Stormont could do worse than develop a Sláintecare approach to health service reforms.

I was on Nolan this morning discussing how the Secretary of State Hilary Benn had hit a few nerves yesterday on the first anniversary of the restart of Stormont when he laid out the abysmal Health record in Northern Ireland…

53% of people waiting for a first appointment with a consultant are waiting for more than a year in Northern Ireland. In England, that figure is 4%. That’s right, 53% compared to just 4%.

Mr Benn said he agreed with recent comments from Ms O’Neill that the state of the health service in Northern Ireland is “dire and diabolical. And this is despite UK Treasury data showing that spending per head on health is nearly £300 a year higher in Northern Ireland than it is in England.

When the SoS made reference to the lack of reforms in Northern Ireland truth of the matter is that between 1997 and 2007 over 100 new hospitals were built in the UK, albeit using the now controversial PFI funding model. In NI, just two benefitted.

The primary reason NI missed out was that Stormont was down in that critical period between 2002 and 2007 when most of the capital investment was taking place. Indeed, Stormont has been down for something like 11.5 years of its existence.

Collapsing Stormont has been ruinous in opportunity costs as evidenced in our current state. As Conservative Shadow Secretary of State Alex Berghart noted if you can wait up to 8 years for an operation, health service is a questionable description.

The truth is that in missing those funding opportunities in the naughties the health service in Northern Ireland it costs far more to run an inferior service to the one in England (Northern Ireland 4k-4.5k England, 3.2k – 3.5k). What’s needed is investment.

Greater Belfast with a population of 700,000 to 750,000 has no less than four acute hospitals. Cardiff with about one million in its greater metropolitan area has just one. Greater Birmingham also has four but they serve a population of around 2.8 million.

Bengoa is full of ideas, some more costly than others. But bringing specialist care into a smaller number of high performing hospitals will take significant capital investment in order to produce savings and better patient outcomes in the longer term. 

As my old mate The Dissenter notes on Twitter, we know about Bengoa, but that was not a costed plan never mind a case for investment. When it was launched nine years ago the current FM warned health costs would be unsustainable in ten years.

Stormont claims it needs more money to invest. Where are the agreed, detailed, costed, timelined plans that would be the basis of investment. Let’s start with health…. Not a report(s) sitting on the shelf. Actual agreed, detailed, costed, timelined plan to reform health?

— Sapere Aude (@thedissenter) February 5, 2025

So where’s the costed investment plan? And where is the political cover to: one, ensure the health minister has enough cash to deliver all the necessary reforms; and two, take the tough decisions that major rationalisation of the hospital system requires?

A clue may lie in how the broadly supported Sláintecare plan for the reform of the health service in the Republic, which originated in June 2016 when Social Democrat TD Róisín Shortall set up an all-party “Committee on the Future of Healthcare”.

Progress is slow, but the consensus means all parties are committed to it in broad terms, reducing the possibility that whichever minister is in charge of health they are working within that broader consensus. Without it, we’re just stuck in the weeds.

Mick is founding editor of Slugger. He has written papers on the impacts of the Internet on politics and the wider media and is a regular guest and speaking events across Ireland, the UK and Europe. Twitter: @MickFealty