Soapbox: Co-destruction of health services is rock bottom for our democracy

Mic Moore is a policy worker in the voluntary sector and vice chair of the NI Government Affairs Group.

Change is the only constant.

This nugget of wisdom survives from ancient Greece, where the first known democracy emerged in Athens. Some twenty-five centuries later, we await functioning democracy in Northern Ireland with growing desperation.

We know that in politics, things can change very quickly. In June 2016, for example, Jonathan Bell stood in the Assembly and praised his party leader in a churlish taunt to then-UUP leader, Mike Nesbitt: “Your defence is terrified because Arlene Foster’s on fire”. By the end of the year, Bell’s RHI allegations against Foster had helped raise the temperature to parliamentary melting point.

At other times, we only get the illusion of change.

Launching her vision for transforming the health service last year, Michelle O’Neill proclaimed “this Executive is united as never before in its commitment to take the right, perhaps difficult decisions. But we know this is the only way to deliver better outcomes for our people.”

Less than 12 weeks later, that Executive was no more. Martin McGuinness signed off on his political career by declaring that “we now need an election to allow the people to make their own judgement on these issues democratically at the ballot box”.

The democratic process is often caricatured as a simple game of numbers. If your vote ends up in the biggest pile, you’ve won. You can look forward to four or five years of the same decisions you would make, if you weren’t able to hand that burden over with your ballot paper. You’ve helped to bring about government in your image and that of people like you.

It’s more complicated than that, particularly in this part of the world where there are additional hurdles. You need to back the biggest party in your community designation, then hope for an Executive to be formed, and that your preferred party takes Ministerial portfolios that can really influence the issues you care about – and that’s just to get things started.

Now we’ve had that Assembly election, and a UK general election, both resulting in a greater share of support at the ballot box for two biggest parties. But the effective absence of government here, above the level of local councils, since January undermines any claims that we are truly seeing democracy in action.

Instead we have seen an even more grim caricature, wherein budgets for health services are the numbers in play and the difficult decisions are which cohorts of people in need will be denied care. The determination for compromise and cooperation shown by the Health Minister last autumn has vanished. Any unity that existed is a distant memory, the difficult decisions are being handed back to the public and achieving better outcomes sounds like an absurdly lofty ambition.

The sentiments expressed in O’Neill’s foreword are not the only part of the Delivering Together strategy to be upended in all of this. Central to the approach for transforming health and social care is the concept of co-production:

“We must work in partnership – patients, service users, families, staff and politicians – in doing so we can co-produce lasting change which benefits us all.”

Instead, we have a consultation on a ‘Savings Plan’ for each of the HSC Trusts – an opportunity to participate in the co-destruction of public services which should be considered priceless. Just like in January, the people have been abruptly called on to exercise judgement at a time of crisis. The cost of political failure to HSC Trusts has been set at £70 million, in the next seven months alone. But it is obvious that human costs will follow, in the form of delayed treatment, absent care and all the sorry consequences of both. There’s no way to win this game and no meaningful choice to be made.

The sense of tragedy is heightened because passing of the baton of healthcare transformation across party lines appeared to have been seamless. O’Neill’s vision adopted most of the work of Professor Bengoa’s Expert Panel, which had been set in motion by Simon Hamilton before the 2016 election. Actions had been specified, dates had been set and proof was emerging that things were moving as planned.

Now that vital programme is stalled, but change carries on in alarming ways. Bengoa clearly demonstrated that our health service sits on a burning platform. The proportion of older people in the population is increasing, chronic ill-health is becoming more prevalent and it’s becoming ever more difficult and expensive to meet local needs in an outdated system.

In the weeks to come, we can expect to hear more politicians try to spin certain illusions: the pressures on health and social care have been exaggerated, there’s no need to withdraw services, this is all a cowardly and cynical ploy by unaccountable civil servants.

No sooner had the HSC Trust’s public meetings ended than some voices were almost dubbing it Democracy vs. the Bureaucracy. This is a distraction – we weren’t being treated to a preview of Mayweather vs. McGregor, though a spectacle half as lucrative would certainly help our beleaguered public services right now. The health service has a statutory duty to achieve breakeven at the end of the financial year. Every political party needs to urgently decide if it’s in or out of power-sharing, so that the needs of vulnerable people don’t get sucked into the vacuum.

Democratic accountability and the opportunity to effect real, positive change aren’t just a part of the election cycle that normally only comes around every four years. They’re built into the proper day-to-day functioning of political institutions, where tough compromises and difficult decisions should be par for the course. Some would say that this is the only way to achieve better outcomes for our people.

Image by Jane Rahman on Flickr

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