To start off with every Department and Government Agency would reduce total costs by 3% a year for each of three tax years ending April 2011 as part of wider ‘efficiency gains’ associated with the Comprehensive Spending Review (CSR). In parallel to this the Assembly also pursued savings as a result of the Review of Public Administration (RPA). In Health this institutional restructuring resulted in redundancies across management and administrative staff positions.
These cuts agreed at Departmental level were imposed on the five Health and Social Care Trusts and the NI Ambulance Trust under three plans. The Strategic Change and Efficiency Programme (SCEP) set a target of £344 million in cuts across the north. When they were announced the local minister explained that 84% (£289 million) would be achieved through ‘savings’ in pharmaceutical expenditure, procurement initiatives, administration costs through the Review of Public Administration and ‘improved’ productivity. The implication being that a considerable proportion of the ‘savings’ was to be achieved by reducing the total wages bill associated with the pay of health care workers (considered a legitimate target by the Minister). But even in this benign presentation it was conceded (through omission) that the remaining 16% of ‘savings’ would necessarily come from the delivery of front-line services.
The second plan, the Modernisation and Improvement Programme launched in April 2009 and implementing the RPA restructuring resulted in a further £53 million of annual ‘savings’.
The main cuts, however, are to come through the CSR itself which will result in ‘savings’ of £700 million for the health service alone in the three years to April 2011. These much larger cuts are to be achieved through reducing the turnover of the workforce by enforcing a recruiting moratorium, increasing the pressure to provide health and care services in the home as opposed to clinical centres and by consequent reductions in staffing and overheads associated with maintaining hospitals.
The Western Health and Social Care Trust covers the council areas of Limavady, Derry, Omagh and Fermanagh and caters to around 300,000 people in this highly rural area. Under the CSR cuts it will have to find ‘savings’ of £9.682 million in the 2008-09 tax year rising to £12.150 million in the 2009-10 tax year and £14.175 million in 2010-11. This represents cuts of 2.5% rising to 3.5% of the total budget over the period. It has planned that £8.7 million of these cuts will be at the expense of acute (emergency) services a further £3.1 million will be achieved in the area of mental health services and £6.8 million in Primary and Older People Care services.
On foot of these commitments, in December 2008 the Trust published proposals to severely scale back the provision of day care services for Older People and those with Disabilities. The initial proposals recommended reducing day care services by a day each in Beragh, Castlederg and Dromore in Tyrone and Belcoo, Garrison and Irvinestown in Fermanagh. It also proposed merging provision (and reducing places) in Omagh and Strabane). Day care provision was to be privatised (to community groups) in Newtownstewart and Gortin in Tyrone and Newtownbutler in Fermanagh. In another document, the Trust proposed a staggered closing of residential care facilities (homes) in Strabane, Omagh, Derry and Lisnaskea.
Such was the reaction from communities that the political parties and local authorities were forced to move to oppose these cutbacks and the Trust subsequently partially withdrew from implementing these proposals directly and has chosen to delay and gradually reduce provision without being noticed. Although the next round of cutbacks has not been identified by the Trust, it is anticipated that these will be much harsher than those announced in 2008.
The thrust of health policy across the board has been that patients in hospitals and elderly people in residential homes ‘want’ to go home and free up bed spaces. As a result of this warped perspective mothers in maternity wards are forced through the system in a matter of hours and recommendations reducing support for Older People living residential care can be justified in the interests of the freedom of choice of those living in those facilities. At the same time as they transfer responsibility from public health care facilities to homes and communities, the government have been promoting the privatisation of carer services through the adoption of personal care contracts. Parallel to this they have been enforcing a massive onslaught on domiciliary care provision (estimated by a Unison representative at 10,000 hours this last year). At the same time, they are continuing to cut-back on hours of day care provision further increasing the pressure is for Older People and the disabled to be cared for at home. Families under this strain are being forced to pay for care at a time when they cannot afford to.
Staff protesting the range of cuts at the Erne Hospital last weekend indicated that they would not accept the proposed cutbacks. Benny Cassidy. senior unison organiser at the Erne Hospital, said his members and other workers across the north were committed to protecting public services.
“We deserve better. We want a fair and equal society – not one where half the population exists below a living wage, and vital services are sacrificed. We are standing up for our jobs, our families and our communities.”
Speaking to Socialist Party members and supported on the picket line he and other workers agreed that none of the Assembly parties were delivering and that what was needed was more protests to fight the cuts. “This is only the start” said one worker.