you get to make important decisions. You get into politics to make lives better. Would I do it again? Perhaps if I was that age again, but you should never go back. However, knowing what I know now, would I do it again? Yes, it is a rare privilege. You're serving people and making decisions that make a difference, and you can be a force for good.