NI leaders call for multi-year funding

In a response to the draft Budget for 2021/22, the chairs of the 17 Department of Health arm’s length bodies added that additional funding was needed to put health and social care (HSC) organisations into recurrent financial balance and to meet unavoidable pressures in 2021/22. All trusts had recurrent underlying deficits, largely because of unmet savings plans that have followed 10 years of significant cash savings, they said.

Over the last few years HSC organisations have relied on in-year non-recurrent measures, including adjustments to allocations and slippage on new investment to remain in financial balance. But the Northern Ireland Confederation for Health and Social Care said these arrangements did not support robust financial planning and resilience.

Recurrent, multi-year budgets were needed, and would support more timely decision-making – for example, around multi-year training programmes – and allow pay awards to be agreed earlier.

However, the paper warned that whether budgets covered one year or a number of years, HSC organisations must be in a position where they relied less on non-recurrent in-year funding. ‘True long-term service change cannot be achieved with short-term investment and trusts cannot plan effectively without a recurrently funded baseline and funding certainty in relation to new investments,’ it added.

Additional funding was needed to enhance and transform services. Elective care in particular required radical reform, alongside investment in workforce and infrastructure, to tackle ‘unacceptable waiting times’, which are the longest in the UK.

Immediate steps should be taken to commission and fund extra medical and nursing training places, the response said. Trust nursing vacancy rates varied between 8% and 18%, though in some specialties it can be as high as 40%. Though there was a 30% increase in nurse training places in 2020/21, trusts will not see the benefit until 2023/24. Even then, there will not be enough nurses to meet expected demand.

The chairs said a 2018 HFMA analysis showed a significant disparity between health funding in Northern Ireland and England. Potentially, the gap had widened since then as it was not clear whether HSC had received its full share of the Barnett consequentials arising from the £20.5bn investment in England in the five years to 2023/24.

In February, a Department of Health analysis of its draft allocation insisted it would not have enough to meet growing demand and the rising needs of an ageing population. Funding would fall short of the amount needed for a sustainable rebuild of the health service, it said. Only £52m of the proposed settlement was additional mainstream funding, and this had been earmarked for Agenda for Change pay increases.

The chairs agreed with the Department’s analysis, insisting the proposed £495m increase would not be enough to address deficits and unavoidable cost pressures.

They added: ‘Trusts are even more concerned about the fact that only £52.1m of the total £495.2m will be allocated on a recurrent basis. This will not be sufficient to even cover pay (to include national minimum wage) and price inflation, which are recurrent inescapable pressures and are estimated to cost around £150m. It should be noted that previous annual budgets have included a much higher percentage of recurrent monies; for example, last year [the Department] received a budget uplift of approximately £400m, of which £344m was recurrent.’

Health minister Robin Swann (pictured) has said non-recurrent funding would not address major structural problems in health and social care, and called for a sustainable, long-term fix.