Debate contribution: Health and Social Care Transformation

Debate contribution by Mr Colin McGrath on 6 October 2026.

MLA: Mr Colin McGrath
Party at the time: Social Democratic and Labour Party
Date: 6 October 2026
Type: Debate contribution
Business: Private Members' Business
Heading: Health and Social Care Transformation
Assembly identifier: Official Report component 5777027

Text

Thank you very much, Madam Principal Deputy Speaker. I welcome the debate and the proposal in the motion. I hope that our amendment can be seen as a small contribution to the motion, while not changing it massively. Our amendment revolves around the line in the Bengoa report that sums up where we are today better than anything else. The report said that "change is everybody's business". That report was published 10 years ago, yet patients are still waiting and staff are under unbearable pressure. Communities too often find out about change when the service is right on the brink and about to collapse. The BMA's description is absolutely devastating; it says that we are witnessing "reform by service collapse". It says that difficult decisions have too often:
"been delayed, diluted or abandoned when they become contentious"
and that "reform cannot be endlessly discussed." That is why the SDLP has tabled this amendment, which, we believe, strengthens the motion. The debate cannot simply end with another demand on one Health Minister to fix everything or to change his approach, and for him to demonstrate political leadership. Our amendment commits the Assembly to "working constructively" towards:
"a shared programme of health reform over the next five years",
and asks the Minister, whoever that Minister will be, to reach out and work with the other parties to build a consensus that is "capable of sustaining difficult decisions" and surviving changes of Minister or electoral cycles. That is not about letting this Minister or any Minister off the hook. The Health Minister is responsible for his Department and he must make the decisions and show that leadership. Where decisions are delayed or mistakes are made, the Assembly should rightly hold him to account. However, the fiction that one Minister sitting in Castle Buildings can transform our entire health and social care system on their own has to end.
Health does not begin at the hospital door. It begins with somebody having a warm home, a child growing up in poverty or someone being able find secure employment. It is about whether schools equip young people to live healthy lives, whether our communities have decent public transport and whether older people are supported to remain independent.
Never mind Bengoa for a moment — does anybody remember the 'No More Silos' report? Mental health, addiction, poverty, housing, education, employment and isolation do not fit neatly into departmental silos, so neither can the solutions. The Department of Health itself has already acknowledged that. Its reset plan says that:
"healthcare interventions are only one element of improving well-being, alongside ... employment, housing, education".
The plan concludes that resetting health and social care:
"can be delivered only through a whole government approach".
That need for collective political responsibility is not simply our view. Professor Gabriel Scally, who has decades of experience in public health, says that public trust has been shattered. If we want people to accept difficult changes to services that they have relied upon for generations, we cannot simply announce those changes and tell communities that the experts know best. We have to bring people with us. We have to demonstrate that the alternative is genuinely better, safer and sustainable. Crucially, we have to stand together politically when the evidence supports change. That is what political leadership on health transformation should look like. That was achieved in the South when Sláintecare was agreed in 2017. Whatever criticisms can be made of its subsequent implementation, its origins matter. In 2017, politicians from different parties came together around a 10-year vision for health reform. They recognised that reform at that scale had to reach beyond one Minister, one Government and one electoral cycle. That is precisely the political maturity that we need here. If that is the diagnosis, our politics needs to catch up with it. Health must become a collective Executive priority with collective Executive ownership. That means that every party that sits around the Executive table must resist the short temptation to land a few blows and remember that, as they so love to remind us, they are in the Executive. Let us look at the Health Committee. I am supposed to be the sole Opposition member out of nine members, yet on that Committee it appears that one of the nine is the Minister's rep, who backs him up, and the other eight are in opposition. Yes, a Committee is meant to hold a Minister to account, but all that we ever see —.
I do not get extra time, so please make it quick.
My goodness, that was short. Thank you. Yes, and that is exactly the point: we are there to hold the Minister to account. If the Committee is being oppositional, however, that points to the core of what we want to achieve with this amendment, which is to encourage everybody to be forward-looking together on transformation. If there was a whole Executive approach when it came to transformation, we could see agreed principles, an agreed direction of travel, and the space to make the necessary changes instead of what we see at the moment, which is simply collapse in the system. We cannot demand transformation in principle and oppose every difficult manifestation of it in practice. We need an agreed direction of travel that can survive the political pressure that inevitably comes when change reaches a particular hospital, service or community. That is what our amendment seeks to achieve. There is another issue that we cannot ignore. We are entering the final five and a half months of this mandate. Where is the health legislation? In March, I asked the then Health Minister what primary legislation he expected to introduce before the end of the mandate. His response, on the day that he resigned, identified the control of data processing Bill, a safe and effective staffing Bill and the duty of candour Bill as legislation that he hoped to introduce. The answer was there in black and white, yet here we are and the only piece of primary health legislation that has been brought through the Assembly has been about overturning hospital car parking charges. That is baffling. How are we meant to achieve change in our health service when we do not even have legislation that can pass through the House? There is a danger — it is, I think, very much the reality — that our Executive have become good at describing the crisis but totally ineffective at changing it. They are rather good at amplifying or engineering a crisis but not so good at ending one. We need decisions; we need legislation; and we need delivery, but, for that to happen, we also need political courage. Bengoa told us 10 years ago that the choice was stark: resist change and watch services deteriorate towards collapse or embrace transformation and build a sustainable service. Change is everybody's business, as I said. The public do not care which Department wins an argument around the Executive table. They just want the Government to work and to work right now. I defy Members to find one person who thinks that this place is operating as it should. It is time for maturity, decency and, dare I say it, even a dose of shared effort in our politics.

1,215 words. Text as published by the Northern Ireland Assembly.

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