Wash your hands and cross your fingers for North's next Covid wave

There will not be another lockdown in Northern Ireland, DUP First Minister Paul Givan has predicted, despite Covid figures on course to overwhelm the health service by mid-December.

Although the DUP has always harboured an ideological hostility to lockdown, the reasons Givan gave were financial: the UK’s furlough scheme ended in September, along with other support from London that in the first 12 months of the pandemic amounted to half Stormont’s usual budget.

Even if the Northern Executive wanted to use its own money to revive furlough it lacks much of the administrative machinery, as the tax system is not devolved.

Passports are in danger of being a token measure. Because preparations for them were not undertaken they cannot be issued in time to require compliance before mid-December

Tánaiste Leo Varadkar’s promise that major restrictions will trigger a return of the pandemic unemployment payment is not a pledge Stormont can match. There would have to be a lockdown in Britain to revive UK furlough, which appears highly unlikely, as figures there are high but stable.

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Figures in Northern Ireland had been similar until last week, when the Executive received a chilling report from its pandemic modellers: cases had risen 23 per cent in a week, with rises in every council area and age group under 60; positive test rates and the proportion of serious cases were also rising; and hospital admissions were up 19 per cent.

Deaths and intensive-care occupancy were down but only because these are lagging indicators. They are certain to rise significantly over the next two to three weeks.

Restrictions

This was the briefing that warned Stormont of the health service being overwhelmed as its “central scenario”. It called for immediate improvements on compliance with existing measures, such as masks, limiting contacts and working from home, followed by “more severe restrictions” if this does not reduce community transmission by mid-December.

The modellers were not optimistic, noting public fatigue with guidelines and low observance of voluntary advice in the hospitality sector.

Stormont responded by approving mandatory vaccine passports, something the UUP and SDLP had been calling for since March but which the DUP and Sinn Féin had blocked. The DUP voted against passports again last week, although it did not use its Executive veto, making its objection a token protest.

Passports are in danger of being a token measure. Because preparations for them were not undertaken they cannot be issued in time to require compliance before mid-December, too late to bring down community transmission.

The Police Service of Northern Ireland and the Alliance-controlled department of justice have refused to take responsibility for enforcement, passing the buck to a hospitality industry on the verge of open revolt.

The only meaningful measure to control cases is vaccination and especially the booster programme, which has been progressing steadily and will now be ramped up. A quarter of the adult population has had a booster, targeted by age for maximum effectiveness. The triumph of Northern Ireland’s vaccination programme should be recognised but it must also be recognised this is now effectively the sum total of Stormont’s pandemic response.

It took the Executive until this week to agree a call for better voluntarily compliance with existing measures. New advice was issued to work from home but there is no support to do so. Givan, his Sinn Féin counterpart Michelle O'Neill and UUP health minister Robin Swann put on a show of unity with a joint press conference, to underscore a consistent message to the public. However, all that message amounts to is: get your shots, wash your hands, cross your fingers and hope for the best.

If success is to be judged by protecting the health service, Stormont has already failed.

One of Northern Ireland’s major hospitals, Craigavon, closed its emergency department twice last week to all patients not at immediate risk of death. Intensive-care staff in Belfast are resigning in droves due to intolerable pressure. A senior health official told the BBC the system is “absolutely on the edge”.

Structural reform

Givan, O’Neill and Swann were mocked for a vacuous press conference but they did make one commitment of potential significance. All three spoke of the need for long-term structural reform of healthcare, promised a united approach from the executive and referred to the three-year Stormont budget nearing completion.

Northern Ireland needs to rationalise its network of small general hospitals into fewer, larger regional specialist centres. This has been policy since the 1990s, confirmed by at least half a dozen official reports, most recently the 2016 Bengoa report.

All five executive parties are signed up to Bengoa, yet all five have objected to rationalisation at local level. Centralising hospital services has turned out to be almost politically impossible.

There is also an urgent need for multi-year budgeting, after seven years of single-year budgets due to repeated Stormont deadlocks. Health managers have said this is even more important than money.

If anything positive is to emerge from an impending Covid crisis, it might be finally shocking political parties and the public out of their parish-pump resistance to health service reform.