In Professor Bengoa’s report ‘Systems Not Structures’ – completed last year – he noted that through all the discussions his expert panel had with those involved in the health service, the message they heard most frequently was that the status quo was unsustainable.

What I take from that  – and I imagine what most people would take from that – is that substantial change is needed within the health service in Northern Ireland, or it risks buckling under the pressure. It is in this context that the proposed cut of £70 million to healthcare services is most worrying.

This amount is in truth relatively small compared to the overall health budget (which runs in at around £4.6 billion each year). However, these cuts are another step in the wrong direction for a health service that is in dire need of reform. We are no longer even providing the status quo – we are going backwards, and moving away from the principals set out in ‘Systems Not Structures’ and the ‘Delivering Togetherroadmap completed by (then Minister for Health and now Northern leader of Sinn Féin) Michelle O’Neill.

But these cuts are not isolated in their potential to prevent the effective long-term reform of services. In June, proposed cuts to nursing and AHP training budgets of almost £2 million ran absolutely contrary to the principals of reform.

The worrying thing is that we have known the challenges facing the health service for so long. Professor Appleby delivered two reports on the need for reform in the health service in Northern Ireland. Transforming Your Care and the Donaldson Report also paved a path for policymakers. However, we are yet to start reform in earnest.

To implement the necessary changes there needs to be a) political agreement; and b) adequate funding.

At the minute we have an empty Stormont chamber, and budget cuts.

It’s not that we are simply not reforming services. We are watching the health service decline.

Waiting lists are going up. Targets for cancer care are being missed. GP services are on the point of collapse right across the country.

In the Nuffield Trust’s report, ‘Learning from Scotland’s NHS’, author Mark Dayan states that,

[Northern Ireland] does not yet have an overall quality improvement initiative that combines a method for making change happen with clear goals and metrics that suit the process. The OECD found that Northern Ireland shared with England a sometimes confusing panoply of quality initiatives without clear prioritisation.

This lack of prioritisation is only being brought into sharper focus by the lack of the Executive, and the latest proposed cuts to services.

Professor Deirdre Heenan – at a recent health conference – called for the appointment of a Health Czar to ensure that wider reforms could be implemented without political interference. Without an Executive, this – and the plans for reform we already have – can’t even be fully debated, never mind implemented.

The Transformation Implementation Group – set up to work towards the ‘Delivering Together’ aims – meets regularly and acts to implement the reforms. In their latest meeting they stated that,

Members agreed to attend a workshop in September to agree priorities for the next tranche of transformation work and enable options to be prepared for future Ministerial consideration.

There is no minister to consider or approve this work, and instead of discussing this next tranche of transformation work, we are discussing the further reduction in the health budget, and potential damage to plans for overall reform.

These issues aren’t isolated to health care. Many areas of policy are being affected by the absence of government.

But, after five reviews, four sets of experts, three Assembly terms, two intractable parties and an Executive nowhere to be seen, these cuts and the lack of political direction is setting back health reforms at a time when we should be looking to build a world-class service for the future.