Northern Ireland's new health minister will have to contend with stretched resources and rivals who are suspicious of her every move, writes Seamus Ward

They say nothing is ever straightforward in Northern Irish politics, and last week's devolution of power from Westminster is no exception. The complex relationships between the politicians - many of whom have just begun speaking to one another, some of whom will not speak to others - will play an important part in this new dawn.

Old animosities will die only very slowly and there is concern that local public services, including the NHS, will suffer.

The most obvious flashpoint is the fact that new health minister Bairbre de Brun is a member of Sinn Fein.

Though she has so far escaped the spotlight cast on to Martin McGuinness, the education minister and the other Sinn Fein member of the Executive, it is unlikely this will continue to be the case for much longer.

The local health service has already suffered because of delays in the peace process - it awaits the final decision on a comprehensive restructuring of trusts and health boards, which will also probably see the introduction of local commissioning groups.

Sensitive decisions on the reconfiguration of services, including the rundown and closure of some hospitals, have to be made. A new resource allocation formula is also waiting in the wings, and greater cross-border cooperation promises to improve access to healthcare in some of the remotest areas of Northern Ireland.

Like its counterparts in the rest of the UK, the province's health service is short of funds. Just last week Robert Toland, chair of the Western health and social services board, warned that a gap had opened between the available resources and demand. Years of cash-releasing efficiency savings, which were replaced by productivity savings two years ago, had left the service starved of resources.

Unsurprisingly, given the hothouse atmosphere of Northern Irish politics, most managers contacted by HSJ were unwilling to speak on the record about devolution. Though some cautioned that the Assembly could fall if the IRA fails to decommission, there was optimism that many of these issues would be sorted out soon.

The Northern Ireland NHS Confederation has already held meetings with Assembly members. 'We are looking forward to meeting Bairbre de Brun, probably in the new year, and working in partnership with her, ' says Alan Gilbert, the confederation's spokesman. 'We are also taking steps to link in with the Assembly committee on health.'

The British Medical Association, which has also been holding talks with all the main political parties about the future of the health service, warmly welcomes the new minister.

Maurice Dunlop, chair of the BMA's Northern Ireland Council, says: 'We know from our contacts and discussions with Sinn Fein that they share with the BMA our desire to reduce bureaucracy within the NHS and provide equitable and good-quality medical care for everyone in Northern Ireland.'

The political outlook of the new government could mean more money for health and social services, which are still integrated in Northern Ireland.

While most of the political parties are centre-left, many of Sinn Fein's founding members were Marxists. Though these views may have dimmed somewhat, their political credo is still firmly socialist. It has opposed the closure of hospitals throughout the province.

Unlike the Scottish Parliament, the Assembly has no tax-raising powers but it can decide how much to spend in each area. With a socialist in the chair at the department of finance (SDLP's Mark Durkan), Ms de Brun will get a sympathetic hearing when she goes in search of new money.

But public spending in Northern Ireland is stretched and the most likely source of cash - cuts in the£1bn law and order budget - will not be readily supported by unionists. Also, each minister will be keen to make an early impact by getting money for their departments, so Cabinet battles are likely.

Senior local managers are said to be worried that the finance department may take the easy way out and reintroduce cash-releasing efficiency targets, which they believe would damage the service's ability to meet demand. That is an outcome no one wants to see from the first all-inclusive government in Northern Ireland.

Heavyweight fighter: Bairbre de Brun It was something of a surprise when Bairbre de Brun was nominated for the health, social services and public safety brief by Sinn Fein president Gerry Adams.

Education or agriculture were thought to be the 44-year-old teacher's preferred posts, yet she seems excited about taking the reins at the biggest spending ministry in the new Northern Ireland Executive.

The Dubliner has been a permanent fixture at the Belfast peace negotiations over the last four years. She has a formidable reputation and, on her rare appearances in the British media, she has never been shy of tackling heavyweight political interviewers such as John Humphrys.

She will need all her skills if she is to tackle ill-health caused by social deprivation and unemployment, which is higher in nationalist communities.

Directing resources to these areas would be attacked by unionists. She may also face accusations of bias if she opts to centralise acute hospital services in Belfast, particularly if it benefits the Royal Victoria Hospital, which is situated on the edge of her constituency. Her immediate priorities are to listen to patients and staff and to expand cross-border links with the Irish Republic's health service.

This could mean patients in some rural areas being treated in the Republic and vice versa. There could also be greater co-operation between ambulance services. Despite the long wait to reach power, and the volume of decisions that she must make, Ms de Brun told the Irish News last week that she would not make major decisions quickly.

'The one issue I want to concentrate on is getting the overall picture right. I won't be taking hasty decisions unless it's very clear that those are the correct decisions, ' she added.

Planned spending on health and social services in N Ireland

Year£m change (cash terms)

1998-99 1,721.0

1999-00 1,849.1 +7.4

2000-01 1,971.8 +6.6

2001-02 2,074.0 +5.2