Debate contribution: Waiting Lists: Action Plan

Debate contribution by Mrs Diane Dodds on 20 February 2024.

MLA

Mrs Diane Dodds

Party at the time

Democratic Unionist Party

Date

20 February 2024

Type

Debate contribution

Business

Private Members' Business

Heading

Waiting Lists: Action Plan

Assembly identifier

Official Report component 4380533

Read the official Assembly record

Text

I beg to move

Thank you, Madam Deputy Principal Speaker — or whatever way round that is. I am pleased that we have the opportunity to discuss this important topic, and I thank the Health Minister for his attendance in the Chamber. I am sure that every MLA in the House can attest to the fact that, every week, we meet constituents who are ill, in pain and on a waiting list. They have lost hope and faith in the very NHS that was meant to look after them from the cradle to the grave. Let me reinforce my belief that a well-funded, properly functioning NHS, free at the point of delivery, is my sincere goal. It saddens me that we are very far from that objective. Tackling waiting lists is one of the pivotal issues on which the success or failure of the Executive will be judged. We cannot fudge the issue or talk about everything else but not address that most fundamental of issues that impacts on our constituents every day.

I would like to make some progress. Minister, I understand and appreciate that you have a challenging brief, and I hope that, in highlighting the issue in the Chamber today, we will lend weight to your arguments for resources to tackle the problem. Equally, Minister, the issue will not go away, and we will hold you and your Executive colleagues to account on the progress in tackling it. In bringing the motion, I want to be clear on the uncomfortable truths about waiting lists. The Northern Ireland Audit Office (NIAO) report of 2023 makes for stark reading. No formal waiting time targets have been achieved since 2014. Between March 2017 and 2023, patient waiting lists exceeding maximum waiting time targets have increased exponentially. The equivalent of 26·3% of the Northern Ireland population is on a waiting list compared with 12·4% in England. That means that, compared with England, more than twice the proportion of our population are on health and social care waiting lists. In Northern Ireland, 51% of those on a waiting list were waiting over 52 weeks for assessment or treatment compared with 5·4% in England. From the Department's waiting time statistics, we know that 87·9% of patients diagnosed with cancer received their treatment within 31 days versus the 98% target, with gynaecology having the poorest outcome of 78·1%.

There are huge regional variations in the statistics, with some trusts performing much better than others. That postcode lottery of treatment is unsustainable and unfair. In the Southern Health and Social Care Trust area, the wait for a routine urology assessment is 153 weeks. There is a potential further wait for treatment of 151 weeks. The wait for a rheumatology outpatient assessment is 201 weeks, and, for neurology, it is 172 weeks. I have used figures from my local trust; other figures are available, and the wait times are just as shocking. It is long past the point where we can call this a service. It is clear that very poor waiting time performance is significantly increasing the number of patients at risk of developing serious conditions and illnesses. Their quality of life will have been reduced by spending protracted time waiting on tests, treatment or surgery. There is deep concern about the prevalence of late diagnosis. Between 2012 and 2017, one quarter of cancer diagnoses were made in emergency departments and not in primary or elective care. It is morally unacceptable that we are allowing patients to reach that stage in their journey before serious illness is detected. Minister, we all know that that is not a sustainable position. We know that Northern Ireland has the worst waiting lists in the United Kingdom. Simply doing a little more or investing a little extra will not make a significant difference. That is why it is imperative that you and Executive colleagues have a clear plan to reduce waiting times. In their latest funding offer, the UK Government said that they will grant an additional £34 million to tackle waiting lists. However, the Northern Ireland Audit Office report indicates that £909 million would be required to reduce waiting times substantially. The elective care framework estimated that £707 million is required to ensure that, by 2026, waiting times do not exceed one year. The Department has now conceded that those targets cannot be met. I know that you are very soon in post, Minister, but is that still your view? Stabilising this fundamental public service will require significant investment. Minister, we need your Department to provide robust figures on the cost of stabilising the service, and we will be watching the future budget proposals for investment. However, funding is not the only solution. Recruitment and investment in staff are vital. I hope, Minister, that you will be able to reverse the decision taken last year to halt the recruitment of nurses onto university courses. We trust that you will be able to reach satisfactory agreements on pay so that staff can feel valued, and that you will work with trusts to ensure that staffing levels are safe and appropriate. While there is a need to increase the number of staff, that must be accompanied by an overhaul of inadequate, out-of-date and poorly maintained physical and digital infrastructure. Those investments will lead to more efficient delivery of services. Other options that must be delivered include the use of primary care for routine elective procedures and tackling the extreme pressures on social care. We need to be realistic about the extent of progress that the system in its current form can achieve. Clearly, we do not have sufficient capacity, and all the training and recruitment efforts in the world will not turn that around in the short term. We need to find partners who can assist us, and we need to look beyond our usual local providers. The small independent sector in Northern Ireland will undoubtedly have a role to play, but it is dwarfed by the volume of the additional capacity that is needed.

I will shortly, if you just let me finish this point. Continuing in the old way, with small contracts at the end of the financial year, will have only a minimal impact. I was very concerned when I was contacted by one private sector provider who indicated that patients who it had been anticipating this month for urgent red-flag endoscopies had not been forthcoming due to trust financial concerns. They had made arrangements to carry out 2,000 endoscopies and 1,000 urology procedures in the six weeks leading up to the end of the financial year. Have those red-flag patients simply ended up on another waiting list? I can only imagine their fear and concern. I will give way to the Member now.

I thank the Member for his intervention. I am not interested in playing politics on this one today. It is extremely important for Northern Ireland that we go forward with a plan to sort out this issue. Every day those people, who are in pain, want us to do that. Northern Ireland can only do so much by itself. We must seek to partner, on a much larger scale, with national or global providers that can work alongside us to provide the additional skilled staff that are required in the short term, as we enhance our capacity. Let me be clear: investing in our own staff and infrastructure is my preferred option, but the needs of our waiting lists and the urgent requirement to address capacity will take radical short-term solutions. Some in the Chamber may have an aversion to considering working alongside the independent sector, but I am not necessarily suggesting that we have to pursue private providers. There are a number of non-profit organisations from the United States, for example, that operate internationally. The University of Pittsburgh Medical Center is a global non-profit health enterprise with 92,000 employees internationally, 40 hospitals and 70 cancer centres. It has partnered with a number of hospitals in the Republic of Ireland, providing state-of-the-art radiotherapy treatment in Cork and Waterford, and is also involved in hospitals in Kildare and Kilkenny. There is undoubtedly a political and broader interest from the US in Northern Ireland's affairs, and perhaps there are ways in which we can encourage that and harness it for genuine practical benefit and for the welfare of our patients. We should not underestimate the anxiety that people experience when waiting for a diagnosis, nor the impact on loved ones. We recognise that additional money alone is far from being the answer, as Northern Ireland already has the highest per capita spend in the whole of the UK, but we must maximise the outcomes from investment. We must see more procedures proceed. It is surprising that that can happen in the private sector but not in our NHS. There must be clearer separation between emergency and planned care.

Yes. I had assumed that I would get an extra minute because of the intervention.

Oh, right. Sorry. Thank you. We need to sweat our assets. Can I take two seconds, Madam Principal Deputy Speaker —.

1,519 words. Text as published by the Northern Ireland Assembly.

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