Operations and staff could be affected as health trusts are told to save £10m a month
Northern Ireland's health trusts are today facing the biggest cash crisis in their history as they are forced to find savings of £10m a month.
The health trust boards have to cut a total of £70m from their budgets in the current financial year - which has just seven months left to run.
After separate meetings, the five trusts will this afternoon spell out their proposals to implement the spending reductions. The early impact is likely to be on agency workers, locums and other temporary staff where savings can be achieved almost immediately.
But non-urgent procedures, operations, and other appointments are also likely to be postponed or even cancelled.
The urgent need to save the vast sum - which health service sources say is unprecedented since the trusts were formed - is the first key pressure point to emerge for the five main political parties since the Executive fell.
The £70m total of cuts would have been even worse, however, but for a £60m injection announced by Secretary of State James Brokenshire in July - the result of unspent departmental cash elsewhere.
There are two more so-called 'monitoring rounds' to hand out unspent money in the current financial year but it is not known how much it will amount to, and there are no guarantees over where it will be spent.
The Department of Health has told the trusts their priorities must be quality of care and patient safety.
But health service chiefs privately admit they are in uncharted waters in the continuing absence of a Stormont minister.
And any decisions taken by a permanent secretary would be wide open to a legal challenge.
Like other Northern Ireland government departments, health has now been without a minister since March, with little prospect of an early deal in the negotiations to restore Stormont.
However, the share-out of the spending cuts across the health trusts - Belfast, Southern, Northern, South Eastern and Western - are said to be "proportionate". A six-week public consultation starts today after which the trusts will draw up their final plans.
In the likely continued absence of a health minister, there could be a further period of public debate, particularly if some of today's temporary measures look like becoming longer-term.
Last night the largest health service union, Unison, urged the five trusts to refuse to comply with the savings demand - even though they, like the department, have a statutory duty to live within their means.
"The Health and Social Care system cannot spend money it does not have and savings must be applied to this year's budget in order to achieve financial balance in 2017/18," a departmental statement said. But Unison regional official Patricia McKeown said the union wanted to remind all trusts "that they have both legal and moral obligations to the people of Northern Ireland and to the health service workforce".
She added: "The people are suffering from rampant rationing of care. The workforce is suffering from pay capping and increasing casualisation.
"At the same time, private medicine is mushrooming as some make extraordinary profits from a growing crisis."
The department has also asked the Health and Social Care Board to work with the trusts to try to mitigate the impact of some of the cuts.
Amount that the health trusts have to cut from their budgets in current financial year, which has seven months left to run
Sum of money injected into the health service in July - the result of unspent departmental cash elsewhere
Staff costs account for 72% of trust costs, according to Unite's Kevin McAdam, who feared jobs may be put at risk due to the budget crisis