What could the DUP alliance mean for health

Those of us who call Northern Ireland home may have been disappointed, but not shocked, to see a return to so-called ‘tribal voting’ in the devolved nation after a roller coaster year. But those responsible for maintaining the Democratic Unionist Party (DUP) website almost certainly had the biggest surprise of all: a website meltdown brought about by the highest volume of traffic ever witnessed, as a direct result of the hung parliament. So, who are the DUP, what have they said about health and social care and what can we expect from their negotiations with the Conservatives?

At Castle Buildings, Stormont, home to the Northern Ireland Assembly, the DUP have had a difficult year so far. Their leader and First Minister, Arlene Foster, has been mired in the Renewable Heat Incentive scandal and their local representatives out of Government due to the subsequent collapse of the NI Assembly. But Theresa May’s snap Westminster election has, like so much else, turned that on its head. Arlene Foster’s party saw a resurgence in their popularity in the election and have returned 10 MPs to Westminster. Crucially, the Prime Minister is now reliant on the support of these MPs to form a majority Government, most likely via a ‘supply and confidence’ arrangement. The full details will emerge in the coming weeks but for now the discussions are underway and no one should underestimate the negotiating skills of the DUP, forged in the crucible of successive power sharing agreements and mandatory coalition government.

For those unfamiliar with the party, the DUP are highly socially conservative, although from an economic perspective, they are pragmatic and populist in their approach. The DUP’s likely demands won’t be found in their 2017 general election manifesto – which was written on the assumption of a Conservative majority – but in their Northern Ireland Plan, which was drawn up in 2015 in preparation for a hung parliament. The NI Plan set out demands for an increased budget for Stormont, including a real-terms increase in health spending and a yearly commitment to £80M additional funds to tackle waiting times, which are much higher than elsewhere in the UK.

Plans are underway to establish “accountable care systems” in Northern Ireland,  similar to the current plan set out by NHS England, so any negotiating list is likely to revisit the 2015 pledges, seeking additional funds to bolster the costs of implementing the reform agenda. New concessions could include the extension of NI welfare reform mitigations such as dropping the ‘bedroom tax’, to the wider UK and retaining the winter fuel allowance and triple lock on pensions. Brexit was not a consideration at the time the NI Plan was written, but it is likely to be the cornerstone of the negotiations.

As staunch advocates of Brexit during the EU referendum and despite Northern Ireland voting to remain in Europe (56% voted remain with border areas most heavily in favour), the party has continued to support the UK wide result. It does however, share the concern that a hard border would be detrimental to the economic fortunes of Northern Ireland, particularly in terms of trade and travel. As a party that champions the union above all else, it is opposed to any internal UK borders, and so the idea of having a ‘soft’ north/south border but controls at the east/west level (airports and ports) would be seen as anti-union and would therefore be unacceptable. So far, they have objected to calls for ‘special status’ for Northern Ireland, against the wishes of some of the main NI political parties, the Irish Government and EU member states, who are sympathetic to the proposal as they fear it risks the union. A ‘softer Brexit’ to obtain cross party consensus may work for both parties in their negotiations, although the long-term implications are hard to define at such an early stage.

With regard to the implications for health, Sinn Fein held this Ministerial portfolio in the Northern Ireland Assembly prior to the collapse of power sharing in January. The last Health Minister took over at a critical time setting out her vision for delivering on much needed reforms identified in a series of reviews over the last few years. Her DUP predecessor, Simon Hamilton, oversaw part of the last review and was instrumental in leading the reform agenda that set the scene for the major policy paper, Health and Wellbeing 2026 - Delivering Together. He also supported the introduction of much needed ‘All Island Services’ such as the Paediatric Congenital Cardiac Service and important cross border services such as the Radiology Service based in the North West treating patients on both sides of the border. The Brexit implications for such cross border services, including ENT and Urology and for those who staff them, are yet to be determined.

The last Minister managed to achieve agreement on major structural and cultural change with her DUP partners in government, including the need to expand cross border services. These plans now lie unimplemented, waiting for the conclusion of local talks aimed at restoring devolution, in turn delayed by the DUP Westminster discussions.

The election delivered surprise results across the UK and catapulted the DUP into the national spotlight – there may be many more surprises to come.