Just days before the General Election 2019, political parties competing for people’s trust have published their manifestos. The National Health Service (NHS) takes a central role in the political campaigns. Health and the future of the NHS, particularly during the turbulence of Brexit, are key concerns for everyone. But have politicians heard the people of Northern Ireland (NI)?
The election coverage has been dominated by the clash between Tory and Labour in England, with fact checking articles and the abundant analysis of political claims casting some light on the validity, honesty and effectiveness of much of the political rhetoric. The party manifestos of the leading UK parties are centred around England and the experiences of English patients. Promises have been made to increase NHS funding, improve waiting times and employ more NHS frontline staff. How do these promises measure up to the specific expectations and needs of people in NI?
We have some answers. As part of our research on health after Brexit, we talked with more than 200 people in two NI border cities. At a time when political pundits and experts dominate discussions on how realistic party policies on health are, we listened to the voices of people on the ground. The stories we have heard are striking. Contrast politicians’ confidence that the NHS will be protected: we heard about serious concerns over the impact of a potential hard border on health. People worry that established health corridors between NI and Ireland will be disrupted. The people we listened to express their fears that the ‘NHS is failing’; that medication shortages and NHS staff shortages are imminent in the context of Brexit; that the future of the NHS spells privatisation; and that politicians are ‘self-serving’ and ‘liars’. The stories we heard demonstrate high levels of anxiety and a collapse of trust in the politics of the establishment.
In Derry/Londonderry, we spoke with a woman and her young daughter living south of the border. The child has a serious health condition requiring regular access to a medical expert. There is no such expert where the family lives, so they regularly travel to the NI to see a doctor. This is made possible by the integrated health system on the island, where patients can move freely across the border and be reimbursed by their local health trusts for health services accessed elsewhere. For this family, as well as many other people, the growing danger of a hard border in the case of a no/bad-deal Brexit means no access to medical treatment and medication with grave circumstances.
The fear is that integrated health on the island is not only a practice that has been developed over many years. It is often the only way in which people can access the health services they need and are entitled to. People told us about established health corridors for children with heart conditions living in the North travelling to specialised hospitals in Dublin. About people crossing the border daily to purchase medications they need for a better price. About patients being redirected away from the hospitals where they live to hospitals in bigger cities, under the pressure of hospitals budgets being inadequate and units closing as a result. Yet the main UK political parties have not even mentioned integrated health on the island, let alone committed to protecting and strengthening it. This does nothing to reassure people in NI that their needs are recognised and met, despite the rhetoric on improving the NHS.
The majority of people we spoke with feel ‘worried about the future’ in general, but especially in relation to the NHS and health. Some of the concerns we have recorded are ‘high levels of unemployment and poverty [in NI], resulting in ‘less tax money for the NHS’; an ‘aging population not paying enough into the NHS’; and a ‘struggling NHS’ and ‘crap NHS’ particularly with waiting times to see a GP or a specialist. More specific to Brexit concerns are ‘medication shortages’ and ‘having to travel far to get medication’; EU staff being ‘put off and leaving’; ‘not enough doctors and nurses’ working in the NHS; and ‘not enough help for elderly people living alone’ as a result.
The fears we have recorded are a troubling mixture of lived experience with the NHS and populist politics blaming others for the perceived problems with the NHS. Years of Tory austerity have resulted in people buying into the narrative of personal responsibility for health: people try ‘not to rely too much on the NHS, ‘only call the GP when really ill’ and ‘be responsible by taking your medications’. Some feel the blame lies with ‘too many migrants’ using the NHS, with only ‘those who pay in’ being seen as legitimate users of the health system. Predictions for the future of the NHS include ‘a USA style system leading to high mortality rate’ with a growing concern that the NHS will be privatised and people will be pushed to look for private healthcare providers, offering a more effective and speedy access to health. As one man from Newry put it: ‘You pay a lot into [the NHS] but you don’t get much out of it’. The people we spoke to paint a dark picture overall, where health is seen increasingly as the privilege of those who can afford a healthier lifestyle, or who can afford to go ‘a bit private with health’.
On the eve of the election it is doubtful that the main UK parties have taken the specific needs of NI people into serious consideration. Integrated health; clarity on how a hard border would impact health; and the local perception that people are better off going private are not reflected in their manifestos. Perhaps we should expect local NI parties to have a better understanding of the needs of their constituents? It is striking that the two main NI parties, Sinn Fein and the DUP, have not put the NHS at the heart of their electoral pledges. Both their manifestos contain minimal mention and vision for the NHS. With this election being treated as a second Brexit referendum, the fears, anxieties and expectations of people here about health seem to be lost. The NI concerns about health and the NHS are part and parcel of growing inequality, poverty and social tensions. The established parties must take NI and the specific health situation here seriously in order to give any credibility to their political promises and rhetoric. Anything less is empty words that will do more harm to NI health staff and patients in the turbulent months to come.
Dr Ivanka Antova, Research Fellow; and Dr Mark Flear, Reader, from the School of Law at Queen’s University Belfast; and Professor Tamara Hervey, School of Law, University of Sheffield; and Dr Matthew Wood, Department of Politics, University of Sheffield, work on the ESRC funded ‘Health Governance after Brexit: Law, Language and Legitimacy’ research project.
The project is an ESRC funded project exploding issues of legitimacy, accountability and responsibility for health governance after Brexit.
