While the NHS’ struggles have long been known across the UK, Northern Ireland’s health crisis eclipses that of the rest of the country by a considerable margin. This week more than 20,000 health service workers went on strike in unprecedented industrial action across the region. It was the first time in its 103 year history that members of the Royal College of Nursing joined the strike.
Healthcare workers warn that services are on the brink of dangerous collapse. Figures show that between summer 2018 and summer 2019, 105,450 people in Northern Ireland who were referred by their GP to a consultant had to wait more than a year for their first appointment. In the same period in England, just 1,233 people were subjected to the same wait time. The numbers are particularly stark when you consider that Northern Ireland’s population is just 1.8 million, compared to England’s 55 million. Similarly, the proportion of patients seen within four hours in A&E departments stands at 81 per cent in England, compared to just 66 per cent in Northern Ireland.
The origins of the healthcare crisis are numerous and complex. The lingering effects of sectarianism and enduring divisions along nationalist and union lines has left Belfast city with an excessive number of hospitals, which often duplicate services for the two communities. This creates considerable costs for the health service: the major Bengoa review of health services in 2016 recommended that several hospitals should be closed to end this overlap.
While funding for the health service has long been stretched, the collapse of Stormont in 2017 has made the issue particularly acute. The power-sharing agreement between the DUP and Sinn Féin came to an abrupt halt in January of that year amid a bitter row over the former party’s alleged role in a financial scandal.
Since then, the region has been run by civil servants in absence of a government. Without ministers present who would normally take policy decisions, civil servants have been tasked with following in the spirit of the last Health Minister’s decisions – and avoiding not introducing any new policies that could be controversial.
In some cases, the result has been prolonged austerity. In 2014, former DUP Health Minister Jim Wells ended pay parity between health care workers in Northern Ireland and the rest of the UK. Westminster announced three-year pay increases for NHS workers in 2017, but with no government in place to sign off the legislation, civil servants in Belfast have continued with Wells’ fiscally conservative policy.
The Royal College of Nurses says that the real term value of their staffs’ pay has therefore dropped by 15 per cent over the last eight years. Hospitals are struggling to fill nursing posts as poor wages are turning off graduates. Nurses say this has resulted in dangerously low staffing levels, which is putting patients’ health at risk.
Earlier this week I joined nurses on the picket line of Royal Victoria Hospital in West Belfast. Infamous during the conflict for its role in providing crisis care for gunshot wounds and bomb blast injuries, it now specialises in heart surgery and maternity care. In torrential rain and biting cold, dozens of nurses wrapped up in their warmest winter coats and woolly hats struggled to clutch strike banners, flasks of tea and umbrellas. Every few seconds, passing cars hooted their horns in solidarity or wound down their windows to offer words of encouragement.
The nurses explained that they would have much rather been inside the building behind them and back at work, but had been driven by desperation. Hailey Allen, a nurse at the hospital for 22 years, said: “There’s staff coming in to work on a daily basis and they’re in tears within hours because of the stress levels. The staff are getting more and more demoralised. We’re haemorrhaging staff left, right and centre.”
Allen explained that her colleagues often find there are fewer nurses than necessary to manage the number of patients on their ward at the start of a shift. This is compounded by some of the nurses being agency workers rather than permanent hospital staff, meaning they don’t know how to find their way around the building or the specifics of a medical issue.
“There are things that specialist staff know to do, that agency staff just won’t know,” Allen says. “It puts so much pressure on the permanent member of the staff, who then feels responsible for the full ward and for what the agency staff are doing.”
One of her colleagues, who asked not to be named, has been a nurse for 21 years. She told me that nurses have become particularly enraged about Northern Ireland’s politicians continuing to receive a full salary despite the parliament not operating since 2017. “They’ve got paid for the last three years. Imagine if you didn’t go to work for three years – do you think you’d get paid? It’s not just health; there’s so many things that need [to be] sorted out.”
Politicians, Allen added, aren’t fully aware of the extent of the health crisis – political walkabouts don’t give a fully picture of reality. “They turn up at the hospital and the management have had time to plan and put on a nice wee show… they walk in to the emergency department and there’ll be barely any patients there, whereas normally they’re stacked in bunk beds.”
While we stood outside the hospital, politicians gathered at Stormont for a round-table discussion as part of a fresh round of negotiations that began on Monday. The health crisis has put particular pressure on Northern Ireland’s major parties, Sinn Féin and the DUP, which both suffered a drop in vote share in last week’s Westminster election, prompting optimism that they may return to Stormont in response to voters’ frustrations.
While the British government has the power to intervene and increase nurses’ pay, it has continually refused to do so, and insisted that the decision must be made by Northern Ireland’s politicians instead. In a statement yesterday, Sinn Féin Vice President Michelle O’Neill denounced this stance, accusing the British government of “exploiting the suffering of patients as political leverage” in the Stormont negotiations.
But the DUP and Sinn Féin remain the focus of dismay and anger for voters. Though the Stormont negotiations have failed numerous times over the last three years, the extent of this crisis may be enough to finally see Northern Ireland’s deadlock broken.
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