Deirdre Heenan: Ambiguous targets, uncertain budgets – the thousands in pain on waiting lists deserve better than this

Over a year since the re-establishment of the Stormont institutions, the executive’s Programme for Government (PfG) has finally been published.

The draft programme which appeared in September was widely criticised as abstract, rambling and ambiguous. A document that in many respects was completely meaningless waffle.

One might have imagined these critiques and a consultation process that garnered over 1,400 responses would have ensured a much more robust, ambitious final document with clear priorities, deliverables, targets, timescales and metrics. Wrong.

In relation to healthcare, one of the few discernible differences between the final document and the previous iteration is the inclusion of a number of targets.

Good news? Well, no not really. The targets are confused, ambiguous, and the necessary budget lines have not been confirmed by the Executive.

With reference to cutting waiting times, the PfG states: “With Executive support, invest up to £135 million a year to reduce waiting lists by treating an additional 70,000 patients and a further £80m a year to increase elective care capacity.”

With Executive support? Not confirmed but conditional. It seems that the necessary funding to support this aspiration has not yet been identified nor agreed.

Mike Nesbitt has confirmed that he is writing to the First and Deputy First Ministers to seek clarification on the financial position for health. He wants them to “show him the money”.

This is an absurd state of affairs. Isn’t the whole point of a Programme for Government having an agreed set of fully-funded priorities, aligned to a budget? Making difficult choices, communicating them and getting on with delivering.

Presumably, if this additional funding does not materialise, the priority of “addressing the waiting lists” goes up in a puff of smoke.

The PfG also provides no detail on how the proposed additional funding will be spent.

Unlike unscheduled treatment, elective care is planned in advance, yet this remains a grey area.

How can we increase capacity in a health and social care system that is already struggling? Is an enhanced role for the independent sector envisaged?

What type of surgeries will be prioritised? Will those waiting the longest be seen first? What of the cross-border directive?

In a further unexpected plot twist, shortly after the publication of the PfG it became clear that the Health Minister was unaware of the ‘apparent’ allocation of additional funding for waiting lists.

After landing the unexpected funding bonanza, Mike Nesbitt appeared delighted, acknowledging that he didn’t know that “this money was coming”. Furthermore, he had no plans on how to spend it.

Incredible. He later helpfully explained that within the four-party coalition there was not an “equal distribution of knowledge in the build-up to the publication of the plan”. A somewhat convoluted way of saying ‘I was kept in the dark’.

It does though rather beg the question, did he sign off the document, unaware of its contents? Yet another unedifying glimpse into how ‘coalition’ government works here.

It will be a hard sell for anyone to see this whole debacle as good governance. Meaningful pledges are funded pledges. At best the promise for “up to £135m for waiting lists” is aspirational.

One could be forgiven for suspecting that it was shoved in at the last minute to take the bad look of a deeply disappointing document.

This PfG should have marked a turning point for addressing the long-standing systemic issues in our beleaguered health system, including waiting times, workforce, social care and primary care.

Unfortunately, this is not an agenda for change but a manifesto for more of the same. We deserve better.

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