NI health minister: will someone think of the service?

The DUP seem to have had a bit of a problem with Health Ministers. Despite health and personal social services being the largest department by spending, it is actually unlikely that they wanted it. It is unlikely anyone wanted the ministry and it was the penultimate one chosen. At some level the DUP can be given credit that they did not take Higher Education and leave Alliance with the baby but the number of recesses etc. which were held during the negotiations over choosing the ministeries imply that no one really wanted it. Margaret Ritchie was apparently offered a stiff drink to take it and then Peter Robinson suggested he would need gas and air.

The DUP chose Edwin Poots who whilst not the most charismatic DUP politician had developed a reputation of competence at the Department of the Enviroment. Robinson also announced that he would change Poots part way through for Jim Wells which caused some concern as Wells had a reputation as a bit of a maverick and had made a number of odd suggestions about health care including one that staff should be able to be moved to where they were needed in the province.

There is no defence for Wells’s comments about homosexual adoption as there simply are no credible studies supporting his contention that it increases the likelihood of child abuse and his behaviour to a constituent seems to have been beyond the pale. Poots’s concerns about homosexuals giving blood do seem to have more foundation though the benefit of a life time ban is attenuated in NI by the fact that we access blood from mainland GB which has, rightly or wrongly, relaxed the ban on homosexuals giving blood.

The issues which Wells and Poots got into trouble over are, however, essentially minoritarian ones. Homosexuals adopting or giving blood are clearly within the provenance of the Department of Health and Social Services but they are not in reality mainstream issues: they are not the central plank of what health and social services does. The main issues of concern for everyone in health terms in Northern Ireland (homosexual or heterosexual) are that we have the pretty much the longest waiting lists (Wales is sometimes almost as bad); poorer access to cancer drugs and longer A+E waiting times (just to mention a few of the problems). All that despite a larger per capita spend on health.

Prior to the DUP having health it is not as though the picture was sunny. Bairbre de Brun made almost no decisions during a time of relative financial plenty. Michael McGimpsey seemed like a rabbit caught in the headlights by the enormity of the problems. Just prior to him leaving he suggested that there was no money for anything and that the system was bankrupt without actually proffering any solutions.

Poots on the other hand found money to keep the system afloat and actually presided over very popular developments (eg the Cancer Centre in Altnagelvin). He also, however, made decisions which whilst vital to the future of the health service were less popular. He set in train the process to stop Childrens Cardiac Surgery in Belfast, finally agreeing to the suggestions of at least two expert reviews. He also instituted the Donaldson review which proposed a dramatic reduction in the number of acute hospitals: more dramatic even than the previous Compton review.

Poots seemed to be willing to countenance such a reduction even if it meant closing the likes of Lagan Valley in his own constituency. Jim Wells might have been expected to reverse these decisions given his previous utterances but continued with them including his recent decision to accept the closure of Daisy Hill’s Stroke Unit.

That decision led to a huge protest march though there was some acrimony regarding its politicisation.

It is clear, however, that by making decisions both Poots and Wells made enemies both in their own party but also elsewhere. Although that was not the cause of the scandals that caused Wells’s downfall it may well have been the main reason for Poots’s removal. In contrast complete incompetence did not hurt McGimpsey who even turned up at rallies opposing cuts his own department was making.

What the DUP will do now is interesting. They presumably want a safe pair of hands but Poots especially was seen as exactly that. The alternative to making the needed changes is for the NI NHS to fall even further behind the rest of the UK and quite possibly to the disasters McGimpsey was predicting. If Robinson tries to put in a caretaker minister it is likely to end up back where McGimpsey had it. Alternatively if he puts in a more dynamic minister who will force through the changes they may well damage or destroy their own career. Even if all the needed decisions were made it would be several years before the benefits were seen: hospitals take a long time to build and the assembly only has no money and only a year to run.

Most likely then that Robinson will opt for a fairly cautious approach and hope that another party takes health next time. Unless that is that Robinson would like to see fixing the N NHS as his legacy and has a minister in waiting with the same aim and a willingness to sacrifice their career. Willing (rather than accidental like Wells’s) self immolation is a rare form of martyrdom amongst politicians. Since he has already passed through the fire once maybe Poots should be given his old job back?