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Editor's Viewpoint: We cannot escape the reality of cuts

For some time there has almost been a sense of denial about public spending cuts in Northern Ireland, but now the reality is becoming evident, especially in the NHS.

Leaked proposals show that healthcare in the province is about to undergo its most comprehensive shake-up in a generation, with 2,000 permanent jobs facing the axe, elderly services and prescription drugs budgets being radically overhauled and, most controversially, a reduction in the number of hospitals and midwifery-led maternity units.

No-one should believe that these are issues which can be fudged. The scale of public spending cuts is such that very difficult choices will have to be made. That is not to say that there shouldn't be a proper debate about the issue of funding the health service. Indeed, that is more important now than ever. But it must be a mature debate on all sides and not just an attempt to save parochial services.

Politicians cannot simply champion projects which will play well with voters. The debate should centre on key issues like what efficiencies can be made within existing structures. That means examining services right from the top of management to ward level. Can the service perform more effectively and thus mitigate some of the budget shortfall?

We also must ensure that if hospitals close, those that remain are of sufficient geographic spread to serve the whole province, and that they are properly resourced and equipped to meet the needs of the population. Any overhaul or centralisation of services again must be allied to greater efficiency and maximum effectiveness. It would be utterly pointless to contemplate radical change in the NHS here without an accompanying guarantee that it would continue to deliver high quality and wide-ranging healthcare.

But what cannot be denied is that such change is coming. Our energies should be channelled into ensuring the best possible outcomes, not simply, Canute-like, resisting the inevitable. A more compact, high-quality service would be infinitely better than the current service dying slowly from funding starvation.

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