Debate contribution: Supply Resolution for the Northern Ireland Spring Supplementary Estimates 2023-24 and Supply Resolution for the Northern Ireland Estimates: Vote On Account 2024-25

Debate contribution by Mr Danny Donnelly on 9 April 2024.

MLA

Mr Danny Donnelly

Party at the time

Alliance Party

Date

9 April 2024

Type

Debate contribution

Business

Executive Committee Business

Heading

Supply Resolution for the Northern Ireland Spring Supplementary Estimates 2023-24 and Supply Resolution for the Northern Ireland Estimates: Vote On Account 2024-25

Assembly identifier

Official Report component 4482192

Read the official Assembly record

Text

I speak today as the Alliance spokesperson for health, and I will highlight some of the priorities facing the Department of Health. As my colleagues have indicated, we will support the motion, and I thank the Finance Minister for tabling it. As we have heard many times today, there is no question that every Minister and Department are facing severe financial pressures, and Health is no different. In the Health Committee on 14 March, the Minister indicated that additional significant investment would be required to deal with some of the key issues facing the Department. We can see some of those pressures throughout our health service. We have previously discussed waiting lists in the Assembly, and it must be an urgent priority of the Department to tackle our unacceptable waiting lists. Too many people across Northern Ireland are suffering as they languish on waiting lists, getting sicker, losing mobility, having mental health issues and, sometimes, not even getting the surgery they have waited for. We will all have heard the shocking statistics over the last few months and years, but a recent report on the performance of Northern Ireland's healthcare highlighted that 60% of patients had waited for more than a year for in-patient treatment at June 2023, compared with just 5% of patients waiting more than a year to complete the entire pathway from referral to treatment in England. The report starkly describes a system operating at the very edge of its capacity and capability, highlighting that it is not fit for purpose and needs to evolve considerably in the coming years. Domiciliary care is another area that urgently needs to be addressed. Many people cannot access domiciliary care packages to ensure that they can be cared for in their home. In November 2021, Minister Swann invested £23 million to improve the terms and conditions of domiciliary care workers in the independent sector. That was welcome at the time, but we need further protection and support for our domiciliary care workers. It was also welcome that the first Adjournment debate of this Assembly mandate was about domiciliary care packages. It affects many families in East Antrim, and I am sure that that is the same for all MLAs across the Chamber. As mentioned in that debate, the timely provision of domiciliary care packages lessens the pressure on hospitals and therefore on waiting times by allowing people to be supported in their own home. Being able to safely discharge patients when they become medically fit makes more beds available in the wards for patients who need to be admitted for care and improves patient flow throughout our hospitals. People are arriving at A&E departments in ambulances, waiting outside in an ambulance and then waiting in crowded A&Es for a bed for further treatment. Further investment is required to continue to alleviate the pressures on the domiciliary care sector. Another crisis in our community is our community pharmacy sector. The Department of Health has taken a number of measures in recent months, such as the authorisation of £4·8 million by the permanent secretary in November 2023 and £10·1 million authorised to help stabilise the service by the Minister in February 2024. Those were helpful but cannot resolve the long-standing funding deficit that has been building for over 15 years. In addition to resolving the £15 million shortfall, immediate policy changes are required, such as a reviewed community pharmacy contract and a drug tariff specific to Northern Ireland that recognises our unique factors. The challenges facing our GP surgeries are also evident. We will all be very aware of the impact they have had on GP appointments. Every day, we hear from constituents about how difficult it is to access their GPs. The conditions simply are not there in the practices to meet demand. Chronic underfunding, a lack of proper workforce planning and the impact of the COVID pandemic have provided a perfect storm of conditions to lead the service to this breaking point. The findings of a recent Audit Office report include that almost one in three GP practices have sought crisis support services in the last four years; 13 practices handed back their contracts or gave notice of doing so between March 2022 and March 2023; and 39 practices were assessed as being at risk as of March 2023. That speaks to a full-blown crisis. Primary care has become more difficult and challenging, particularly in rural areas, and I have seen that at first hand in my constituency of East Antrim. The year 2023 was the worst to date for GP surgeries having to hand back contracts. We must take steps to address the challenges facing general practice in Northern Ireland. That should include an indemnity solution for GPs in Northern Ireland, who are disadvantaged in comparison with the rest of the UK due to the higher personal cost of indemnity. We must also urgently recommence the roll-out of multidisciplinary teams that began in 2018 but has effectively stalled since then. As with so many of these issues, funding will be key. The wider transformation of our health and social care service must be an overarching priority for the Department. The Bengoa report has been sitting on a shelf since 2016, and we have missed opportunities for genuine reform through the lack of progress on that. It was envisaged as a 10-year programme, but we are now more than three quarters of the way through that 10-year period with almost no progress. The main reason for that has been wider political instability. The absence of a functioning Executive and Assembly for five out of the last seven years has resulted in the absence of financial decisions and scrutiny. With last year's Budget, we saw the devastating impact of that stalemate, with an unaccountable Secretary of State making decisions over which we, as MLAs, had no say. Until we see genuine reform of our political institutions to ensure that never again can one party prevent the Assembly and Executive from functioning, we will not be able to commit to the transformation that is required to fix our health service and ensure the best outcomes for our people. The importance of having an Executive and a Health Minister in place has been reinforced by the positive steps towards a pay settlement for the health and social care service in Northern Ireland through the proposed consolidated pay uplift and the non-consolidated payment. Minister Swann rightly identified pay as a priority. It is clear from the previous restoration in 2020 that progress can be made on such essential workforce issues only with a Minister and a full Executive in place. We must never again allow our valued healthcare staff to go without the fair pay that they deserve. Without the workforce, there is no health service and there can be no transformation. While those pressures are significant and further investment is clearly needed, we must also assess the effectiveness of what we spend on the health service in relation to outcomes. We will continue to push for transparency on health spending to ensure that we get as much as we can for the money that is spent. The Minister must be clear on how investment is addressing the pressures and improving outcomes for the huge number of people who continue to suffer ill health, be that on waiting lists or in crowded wards or dangerously overcrowded A&E departments.

Thank you.

1,236 words. Text as published by the Northern Ireland Assembly.

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