Health and care services

Health budget: Department projects £732 million shortfall

With the Budget allocating a total of £7.3 billion in funding for health spending, Secretary of State for Northern Ireland, Chris Heaton-Harris MP, said in his budget statement that the funding “also ring-fences funding for abortion services, as ensuring availability of services is a statutory duty on me as the Secretary of State for Northern Ireland”. The £7.3 billion makes up slightly more than half of all public spending allocated for local departments.

Heaton-Harris was forced to deny that the Budget was designed to “punish the people of Northern Ireland” for the continuing absence of the Assembly and Executive, as had been alleged by the DUP. “The purpose was not to punish anybody with this budget,” Heaton-Harris said. “It is to make sure services can continue in the absence of devolved government.”

In a May 2023 letter to local parties’ health spokespersons, Department of Health Permanent Secretary Peter May said: “I wish to emphasise that, like all other departments, we are in an impossible position of being asked to fulfil conflicting responsibilities. This involves trying to balance our responsibilities to live within the budget we have been given, act in the public interest, and safeguard services. Decisions are required that we do not wish to take and that are not in the best interests of the health and social care system.”

Department ‘efficiencies’

The Department of Health states that the projected £732 million shortfall includes estimated pay pressures of £375 million, including the costs of fully implementing the English pay offer for Agenda for Change Staff.

The Department of Health, prior to the Secretary of State’s budget, had already made public plans for savings in the region of £260 million, which it states will reduce the funding gap to around £470 million. “While some impact from these measures is inevitable, measures up to this value may be achievable without long-term or irrevocable damage to services,” the Department of Health states.

In addition to these steps, the Department has stated that it is making efforts to ensure additional savings of £100 million, which will be predominantly sourced from a £55 million cut in funding for local health trusts and a £34.6 million cut in waiting list initiative funding. The Department clarified that it still intends to invest £61.4 million in waiting list initiative funding in this financial year.

The £100 million savings also involve reductions in the Core Grant Scheme for community and voluntary groups, thereby ceasing the Covid-19 Wastewater Surveillance Programme and ending Covid-19-related support funding for dental services.

Comparison with other administrations

Heaton-Harris’s budget has hit the Northern Ireland health sector worse than other parts of the UK, in spite of the general state of the health service being worse than those in England, Wales, and Scotland.

Whilst health spending in for the NHS in England increases by an average of 3.3 per cent per year, the corresponding increase in Heaton-Harris’s budget was only 0.5 per cent.

The shortfall in the needs of the health budget can be exemplified by a report from the Northern Ireland Audit Office, which states that, in December 2022, 500,678 people were on waiting lists, a figure which represents 26 per cent of the population of Northern Ireland. For comparison, the corresponding figure in England is 12 per cent and the corresponding figure in Wales is 24 per cent.
Political reaction

The budget allocation has attracted condemnation from both the Sinn Féin and the DUP.

Sinn Féin Assembly health spokesperson Linda Dillon MLA said in September 2023: “Our health and social care system in the north is at breaking point as a result of 13 years of Tory cuts which has underfunded and undermined our public services.

“Staff are stretched to the limit and burnt out from working long hours, while also dealing with chronic under-staffing which has heaped extra pressure on already stretched workers.”

This sentiment has been echoed by Paul Givan MLA, the DUP Assembly health spokesperson, who said in March 2023: “There is clear evidence that the funding gap on health and social care in Northern Ireland compared to England is widening.

“The Barnett Formula is failing to take into account the need which exists in Northern Ireland and the Autumn Statement which increased spend in England by £8 billion has not been reflected in Northern Ireland’s health budget. HM Treasury needs to provide the funding needed to meet the needs of our population and the work of transforming of our health and social care services needs to move forward.”

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