Belfast Telegraph

John Compton: We'll witness indignation and anger, but the reality is we've known about this for months

By John Compton

Yesterday's meetings at all five Health and Social Care Trusts approved documents to go out for public consultation to achieve £70m savings by March 2018.

No doubt we can all look forward to political indignation, union anger and public bewilderment at the potential consequences.

In reality, there is no surprise about what has happened. The service was about £300m short at the start of the year, by mid year it is £70m. Politicians, unions, professional bodies and senior and middle managers have known about this difficult financial climate for months.

In these circumstances there is always the clichéd response -too many men and women in grey suits, greater efficiency in delivery or doctor 'bonus' payments.

The truth is that this response is all nonsense and is merely avoidance of asking the difficult question - how are we to find £300m each and every year to maintain our health and social care system?

About half of it will come from government and the service in one form or another but in our present arrangements the other £150m will remain a profound challenge leading to many more days like yesterday.

Let's hope, however, the system gets better at explaining what the choices are. In this regard, yesterday wasn't a great day. If it was known at the beginning of the year action to achieve financial balance was necessary, why is it late August before there is a real public debate?

Cash won't begin to be saved if approved after consultation until November, leaving five months to achieve the £70m target.

Even with the best will in the world this is a tall order and many in the system think at best only 50-60% of the target is achievable. How does that impact on financial balance?

What is less straightforward is what was not said or made crystal clear. Will the £70m create a full break-even position in a year? It is only savings for this year, will next year's problem be £370m and rising? Is the pay award for this year to be made and where does that figure in the financial plan?

Finally, what of extra winter support which all trusts have been used to year on year? Is there access to the millions regularly spent over the winter this year and exactly where will our waiting list times be? If not, what are the implications? The cynic might ask with this lack of clarity regarding the total financial position if what's happening is just a giant game of 'chicken' - with health and social care reducing itself to running the service like a financial spread sheet to wring out necessary extra resource?

I sincerely hope not. Creating anxiety for those who are vulnerable in this way would be unforgivable.

Whatever the driver, it is a fact that the service we all depend on in this climate will pose greater risk of not being available to us when we need it and by implication a more challenging risk environment to those who deliver that service.

On a positive note, it is time we all realised exactly how financially fragile our health and social care system has become and that there are no easy fixes.

Some might argue that had a devolved government been in place, yesterday might been have avoided - perhaps!

However, it would not have avoided the financial difficulty. In all probability it would have done what it has always done, a robbing Peter to pay Paul exercise.

The fact is the financial problems in health and social care are such that they will pose a real threat to a returning Executive.

About 50% of the Northern Ireland block is now consumed by health and social care and yesterday told us this percentage needs to be bigger.

What does that say to those who might grapple with that task?

Is the NI Executive going to be imprisoned by the scale and demands of the Health and Social Care system for the foreseeable future or is it and, are we as citizens, going to finally accept reform means change, some of which we may find unpalatable.

Choice is coming and if yesterday told us anything it starkly pointed to the choice of an increasingly fragile service or one where reform is essential and realism about finance is unavoidable.

John Compton is the former chief executive of Northern Ireland's Health and Social Care Board

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