Public Affairs

NHS crisis is a problem for our economy

Economist Paul Gosling assesses how crisis in our health sector and challenges in other public services are a component of economic underperformance.

Drilling down into statistics is essential to understand public service outcomes and how policy needs to evolve. An example is with the health service. Until the Pivotal think-tank published its ‘Moving Forward’ report three years ago, the scale of the NHS crisis in Northern Ireland had not fully registered. We all knew it was bad, but perhaps not quite how bad it was.

More than 1,000 people in England had at that time waited over a year for planned surgery. In Northern Ireland, the number was more than 120,000. When adjusted for the comparative sizes of the two populations, this represented a waiting list hundreds of times longer in Northern Ireland than in England. In the subsequent three years, waiting lists have grown further.

It is also essential to recognise the inter-connectedness of public services. We must break out of our silos, recognising that problems in one public service affect other services and the rest of society.

August’s Labour Market Statistics reveal Northern Ireland’s economic inactivity figure to be 28.3 per cent. This compares to a UK rate of 21.4 per cent – a substantial difference. While Northern Ireland’s employment rate is 69.7 per cent, the UK’s is 75.5 per cent. It is perhaps unnecessary to add that Northern Ireland has the highest economic inactivity rate and the lowest employment rate of any UK region. These are important factors in our low regional productivity and wealth generation.

Long-term sickness and disability are the most common explanations for economic inactivity in both Northern Ireland and the UK. But it is a worse problem in Northern Ireland than the rest of the UK – accounting for 31.3 per cent of economic inactivity in Northern Ireland, compared to 25.4 per cent across the UK.

We should consider how the waiting times and waiting list crisis in Northern Ireland affects our economic performance and productivity. This is not to understate the impact of health waiting lists in terms of the distress to patients and the earlier death for many because of delays in diagnosis and treatment. But it is to say that one of the responses to weak economic productivity must be to reform and strengthen our NHS.

These are long-term trends and in the past the assumption was that the length of the waiting lists was in part the result of the physical and mental injuries caused in the conflict. Nearly 25 years on from the Good Friday Agreement, there are fewer working age people who were personally affected by that violence. It may, though, suggest that the NHS needs to invest more in therapies to reduce inter-generational trauma.

Of course, we must also address other factors in our high economic inactivity rate. Another is the high number of people unable to work because they are looking after the family and home. This demonstrates that we need to invest more in childcare, expanding and subsidising it. Childcare is substantially underfunded here, compared with the rest of the UK.

While there are a range of causes of our current labour shortages, the crisis in the NHS is clearly one of them.

Paul Gosling is a writer and public speaker, specialising in the economy, accountancy, co-operatives and government and the public sector.

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