Debate contribution: Health and Social Care Transformation

Debate contribution by Mr Matthew O'Toole on 6 October 2026.

MLA: Mr Matthew O'Toole
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 5777118

Text

Thanks, Madam Principal Deputy Speaker. I thank all Members who participated in the debate. Since we became an Opposition nearly three years ago, we have been clear and consistent, boringly so, about the need for us to be a constructive Opposition, and we meant that. That is why our amendment does not go in for calling out this Minister. We have no fear about calling out, challenging and scrutinising individual Ministers, but our amendment is about acknowledging that we face not only a vast crisis in our health service but a structural failure of our politics collectively — all of us: Opposition, Executive parties, left, right, unionist and nationalist — in talking about our health service. Our health service is delivering some of the worst outcomes in these islands. Our waiting times are shocking. The red-flag statistics are shocking. They are all shocking. I will not list them, because I do not want to use up my brief time to talk about how bad they are. It is clear that Health is the biggest area of Executive spending and is getting bigger. It accounts for more than half our entire Budget. It is bigger than the whole Budgets of certain UK Departments. That means that it will take more than one Minister from, with all due respect to the Minister, a small party to achieve the big structural change that is needed in our health system. It is a decade on from the Bengoa report. I will not go through everything that Bengoa said, but, as my colleague Colin McGrath said clearly, this needs to be about fundamental system change. In order to achieve fundamental system change, those who have political influence and political leadership, from the Minister down, including all of us, need to be willing to talk honestly about how we need to change the service. That is why our amendment talks about a new political consensus. We are the Opposition, and we have no fear of challenging people and being direct when it matters, but we are also clear that we need to develop some kind of consensus, because the way that our politics talks about health at the minute is not working. It fundamentally does not work. Service transformation is being done via collapse. That is what people fear. It is what the BMA says, and it is what, in a sense, local communities are saying.
People are not hearing an explanation of how a restructured or collapsed service will lead to better outcomes for them, their communities and their families, so they do not accept it. In some places, they are right not to accept it. As Colm Gildernew said, people in the South West Acute Hospital's catchment area deserve to know why that state-of-the-art facility is not taking patients from Sligo or Cavan. People in Daisy Hill Hospital, which, again, is close to the border, have a right to know why certain acute services that it would be perfectly reasonable to see delivered there are not being delivered there. We have a responsibility to ensure that we use the all-island context where necessary and also that we make difficult decisions where necessary. Where there are difficult decisions to be taken, we need, as Colin said, to explain to people why they are necessary. I will do a bit of that today. I start by thanking the Minister for making a decision on 24-hour thrombectomy care. We often have reason to be challenging, sceptical, negative and harsh in the Chamber. That is a good thing. We had an Opposition day motion on delivering 24/7 thrombectomy care not so long ago. I would like to think that that is evidence of our influence, but I do not think that it is that alone. I am done with not being honest with people about how we need to change our health service. Eighteen years ago, my father, who was in his early 50s at the time, was sitting in his local pub in Downpatrick and had a massive stroke. He was sitting next to somebody who worked in the health service, who spotted the signs immediately. He was taken to hospital within minutes. It happened in the summertime, so there were not any winter pressures on ambulance services, plus it was almost 20 years ago. He arrived at the old Victorian Downe Hospital, which people understandably wanted to be kept open, but my dad did not get the care that he needed and almost died. I was living in London and got a phone call on a Thursday evening. I flew back on the Sunday, and he was near death, because he really had not received the kind of specialist stroke care that he needed. That Sunday, we had to fight, as people do, to get him to a specialist stroke unit at the Ulster Hospital. I travelled with him in an ambulance up to the Ulster. When we arrived, the consultant told me and our family that, in all probability, he was going to die that night. He received the last rites, so we had to phone his family. He did not die — he managed to live, and he has since met six grandkids — but if he had stayed in the local hospital, he would be dead now. Local is therefore not always best, and, as political leaders, we need to be willing to say that to people sometimes. In some instances, people will rightly fight — in many instances, we will fight with them — for local services, but I had to travel up a rural road in an ambulance with my da when he was in his early 50s, and he received the last rites. If he had not made that journey, he would be dead now. We owe it to our people to be honest with them at times. I am not talking about every instance in which Members have talked about hospitals in their area. People deserve to fight for services in local hospitals, but, when there is clear evidence that services need to be transformed in order to deliver better for our people, we are letting them down if we are not honest with them. I have spoken about my own family's experience. If my dad had not received specialist care, he would not be with us. If we want to make change, we have to take people with us, which is why I have shared my experience today. I do not think that we all have to share personal family or medical histories, but we need to be honest with the communities that we serve. We know that, for so long, our politics has engaged in either sound bites or toxicity while services are getting worse. The public want some leadership, particularly when it comes to the health service. That is what our amendment is about today. We commend it to the Assembly.

1,155 words. Text as published by the Northern Ireland Assembly.

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