Abstract
The Northern Ireland health service faces major restructuring at a time of extreme fiscal austerity. This paper assesses the capacity of the service's administration to meet this challenge, focusing on past distribution of resources across programmes of care. The central finding is that resources generally appear to be distributed on a pro rata basis with little evidence of strategic direction. Within a context of generally poor performance against previous targets, and low productivity compared to England, the outlook for major restructuring is not sanguine. That the administrative structure is embedded in a political framework that favours consensus over leadership is a further cause for concern.