John Simpson: Pragmatism required over strike in NI health service
The general election is over. New government arrangements at Westminster are under way to allow normal decision making. That 'normality' still leaves Northern Ireland without a devolved Government and an unsatisfactory gap in decision making for the health and social services.
The local decision making for the health and social services, in the absence of a local minister, falls on the Permanent Secretary, Richard Pengelly.
He has the authority to use the available budget to maintain the complete range of services. He does not have the authority to change the policy framework.
Hence the dilemma caused by the apparent inability to offer a pay settlement which would be at odds with a previous ministerial decision creating a pay structure which set Northern Ireland parameters for some staff which differ from pay parity in a comparison with the English NHS.
Mr Pengelly is defending a two-edged argument. Although there are strong voices that the industrial dispute should be settled by an offer of pay parity with England, that principle is not to be assumed as binding.
There is an argument that the delivery of devolution should expect local decision making which may, or may not, try to deliver parity.
Potentially, devolution should be able to deliver different results depending on local circumstances, whether to differ upwards or downwards.
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Mr Pengelly must find a way to settle the current industrial dispute. With hindsight, past management decisions have been confusing.
The public have been given an apparently inconsistent defence: no Minister, therefore, no decision ... followed by a decision to reallocate funding to make a constrained pay offer.
That opens the way to a pragmatic one-off further step to reach a settlement, so that further damage to healthcare can be avoided.
Critically, steps should now be taken to combine a pragmatic settlement of the dispute along with an agreement to find a new longer-term dispute resolution mechanism which allows for an agreed form of independent conciliation before industrial action is taken.
There would be near general support for a shared vision that withdrawal of medical or nursing services for patients should be a last resort, after conciliation has been attempted.
The current dispute sits uncomfortably alongside the inadequate activity to reverse the record levels of waiting lists for medical consultation and in-patient services.
Reducing waiting lists does not seem to have attracted even modest management action to avoid the personal discomfort, or worse, for so many people.
Official responses have endorsed the advice of the Bengoa report but, in terms of improved performance, there is little confidence that there is a clear operational agenda for change.
There have been small changes in clinical arrangements is some specialist treatments, but these have been only marginal.
If the health service management knows how to tackle the waiting list problems, this message is not being convincingly delivered.
If there is a need to find selective sequential capital proposals, the local finance budget could be adapted. Implementing Bengoa should not be delayed by the absence of a Minister.
That report was endorsed before the Executive fell.
With the current overall performance difficulties, although there have been some objections, there is now an exceptional case for an extended series of treatment agreements for wait-listed patients through short-term contracts with the available private sector facilities.
There is some spare capacity in each of the three largest facilities.
The Ulster Independent Clinic has an annual turnover of over £28m (before adding medical fees), 352 Medical Group has a turnover of £35m and in the North West, Corvally Healthcare's turnover is about £12m.
If ever there was a case for exceptional, rule bending, special measures it is now. The NI health service budget for 2020-21 is now being decided. Ideally, local political institutions should play a part.
If not, the price of human suffering more than exceeds the necessity to find answers.