UNISON last Friday challenged all five Health Trust Boards in Northern Ireland to refuse to comply with a Tory government demand for £70 million cuts.
In addresses to all five Trust Board meetings, Unison representatives said: ‘Chair, board members, we start our contribution by paying tribute to the public and our members who have spearheaded a public campaign over the past 6 weeks – a campaign that has very publicly rejected these outrageous and dangerous cuts.
‘It is clear that the very public fight to protect our health and social care services has forced the Department of Health to make its latest announcement. Across Northern Ireland, many patients, clients and staff have breathed a sigh of relief. But all is not as it seems. Let us recap. Five Trusts were told to make £70 million in cuts. All five of you did that by producing outrageous proposals which for 6 weeks caused fear, apprehension and distress for patients, vulnerable adults, and health and social care workers alike.
‘We asked you not to do that, but instead of standing up with the people to press for the resources you need, you rolled over and did what you were told. This is not guardianship of the health service.
‘We have now seen the letter you received from the Permanent Secretary on Wednesday. It is written in a language that rivals any script from the comedy satire “Yes Minister”. What the letter actually says is not what the public, the media and possibly Non-Executive Directors have been led to believe.
‘From our reading of this letter £40 million has not been restored to the Trust budgets. Instead, only £18 million has been restored and all five Trusts are still required to make £52 million in cuts between them. The Department of Health attempts to show a softer face by stating that it will absorb a further £10 million of risk on the hit to your budgets until the end of the year. You told us 6 weeks ago that you had no choice but to ‘break even’. Perhaps you might ask the department how it manages to break even by absorbing £10 million in risk.
‘The Department declares that this means that instead of making £31 million worth of highly controversial cuts affecting patient care, social care, and waiting lists you are required to make £3 million of what it still describes as controversial cuts. This instruction was issued to you before any consideration of the public response to the consultation.
‘We told you that this consultation was a sham before you started. This latest instruction confirms that it is still a sham. Do not allow this Trust Board to be hung out to dry by either the Department of Health or the Health and Social Care Board. Trusts have also been instructed to make £39 million of what you and the Department are wrongly calling low impact cuts. Yet, you have failed to disclose what the real impact of your share of this cut will be in your Trust.
‘You have failed to disclose the impact on your staff, and the knock-on impact on patients and clients. In doing so you have once again by-passed your legal responsibilities for collective bargaining. Let me be clear – should you continue to do so then you will create a major trade dispute between us and this Trust.
‘You are only today considering the public response to all of your cuts proposals, a mere 5 working days after the consultation closed. We know that between them, all the Trusts have received thousands of responses on behalf of hundreds of thousands of people – many more than could be properly analysed and weighted in this time frame. Yet the department instructed you two days ago to go ahead and make these cuts. This makes a complete mockery of your position as a Trust Board, undermines public confidence in you and lays bare any attempt to fool the public.
‘No mention is made in the letter from the department about where the rest of the £40 million is going. The 5 Trusts are receiving only £18million of it. The department is to underwrite a further £10 million as risk against your budget cuts, so what is happening to the other £22 million? This is deliberately unclear and you must challenge it.
‘The health service in Northern Ireland is underfunded. Yet there is still clearly more money in the system including, not only unallocated funds, but money which was allocated and has not been spent. In addition, there is £1 billion secured as a result of the supply and confidence deal which includes significant additional funds for the health service. We are confident that a collective and joint approach from the leadership of the health service and the unions would go a long way to securing the resources needed to do the job.
‘While this is also clearly a job for our politicians, the fact is that the damage to the health service budget took place on their watch. It is no longer permissible to hide behind the Treasury allocation or to argue that we cannot allocate more to an underfunded health service. We very much want devolution to return, but only on the basis of an equality and human rights framework.
”Had they adopted this a decade ago, the health service would not today be facing the same crisis. Nor can any devolved government here again argue that there is no more money available from Westminster. The recent billion pound deal demonstrates that there is.
”What is clear is that you have a further instruction from a government department to ignore the public consultation you have concluded, leaving you open to legal action. You are once again in breach of your legal and moral responsibilities. The departmental instruction is also embedded in an austerity programme that should by now have been swept aside and which contains the following statements:
‘The financial position is quite simply unsustainable, and real and rapid transformation will be required if we are to deliver on the outcomes set out in “Delivering Together”.
‘You and we already know that this can only be delivered by additional investment and not further cuts. This was clearly signalled by the outgoing minister but the department chooses to ignore this and goes on to state:
‘The need for ongoing and regular savings plans can therefore only be mitigated if transformation of the HSC moves forward without delay. This Board has an obligation to the public, its workforce, and trade unions to expose exactly what this sentence means. Is this the threat that your budgets will be further slashed unless you close facilities and stop programmes of treatment? We suspect that this is precisely what it means.
‘So, far from getting you off the hook, this new departmental instruction begins to lay bare the fact that decisions are being taken behind closed doors without any intervention from those we have elected to serve us. Unison also warned 12 months ago that transformation would only work if it was a genuine partnership with unions, staff and public. We will not accept attempts to bully or force cuts to vital services which harm the health of the public and threaten our members.
‘We are not prepared to accept this position – particularly as nothing has been said or done to allay our suspicions that a full blown privatisation agenda is emerging and that this crisis is being manipulated. Cynically, if sufficient crisis are created in our health system it becomes easier for the public to believe that the only way to solve the problem is pay to go private. You know this, we know this. You have the evidence that this is now a daily occurrence.
‘You may attempt to dismiss our fears on the grounds that we are a trade union and “we would say that anyway wouldn’t we”. However, you should know that at the recent meeting of the health and social care board which approved the commissioning plan as if there were not cuts at all, the Chair of the Board, in his closing remarks, made a disturbing statement that our health service was the only one in the world that was funded through taxation and that it was time to have a discussion about this. Such a statement flies in the face of the founding principles of the NHS but we are hearing this from more than one source. We believe this statement has to reflect a wider conversation that is taking place far from public and political scrutiny.
‘You have now been issued with a new set of instructions from the department. It still wants £3 million worth of controversial cuts immediately. These cuts have been rejected in the public consultation. You promised 6 weeks ago that today you would give proper consideration to the public response. You cannot now ignore it. If you take decisions today to implement any element of the 39 million in so called low impact cuts then you cannot hide behind the department. You must fulfil your additional obligations to come to the bargaining table with the truth about what these cuts really mean for services and staff. You are then clearly required to engage in a full 12-week public consultation in accordance with your statutory equality duties.
‘We wait in anticipation for you all to do the honourable thing which is to:
• challenge the entire contents of the department’s letter;
• accept the results of the public consultation, which has clearly called for no cuts to be imposed;
• refuse to recommend any major/controversial cuts to the department and refuse to approve any cuts you have wrongly characterised as low impact and upon which you have completely failed in your duties to negotiate with Unison.
‘If you do not do so, we will challenge you using all legal means at our disposal, a process that has already begun through the complaint Unison has submitted to the Trust for the major breaches of your equality duties. You are meant to act as guardians of the health service as members of this Trust Board. Today, we are repeating our call to you to stand with us to challenge the lack of funding for proper health and social services in Northern Ireland.
‘You have seen over the past 6 weeks that we are prepared to fight for it, and the public is prepared to fight for it. It is time that this Board, both Executive and Non-executive alike, demonstrated that you too are prepared to fight for the public you are appointed to serve.’