Financial stability and long-term planning critical for public sector transformation

Some 70 per cent of respondents in Deloitte’s annual State of the State report say they want healthcare in Northern Ireland to be prioritised for public spending next year
Some 70 per cent of respondents in Deloitte’s annual State of the State report say they want healthcare in Northern Ireland to be prioritised for public spending next year

HEALTH and the state of the health service has always been a hot topic, but since the beginning of the pandemic it has dominated the news, social media and conversations in most of our daily lives.

Covid has undoubtedly had a profound impact on the health sector in Northern Ireland. Our waiting lists were already the worst in the UK prior to the pandemic and now the situation has been exacerbated as appointments and procedures are put on hold.

So it's no surprise that in Deloitte’s annual State of the State report for NI, citizens surveyed overwhelmingly wanted healthcare to be prioritised for public spending next year, with 70 per cent of people identifying it as a priority policy issue.

Spending on health already makes up the largest part of the Stormont budget and earlier this month Finance Minister Conor Murphy proposed a further 10 per cent increase in health spending over the next three years as he launched a public consultation on his draft budget.

But it’s widely acknowledged that more money alone won’t solve the problems currently facing the health service. We already spend more per head than rest of the UK on health, yet we still have the worst waiting lists. We have to be smarter in how we spend resources.

Feedback from public sector leaders interviewed for State of the State shows they believe transformation of the whole health system, with targeted investment, is needed to make meaningful improvements in healthcare delivery.

There was a general recognition from those we interviewed that we have enough glossy strategies, including the Bengoa report but now is the time to get on and deliver health reform.

Financial stability and long-term planning are critical for public sector delivery and transformation, so the proposal of a multi-year budget was welcome. But no sooner had the consultation been launched than other political parties within the Executive started to find fault with it.

All governments across the globe have spent the past two years trying to navigate the Covid-19 pandemic. What's different here is that we have a five-party mandatory coalition, and at times it is difficult to get a single, consistent message from Executive ministers. Occasionally we see unity but recent issues such as Covid passports show division normally isn’t far away, fuelled by the different risk appetites of parties.

Views in Northern Ireland towards the devolved administration are more negative than elsewhere in the UK, particularly when it comes to doing the right thing for society and in delivering major projects on time and to budget.

But heading into an Assembly election next year, all the parties will want to strengthen their health credentials and demonstrate they are thinking about the futures of their constituents and their children, so the current crisis maybe a perfect opportunity for then to see progress on health reform.

The pandemic has exposed structural weaknesses in the healthcare and social care system. But other areas are also ripe for reform, including education, justice, and wastewater infrastructure. Brexit and the pandemic have diverted government from undertaking these critical reforms and resources have been diverted away from them, but all of these problem areas will need addressed in the short term.

We know there is also an urgent need to reform and modernise the NI Civil Service to ensure it has the relevant skills, expertise and risk appetite to deal with existing and future challenges. Acceleration of digitalisation across the public sector to enable more agile and flexible working has shown what is possible – delivering productivity benefits and making it likely that hybrid working is here to stay.

While many public sector workers are exhausted, sickness related absence levels are down by as much as 40 per cent in some departments. Some senior civil servants said their organisations haven’t lost a day to work related stress thanks to home working. Outputs are up, and staff surveys show staff satisfaction is up. All of this is significant given the civil service in NI has grappled with high levels of sickness and work-related stress for years.

In 2022 we will likely see government and business organisations placing more focus on the future of work than ever before, reducing commuting to an office and workplaces being used more for collaboration and relationship building.

The pandemic has shown that we can accelerate delivery while still following due process. What needs to change now is the speed in which we stand things up and take action.

:: Marie Doyle is a director at Deloitte