This debate must challenge vested interests both inside and outside the Health and Social Care Service. Our politicians in the past have agreed on many costly reorganizations that wasted billions of pounds and delivered nothing but privatization and fragmentation. The only outcomes were a detriment to patients and service users and millions of pounds being paid to private Consultancy firms who were not interested in the best clinical outcomes, but a cost cutting exercise to balance the books.

The Department claims in this latest report that reducing health inequalities is one of its key objectives. This was one of their key performance indicators when the Assembly was set up, yet despite the fine words and noble sentiments, health inequalities have not improved and the March 2024 report from the Northern Ireland Audit Office highlights the fact that not only have they not improved, but have worsened over the past two decades.

All reports from experts in the field make the crucial point that social and economic issues must be addressed to improve health standards and deal with health inequalities. Health inequalities have several root causes but poverty, unemployment, low pay, and educational underachievement plus the lack of decent public housing all features as key factors. The fact that no budget or financial allocation has been included in this latest report would indicate the lack of any serious intent to improve health standards for our citizens or to tackle health inequalities for those living in areas of multiple deprivation.

The Department’s statement that in some cases reconfiguration will require additional money to deliver, speaks volumes for how little they and the Executive understand the problems that would be faced by many communities and individuals by implementing some of these recommendations. The health and wellbeing of some of our most vulnerable citizens could suffer. This also indicates the lack of any joined up thinking or cross departmental working. Little thought seems to have been given to the distance people would have to travel or the lack of public transport and the cost associated with travel.

The lack of accessibility to Emergency Departments or Surgical Services in rural areas will create a major problem compounded by the lack of ambulance cover across Northern Ireland and the continuous overcrowding in Emergency Departments in all existing hospitals. Past decisions on bed and ward closures moving services and building hospitals and health facilities in the wrong locations have created this unacceptable situation. The current staff shortages in the Health Service are not the fault of patients or service users they are the results of deliberate underfunding and staff cutbacks over the past decades and the lack of any proper workforce planning. It is outrageous for the Department to seek to reconfigure services on the back of a situation they not only allowed to happen but actively encouraged it is also unacceptable for patients to be expected to follow the medical staff and Consultants the reverse should be the case.

There is no doubt that we have a major crisis within our Health Service, but it did not happen by accident it happened by design. It happened because of previous decisions taken by previous Ministers and endorsed by the Executive and the political parties. They allowed vested interests inside and outside of the Health Service to set the changes that best suited their own ideology and career opportunities. these decisions were contrary to the founding principles of the National Health Service.

Privatization, fragmentation, bed closures, staff cuts, and reduced services to balance the books on the backs of workers and the most vulnerable in our society went unchallenged by those charged with scrutinizing all health proposals and decisions, they engaged in rancor instead of rigor and allowed this situation to evolve.

To deal with all the problems facing the Health Service and tackle health inequalities there needs to be a joined-up approach with the entire Executive playing a full role in tackling the problems. It is their responsibility to ensure that the appropriate infrastructure needed to facilitate positive changes and the delivery of an improved standard of health care is in place. None of these proposed changes should take place without a full public consultation and a detailed Equality Impact Assessment on how these proposed changes will impact on those within rural communities, not a high-level assessment by the department.

To tackle health inequalities and deal with the root causes the Executive needs to urgently put in place the long promised Anti-poverty strategy, legislate for a real living wage and proper terms and conditions of employment for all workers and commit to ensuring that affordable and free childcare places are made available now, not at some future date. An immediate house building program needs to be scheduled to deal with poor living condition and homelessness and allocated on objective need.

Welfare benefits need to be changed to eliminate the two-child cap and Winter Fuel payments reinstated without means testing. These are the bare minimum first steps required to start the process of tackling health inequalities.

The Health Service cannot be fixed by the extended use of the Third Sector or by introducing performance related pay for those not already receiving such enhancements, merit payments for medical staff and performance related payment for Senior Managers have contributed precious little to improving the standard of health care to patients or service users.

 The health and wellbeing of our citizens can only be achieved by having a fully funded through taxation Health and Social Care Service free at the point of entry and delivered by staff in the direct employment of the Health Service including all medical staff Consultants, Doctors and General Practitioners.

The Workers Party believes that only a Socialist system of government can deliver for the working class. But in the meantime, we will fight for high standards of Health and Social Care, to tackle the health inequalities that working class people have suffered for decades. Our Bill of Rights that was part of the Good Friday Agreement might have helped solve some of these problems, but it has never been implemented like many of the other measures that may have made life better for all our citizens the majority of them being the working class.