Firstly, let me say that it makes absolute sense to have a collaborative and more integrated all-island approach to delivering an effective and patient-focused healthcare system.
The proposal in the documents is not rocket science, but it also shows that Sinn Fein takes no responsibility for any current failures in the delivery of healthcare, based on the argument, “It’s not my fault, Gov.” That is true in the 26 counties, but up here, Sinn Féin has avoided taking up the health portfolio since the publication of the Bengoa Report in 2016. Why, you may ask, because it is challenging and would have meant closing some hospitals, which the paper euphemistically calls hospital reconfiguration, creating a new healthcare infrastructure, and downsizing the bureaucracy. Like water rates, this would be ideologically unacceptable to Sinn Fein and like their orange counterparts, they whine on about a lack of funding and, of course, blame the Brits. However, can we ignore their failure to explain the changes necessary to keep the service sustainable or what I believe, that the political class lack the vision, the political will built on a political and governing system where a collaborative problem-solving approach to governing, delivering change and reform is an illusion.
According to the Nuffield Trust, funding has undoubtedly been tightly constrained compared to rising need in recent years. However, it is not clear that Northern Ireland is radically more underfunded relative to other UK countries, particularly Wales, which has lower funding per person. We have one Health and Social Care Trust for every 320,000 of the population. In England, there is one equivalent Integrated Care Board for every 1.5 million of the population, and Wes Streeting has recently shut down NHS England. The structure here is highly centralised and siloed, and a chasm exists between a well-informed, patient-focused and the responsive culture necessary to understand the reality on the ground and drive change.
The paper talks about what health is. We know it includes “well-being” and mental health, but the paper ignores the role of education can play in the two areas. It talks about a progressive tax system, which we have, but still feel the need to give everyone FREE PRESCRIPTIONS. I am on the left of the political spectrum, believe in a fairer tax system, where capital should carry should bear more of the burden than income. However, I would not be giving the bunch on the “hill” an additional penny of tax revenue, based on past performance, one being the vanity project called Belfast Central Station costing some £350 million and the debacle over the children’s hospital that has gone over budget by £450 million.
The next issue is whether there is a right to healthcare. The paper discusses all the different conventions and acts, showing their wonderful understanding of human rights legislation. The reality is that the right to healthcare here was established in 1948 by Attlee and Bevin, and that is not changing. If that right were ever to be undermined, the Bolshevik revolution would be like a picnic.
We are also aware of factors influencing health outcomes, such as poverty, housing, insecure jobs, education, income inequality and the cost-of-living crisis. Thanks for stating the obvious, and like a large part of this paper, no solutions. Sinn Féin is proposing a root and branch revision of the system, but the details and timeline for both jurisdictions are unclear. In addition, strangely, the report fails to mention AI and its impact on the delivery of healthcare. Ideas on the future funding of healthcare are also not discussed, and in addition, ignore changing demographics and the cost of innovation and new drugs. One statistic to be aware of, today in the UK, there are 3.8 workers to 1 retiree, and by early 2040, there will be 2.5 to 1.
In respect of weakness, Deirdre Heenan’s quote failed to mention that 47% of people in the Republic have private healthcare, and the dreaded agency and locum system is a scam being paid for by taxpayers across the Island. This scam is a failure of workforce planning, and it is the dedicated work of doctors, nurses, and care staff from outside the EU who keep the healthcare systems of Northern Ireland and the Republic from collapsing. Perhaps you could mention that to those who target migrants across the island.
Bengoa provides a broad framework for change and reform with 15 recommendations, however, with no specifics other than the absolute necessity to ensure a coordinated and integrated approach to healthcare and social care. This issue seems to have been overlooked in the paper.
The paper lays out the need for a universal healthcare system; who would disagree? No one with a modicum of wit would disagree with the need to collaborate on the delivery of healthcare across the Island, but please stop banging on about unification. Just as a side note, I do not quite understand the difference between Sinn Fein proposals and Sinn Fein Proposes.
Finally, the paper largely states the obvious need for reform and the mechanisms needed to achieve it; otherwise, it is far from a groundbreaking piece of work. Not to be accused of being a whinge bag, well done to one of the parties for giving healthcare delivery its rightful place at the top of the political agenda, though on balance, the document has resulted in a tree not doing a more important job, carbon sequestration.
Suneil Sharma
5th July 2025
The Gob 
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