Northern Ireland in no position to take a one-two-three punch

A trio of major policy debates that feel like they are running in parallel are dominating Northern Irish discourse.

One of these is, of course, Brexit.

The failure of Labour’s motion in the Commons to make No Deal more difficult, along with the dominance of Hard Brexiters in the current Tory leadership race, makes leaving the EU without a deal much more likely (although by no means certain).

Massive structural reform of Health and Social Care (HSC) in NI is another.

Scope has written many times about the immediate need for health reform, why it is a necessity and not a nice-to-have, and also about why – despite reports dating back to 2011, urging change – it has taken so long to get going.

The Department of Health (DoH) is now gaining a bit of momentum with its reforms. Some crucial changes are in motion and Permanent Secretary Richard Pengelly is increasingly on the front foot, laying out the reasons why the status quo is a route to doom. However, this is an amazingly complicated process and there is a long way to travel.

The third is Welfare Reform and, specifically, the end of the mitigations package previously negotiated for NI.

What is being hailed as the #cliffedgeNI is coming in March next year. If no new mitigations are arranged, or other adjustments made, some of the people who are most dependent on benefits are set to suffer.

Alongside the continuing absence of Stormont (which is unlikely to get fixed until after some resolution on Brexit, given the political dynamics involved), and orange-and-green issues, these three policy areas occupy a huge amount of space in the public conversation.

They feel like they are happening in parallel. They are not. At some point they will converge.

Brexit

A No Deal Brexit presents Northern Ireland with a huge of specific problems (and hardly any, if any, tangible positives).

So much so that a number of third sector organisations, including NICVA, have established the Brexit and Human Rights Working Group.

Last Friday released a statement, published in The Guardian, warning of the terrible consequences of No Deal, including food insecurity, a hardened border, loss of access to medicines, the end to the energy single market, the erosion of various rights and protections, and various blows to the economy.

The statement says: “As representatives of Civil Society, we believe that Northern Ireland is on the brink of a No Deal Brexit emergency. In an evolving political landscape, a variety of factors indicate that the potential for a No Deal Brexit has now escalated significantly…

“There is also currently no clear mechanism by which the UK Parliament can prevent a No Deal Brexit. Therefore, the possibility of the UK leaving without a deal in October, either by accident or design, has dramatically increased…

“A No Deal Brexit means Northern Ireland will be thrown into a state of emergency and without a sitting executive to respond to this crisis, we face an unprecedented threat to our rights…

“A No Deal Brexit would be a disaster for Northern Ireland. We call on the UK government to accept that a No Deal Brexit is not a viable option and do everything in its power to prevent this possibility as a matter of urgency.”

Health reform

Our health system, as it stands, will collapse soon.

Health and Social Care already accounts for about half of our budget. Funding cannot keep up with rising costs. The effects of this are already being felt in many ways, such as growing waiting times for elective services.

The BBC ran an intriguing programme this week called Spend it like Stormont – “In the absence of politicians at Stormont, [presenters William Crawley and Tara Mills] speak with those in charge to find out why those services are under strain.”

DoH Permanent Secretary Richard Pengelly was on the show, explaining the need for specialisation of services at, for instance, hospitals and increasing efficiency and quality of care together.

"We have enough money to run a world class health service, but we don't have enough money to run this health service.

"At the moment to run the same service this year as we did last year and next year, it's about 6% increase per annum.

"If we continue on that trajectory, within about 20 years the health service will need virtually all the money that's available to the executive…

"It may mean that members of the public have to travel a little bit further and in some cases a little less. You can't replicate every service in every location."

#cliffedgeNI

The Cliff Edge Coalition NI is a group of over 70 organisations – including Housing Rights, Advice NI and NICVA – worried about the end of welfare reform mitigations next March.

It has two key messages:

• The protection in place to support people impacted by welfare reform through mitigations is due to end in March 2020.
• It is important that people impacted by welfare reform in NI continue to be able to access support beyond March 2020. This support should take account of the new challenges people are facing, particularly Universal Credit.

They also have several specific concerns about the ongoing roll out of Universal Credit (UC) to NI, including (but certainly not limited to) that access to the internet and IT literacy is a barrier for some claimants entitled to UC, a significant decrease in discretionary support, the acute impact on women and children (and also the possible impact of UC’s two-child policy), and various problems with housing such as the crude application of the bedroom tax and the vulnerability of low-income private renters.

Coming to a head

No Deal Brexit could happen in October – and, if it does, could be an enormous disaster for NI. The welfare reform mitigations are set to end in March. The health service will crumple over the next few years without a series of massive, inter-related changes (many of which, in isolation, might be unpopular and be strongly opposed).

Each of these are major issues, but what about them in combination? What happens to Northern Ireland if all this comes to pass?

If Brexit does severe damage to the NI economy, it will shrink the public purse. Public demand for Health and Social Care will not shrink, people who rely on benefits will not have fewer needs – but both these problems will be exacerbated by a smaller budget. There is little or no room for savings elsewhere in NI public spending (especially with an education system also ready to fall flat).

Then there’s the link between HSC and welfare. Those on benefits tend to have a greater reliance on health and social care than the general population.

Brexit, HSC and welfare reform are a triangle of policy issues capable of affecting each other. Problems that hit any one of them will make things more difficult for the other two.

If all three break bad, Northern Ireland is in trouble.