THERE is little doubt that our beleaguered health and social care service is the sickest of the north's ailing public services.
All are in poor shape, assailed on all sides by a toxic mix of Stormont dysfunction, budget pressures, inflation and the cost of living crisis.
There are specific factors which have led to health needing life support in far too many areas. These include the Covid-19 pandemic, the needs of a growing number of older people, over-stretched domiciliary care and difficulty in recruiting the right staff to deliver increasingly complex and specialised treatment.
Significantly, there has been long-standing political reluctance to grasp the nettle of conducting the sort of deep and difficult reforms that are patently needed.
These were set out most recently in the Bengoa report of 2016. Its recommendations were enthusiastically welcomed by the Stormont Executive, yet local opposition to proposed changes – especially those involving hospitals, such as emergency general surgery at Daisy Hill in Newry or the South West Acute Hospital in Enniskillen – has often been led by politicians from those same parties.
Health service managers and civil servants have been stuck in the middle. Even accounting for the Covid emergency, little progress has been made. It seems that change, when it happens, will occur piecemeal and through the collapse of buckling structures rather than planned reforms.
The symptoms of this malaise are widely seen in, among other things, spiralling waiting lists, difficulties accessing GPs and unconscionable waits in emergency departments. Little wonder health and social care staff feel burned out and driven to strike action.
The challenges are felt across Northern Ireland but people in Fermanagh have reason to feel particularly vulnerable.
GPs in Brookeborough and Tempo have given notice that they are withdrawing from their contract, the third practice in the county to do so in a matter of months.
It's a worrying development for around 8,000 rural patients at a time when there is already concern at changes at the SWAH.
The situation emphasises the difficulties in not only recruiting doctors but in retaining them. When Maple Healthcare in Lisnaskea, one of the north's largest surgeries, announced it was withdrawing services, it cited "excessive stresses and intolerable pressures".
With a cohort of GPs nearing retirement age, the pressures on our family doctors will only become more acute.
The Department of Health must work harder to attract and retain GPs and if devolution at Stormont is revived, the health service must be allowed to urgently implement Bengoa.
