Debate contribution: Health and Social Care Transformation
Debate contribution by Mr Danny Donnelly on .
- MLA
- Mr Danny Donnelly
- Party at the time
- Alliance Party
- Date
- 6 October 2026
- Type
- Debate contribution
- Business
- Private Members' Business
- Heading
- Health and Social Care Transformation
- Assembly identifier
- Official Report component 5777007
Read the official Assembly record
Text
I beg to move
Thank you, Madam Principal Deputy Speaker. We are ten years on from the Bengoa report, 'Systems, Not Structures', and it is clear that, since then, we have not progressed the reforms that are needed. In 2016, an article titled, "A fresh, new strategy for the Northern Ireland health and care system?" discussed the new strategy for our health service and concluded:
"my overall verdict on the new strategy for the Northern Ireland health and care system is that it does, without a doubt, look like a very fresh, fresh start. Hopefully it will stand the test of time – 10 years to be precise – as well as the tricky politics and public debate that will inevitably come with it."
Reading that now, I wonder what the author would make of where we have arrived. The argument for transformation has stood the test of time, but the functionality of these institutions has not. Of course, the pandemic had enormous impact, but five years of political collapse and paralysis and a disastrously implemented Brexit had a hefty price tag attached, and we are still paying the price. No explanation relieves the Assembly of its responsibility or can become a permanent excuse for failing to move forward. Having worked in the health service for 20 years, I have experience of seeing the decisions that are made here and experience of their consequences. I see colleagues across the system keep a health service going through goodwill and a deep sense of responsibility to their patients. Each year, they brace themselves for winter pressures. They know that, when someone cannot leave hospital because there is no care package or nursing home placement available, the consequences will be felt in increased corridor care and overcrowded emergency departments. They see the impacts when palliative care is unavailable to patients and their families, and they absorb the cost of medication shortages to continue patient supply.
They will do everything that they can to make those situations bearable, often at considerable cost to themselves. When they come through another winter or another crisis, they are therefore faced with the expectation that they will find the strength to do it again. We are asking their commitment to compensate year after year for our failure to make the changes that they need to see made. As an MLA, I know that there are colleagues across the Chamber who care deeply about the situation. I have worked with them, and I do not doubt their desire to improve things, but that makes the distance between our intentions and what we deliver all the harder to accept. People working in the health service have had to watch this place collapse, wait for it to return and then listen to the arguments that paralysed it threaten to consume it again. I have conversations with colleagues in the health service now about how little opportunity there seems to be to recover between shifts. They go into work already worried about whether they will be able to provide the standard of care that their patients need. There is evidence of the consequences of prolonged waits. They cause harm. The Royal College of Emergency Medicine (RCEM) has calculated that more than 1,000 excess deaths in each of the past three years were associated with long waits in overcrowded A&E departments. Twenty years ago, such things happened rarely, if ever, but they are commonplace today. We have an ageing population, with the number of people aged 65 and over projected to increase by almost half in the next 25 years and those aged 85 and over projected to more than double in the same period. We have a lack of adequate social care and underfunded and under-resourced community care that is driving up corridor care and overcrowding in A&E departments, and that is having a huge impact on ambulance response times in our communities. There is an underfunding of community pharmacy, with an outdated clawback mechanism, medication shortages and a continued expectation that pharmacies will absorb costs and keep the service running by effectively subsidising the supply of medicines in Northern Ireland. We have the Department at odds with GPs, who are the main point of access to the health service here. GPs are unable to agree a contract or pursue engagement on the neighbourhood model. GP surgeries see over 200,000 patients every week in Northern Ireland, yet they are funded by only 5·4% of the entire healthcare budget. In other parts of the UK, funding is closer to 10%. We have had a neurology review with no concrete next steps, while 26,855 patients wait for a first neurology consultant appointment, with a median waiting time of 77 weeks. We have no women's health strategy, despite the many issues that affect women in Northern Ireland having been highlighted in the Chamber. We have a mental health strategy from 2016 that has been underfunded and under-delivered, and it has now effectively been shelved. There are currently no commissioned services for ADHD assessment and treatment of adults in Northern Ireland, and there is a continued refusal of shared care arrangements for those who get a private diagnosis. There has essentially been a collapse of NHS dentistry. The Mental Capacity Act (Northern Ireland) 2016, some 10 years after its passage, remains only partially commenced, with no indicative timetable for full commencement. We are driving many people in Northern Ireland to spend huge amounts of money in order to access timely healthcare through becoming patients in the private healthcare sector. It is a two-tier health service. We have had three separate Health Ministers in this mandate alone, with a dispute over delay and transformation to thank for the most recent of those changes. The recommendations from the Health Committee's recent inquiry into palliative care are no further forward. There are shortages across many areas of the healthcare workforce, so we need a workforce strategy. Cancer waiting times in Northern Ireland are currently the worst on record, with around seven in 10 patients — 71% — not starting treatment within the target time of 62 days of being referred to hospital. If that performance continues, around 20,000 people could miss that target over the next five years.
Yes. Thank you for that. I absolutely agree. I am sure that Members across the House have constituents who have raised such issues with them. Constituents have come to me with concerns about their very long waits. This year, there is an additional pressure of having to cut 4% from trust budgets — or, rather, "make cash-releasing changes". The trusts will have fewer resources available to absorb pressure this winter. Like many who work in the health service, that is something that I am hugely concerned about. None of what I have mentioned, however, even scratches the surface of the issue. We know that we need transformation; we have been saying it for years, but what does that actually mean? Transformation is defined as a complete or major change in appearance, form, character or nature of something or someone. It is fair to say that more than just our health service is in need of transformation. It is said that the definition of insanity is doing the same thing over and over and expecting different results. It is easy to stand here and say that we stand up for our health service in a speech, but if we continually expect health service staff to take responsibility for their patients while we repeatedly walk away from our responsibility to them, we are failing in our jobs and in what we are supposed to do, effectively turning our backs on transformation. For those colleagues who want to revisit the past, I suggest returning to the Bengoa principles of reform — returning to the case for change and asking what each of us is prepared to do in order to deliver it. Professor Bengoa, who is returning to Northern Ireland soon, stated in 2016 that we had to reform our health system because, as he put it, the platform was burning. The platform has been burning for 10 years, and the need to reform is now urgent. The rhetoric of division does not die once we leave this Chamber, and the consequences of our decisions do not remain within these walls. I call on my colleagues in the Assembly to change the narrative and to work towards the transformation of our health service for people here. I call on the Minister today to outline his plans to make progress on health and social care transformation and to improve patient outcomes before the end of the mandate.
1,442 words. Text as published by the Northern Ireland Assembly.
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