Sam McBride: Politicians are killing people, yet the public remain remarkably restrained

Not deliberately, of course.

Although politicians disagree as to how our society should be structured, they overwhelmingly care about their constituents, their families and their friends who are impacted by their decisions.

But in recent days a dark truth has become inescapably explicit: The inaction of some politicians is having fatal consequences.

Depending on one’s political outlook, that blame may be apportioned in different directions. But every one of those directions points to either the DUP, Sinn Féin or the British Government.

The health service in Northern Ireland has been under exceptional strain for years. Even in the last days when Stormont was ‘working’, waiting times were rising substantially.

The simple explanation for that – and the one preferred by Sinn Féin – is that heartless Tory toffs simply wouldn’t send enough money to Stormont to pay for an adequate health system.

The more honest answer is that Stormont’s profligacy, infantile populism and prioritisation of tribal disputes significantly undermined the health service.

Unpopular reforms which medics and medical experts largely support – including the centralisation of services in centres of excellence, which would necessarily downgrade some smaller hospitals – were repeatedly not made.

Some DUP ministers such as Edwin Poots and Simon Hamilton, along with the Alliance Party, stood out as rare exceptions because they were prepared to consider some unpopular measures such as the reintroduction of prescription charges to fund wider health spending.

Even when, just months before Stormont’s implosion, the parties came to sign up to the Bengoa Report on health reform there was a sense that it was easier to do so because Professor Bengoa had been less explicit about moving services away from some smaller facilities.

If history is a guide, when that eventually became clear, at least some of the parties would have been standing in protest against their own reforms.

But Stormont’s health failures went beyond putting off unpopular reforms. The administration jointly led by the DUP and Sinn Féin prioritised huge salary hikes for their hand-picked special advisers (Spads) over investing that money in front line services.

In 2011, DUP finance minister Sammy Wilson approved a nine per cent hike in Spad salaries, despite cuts across the public sector at the time. With typical secrecy, the Executive did not announce the decision.

Salaries for many of the Spads more than doubled since devolved government returned to Northern Ireland in 1999 and stood at £92,000 for some of the top spads before Stormont’s collapse – more than the starting salaries for a hospital consultant, a school principal or an RAF Wing Commander.

In the world of government spending, that was small change and would not have transformed the health service. But it was an example of the Executive’s priorities.

Largessé was lavished on those within the DUP and Sinn Féin’s golden circle such as spads, on publicity photos of ministers, spin doctors and pet projects while public sector workers were told to tighten their belts – “pay restraint”, as Arlene Foster described it on The View on Thursday, was not for everyone.

While Stormont was in place, the DUP simultaneously boasted that Northern Ireland had the UK’s lowest household taxes while complaining that there was insufficient money for public services.

For Sinn Féin’s part, it demanded that London pay more and more money while in denial about the vast subvention from GB taxpayers and refusing to use its limited tax-raising powers such as the regional rate and water charges.

Sinn Féin’s big tax idea – slashing tax for the biggest corporations – was not only ideologically absurd for a supposedly left-wing party, but would have reduced by several hundred million pounds the money for public services.

There are arguments against increasing taxation, but they are not best made by parties complaining that public services are crumbling while the local population pays less tax than citizens elsewhere in the UK.

The day of reckoning for those misplaced populist priorities is now upon us. Last week it was confirmed that more than 133,000 patients are waiting more than a year for hospital treatment (across all of England and Wales – a population more than 30 times larger than that of Northern Ireland - the figures is less than 6,000). More than 300,000 people are waiting to see a consultant – one in five people in Northern Ireland.
The Royal College of Surgeons, not a body known for hyperbole, now says that “Northern Ireland’s healthcare system is at the point of collapse”.

That crisis has in recent days escalated with industrial action, including strikes, by health staff over pay and staffing levels which unions say are unsafe – but the issues cannot be addressed without either a direct rule or devolved minister to take decisions.

Some cancer surgery has been cancelled as a result. Others waiting for tests – already facing life-threatening delays to even be diagnosed with the deadly disease – have, after that long wait, had them cancelled.

Medics speak of their anguish at the knowledge that the length of the waiting lists – more than four years in some cases – means that treatable conditions will become incurable or those who if they saw a consultant would be diagnosed with a life-threatening condition will never even be diagnosed with what will kill them.

Sinn Féin is still refusing to allow Stormont’s return until an Irish language act and other issues – which have over time become increasingly opaque – are agreed.

Since August 2017, it has been clear that the DUP has conceded that there will be Irish language legislation. The debate has been about what that would be called, with both parties pedantic about whether it is called an ‘Irish language act’, and the sequencing of when it would be delivered.

The DUP proposes that Stormont should return immediately and then legislate for Irish within a set period, whereas Sinn Féin demands that the legislation is agreed first, distrustful of the DUP engineering a situation where it may be more difficult for Sinn Féin to walk out of Stormont a second time if the DUP reneges on its word.

Given that the smaller parties are powerless to restore Stormont, if the DUP-Sinn Féin duopoly cannot agree to govern, there is only one credible alternative: direct rule ministers, or at least a direct rule health minister.

This week Secretary of State Julian Smith and the NIO repeatedly declined to answer directly when I asked if they would even consider direct rule at a point where people are dying as a result of the impasse – a situation which would be intolerable anywhere else in the UK.

Mr Smith said that health “is a devolved matter”, implying that three years after devolution collapsed it is still in place. It is difficult to conceive that republicans would take to the streets in protest if Parliament was to implement direct rule in the Department of Health – as Lord Empey has proposed – in order to save lives.

On Tuesday, a disturbing BBC Spotlight programme included the story of an elderly man living in a fold who told how after years on a waiting list for a painful hand injury he had sold family heirlooms in an attempt to fund a private operation but couldn’t raise enough money and now fears he will die before being treated.

The programme closed with incredulous words from Castlederg GP Dr Brendan O’Hare: “I cannot understand why this population is so docile. If you trample on their cultural identity, they will riot in the street. But if their granny’s legs are literally falling off, they just accept it.”