The Community Development and Health Network is Northern Ireland’s leading organisation working to empower communities and tackle health inequalities using community development.

CDHN's response to the proposed financial saving plans for the health Trusts

Community Development and Health Network (CDHN) is a regional network organisation, consisting of over 1800 members.  We support and engage our network to advance their knowledge and skills in community development and to influence policy in order to reduce health inequalities.

1. The proposed financial savings will lead to greater health inequalities across a range of indicators.

Health inequalities are the unfair and avoidable differences in the health status of people in our society.  The conditions in which people are born, grow, live, work and age, the wider determinants of health, shape health.  They can be health protecting and promoting or health damaging.   The   social   determinants   of   health   per   se   do   not   cause   health   inequalities;   they shape health, good or bad.   It is the unequal distribution of the determinants of health which cause health inequalities.    Access to and quality of health and social care is a determinant of health.  The proposed financial saving plans for the five Trusts will be catastrophic and have long term impacts; reducing people’s quality of life and potentially length of life, especially of the most vulnerable and those living in deprived areas.

2. Trusts and health and social care must be transparent and accountable when presenting the public with information and in their decision making.

It is important the Trusts and the wider Health and Social Care system are transparent, accountable and fair.   When consulting with the public on decisions it is important to share all pertinent information.  It would have been beneficial for the consultation documents to highlight the rationale behind why particular services or wards were identified and how cuts to these areas and the resulting impacts compare to cuts and impacts in other areas.

3. Cuts to domiciliary care, closure of beds, wards and services must be prevented.

Cuts to domiciliary care, closure of beds, wards and services such as rehabilitation or day surgery, along with the postponement of specialist drug treatments, will push those who can afford to pay privately to do so. This will increase inequality and undermine a key founding principle of our health and social care system: free at the point of delivery.   Many of the areas identified for cuts, such as those to domiciliary care, mean that the most vulnerable in our society will be the most affected.   Cutting day surgery will impact most on those already bearing the brunt of inequality, as 41% of day cases come from the most deprived areas. 

People dependent upon our health and social care system, and unable to afford costly private treatment are likely to become displaced to another part of the system in an attempt to have their needs met.  Displacing people does not address the issue rather it serves to increase pressure on other areas which, in the longer term, will not have the capacity to deal with this additional burden.

4. Long term work force planning needs to take place, not reactionary short term measures to reduce workforce costs.

Where CDHN agrees with the areas for potential saving is in the reduction of locum and agency costs.  There is little doubt that fulfilling staffing quotas through permanent staff provides better quality care over the longer term, improves morale within the service and improves the efficiency of the service.  We do not, however,  agree with the level and timeline for these reductions.  The reductions need to happen in a controlled manner, so as not to have an adverse impact on patients or on staff, and this can only be achieved through effective workforce planning.  Balancing the time it takes to recruit staff, train professionals and manage retirements, means that a long term approach to workforce planning is necessary to reduce locum and agency costs.

5. There is a strong need to move to three year budget cycles and to improve the flexibility with budgets i.e.: transferring between capital and resource, managing slippage.

We have no doubt that,  with increasing costs in a time of austerity, savings should and must be made but these should be planned and where possible be multi-year rather than in year.  The current rules and regulations for government departmental spending in relation to in year expenditure, capital verses resource, reinvestment of slippage etc., inhibit the effective running of large organisations such as the HSC Trusts.   

6. MLA’s must return to Stormont to address these issues and prevent the catastrophic cuts to our health and social care services, which will impact on the lives of the most vulnerable in their constituencies, increase inequality and erode the  service upon which everyone in our society relies and values.

Our understanding is that if the current impasse in Stormont was addressed there would be the opportunity to prevent these cuts, and improve future budgeting for our public services. 

CDHN are happy to discuss any part of this response in more depth.

Contact: Meabh Poacher, Policy Officer - 028 30264606,