“We are going to proceed with the Altnagelvin extension [] and that’s the end of the matter.”

The Northern Ireland First and deputy First Ministers’ separately declared commitment to reverse the NI Health Minister’s decision to postpone the funding of a new radiotherapy unit at Altnagelvin hospital is yet another populist move without regard to budgetary considerations – this time just ahead of an election.

It also undermines the position of the smaller parties at the NI Executive table and the authority of the Executive itself.

From the BBC report

Mr Robinson said it could be overturned on the basis of a cross-community vote.

He said that under the ministerial code the Executive, not the Minister, has the final say.

“We are going to proceed with the Altnagelvin extension for cancer care and that’s the end of the matter,” he said.

“The Executive is able to take this decision and the SDLP, Sinn Fein, and the DUP have now all said that they will go ahead with this project,” he insisted.

Actually, the Assembly has the final say, but we know that OFMDFM don’t concern themselves too much with that either…  And there’s an assumption in the comments by the DUP leader of the election result.

As for the ministerial code, it does allow for the referral of any matter which

(vi)  is significant or controversial and which has been determined by the First Minister and deputy First Minister acting jointly to be a matter that should be considered by the Executive Committee; [added emphasis]

Including retrospective consideration.  But with “the end of the matter” already declared, there’s not much consideration required in this case…

Perhaps they could consider which of the capital projects the Health Minister did approve they would postpone instead?  From the Ministerial statement

Today I am announcing that, subject to normal business case processes, construction can start on the following high priority schemes:

  • The next phase of the Ulster Hospital Redevelopment which will replace the current Ward Block;
  • The new regional Maternity Hospital at the Royal;
  • The new enhanced local hospital at Omagh;
  • A new Acute Psychiatric Facility at the Belfast City Hospital;
  • A new A &E Department and Ward Accommodation at the Antrim Hospital;
  • New Operating Theatres at Craigavon Hospital;
  • and new Health and Care Centres in Ballymena and Banbridge.

And they’ve had plenty of time to invoke section 2.4(vi) of the ministerial code since the publication of the draft budgets spending plans in January.  The Health Minister highlighted the risk of delay to a number of major capital schemes, including the radiotherapy unit at Altnagelvin, in the consultation document on his draft budget [pdf file].

But with an over-commitment of £240million already incorporated into the NI Executive’s final budget over the next four years, what’s another capital project or two?

Here’s one they might want to think about referring for consideration at the Executive Committee.

So much for the big incentive to learn how to govern…

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  • Marvellous.

  • Cynic2

    Might the Health Minister now have to cancel another project perhaps to compensate? The Ulster Hospital Expansion for example?

    “Peter Robinson stole your money to pay for Derry and Donegal” should play well on the doorsteps of East Belfast

  • Zig70

    judicial review anyone? Costing more than the extension.

  • There’s plenty of wiggle-room to be exploited!

    On another note, Tuesday was obviously sponsored by square brackets. Can we agree what tomorrow’s meme will be now!?

  • FuturePhysicist

    Well Cynic2, I think a key question would be if the people of Tom Elliot’s constituency prefer travelling north or east for their cancer treatment?

  • Pete Baker

    Alan et al

    It’s not about “wriggle room” and it’s not about “square brackets”.

    The original post is about the populist declarations of OFMDFM in the face of budgetary cuts and the resultant undermining of other parties at the Executive and the authority of the Executive itself.

    Try to focus on the reality of what’s happening, rather than playing the election game.

  • joeCanuck

    It demonstrates clearly that we do not have a Cabinet; just a pile of planks. Where is the glue to come from to make a functioning whole?

  • Driftwood

    Could Peter Robinson not just buy a new Radiotherapy unit for Altnagelvin for a fiver? He seems to be able to buy incredibly valuable stuff like land for a fiver.
    A very good ebayer?

  • Drumlins Rock

    I presume that the outstanding Business Case from the Finance Minister, and iron clad commitment from the Irish Government (if even that is of any use in the current circumstances) are of any significance?

    See you in court Peter & Marty….

  • Cynic2

    Its not just a JR from Altnagelvin residents. What about the rest of the poor sods who didn’t have Marty lobbying for them. If I was them I would be straight down to the High Court for, by his own definition, if Altnagelvin was a Catholic Project then any Protestant ones abandoned to fund it must have been decided on a sectarian basis. And by the DUP!!!!!

    But I am puzzled. Just why is Peter so keen to support SF in the teeth of an election? What do they know that we dont? Where’s the deal?

  • FuturePhysicist

    I don’t think there is an election game being played here Peter Baker, every party in the region including the UUP back the radiotherapy development. I don’t know a single one who oppose it. Maybe the TUV.

    The ROI have made a promise to pay for 1/3 of all costs, capital and personnel, money could be saved from transport costs, and decentralizing staff from Belfast, it could be saved from using medical equipment suppliers from ROI sources.

    And the shortfall is in staffing and training, which cannot be allowed to kill the project. This isn’t a matter of local populism, because this facility will save lives in half the geographic land mass of the six counties, and a quarter of the Island of Ireland.

    The business case must be made, and the staffing costs investigated.

  • Drumlins Rock

    FuturePhysicist,

    from my part of F&ST its a no brainer, Belfast takes half the time, and from even the remotest region of Fermanagh (and south Donegal come to that) its probably equal. Same also applies for most of Mid Ulster and about a third of West Tyrone. The question then arises, will we be allocated treatment at Altnagalvin in order to make the unit viable? simply moving the problem elsewhere.

  • iluvni

    Does that mean then that the A2 road improvement scheme can go ahead too, on the whim of OFMDFM….or is that already taken care of given all those chummy giggles and smirks between Sammy Wilson, Alastair Ross and Conor Murphy during the budget debate?

  • FuturePhysicist

    Drumlin’s Rock…. and what about Sligo, Leitrim heck even parts of Mayo? What about waiting lists, or even hospital closures? And speaking of viability, the staffing deficit would still be a systemic problem in the over-utilized radiotherapy units of Belfast. The minister admitted that the ward was viable, but the staffing of it, in his own words:

    Revenue is critical to the project. Decisions to commit the revenue were to be taken in 2011-12 to commence the necessary specialised training of staff for them to be fully trained and available when the project opens in 2016. These include oncologists, radiologists and radiographers. The current budget does not enable this decision to be taken.

    Now the question arises, if you struggle to tackle this staffing problem with ROI assistance, how the hell will it be tackled without it? (Which will happen if the radiotherapy satellite unit is scrapped!)

  • Drumlins Rock

    FP,
    Sligo Leitrim etc. would not be served by a unit in the Northwest, Belfast is as close if not closer time wise, just check google maps. as for “this facility will save lives in half the geographic land mass of the six counties”, the areas that are halfway (about 45min) form an arc from Coleraine through Magherafelt to Omagh, touching only 4 constituencies out of 18, and about 15% of the population and about 1/5th of the land area.
    However…
    None of that is relevant atm. as it had no bearing on the ministers decision, the reason it did not proceed was for 3 reasons, 1. the Business Case by the finance department had not been completed. 2. at that stage no commitment from the RoI minister had been recieved, despite several requests, and 3. the money wasn’t there!

  • FuturePhysicist

    http://www.theyworkforyou.com/ni/?id=2011-03-15.7.2&m=90322

    1&3 are addressed there, and 2 is addressed below by a junior H&C minister.

    http://www.kildarestreet.com/debates/?id=2011-03-24.271.0

    Yesterday, the Minister, Deputy Reilly, wrote to his counterpart Minister in the North, Mr. Michael McGimpsey, MLA, to reaffirm this commitment to the Altnagelvin project and to confirm the substantial capital and revenue contribution already promised in respect of radiotherapy patients from the South.

  • FuturePhysicist

    Also It’s quicker for patients in Fermanagh, Leitrim, Sligo to travel to Derry, rather than travel to Belfast only to be referred to Dublin. It may even mitigate the burden from North Antrim.

    http://www.londonderrysentinel.co.uk/news/local/vital_cancer_centre_required_to_relieve_over_burdened_belfast_service_by_2015_stalled_1_2527761

    You do the Google maps.

    And I honestly don’t believe that it’s faster from someone in Belcoo going the long and often jammed roads of Armagh and Down than the route up north through Tyrone.

    I’m sure those 4 constituencies cover more land than Lagan Valley, Strangford and the 4 Belfast constituencies, which city hospital facilitates.

    And since this is only a satellite unit, this will be a proportionate cost in comparison to the unit that is being overused and can only be greatly overused in City.

  • FuturePhysicist

    I meant to say become even more greater used in City.

  • Pat Mc Larnon

    This decision is opportunistic and populist yet when Ruane reverses a decision made by a previous minister it is calamitous and evidence of her unsuitability for obvious.

  • unionistvoter

    In the week before the decision the Irish Health Minister refused to take calls from Michael McGimpsey.

    What inference was he supposed to take from that?

    The revenue costs will be £2 million in 2011 – 2012 directly taken from the budget of the Western Trust, every Trust is squeezed already and as people will see from the commissioning plans due to be published in May there are massive service cuts in the pipeline.

    An extra £2 million would probably wipe out domicillary care in the West of the province entirely.

    Let the Executive override McGimpsey, but they must take responsibility for the consequences if they don’t provide new money.

  • Turgon

    I”t’s quicker for patients in Fermanagh, Leitrim, Sligo to travel to Derry”

    I am very dubious about this. Re Letrim and Sligo I cannot comment from personal experience. However, from the point of view of Fermanagh that is simply factually incorrect. The distances are sometimes (only sometimes) slightly shorter from Fermanagh to Londonderry but the travel time is much longer from West Fermanagh and from East Fermanagh the travel time is longer (to Londonderry) as usually is the distance.

    Someone in Rosslea can get to Belfast in about an hour and a half by car without much difficulty: they would find it very difficult to do it in less than two and a half hours to Londonderry. Coming along the Clogher Valley the travel times to Belfast fall but those to Londonderry change little.

    The danger here is (well it is actually an almost certainity) that Fermanagh and Tyrone patients will have to go to Altnagelvin in order to keep the new unit’s patient numbers up: this will considerbaly increase their travel times. For them the new radiotherapy centre in Altnagelvin will be a major set back in convience.

  • Neil

    None of that is relevant atm. as it had no bearing on the ministers decision, the reason it did not proceed was for 3 reasons

    Nah, it was for one reason, Michael McGimp’s party has literally zero chance of getting a seat in Foyle.

    Is it populist for politicians to attempt to follow the wishes of the majority in the electorate? Well, obviously yes if you are a UU voter who see’s that the light at the end of the tunnel is an oncoming train.

    McGimp has been a disgrace, and proven to be so. Everyone’s favourite economist, John Simpson went over the health budget figures and suggested that McGimp was scaremongering over what amounted to a tiny overall cut, and in no way should the Health Service be anywhere near ‘bankrupt’ – McGimp’s term.

    And as usual the UU people on Slugger aren’t happy (well, you wouldn’t be would you). Having failed to circumvent democracy once (through attempting to have power not commensurate to your votes by making friends with the winner – Call Me Dave – like the weakling making friends with the school bully), and looking like attempt number two since the Westminster elections is in the shitter (thanks to your fearless leader explaining to the Unionist electorate that they should really vote DUP to keep Marty away from the FM post), you apply the cherry to the top of the cake.

    You get all hot under the collar that your Minister (who achieved less than 10% of the vote) from your dying party (who continue the downward trajectory with a measly 15% of the vote in NI) can’t do just as he pleases, while the other parties which by far and away represent the majority of people – making up a whopping 70% of the electorate should have the audacity to suggest that your tiny little mandate should allow you the right to ride roughshod over the wishes of the majority.

    Old fashioned Ulster Unionist democracy. We wear the bowler hats, you should do as we say. Fuck that. The representatives of the 70% of the electorate won’t roll over for the (kack handed, useless, arrogant) representative of 15% of the electorate. Especially in a decision affecting one (of the many) areas where the UUP have fuck all chance of getting a seat.

  • Neil

    Let the Executive override McGimpsey, but they must take responsibility for the consequences if they don’t provide new money.

    So what should we do, stand still? McGimp can’t find a single penny of waste in the NHS here. There are no savings to be made through efficiency. Couldn’t shave 1% off his budget or PEOPLE WILL DIE WE’RE BANKRUPT OH MY GOD WHAT ARE WE GONNA DO!?

    Bollocks. He’s done his best to fight to retain his full budget (actually wants his budget increased) and hasn’t done a thing to try to save money. He’s founght everyone (attempting and failing to make political capital out of the situation) tooth and nail.

    As for the argument that people from Fermanagh would have to go to Derry/Belfast. Derry would I’m sure have enough on it’s hands with the people in Derry, Tyrone, Armagh, and Donegal. Spurious reasons for objecting, people from Antrim, Fermanagh and Down are closer to Belfast. That gives four counties going Derry and three going to Belfast. Seems reasonable.

    And Sligo is closer to Derry. Check your routefinder, I did. 40 minutes saved going to Derry than Belfast. There you go, 5 counties using Derry and 3 using Belfast. At that rate some Derry folk will have to visit Belfast City Hospital as Derry won’t have the capacity.

  • Turgon

    Neil,
    Such is the nature of Trusts that almost certainly Fermanagh people will have to go to Altnagelvin. The new radiotherapy centre will need that to keep its number up: the population is not actually that big.

    I am also interested that you think Armagh people should go to Altnagelvin. Maybe recheck your route finder: where exactly in Armagh is closer to Altnagelvin than Belfast? Try telling the people of Lurgan that they are closer to Londonderry than Belfast.

  • Cynic2

    “I don’t think there is an election game being played here Peter Baker”

    …… I am sorry but its naked sectarian electoral politics on all sides – except perhaps McGimpsey.

    I dont like the man and would never vote for him but he made a rational spending decision to concentrate limited cash on one regional cancer centre. that is being overturned by the SF/ DUP cabal for pure sectarian and electoral reasons that will never survive a JR if someone disadvantaged elsewhere – or even the Health Minister’s Party – will mount one. But poor Tom isnt really up to that sort of fight so the Stormont Pork Barrel will just keep rolling downhill until its empty of cash. It wont take long

  • Cynic2

    Real politics for the DUP would have been to trade Altnagelvin for something else in an area SF is prepared to concede – Education for example.

    But either they simply aren’t up to that or Marty has a firm grip on the dangly bits of a weakened and desperate Pete the Prod

  • Cynic2

    “Armagh people should go to Altnagelvin”

    When DFM tells you to go, you will go.

  • FuturePhysicist

    Unionistvoter, Turgon firstly you are missing the point …

    McGimpsey is refusing to invest in services and personnel that will reduce the burden on the City Hospital.

    How much revenue will be lost when Cancer Patients from every part of the North of Ireland (and I don’t mean Northern Ireland) are clogging up facilities, clogging up the car-parks, clogging up rooms … and slowly killing the few overburdened oncologists, medical physicists, radiotherapists and radiographers of the region, and these people having to be paid more as a result.

    These are personnel who are exposed to radiation, they’ll all die of cancer themselves if they are forced to have long hours. And there’s a shortage of them!!!

    But alas we can spend money on homeopathy and some silly prescriptions because it’s what the NHS does in the UK.

    In saying he cannot train these specialists in Derry, he has essentially said he cannot train these specialists anywhere. He’s saying that the region’s health service will have to simply attract ready trained doctors and specialists from outside the region. I cannot believe the long term cost efficiency of this strategy.

    It’s not just a matter of people west of the Bann going to Belfast, it’s a matter of people going to Belfast and either getting a plane or going down the motorway to Dublin, perhaps even to get a plane there. the City hospital does not have an infinite number of radiotherapy rooms and beds.

    Essentially deferring some of these services to the Second City in the region makes sense in principle, if not what’s the point of even having one. You may as well move the people of the three western counties to ghettos. The City of Culture bid and increased tourism will help to boost revenue by the time the facility is to open in 2016, if it does.

    How much will taxpayers in the North of Ireland have to fork out of their own pocket to go to the Island of Britain or to Dublin.

    How much revenue would be saved having ROI trained and paid for doctors and specialists than an ROI trained business person?

    And then there’s the equality issue, i.e. how much revenue are people in the West, subsidizing services in the East?

    Surely the East’s slice of the cake is made bigger by essentially providing all the radiotherapy services for the North of Ireland and does so without revenue from the Republic.

  • Fair Deal

    Pete

    ” The Northern Ireland First and deputy First Ministers’ separately declared commitment to reverse the NI Health Minister’s decision to postpone the funding of a new radiotherapy unit at Altnagelvin hospital is yet another populist move without regard to budgetary considerations”

    Your basis for this claim?

  • dwatch

    Cynic2 : ‘Might the Health Minister now have to cancel another project perhaps to compensate? The Ulster Hospital Expansion for example?’

    McGimpsey is no longer Health Minister, he stood down along with all other ministers when the assembly was dissolved at 0001 GMT on Friday last. I wonder which party will take on the next health minister? Any guesses?

  • FuturePhysicist

    Dwatch: McGimpsey is no longer Health Minister, he stood down along with all other ministers when the assembly was dissolved at 0001 GMT on Friday last. I wonder which party will take on the next health minister? Any guesses?

    Alliance are the only party that wish to prioritise it. My guess is that It’ll be the SDLP, after DUP take finance and Sinn Fein trade & industry.

  • FuturePhysicist

    By prioritise I mean make it clear that it’s their first choice pick

  • tinman

    I wonder which party will take on the next health minister?

    One that is either very brave, or very foolish. The health ministry is a bit of a poisoned chalice at the best of times – doctors and nurses get the credit when things go right, managers and ministers get the blame when it all goes wrong.

    And these are not the best of times – ever-tightening budgets mean the headlines over the next few years will be about cuts and closures, lengthening waiting lists and rationing of social care, and the minister will have to explain all that in the Assembly and in the media.

    Or the new minister may wish to make some tough decisions about reining in some building projects or new services, or even closing some A&Es or smaller hospitals. As the story at the top of the thread shows, that is a political open goal; it’s so easy for an opponent to play the populist alternative that it would almost be rude not to.

    Whoever takes on the health ministry in May – good luck to them. They’ll need it.