BBCA total reset of the healthcare system in Northern Ireland is needed to avoid a year-on-year funding deficit of hundreds of millions of pounds, the new permanent secretary of the Department of Health (DoH) has said.
There is currently a £600m deficit in the health budget – a third of which is earmarked for the annual pay award.
Mike Farrar said he has “every reason to believe” Northern Ireland’s health and social care system “could be fantastic”, but said there are significant challenges.
Speaking ahead of the DoH publishing an implementation plan for elective care framework, Mr Farrar said “nothing is off the table” when it comes to cost-saving measures.
“The challenges mainly are expressed as the money that we have available and the challenge that we have in terms of waiting times for care – that’s the big one that I think people are concerned about,” he said.
The DoH is “determined” to get waiting times “to a place where people aren’t being damaged”, he added.
In March 2025, the Health Minister Mike Nesbitt said there would be a “cocktail of delivery” to begin tackling Northern Ireland’s hospital waiting lists.
The DoH is expected to publish “detailed plans and assessments on the financial pressures this year and the measures that will be needed in both the short and medium terms” in the coming weeks.
‘Holding them to account’
Following a series of major building issues in the Belfast Health Trust, Mr Farrar said individual trusts needed to take more responsibility and be accountable when things go wrong.
“[There] isn’t any reason why we should accept that these big capital projects need to slip in the way that they have been doing,” he said.
Mr Farrar also said the culture within clinical teams within the trust had to change.
It follows an internal review into the culture within the cardiology unit at the Royal Victoria Hospital, which the Health Minister Mike Nesbitt has described as “appalling” and “entirely unacceptable”.
“The responsibility there lies with the leadership of the trust – I’m looking to them first and foremost to deal with that,” Mr Farrar said.
The senior civil servant added he would be “giving them space to put this right” and he would be “holding them to account”.
“Inevitably if we don’t see the progress that we would hope to make… then the special measures regime would come into play.”
A former senior leader in the NHS in England, Mr Farrar took up the interim role in April, replacing Peter May who has retired from the Northern Ireland Civil Service.
Mr Farrar was previously the chief executive of the NHS Confederation and Head of Primary Care at the Department of Health in London.
He has also served as chief executive for health authorities in North West England, Yorkshire and Tees.
He has recently worked as a management consultant specialising in healthcare.
In Northern Ireland, he has worked with health service leaders and has also worked internationally on healthcare in the Middle East, Japan, Russia, US, Spain and Australia.
