Opinion

Newton Emerson: How is NHS England able to sort out waiting lists but we can't?

Newton Emerson

Newton Emerson

Newton Emerson writes a twice-weekly column for The Irish News and is a regular commentator on current affairs on radio and television.

NHS England has virtually eliminated all waits of more than two years, meanwhile backlogs in Norlthern Ireland continue to grow.
NHS England has virtually eliminated all waits of more than two years, meanwhile backlogs in Norlthern Ireland continue to grow. NHS England has virtually eliminated all waits of more than two years, meanwhile backlogs in Norlthern Ireland continue to grow.

NHS England has cleared a major part of its Covid backlog, virtually eliminating all waits of more than two years. This was the first step in its Covid recovery plan, announced in February and delivered on schedule.

Meanwhile, waiting lists in Northern Ireland continue to grow. What explains the difference? It is not money, or at least it is not only money: Northern Ireland has higher health spending per head than England, Scotland or Wales. While Stormont’s limbo cannot be helping, nor is it much of an explanation. Ministers in London had little to do with the recovery plan, which was devised and implemented by managers and clinicians. In a matter of months they have separated out elective from emergency care, changed treatment priorities, streamlined processes, brought in new technology, improved communication with patients and made more use of the independent sector. Further steps over the next two years will see expansion of community diagnostic centres and surgical hubs.

Everyone in the health sector knows what reform involves. Rather than waiting for Stormont ministers to sign it off, as they have balked at doing for two decades, the solution appears to be putting the system in the hands of an autonomous body such as NHS England and just leaving the experts to get on with it.

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The tide has finally turned against water privatisation in England, with regulator Ofwat effectively acknowledging the model does not work. This is a moment to reappraise Northern Ireland Water, an unusual ‘government-owned company’ created by direct rule ministers as a vehicle to trundle a public service towards English-type privatisation. The threat of domestic charges was also used to pressurise parties into reaching the St Andrews agreement. NI Water has been stuck in underfunded limbo ever since. Now the danger of being flogged off to a monopoly profiteer has abated, our weird water vehicle could be trundled back into full public ownership, as in Scotland, or forward to a non-profit company, as in Wales. Of course, this is not a moment to propose households pay more. But then, it never is.

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Unlike in the rest of the UK and Ireland, electricity cannot be disconnected from domestic properties in Northern Ireland for non-payment of bills. The industry here has had a ‘zero disconnect’ code since 1996, with any customer in debt moved onto a long-term repayment plan via a pre-pay meter. Gas can be disconnected but only after a pre-pay meter and plan has been offered - a much tighter regulation than exists elsewhere. Although failing to top up a meter could be said to mean disconnecting yourself, consumer bodies still consider it far preferable to standard British and Irish approaches. This looks set to become significant in the coming months.

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The DUP is starting to panic over school uniform costs. Education minister Michelle McIlveen has told her officials to make guidelines on cheaper uniforms compulsory, but admits this will only apply “in future years”. She did not admit this is because it will require a new law, which there is no assembly or executive to pass thanks to the DUP.

Although the impact of the uniform issue might seem particular to present circumstances, it has deep and deeply ironic roots. Costs have ballooned because the DUP considers grammar schools sacrosanct. This defined how the party had Stormont rebuilt under the St Andrews agreement, in response to Sinn Féin’s abolition of academic selection in 2002.

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Sinn Féin MLA Gerry Kelly is bringing libel actions against writers Malachi O’Doherty and Ruth Dudley Edwards. The Council of Europe has flagged both cases as “harassment and intimidation of journalists”, which it defines as including “vexatious use of legislation, including defamation”. Campaign group Index on Censorship, which alerted the council to the cases, says they have “several characteristics of strategic lawsuits against public participation or ‘SLAPPs’.”

Some blame for this must be shared with the DUP for blocking libel reform nine years ago and conniving with Sinn Féin to stall it ever since.

But that is not the whole story. Reform took place in England, yet London remained the world’s SLAPP centre, for Russian oligarchs in particular. Only when Ukraine was invaded did the courts suddenly realise they could dismiss such cases straight away.

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The protocol is not a sham fight but there are times you can see ‘London-Brussels-Scarva’ written on the side of a bus. When the UK published its protocol bill plans in June, the European Commission responded two days later with legal action. This was portrayed as desperately serious by both sides. “Enough is enough,” declared commission vice-president Maros Sefcovic, while observers excitedly fulminating about a ‘trade war’. Now it transpires that the EU’s August 15 deadline for the UK to respond has been extended by a month, at London’s request. Conveniently, this will mean a new prime minister is in place to make the next move. The legal action itself will take up to a year, with trade penalties only the very last resort at the end of a further lengthy process. On that timescale, there could be yet anther new prime minister or a whole new government, as both sides are well aware.