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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  • barnshee

    Around 80% (correct me if I am wrong) of the costs of the NHS are wage and salary costs. Salaries in parts of the public sector have run amuck over the last (particularly) ten or so years. The NHS is no exception -rebalancing -over time will surely help. Time to trim the fat cats. and ignore the squeals.

  • Brian O’Neill

    With a lot of these public/private salary comparisons you are not really comparing apples with apples. How would you compare a doctors or surgeons salary to someone in the private sector? There is no equivalent job in the private sector.

  • chrisjones2

    What crisis?

    Its winter. People get flu. Prioritise to meet demand. If that means some people have to wait an extra week for their non-urgent appointment is this a crisis?

  • chrisjones2

    It is no longer acceptable for anonymous unelected apparatchiks to make painful decisions

    And you think that the public will? They all want an A&E, Cancer Hospital and Geriatric Care at the end of the street with free parking

  • Brian O’Neill

    The article is not about the recent A & E problems it is about the

    £600 million hole in the health budget that they have know about for at least the past 5 years. http://www.northernireland.gov.uk/news/news-dhssps/news-dhssps-december-2009/news-dhssps-21122009-health-and-social.htm

  • Korhomme

    That’s about right, it might be a little more. The problem is that there is so little funding then available for infrastructure, development, etc; much less than is typical in private industry.

  • Korhomme

    Trying to “tell truth to power” is so often a fruitless exercise. It’s quite possible that the poiticians have been told what to expect by the CEOs of Trusts and by senior civil servants. Yet it is politicians who make the decisions, and expect others to implement them

    In hospitals here, I’d expect that acute services, maternity services, cancer services would continue; the looser will be elective services, many of which are surgical. If you have a condition that an operation could fix, you will simply go on a waiting list and remain there. The 1% might choose to be treated privately. In recent years, people have researched on the web, and found an appropriate provider in Europe or Asia; and have been able to get the procedure done there and have a holiday for less than the cost would be here.

  • barnshee

    “How would you compare a doctors or surgeons salary to someone in the private sector? There is no equivalent job in the private sector.”

    Well there is the “private sector” via “the you can wait a year or see me privately next week” system.

    If as you say ” There is no equivalent job in the private sector.” then we have a single employer who in economic terms is a monopsony- only one buyer ( the NHS) interfaces with would-be sellers of a particular product.(doctors)

    Time to use the power

  • hugh mccloy

    The only person to state the truth in years of health trusts, boards and commissioning groups in health was former NHSCT chairman Jim Stewart, and he got sacked.

    Dr O Neill also sits on DLA appeal boards and from what I hear is not the best man to be in front of after speaking to someone who lost their appeal and who is currently on a waiting list for an operation to see if they can go back to work.

    Little is said in this report that he as commissioner was part of the system that set in motion the crash of services in 2010, a crash that led to multiple service closures and the crash we have still not recovered from.

    Dr O Neill resided over the CSR 2008 and knew of the lies and problems and to be fair, said very little, again in Transforming Your Care 2011 the future of health in Northern Ireland, he seemed happy pushing that agenda which included more multiple closures. But he looked very happy with John Compton. By the meetings I was at he was a massive support of Edwin Poots and John Compton

    No he is coming up with a few ideas, maybe he personally is going to be affected, because one thing for sure he was not to bothered when he was in a decision making position.

    if we are looking for problems in health, he is one he pushed a cuts agenda without ensuring that capacity was still in the system to deal with emergencies, another person who aided the destruction of our health service for his own personal agenda and ultimately accountable to no one.

  • hugh mccloy

    “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 un-elected 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.”

    We are not long after a 3 year consultation with the public Dr On Neill, which went the length and breath of the country, apparently the biggest of its kind ever in Northern Ireland, one which you as an un-elected decision maker was part of and cost the tax payer millions, seen private business consultants from KMPG brought in and then promoted to the Health & Social Care Board. What do you want now, another one ?

  • hugh mccloy

    Its about another person who was part of the problem trying to get out of the frying pan

  • hugh mccloy

    How many different salary streams is and was Dr O Neill apart of ?

  • hugh mccloy

    Are you related by any chance ?

  • Brian O’Neill

    Nope. We just share the most common surname in Ireland 😉

  • hugh mccloy

    Just checking 🙂 cant be too sure these days who is spinning. You should do a bit of research into Dr O’Neill and his support for TYC

  • Catcher in the Rye

    There is no equivalent job in the private sector.

    There are several exclusively private hospitals and doctor surgeries in Northern Ireland. As with anywhere else, you make an appointment, have a consultation, maybe surgery, then they send you a bill; it’s all much the same except it happens a lot quicker and you don’t end up stuck in a ward with the proletariat. You can expect to be seeing and hearing more of these kinds of private practice.

    This shouldn’t surprise anyone who has visited a dentist or an optician, where it works the same way.

    Many health service medical practices in NI and elsewhere are private businesses run jointly by a team of doctors. They may contract exclusively to the health service, but they are not employees of the state.

  • notmyopinion

    Even more than the consultants, there is room for saving money in senior executive salaries…