Terminating your care – The £600 million hole in the health budget

Writing exclusively for Slugger, the respected medic Dr George O’Neill gives his proposal to tackle the crisis in A & E. Dr George O’Neill qualified in 1971 and is a General Practitioner in practice in North & West Belfast for 40 years. He was for 6 years Chair of the Belfast Local Commissioning Group and he also Chairs Addiction NI.

The extra £80 million additional funding this financial year to Health is approximately 50% of what is required and will still leave a significant short fall. On account of the inability of our politicians to agree a budget the HSCB and the Trusts have less than five months to ensure they break even… an impossible task. In pursuit of their statutory responsibility to balance their books the Trusts continue to struggle desperately and to repeatedly shoot themselves in the head. The latest example from the Belfast Trust is the arbitrary removal of five hundred home-helps.

The £200 million “extra” agreed for next year is a mere drop in the ocean in the light of an annual NHS inflation rate of between 6-7%. Thus the 1.7% increase is presented as a positive when in fact it is significantly less than the annual inflation rate. It is not sufficient to maintain a steady state. Indeed the non recurrent £80 million given this year, I understand, is included in the £200 million.

Next year Health and Social Care faces a veritable tsunami of redundancies, including bed closures, hospital closures and a reduction in services. The areas suffering the most will be care of the elderly, children’s services, mental health and learning disability. Thus as I have observed throughout my career, the vulnerable, the voiceless, the weak and the unrepresented are first to experience service reductions.

When I was Chair of Belfast Local Commissioning Group I suggested to some of our politicians the Social Services budget should be protected and not the Health budget. I posited if the health budget was protected there is no incentive or imperative for change or improvement. One of our politicians retorted: “to lend support to closing a hospital would ensure the steps of Stormont would be covered with protestors, but if an old lady did not get her care package it would hardly cause a ripple.” When I expressed my surprise and suggested the job of the politician was to protect the weak and the vulnerable it was forcibly pointed out to me that I clearly had never stood for election.

The Ulster Unionist Michael McGimpsey, when Minister of Health, predicted the Health Service would face a short fall of at least £600 million by 2015. He was vilified and dismissed and an opportunity was lost by the DHSSPSI and our politicians to make preparation for the melt down we face over the next 3-4 years. I still cannot understand why so many intelligent and knowledgeable senior administrators and civil servants buried their collective heads in the sand and either hoped the problem would go away or they would be retired with a gold plated pension before the crunch came.

Now is the time for the community to be involved and consulted about decisions which will need to be made and will have a significant impact on all sections of the population. It is no longer acceptable for anonymous unelected apparatchiks to make painful  decisions about  our services and then proceed to a sham consultation. The population is sufficiently mature to be given the opportunity to suggest how services might be improved and where cuts are acceptable, provided the relevant information is shared.  The possibility of a change of administration at Westminster at the next general election will not change the situation. We are truly facing not Transforming Your Care, but Terminating Your Care.

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