Building up health

Progress on health investment continues but fiscal doubts hold up detailed plans.

Health has its own dedicated ‘pillar’ in the Investment Strategy, totalling £3,659 million in spending. This is subdivided into £728.5 million for 2008-2011 and a further £2,930 million from then to 2018. Of the latter sum, £355 million for primary care is to be sourced from additional funds i.e. from outside the Executive.

This amount of funding, according to the department, is available only for schemes which meet strict accounting criteria i.e. being ‘off balance sheet’. These projects are usually funded through private sector finance or third party development. “As a result, projects utilising this capital allocation will need to have a supporting revenue fund to meet the annual financing costs,” a health department spokeswoman said, adding that the department is “looking at all potential funding avenues” given the expected financial constraints ahead.

Such constraints are also used to explain the lack of investment delivery plans in health so far. These documents are due to cover three areas:

• Primary care (£862 million);
• Public safety and technology (£572 million); and
• Hospitals modernisation (£2,225 million).

Delivery plans for the five other pillars have been published but not for health. Asked to explain why this was so, the department’s spokeswoman put it down to an uncertain fiscal future for the sector.

“Given the uncertainty surrounding the availability of funding in 2010-2011, as well as moving forward into the next Comprehensive Spending Review period, final decisions on where the limited resources will be directed have yet to be made,” she said. “It would therefore not be prudent to publish the investment delivery [plans] until there is greater certainty surrounding the level of funding being made available to health and to avoid creating public expectations which may in the end not be affordable.”

The Minister hopes to publish plans “once there is greater certainty and clarity surrounding the level of funding available for health”, specifically around the next spending review period.

Not having delivery plans in place, though, has not held up spending on those projects that have already started. Over the 2008-2011 period to date, almost half of the hospital modernisation money has been spent as well as almost a third of the primary care amount.

agendaNi also asked the department for updates on the main projects outlined in the Investment Strategy itself. The main achievement so far is Downpatrick’s enhanced hospital, which opened in June and the next one on track is the Ulster Hospital redevelopment, where the critical care block is due for opening in April 2010. Other projects tend to be at earlier stages of design, procurement and construction.

By 2018, the Health Service is due to have a network of 35 primary and community care centres. Three have been completed and opened – Carlisle, Grove and Knockbreda – since January 2008 and another three are scheduled to open their doors by 2011 i.e. Portadown (due in the first quarter of 2010), Beechall and Shankhill (both planned to open in 2010-2011).

Work in progress

At present, work is taking place on the following projects, according to the Health Estates Agency:

• Altnagelvin Hospital phase 3.2b
• Antrim day surgery unit and risk project and endoscopy rooms
• Bawnmore children’s home, Belfast
• Beechall health and well-being centre, Belfast
• Conicar at Iveagh treatment and assessment unit, Belfast
• Craigavon trauma and orthopaedic project
• Forster Green children’s psychiatric unit, Belfast
• Lisburn assessment and resource centre
• Muckamore Abbey Hospital phases 3 and 4, near Antrim
• Newry children’s home
• Newry day centre
• Portadown community care and treatment centre
• Regional adolescent psychiatric unit (Forster Green)
• Royal Group of Hospitals phase 2b critical care block
• Shankill health and well-being centre
• Ulster Hospital critical care block