Northern Ireland health spending per person falls below rate in England

Health trusts should be held to account for how budgets are spent, says the Fiscal Council

Health spending per person in Northern Ireland has fallen below that in England for the first time, according to the Northern Ireland Fiscal Council.

It said a squeeze on the amount of money given to Stormont by the Treasury was a factor leading to the reduction.

Extra funding that had been secured for Northern Ireland through political agreements has also come to an end.

That would put pressure on Stormont to address the "relative inefficiency" of the health system, said the council.

It also said the next executive at Stormont should consider sources of additional funding.

This is the first time the Northern Ireland Fiscal Council, an independent body created in March 2021, has scrutinised the finances of the health system.

Its report is being published alongside analysis by the Nuffield Trust, an independent health think tank.

In its report the Nuffield Trust said the Northern Ireland health system was less efficient than that in England.

The Nuffield Trust found that Northern Ireland hospital costs for in-patients, out-patients and day cases were 36% (£410m) higher than in England.

The tough message from these reports is that if health services are to be delivered at a standard similar to England, Northern Ireland must become more efficient.

Whoever the next health minister is will have to decide where to make the cuts.

It will continue to be difficult to maintain existing services, let alone expand or make investments in new services.

That means tough decisions will have to be made about whether to keep all the plates spinning precariously at the same time - or decide to remove some of them in order to stabilise the system.

Both reports conclude that in order to get to grips with the problems and to make change it is necessary for each area to get to the root of how they deliver services and spend money.

The reports suggest that individual health trusts should be held to account for how budgets are spent.

They said the key to success would be "appropriate governance and accountability structures and the funding of transformation and workforce planning".

Northern Ireland has been without a functioning executive since February, when the Democratic Unionist Party (DUP) withdrew Paul Givan from the role of first minister.

Fiscal Council chair Robert Chote said that a functioning executive "allowed for better long-term planning, especially around budgeting for services and workforce".

• Health department in NI faces £450m overspend

The Department of Health accounted for 49% or £7bn of the executive's budget in 2021-22 - that total included funding for social care.

In 2019-20 spending per person on health was 7% (£181) higher than in England, a pattern that has been similar for the past 20 years.

But these reports stress that picture is changing and instead the draft budget in 2021 implied significantly slower growth in health funding in 2022-23 and up to 2024-25 in Northern Ireland than the Treasury is financing in England.

One reason for the drop is the end of temporary funding that was earmarked for health through the New Decade New Approach political agreement, which led to the restoration of devolved government at Stormont in 2020, and the Confidence and Supply deal between the Conservative government and the DUP after the 2017 general election.

The council said the challenges were not unique to Northern Ireland and were being faced by governments across the UK.