In poor health – no sign of a long term cure to Northern Irish governance crisis

Frances Neilson

For Northern Ireland, the impact of Brexit extends beyond the questions of the porosity of the Border; it is a stumbling block to re-establishing power sharing as public services go neglected.

For those not based in Northern Ireland, it felt like the DUP burst onto the political scene from nowhere – with one of the most googled searches of 2017 in the UK being ‘what is the DUP?’

Fast forward two years, and there are few left in Britain in doubt of who the Northern Irish Democratic Unionist Party are; their objection to the possibility of a de facto border in the Irish Sea created by the now infamous ‘backstop’ was shared by many in the Conservatives’ ‘European Research Group’, helping ensure that Theresa May’s withdrawal agreement failed to pass through parliament three times.

With Boris Johnson now Prime Minister, the backstop has been scrapped with its proposals seemingly no longer an insurance policy, but rather just policy. The DUP accused the Johnson Government of “selling Northern Ireland short”, while British press to the east of the Irish Sea hailed the Prime Minister’s new agreement as “vastly-improved”.

In the upcoming election, which many in the Conservative party hope will make the DUP irrelevant to their majority, all signs indicate that the DUP’s voice in Westminster will be diminished, and there is next to no prospect of them propping up a future Conservative led administration, such is the sense of betrayal.

The election is in any event unlikely to return all 10 DUP MPs to Parliament; South Belfast, North Belfast, and East Belfast are all exciting constituencies to watch, although the news of independent unionist MP Lady Sylvia Hermon’s retirement leaves the DUP also eyeing up North Down. Regardless, even with a few changes, the DUP will remain the dominant representation of Northern Ireland in Westminster.

The confidence and supply agreement entered into in 2017 has many critics; from the opposition parties’ outrage over the disproportionate influence of 10 MPs on Government, and particularly 10 MPs from a socially conservative party, to concerns that the agreement would make the British Government a partisan actor in any talks to re-establish a power-sharing Executive at Stormont.

However, in Northern Ireland – which has been without governance for over 1000 days – the £1 billion over five years secured through the confidence and supply agreement has been used to paper over the cracks that run deep and are getting deeper without ministers at Stormont or Direct Rule from Westminster to provide relief. The implications of the removal of that funding could be considerable.

This has especially been true for the Northern Ireland Department of Health, where £300 million of the £1 billion has been directed. Of the £300 million, £200 million is set aside for transformation, £50 million for mental health, and £50 million to relieve immediate pressures. The £50 million for mental health was particularly welcome, although local mental health charities have stated there has been little evidence of the money on the ground. As Northern Ireland struggles to deal with the legacy issues of ‘The Troubles’, there is a clear need for well-funded mental health services; in the 21 years since the signing of the Good Friday Agreement, more people in Northern Ireland have died by suicide than the number who died during the 30 years of conflict.

Without a Health Minister, or Direct Rule, the Department of Health has been more proactive than other departments, pushing ahead with public consultations on Reshaping Breast Assessment Services and Reshaping Stroke Services, the publications of a Suicide Prevention Strategy, a Cancer Strategy, a Cancer Drugs Fund policy, and the implementation of multi-disciplinary teams in GP practices. However, there is only so much civil servants and Permanent Secretary Richard Pengelly can roll out without political leadership.

Prior to the dissolution of Parliament for the election, Lord Empey (UUP) introduced a Private Member’s Bill to the House of Lords to divert health powers to Westminster until an Assembly is restored. This bill will have to be reintroduced when parliament returns, however if the next government is a Conservative one, this is unlikely to pass into law.

While Brexit rumbles on, an Assembly is unlikely to be re-formed. Talks to re-establish a power-sharing Executive are scheduled for 16 December, but little has changed for the DUP and Sinn Féin since the last round of talks. If power-sharing is unrestored by 13 January 2020, the Government will be required to call an assembly election. At present, it is difficult to see a result not returning the DUP and Sinn Féin as the largest parties – which begs the question whether an assembly election would help restore power-sharing. Direct Rule has so far been unfavoured by Westminster and should that be the preferred stance of the next government also, the future of health and indeed all public services in Northern Ireland will remain in stasis.