Delivery or drift? Northern Ireland’s struggle to turn strategy into action

Eighteen months on from the Executive’s return, Northern Ireland’s public services remain under strain: waiting lists continue to grow, housing targets are missed by 25%, and wastewater infrastructure is in crisis. Pivotal’s latest reports make clear that ministers and officials are struggling to turn plans into results. Despite repeated strategies and funding commitments, the public sees little tangible improvement.

Cultural barriers in the civil service ‍

Pivotal's previous policy delivery report highlights why well-meaning plans often fail to produce results. It depicts a civil service culture hampered by risk aversion, siloed working, and a tendency to focus on “keeping ourselves right” instead of achieving tangible outcomes. Despite being described as “intelligent and capable,” civil servants operate within a system that rewards caution rather than action. Decision-making is frequently motivated by fear of audit criticism, legal challenges, or media scrutiny.

Misplaced priorities and performance accountability 

A particularly concerning theme is how performance is valued or, rather, often ignored. The same day Pivotal released its latest report urging improved delivery, headlines broke that Stormont’s top civil servant received a bumper pay and pension increase. The timing was jarring. Rewarding senior officials at the very moment front-line services are failing sends a troubling message about priorities. It highlights a perception that poor delivery has few consequences at the top, while success is not sufficiently incentivized. Even political leaders appeared reluctant to justify or explain the pay hike.

An opposition MLA voiced “shock” at the increase and pressed for an explanation of “why such a rise was appropriate in the circumstances”. This juxtaposition, generous rewards at the summit, fundamental delivery problems unaddressed below, underscores a culture where accountability for outcomes is weak. It suggests that avoiding mistakes has been valued more than driving improvements, a dynamic that must change if public services are to meet expectations.

Challenging the status quo 

The Programme for Government has pledged to create a Delivery Unit in the Executive Office. Previous examples demonstrate that delivery units can be effective. Tony Blair's unit reduced surgical waiting lists from over 40,000 to fewer than 10,000 within two years. However, success depends on genuine political backing and clear authority. Blair dedicated "sometimes as much as half a day a week" to regular stocktakes. Malaysia's Prime Minister granted its Performance Management and Delivery Unit direct access and cross-ministerial authority. Armed with the Prime Minister’s clout, Malaysia’s unit could knock heads together across departments, escalate obstacles to the top, and rigorously track progress. Both initiatives faltered when political support waned.

Structural hurdles in Northern Ireland 

Northern Ireland's planned Delivery Unit faces unique structural hurdles. Michael Barber, founder and first head of the UK Prime Minister's Delivery Unit, relied on legitimacy gained through Prime Ministerial support, which is much harder to achieve with multi-party coalitions. Peter Robinson's previous Performance and Efficiency Delivery Unit was viewed as a "DUP creature," which limited trust and effectiveness among other Executive parties.

This history is a cautionary tale: unless the new Delivery Unit is genuinely owned by the whole Executive (not just nominally, but in daily practice), it may be dismissed as just another outsider “marking their homework”, an external taskmaster to be resented or ignored. To overcome this, the Unit must be set up with clear authority and authentic cross-party commitment. 

Pivotal’s analysis urges that all Executive ministers and departments visibly support and engage with the Unit. That likely means formal mandates (e.g. a joint declaration of support, as Pivotal suggests) and strong leadership from the Head of the Civil Service to encourage cooperation. Without such buy-in, the new unit risks becoming another “strategy document” gathering dust.

Success versus delayed delivery  ‍

Northern Ireland has some success stories of reform and delivery. Uniquely, it has had a structurally integrated Health and Social Care system since 1973, far ahead of other UK regions. More recently, Northern Ireland has embarked on the ambitious Encompass program, creating a single digital care record for every patient. By the end of 2025, all health trusts are slated to be live on this new system, which is described as the “greatest transformational change to the health and social care system in a generation.” After seven years of work, the first trust went live in late 2023, consolidating over 40 legacy systems into one and enabling far more efficient, accessible care information. Early reports show positive benefits and a smooth rollout thanks to strong leadership and user buy-in. While the former might be a quirk of Northern Ireland’s political history, the latter shows that Northern Ireland can deliver major reforms when vision is coupled with commitment and resources.

Yet, Northern Ireland lags behind its UK counterparts in other areas, underscoring the implementation gap. One glaring example is in community pharmacy and prescriptions. England (and others) have long had an Electronic Prescription Service and electronic repeat dispensing, allowing GPs and pharmacies to manage prescriptions digitally and efficiently. Northern Ireland is only now planning to catch up. The new Community Pharmacy Strategic Plan 2030 includes goals to enable electronic transmission of prescriptions and electronic repeat dispensing, essentially moving to a paperless, digital system by the end of the decade. To do so, Northern Ireland must change outdated legislation and build the necessary IT infrastructure (the plan calls for a “Go Pharmacy NI” system integrated with the wider eHealth records).

In the interim, patients and pharmacists still contend with more cumbersome processes than their peers in, say, England. Including these targets in the strategic plan shows that the solutions are known and agreed on, but also highlights the slow implementation. The fact that 2029–2030 is the timeline to fully launch electronic prescriptions, when such technology has existed elsewhere for years, illustrates the broader delivery deficit. Northern Ireland often formulates solid strategies (the Community Pharmacy plan is praised as “positive and ambitious”). The real test is turning those plans into on-the-ground changes within a reasonable timeframe.

The crossroads between drift and delivery

Decades of research on public sector reform have converged mainly on what works: clear objectives, strong leadership, data-driven tracking, empowered teams, and engaged users. In Northern Ireland’s context, reports and reviews have generated no shortage of sensible recommendations, from multi-year budgeting to investing in wastewater infrastructure, from streamlining planning processes to modernising IT systems. The challenge lies not in identifying solutions, but in implementing them. That ultimately comes down to political will and bureaucratic drive. Is there enough collective resolve to push through changes that disrupt comfort zones and challenge entrenched ways of working? Will ministers unite across party lines to insist on delivery and back the civil service in taking managed risks? Can the civil service leadership galvanise its ranks to focus on outcomes, not just process? These questions remain unanswered. 

The new Delivery Unit, the ongoing reforms in health, and other initiatives will provide an acid test in the coming months and years. Northern Ireland is at a crossroads where it must decide whether to continue with 'strategy as usual' or to forge a new culture of execution. The jury is still out, but the recent reports' findings make clear that drifting along is not a viable option. Only through sustained, collective commitment to implementation will the people of Northern Ireland see the promises on paper translate into real improvements in their daily lives.