Debate contribution: Waiting Lists: Action Plan

Debate contribution by Mr Robin Swann on 20 February 2024.

MLA: Mr Robin Swann
Party at the time: Ulster Unionist Party
Date: 20 February 2024
Type: Debate contribution
Business: Private Members' Business
Heading: Waiting Lists: Action Plan
Assembly identifier: Official Report component 4380750

Text

Thank you, Principal Deputy Speaker. I welcome you to your post and look forward to working with you. I welcome the opportunity to speak to the motion, not only to address all the many important issues that have been highlighted but to thank colleagues for the positive, collegiate approach that has been taken to the motion and its important topic. I thank Members for their contributions, and I look forward to working with the Health Committee and the Opposition as we tackle the issues together. I fully agree that it is deplorable that the waiting list targets have not been met since 2014. The people of Northern Ireland are not receiving the care that they deserve on a timely and effective basis. The Opposition Member would not take an intervention when he was talking about 2014 and all the programmes and strategies that were set in place. I wanted to point out to him that the Department of Health has not had a recurrent budget since 2015. We have been working on single-year budgets for the entire time since then, which has not allowed many of the strategies to be fully implemented. It is not that they are sitting there, doing nothing, but that the recurrent funding has not been there to support them. Over the years, a lot of words have been written and spoken about the state of our waiting lists. I do not intend to repeat all of those, but I agree with many of them. It is a matter of deep worry for me and should bring real inner reflection to all who serve in this place that so many people have been waiting for so long for diagnosis, treatment and support. As Members have said, those are real people. They are our constituents, our friends, our families and, indeed, our Assembly colleagues. When someone joins a waiting list, their condition does not stand still — Mrs Erskine addressed that point in her intervention — and additional complications and additional needs come with being on a waiting list that is not fully resourced or supported. It is incumbent on me as Health Minister and, collectively, on us all to ensure that we do everything that we possibly can to address our waiting lists. Fundamental to that is having a clear, time-bound, deliverable action plan. I agree with the Chair of the Committee that it should be fully resourced, with a multi-year budget. In that context, Members will recall that, in June 2021, I published an elective care framework, which detailed a five-year plan that had that dual focus on reducing waiting lists and, at the same time, closing the gap between capacity and demand. That framework, costed at £707 million, contained a range of actions — 55 in total — aimed at reducing waiting lists and improving capacity across our elective care system. It also set out how we would invest in and transform services to allow us to meet the population's demand in future. I made clear that delivering on that plan would require sustained investment to tackle backlogs and increase overall capacity in our health and social care system.
I thank the Chair of the Committee for her intervention, and I look forward to working with the Committee. The £1 billion that was promised was also in the party manifesto of the proposers of the motion. I have already made it clear that that £1 billion financial gap is also what my Department is highlighting for next year to allow us to stand still. I genuinely look forward to working with all my Executive colleagues on honouring the commitments that they have publicly made. I also made it clear then that delivering on that plan would require sustained investment to tackle the backlogs and, as I said, increase the capacity in our health and social care system. I was heartened by the fact that the framework was agreed by all Executive parties and that commitments were made that the necessary resources, as set out in the accompanying funding plan, would be made available. While there has been some progress, which I will touch on in a moment, no one, including the proposers of this important motion, can have missed the damage that the subsequent further political stalemate and interruption have inflicted. On my last day in office in October 2022, after six months of a non-functioning Executive, I said that patients and staff were being badly let down by the politics of this place. I hope that we will see a renewed focus from the outset on where we move in regard to supporting health. In the absence of an Executive and, critically, the absence of any budgetary certainty, the framework has since been starved of the political leadership and the funding that it required. Regrettably, as we were halfway through the five-year time frame, my Department announced last year that its targets were no longer within reach. The situation that we face at present is terrible. At the end of September 2023, as has been said, according to the most recent validated figures, 430,000 patients were waiting for a first consultant-led outpatient appointment, 115,000 patients were waiting for inpatient or day-case treatment and just under 190,000 patients were waiting for diagnostic tests. Those are eye-watering figures for a population of our size. In addition to the backlog of patients waiting, new patients, of course, continue to be added. The gap between demand and capacity inevitably means that waiting lists continue to grow. That said, I want to put it on record that there has been some progress. The fourth interim report on our elective care framework, which was published in January, highlights the start of small but tangible improvements in the waiting list position. As of September 2023, inpatient or day case treatment waiting lists have seen some promising improvements. While they are still at unacceptable levels, there has been decrease of 8·4%, which is just under 11,000 people, in those waiting compared with the same month a year earlier. There has been an improvement in the number of people waiting more than 13 weeks, with 78·6% of patients waiting more than 13 weeks for admission compared with 79·8% on 30 September 2022. Over-52-week waits have also been reduced regionally, although they still remain far too high. It is important to acknowledge and build on improvements to ensure that any momentum is not just maintained but increased. Those improvements alone will not address the backlog.
The Member will appreciate that I do not have a direct answer today, but I will write to her about that. Tackling our lengthy waiting lists is undoubtedly a long-term issue that requires sustained and recurrent funding. It requires workforce development and system-wide transformation. Our health and social care system is complex, and waiting lists are just one component, as has been said today when we expanded the debate to include domiciliary care, care homes and GPs. That whole-circle approach to health has to be addressed. As such, our waiting lists cannot be addressed in isolation. Other fundamentals of the system must be considered and addressed simultaneously. That includes dealing with issues such as workforce pay and the pressures and capacity in secondary, primary and community care, and ensuring that we maximise the capacity that we have in the system. When we see those shocking figures and the appalling waiting times, there is an understandable desire to see them reduced immediately. That requires a whole-system approach and not just piecemeal interventions that can only deliver small improvements in the short term or in isolated areas. That does not mean that there are no short-term measures that can be effective, but the key is achieving the appropriate balance between the short-term effective measures and those longer-term sustainable developments that bring about the optimum effect. We know that we need to transform our health and social care system to become more effective and efficient, and we know what is required. It includes reform and innovation in such areas as our treatment capacity, outpatient reform, imaging, pathology and workforce, along with the protection of elective care from unscheduled care demands. That work is already well under way, and elective capacity has been enhanced through the continued development of our elective care centres. I highlight to Members key examples that are already in place: two dedicated day procedure centres at the Lagan Valley and Omagh hospitals; three elective overnight stay centres at Daisy Hill Hospital, the Mater Hospital and South West Acute Hospital; the expansion of 22 post-anaesthetic care unit beds for elective care across all trusts; three speciality centres for cataracts at the Downe Hospital, South Tyrone Hospital and the Mid Ulster Hospital; an orthopaedic hub at Musgrave Park Hospital, including the Duke of Connaught unit, which is a dedicated orthopaedic day procedure centre; two rapid diagnostic centres at Whiteabbey Hospital and South Tyrone Hospital; a regional extracorporeal shock wave lithotripsy centre in Craigavon Area Hospital; service reviews in general surgery, orthopaedics, urology and gynaecology, which will set the direction of travel for improvement; the introduction and the maintenance of our mega-clinics to maximise patient throughput; outpatients' assessments delivered by GP federations in primary care settings; the development of in-house health and social care capacity; and the continued investment in staffing. The Members who tabled the motion asked me to acknowledge:
"the need to turbocharge investment towards tackling the waiting list backlog".
I not only acknowledge that but stress that investment is fundamental to the whole backlog problem that we face. The initiatives, for which confirmation of sustainable funding would allow further development, include the enhancement of that sustainable workforce capacity through expanding the skills mix and the development of specialist nurse roles and the allied health professionals across a range of specialities.
Other initiatives are the expansion of our preoperative assessment service to improve theatre productivity; building our own diagnostic capacity to reduce the reliance on independent sector capacity; and building capacity and throughput across regional elective care services such as urology, paediatrics and orthopaedics.
Today's motion asks that I:
"publish an updated action plan to tackle the waiting time crisis within six weeks."
The action plan to tackle waiting lists in the health and social care system already exists. I do not want to waste time replicating what is already clearly set out in the elective care framework, because enough time has already been lost. It is, however, almost three years since the plan was published, and, as with all plans, it is important that it be reviewed to ensure that it takes account of relevant changes in our overall Health and Social Care environment and is updated to reflect those changes. It is for that reason that I have tasked officials with reviewing the framework. That review is ongoing and will be completed by June of this year. The motion also stresses:
"the value of partnering on a much larger scale with national and independent providers to maximise existing capacity".
That is essential. We must take all measures and use all resources within our means to ensure the effective delivery of services, and that includes the use of our independent sector. That is what we have been doing with the limited additional resources that have been deployed for waiting list initiatives. We need greater investment in this area, and we want to achieve results and the impact on waiting lists that the people of Northern Ireland need and deserve. Maximum efficiency in the use of the independent sector can, however, be achieved only with multi-year contracts or at least contracts for three years from when they are agreed. That will also provide better value for money. As Members will be aware, as part of the elective care framework, I introduced the Republic of Ireland reimbursement scheme (RoIRS) on 30 June 2021. In June 2022, I announced that the scheme would be extended beyond the planned deadline until an additional £5 million of new funding had been committed. The scheme closed to new applicants on Wednesday 21 September 2022 when that additional £5 million of funding had been exhausted. I assure Members that I will leave no stone unturned as part of my broader consideration of resource investment to reduce waiting lists. I will invest what limited funding there is wherever it will have the greatest possible impact. The task ahead will be much easier, however, if all parties do all that they can to support adequate and multi-year funding settlements. In the meantime, work is under way to provide further building blocks to tackle waiting lists. That includes plans for service reviews in —
— paediatric orthopaedics. I thank the Principal Deputy Speaker for her support in bringing the motion before the House. I also thank the Members who tabled the motion and the entire House for its support.

2,141 words. Text as published by the Northern Ireland Assembly.

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