Health Minister's options are issues of life and death
When then Finance Minister Peter Robinson revealed his first Budget for Northern Ireland in November 2007, I posed the following question in this column: do we want a freeze on our household rates, a delay in our water charges or a damaging squeeze on our health service?
Mr Robinson responded to my criticism with a robust defence of his Budget. As far as the health service was concerned, he said, "simply pumping funds into an unreformed system will not resolve the issue facing the sector" and "there is no scope to increase funding significantly" without damaging other departments.
Today, his Stormont Executive is still at loggerheads over health spending. Boxed into a corner is Health Minister Michael McGimpsey. Mr Robinson - now First Minister - says he should consider his position. This view is echoed by deputy First Minister Martin McGuinness.
Matters are coming to a head swiftly because Stormont has yet to agree a new Budget and the bills for health and everything else in Northern Ireland need to be financed from April 1.
April Fools' Day will take on a new meaning if the current Finance Minister, Sammy Wilson, cannot deliver a Budget by that date. The omens are not good.
Some very unhappy bunnies are coming out of winter hibernation and chief among them is Mr McGimpsey himself.
He has three options. One is to accept that what he says is unacceptable in terms of the draft proposals in the Budget. The second is to engage in brinkmanship to the bitter end in the hope of achieving an improved offer. The third is to resign if he fails to get what he believes the health service requires.
The Department of Health and Social Services is facing a crisis of high magnitude. So, too, is the Stormont Executive and the experiment in devolution itself.
It was always going to be like that because the spending cuts announced by the new coalition Government in London could not have come at a worse time for Northern Ireland.
No amount of political camouflaging at the polls can hide £4bn of public spending cuts. Most likely, David Cameron and Nick Clegg would face electoral meltdown if they had to face voters before the summer, yet this predicament looms for the Assembly in May.
The tensions in the Executive are rising - as witnessed by the criticism of the draft Budget from the Ulster Unionists and SDLP. The very structure of Stormont is now up for debate.
Unfortunately, no consensus is apparent in finding ways and means of making Stormont a more effective institution.
Peter Robinson wants fewer MLAs and departments. Tom Elliott goes further and hints that the Ulster Unionists could form a formal Opposition.
Neither the SDLP nor Sinn Fein appear enthused about tinkering with, or reforming, Stormont as it is presently constituted. Without nationalist/republican support, it is impossible to have change - no matter how much it is needed.
The battle over health spending will bring the Executive's unwieldy decision-making process into sharper focus in the next month.
The health minister and those who administer hospitals and trusts are constantly in the firing line. No matter what a huge proportion of the Budget is devoted to health, it seems not nearly enough.
Northern Ireland, more than any other corner of the UK, is dependant on public health services, but Mr McGimpsey argues that it is substantially under-funded in comparison to the rest of the UK. He stands accused by other parties in the coalition of rocking their boat. Notwithstanding the minister's views, I'm inclined to take the word of respected senior civil servants who say our health service is facing a major crisis and that it needs a minimum injection of another £200m beyond what Sammy Wilson's draft Budget has proposed.
The stakes are high because thousands of jobs are under threat. Services may be curtailed or abandoned. Issues of life and death are on the negotiating table.
If the Stormont Executive cannot fund our health service adequately - and the signs are that it will not - the minister responsible should not shirk from precipitating yet another political crisis.
The day is looming when Mr McGimpsey may have no alternative but to do the honourable thing: resign.