Debate contribution: Health and Social Care Transformation

Debate contribution by Mr Robbie Butler on 6 October 2026.

MLA: Mr Robbie Butler
Party at the time: Ulster Unionist Party
Date: 6 October 2026
Type: Debate contribution (made as a minister)
Business: Private Members' Business
Heading: Health and Social Care Transformation
Assembly identifier: Official Report component 5777094

Text

Thank you so much, Madam Principal Deputy Speaker. I am going to read something in that I have not got printed out. There are two images in this Building that have inspired me every time I that I have come in since I became an MLA in 2016, and they are the measure by which I do my politics. One image is of C S Lewis, under which it says:
"There are far, far better things ahead than any we leave behind".
The other, which faces it, is of Seamus Heaney. It says:
"Believe that a further shore is reachable from here".
I suspect that, when Rafael Bengoa was here in 2016, having been being commissioned by the then Health Minister, Michelle O'Neill, that was the kind of image and vision that he was setting for us. Let me be absolutely clear: that is, fundamentally, front and centre of what I would like to deliver. Even in the short time that I have as Health Minister, it very much is the premise of the vision and principles on which I will make decisions. As the Chair intimated, I have said openly that scrutiny and holding my feet to the fire will ensure that I give of my absolute best, and I reiterate that. I will not be a Minister who hides or ducks. Do I enjoy confrontation? I absolutely do not. However, I know that fair challenge brings out the best in all of us. The term that I use is "iron sharpens iron". I hope that, in the months that we have left here, we can engage with a level of integrity on health in particular, because it stretches across every community in Northern Ireland and impacts on every one of our families. I have a rather large family — some live rurally, and others live in urban scenarios — and they deserve to have equitable access to the health service, which is a point that was picked out in some of the contributions. I welcome scrutiny from wherever but principally from the general public. That is why the health service exists. The roles exist in the health service as a provision for the public, and we must never, ever lose sight of that. Patients are living with the consequences of a system that is under severe pressure, and they deserve straight answers. To be fair, the mover of the motion did not repeat the words in the motion, and I appreciate that. I can accept the debate and the words that have been said today in the Chamber. Unfortunately, however, I cannot support the motion as written, because there are two things in it that I fundamentally disagree with. The first is this:
"this Assembly ... agrees that patients are experiencing severe harm due to successive Ministers of Health delaying progress".
That is inaccurate. It is wrong, and it has no substance because it does not stack up. Secondly, the motion:
"calls on the Minister of Health to change his approach".
No. The Minister of Health will not change his approach, because I believe that my approach is the right approach. As has been said in the Assembly, people come at transformation from very different directions and very different sectors. If you live rurally —.
No, I will not. I want to get through this, Diane, if you do not mind. People who live rurally experience health in a very different way, but I want to give a voice to the public so that they are part of the conversation about the transformation of health, because the transformation of health has to happen — it has to happen — but it needs to have the confidence of the public whom we serve. Let me be clear. Has reform moved quickly enough? Absolutely not. Is the health service in an acceptable position? Absolutely not. However, is it true that nothing has changed? Absolutely not. 'Delivering Together' set a 10-year direction in 2016. The Department's progress reports demonstrate in black and white the various areas in which progress has been made, but, importantly, those reports also recognise that much more remains to be done. Only six weeks into this role, it is patently clear to me that reform has been uneven and that it is absolutely incomplete. As has been referenced, the pandemic put enormous pressures on a service —
Not at this point. — that was already stretched, as did the long periods when the devolved Government were not functioning. For five years out of 10, there was no leadership at the helm of Health driving that much-needed transformation. Those two facts on their own should explain to everyone in the House why progress has slowed. Coupled with that is the fact that we have an underfunded wider Executive. Why do I refer to the "wider Executive" and not just my portfolio? We know that health outcomes are determined by socio-economic performance. If you live in an area where there is poverty or are from a certain demographic, you will, unfortunately, suffer poorer health outcomes. We therefore need to tackle poverty and educational underachievement. We also need better houses and better transport systems, because all of that will help us to deliver a healthier public through a better public service and health system. There are, however, changes that we can see. Multidisciplinary teams provided more than 354,000 additional consultations last year alone. Around 1·3 million people can now get physiotherapy, social work or mental health support through their GP practice. The latest figures show that almost 85% of patients supported by those teams were managed in primary care without needing an onward referral. That matters because reform is not just about having a new plan or structure or closing down a building. It should mean that people get help earlier and closer to home and that they do not have to go to hospital when the right care can be provided safely in their home. That change will take time. Behind every waiting list figure is a person who is waiting for an answer, a diagnosis or treatment, so we cannot lose sight of the fact that we are talking about people. The neighbourhood model is built around that idea. It brings general practice, community pharmacy, the trusts and voluntary and community organisations together around local needs. The Department is bringing together 17 integrated neighbourhood teams, with £4·3 million to support that work. The plan envisages moving around 2% of hospital expenditure over each of the next three years into services that are delivered in neighbourhoods. That "further shore" is now in sight, guys, and that is why this place is important. It can deliver when we are here, doing the work. Initially, the teams will focus on better coordinated support for vulnerable older people to help them stay well and live independently at home for longer. That work builds on services that are already in place. We have secured almost £60 million for Together for Families and £42 million for e-pharmacy, which will help to modernise primary care. Those investments need to make a practical difference to families and patients, and that is a test. If you do not know that much about the Together for Families programme, have a look at it. It is really transformational. It will help us to get upstream, prevent young people from becoming looked-after children and keep families together. That will be transformational not just for budgets but for the lives that people live. "Sensible care" is also part of that same effort. It is about making sure that people receive the care that they need, reducing unnecessary differences in practice and improving pathways so that staff time and public money are used well. It is not about cutting care for its own sake; it is about improving outcomes and the patient experience while making services more sustainable. The reset plan also sets out a shift towards prevention, greater use of digital tools and the provision of more care in the community when such care is safe and effective. To go back to some of the points that were raised, it is an immutable fact that, very often, a hospital is not the best place for recovery, but, unfortunately, it is sometimes the only place for recovery. We need to shift that model, and that will take some time. We need to bring the public along with us to give them the confidence and understanding. It will involve more than moving activity out of hospital, because community teams need the staff and capacity to take on that work, and hospitals must retain the specialist teams and services that people depend on. Those changes have to be planned together. Getting systems to work in tandem is one of the most significant challenges. As Members will know, Encompass is now in place across Northern Ireland. It gives us a single digital care record. That is an important foundation for more joined-up care. Work on virtual wards and remote monitoring could also help people to receive appropriate care at home or in their local community. We should use technology where it makes care safer and easier to access and be clear about the difference that it will make. None of that will work without the people who provide care, because staff are the health service's greatest asset. Sadly, however, staff shortages, the impact of delays in approving pay awards on morale, and growing demand make it increasingly difficult to sustain services. General practice is a clear example. It was referenced by one of the bodies that represents general practice. The Department has established a system workforce management group to improve workforce planning and to look at recruitment, retention and the skills that we need in the future. I know that GP teams are under immense pressure. Supporting the long-term future of general practice must be part of the reform agenda. It is very much part of mine. Staff need to be involved in designing new ways of working and supported to deliver them. We also have to face the position on waiting times. The latest figures since March this year again show that fewer people are waiting for inpatient or day case admission and for a first outpatient appointment, but the overall waits are far too long, and every reduction matters to someone who has been waiting. On Mr Dickson's point, I, too, have served on the APG on cancer. Thank you, Stewart, for your service and for the unadulterated six weeks during which you have held my feet to the fire as regards that matter, because we absolutely need to do better on cancer waiting times. I am actively involved in work on that at the moment. Elective centres, endoscopy services and mega-clinics are helping to increase planned care capacity. Almost 22,000 patients have been treated at the Lagan Valley day procedure centre. The overnight day centres at Daisy Hill, South West Acute Hospital and the Mater Hospital have treated around 29,000 patients between them. For this year, £165 million in recurrent funding has been allocated to increase red-flag, time-critical and routine elective capacity. We need to make sure that investment results in more people being assessed and treated. The motion mentions the BMA's warning about "reform by service collapse". It is serious, and I take it seriously.
However, repeating that phrase does not tell us what to do when a service cannot recruit the staff needed to provide safe care.
Leaving an unstable arrangement as it is can also put patients at risk. Any proposal for change must be judged on the evidence: patient safety, workforce sustainability and the impact on the communities who rely on that service. As Members will be aware, no final decision has been taken on the Causeway Hospital emergency general surgery proposal; indeed, as of today, no recommendation has come to me, as was the case at last week's Health Committee meeting. At Daisy Hill Hospital, the trust's stated intention remains to maintain inpatient maternity services while it continues recruitment and explores every option available to it. I understand how strongly people feel about those services, because, as I said, the health and social care system exists for people, not the other way round. However, we have to have not just equitable access but safe access to the best services. 'Delivering Together' made it clear that reform cannot be done to communities. That is where reform gets difficult. It must be done with communities. The decisions must be based on the best evidence and made with the confidence of our communities. That is why I have established the independent reconfiguration committee to provide expert advice on major or controversial proposals. I will listen to its advice and to clinicians, staff, patients and local communities. The committee was one of the outcomes of the previous hospital network consultation. That has not been forgotten about. It has not been binned; it is being acted on. The motion states that I need to change my approach. My approach is to strengthen care in communities; to increase elective capacity; and to make decisions on service proposals when the evidence is clear — in fact, to make them when I have the evidence and not when I do not have it. I will not make those decisions by slogan, and I will not avoid them because they are difficult. For the remainder of the mandate, I will accept responsibility for what happens next. I will be honest about what works and what does not, and I will focus the Department on delivery. The public do not need another argument about who is to blame. Equally, they do not need more politically motivated debates in the Chamber; we have had too many. They need safe services, shorter waits and care that they can rely on. I will be judged on whether we make progress towards that, and rightly so.

2,325 words. Text as published by the Northern Ireland Assembly.

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