It would be a tragic mistake to miss out (again) on any future expansion of health budgets

It’s best to treat Theresa May’s NHS/Brexit announcement with some scepticism, but perhaps not too much. It may well be what Robert Shrimsley calls “snake oil sloganising”, but an important political concession has been made.

The NHS is running almost on empty, and needs a rebasing injection of funds. But it will also needs accompanying reforms. Not least in Northern Ireland, where we missed out on the Chancellor Brown years when funding ran relatively freely.

Whether May ever delivers that promised extra £20 Billion a year Northern Ireland will almost certainly face strong Whitehall demands to implement a long-delayed programme of reform.

Some have suggested there is a link between general happiness and health (rather than wealth). The top slots in this year’s happiness index are dominated by the Nordic countries, where the democratic voice is strong, from local to national.

Whether in a space which has rarely, if ever, had a functional democracy the consequences of this are well understood is a moot point. But with Stormont down a key interface between people and the governmental system is missing.

In the Bel Tel David Gordon, who now heads up the comms department at the Dept of Health outlines some of the key questions his department’s policymakers need answers to so they can have some hope of fulfilling democratic demands:

What matters most to you when it comes to your hospital treatment? Location? Quality? Waiting times for treatment? It’s all a question of balance.

Clearly, it’s not feasible to have a functioning hospital emergency department at the end of every street. And, obviously, just one for the whole of Northern Ireland is not sensible, however high-tech and well-staffed it might be. So, we end up somewhere in the middle of those two extremes.

There are similar choices to be made with other hospital services. For instance, the long-term plan for tackling waiting lists includes developing elective care centres – stand-alone day surgery and assessment centres. That’s an important part of the transformation agenda for our health and social care system.

How far would you be prepared to travel for an operation, or a medical test, if you knew it would be carried out promptly and expertly, it wouldn’t be cancelled at short notice and you wouldn’t be stuck long-term on a waiting list?

Again, that’s a policy debate we all have a big stake in.

Besides returning Stormont we need a means by which technocrats immerse themselves in the stories and concerns of communities across NI and listen to activists (often dismissed as blockers but who have clues on ways to move forward).

As Una Mullaly pointed out to me on Twitter on foot of my Eight Lessons from the Eighth post, the system has no monopoly on wisdom or even understanding of the need for change.

In short, we need to explore ways to open government’s capacity not simply to listen but to actively generate actionable insight into the real needs of the people and trim the system all the better to meet them.

It would be a tragic mistake to miss out (once again) on the opportunity of a future expansion in health budgets just because our politicians cannot agree on the minutiae of the constitutional nature of our lives together.

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