Special Report: Paramedic with 43 years’ service: Northern Ireland NHS is in its worst state ever
A paramedic with more than four decades of experience has said the health service in Northern Ireland is "the worst I have ever seen it".
Brian Maguire (69), from Belfast, was speaking as the health service braces itself for swingeing cuts, with a projected £160m shortfall this year.
Secretary of State Karen Bradley last week announced the budget for the coming financial year, which will see the Department of Health get £5.306bn.
However, this is £160m less than the £5.466bn health bosses have said they need to maintain existing services.
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Concerns are mounting that the massive black hole in the budget will heap even more misery on the tens of thousands of patients languishing on waiting lists for hospital appointments, diagnostic tests and operations.
Paramedic Mr Maguire, who revealed how patients facing life and death situations are being let down, said: "I have been working in the health service for 43 years and I can put my hand on my heart and say this is the worst I have ever seen it."
And Janice Smyth, head of the Royal College of Nursing (RCN) in Northern Ireland, said: "It is the patients and staff who suffer through all these cuts.
"We are already seeing the effects of massive cuts to the budget in previous years and attempts to save money.
"Nursing posts went unfilled, funding for nursing bursaries and training was cut, and the result has been more people waiting longer for appointments and procedures, trolleys lining the corridors in A&E, and an over-reliance on agency staff which is a very expensive way to run the service."
Last year the health trusts were ordered to find £70m of savings amid uncertainty over the budget. They made a range of controversial proposals, including cutting the number of operations, community care packages and use of agency staff in order to balance the books.
The trusts were able to cancel many of the most contentious proposals at the eleventh hour after the Department of Health was handed £60m through the monitoring round process in July.
However, it is believed they will be asked to draw up similar plans in the coming months as it is not known how much money will become available from this year's monitoring rounds.
As a result, patients, staff and organisations that rely upon the health service for funding face months of uncertainty over the future of services.
Waiting times for appointments are already spiralling out of control, with an increasing number of people turning to savings to pay for treatments instead for painful and debilitating conditions.
Patients, GPs and consultants have told that waiting times of up to five years for some surgical procedures are not uncommon.
According to the most recent official figures, just under 207,000 had waited longer than nine weeks for a first hospital appointment at the end of September, compared to 178,279 for the same period last year.
Almost a third of patients had waited longer than a year for their first outpatient appointment on December 31, 2017.
These figures are expected to rise further as the strain on the budget continues.
Ms Smyth said: "The proposals made to save money last year were horrendous, we all remember them. If the trusts have to implement similar savings this year, then I don't know how we are going to cope.
"One good thing out of the budget announced last week is the £100m for transformation.
"We are in a position where there is some money to take forward the proposals made by the Bengoa Report - but there are question marks over how much we will be able to do in the absence of a health minister to make decisions."