Debate contribution: Health Service Transformation: Funding

Debate contribution by Mr Mike Nesbitt on 17 September 2024.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

17 September 2024

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Health Service Transformation: Funding

Assembly identifier

Official Report component 4537042

Read the official Assembly record

Text

Perfect. Thank you very much, Madam Principal Deputy Speaker, and I thank the Members who tabled the motion and the amendment and everyone who contributed. It is not just an important issue; we should be really passionate about it.

I welcome the opportunity to respond to the debate. I will outline for Members the current position on waiting times; the actions that have been taken and the ongoing actions to address the issues, including, of course, service transformation; the importance of having an appropriately qualified and structured workforce; the complexities of working in a highly financially constrained and challenging environment; and, critically, what we need to do to ensure that we can deliver effective and sustainable health and social care services for all. At the outset, I fully acknowledge that the people of Northern Ireland are not receiving the timely and effective care that they deserve. Far too many people wait for far too long. It is simply unacceptable that our waiting times lag so far behind those in the rest of the United Kingdom, and it is incumbent on me and on all of us collectively to ensure that we are doing everything in our power to address waiting times. I do not intend to rehearse at length my position on the Budget, but suffice it to say that the Budget has imposed severe pressures on all parts of Health and Social Care. You do not have to take my word for it. The draft Programme for Government, approved by all Executive parties, explicitly states:

"It will not be possible to reduce our lengthy waiting times within the funding currently available."

I welcome that candour and the de facto acknowledgement that the health budget passed by the Assembly is entirely inadequate. My immediate predecessor as Health Minister remarked previously on the irony of Members repeatedly demanding more investment in health, having voted for that Budget. I will not labour the point, but the irony klaxon has been sounding quite a bit in the debate. Can Members really demand more health spending when they endorsed a Budget that gave the Department of Health less than it spent last year? We are all aware that elective care waiting times in Northern Ireland have significantly increased in recent years, and I have been clear that that is entirely unacceptable. There are many contributing factors, not least the overall financially constrained environment but also the scale of the gap between funded health service capacity and patient demand and the residual effects of the impact of COVID-19, which had a devastatingly disruptive impact on our health and social care system. In that context, I am mindful of the fact that there was a rise in the number of people waiting for a first consultant-led outpatient appointment in the Northern, Western and Southern Trusts at the end of June. While I do not want to bombard Members with figures, it is important that I be clear about the full extent of the problem. I will therefore draw on the March 2024 statistics, which include four out of our five geographical trusts. At the end of March 2024, 356,000 patients were waiting for a first consultant-led outpatient appointment, 95,000 patients waiting for inpatient or day-case treatment and just under 165,000 patients waiting for a diagnostic test. Of the total number of patients waiting, almost 50,000 were waiting longer than 52 weeks for treatment. Those are eye-watering and, frankly, wholly unacceptable figures for a population of our size. In addition to the growing backlog of patients waiting, new patients continue to be added, and, inevitably, the gap between demand and capacity exacerbates the problem and waiting lists continue to grow. While I fully recognise the severity of the situation and do not want to understate it in any way, I am encouraged to note that, in overall terms, we are beginning to see small but tangible improvements to the waiting list position. At the end of March, there was a reduction in the numbers waiting for inpatient or day-case treatment for the seventh consecutive quarter, with a 14·3% decrease in the numbers waiting since the same month last year. While that is good news, it only begins to scratch the surface of the problem. Those figures are, of course, not just numbers on a page; they represent individuals, family members and friends who are often waiting in pain for life-enhancing, life-changing or life-liberating treatments. It is understandable that there is a sense of urgency about the issue, but there is also a sense of frustration: deep frustration. The reality, however, is that the health and social care system is hugely complex, consisting of a wide range of varied and interdependent elements. Members will be aware that, in May, my Department published an updated elective care framework plan. The framework built on the lessons learned from the first framework published in 2022. It sets out a clear plan to address waiting times, with a focus on areas where the impact would be the greatest: for example, areas where high volumes of patients are waiting for non-complex treatments. I am fully committed to delivering that plan and building on the good work that is already being done across Health and Social Care. It is important that I make it clear, however, that delivering on that plan will require sustained investment. The scope to do that is being severely hampered by the belt-tightening constraint of the current financial environment. As always, we strive to do what we can with the limited resources that we have, and, since publication of the initial framework in June 2022, we have seen the successful implementation of initiatives that have led to benefits for patients and, as I mentioned, a small but tangible start to improvements in waiting lists. Notable achievements include two dedicated day procedure centres at Lagan Valley Hospital and Omagh hospital; elective overnight stay centres at Daisy Hill Hospital, the Mater Hospital and the South West Acute Hospital; the introduction of medical clinics to maximise patient throughput; the expansion of post-anaesthetic care unit beds across the region; an orthopaedic hub at Musgrave Park Hospital; two rapid diagnostic centres; and a programme of outpatient modernisation. It is important that we acknowledge and build on those improvements to ensure that that momentum is not just maintained but increased. It will only be through a continuous and sustained focus on ensuring effective implementation of all those arrangements that improvements will be secured. However, those alone will not address the backlog. We need immediate and sustained investment to secure additional capacity in the short to medium term. The reality is that improved outcomes will be achieved only with significant recurrent investment to transform the delivery of elective care on a sustainable basis and address that gap between demand and capacity. Although the current financial position is extremely challenging, we must continue to do whatever we can with the budget available to improve the waiting list position.

I thank the Member for his comment and can certainly assure him that that will happen. Miss McAllister talked about the plan for hospital reconfiguration. It is at pre-consultation stage. I have asked officials whether it would be possible to bring that plan to the House as early as Monday week, and I await their response. I am keen to do it as soon as possible, and I assure the Member that the assessment of the reconfiguration will be clinically led. In tabling the motion, Members asked that I work with Executive colleagues to make the case for additional funding to Treasury. I have made the point to the Secretary of State for Northern Ireland, the Secretary of State for Health and Social Care in London and the Prime Minister that poor mental health and well-being is a legacy issue of our conflict. Therefore, should the Government in London decide to invest in tackling that issue here, there will be no repercussive effect for England, Scotland or Wales. It is a population health issue only in Northern Ireland, so please be assured that I am fully committed to making the case for additional funding. Some £76 million has been referenced as being invested this year to address waiting lists. It matches the additional investment of last year, but it is significantly less than what is required. It will be used for those with red-flag or time-critical waits: those with cancer or with life-, limb- or sight-threatening issues. The bottom line, however, is that £76 million is not sufficient to do any additional work on those waiting for long periods. It will simply help us to stand still. We need a long-term collective effort, sustained and substantial investment through multi-year budgets, workforce development and system-wide transformation. Miss McAllister mentioned multi-year Budgets: it is my expectation that, when we get to the financial year 2026-27, we will finally reach the point where we will have a multi-year Budget, which, itself, will be transformational for the delivery of public services. My Department estimates that, in addition to the £76 million that I referred to, there is a further requirement of £80 million per year to support elective care and reduce the demand/capacity gap and of another £135 million per year for up to five years to remove the waiting lists backlog and for investment across diagnostics, imaging and pathology. Members will recall that my Department submitted a bid for some or all of that £135 million earlier this year. That included a reinstatement of a form of the cross-border reimbursement scheme, which I am regularly urged to do. In the end, not a penny of that bid was met. The irony klaxon sounds daily in departmental headquarters. On staff, the importance of an appropriately qualified, well-equipped and fit for purpose workforce to underpin all aspects of continuity and change in service delivery cannot be overstated. This is not just about numbers. It is about different ways of working to get the best services for patients from all available resources and having the right staff with the right skills in the right place at the right time. Work continues across the system to stabilise, expand and develop the workforce and to support the more effective use of staff across different specialities. However, progress in those areas has been hampered not only by the continuing pressure on the service but by the uncertainty about funding. We used to worry about losing staff to Australia; today, we worry about losing staff to Athlone. Turning to transformation, the motion stresses the importance of the need for:

"support for the full and timely implementation of the 'Systems, Not Structures' report by Professor Rafael Bengoa in order to deliver a more effective, efficient and responsive health service".

One of my first actions as Minister was to meet the professor on a Zoom call and ask him whether he would travel back to Northern Ireland for one day, not to rewrite his report but to reboot and remind us and share his impression of the positive international initiatives that have occurred in the past eight years. I hope that the whole of the Northern Ireland Executive will again meet the professor and endorse his views when he is here on 9 October. I expect that he will acknowledge what we have done and that the report has not gathered dust on the shelf, and I refer to some of the advances that I mentioned. My key areas of focus for the next three years include delivering reform, tackling waiting lists, improving cancer services, addressing mental health and confronting persistent health inequalities. That is how we deliver better outcomes, saving money, saving the health and social care system and saving lives. I will shortly launch a public consultation on the hospital reconfiguration framework: 'Towards a Northern Ireland hospital network'. I understand that, like politics, all healthcare delivery is local. However, healthcare has made magnificent advances. If I need a procedure that my local facility delivers once a day but I could travel a lot further to a facility that does it 10 times a day, five days a week, I know where I would want to go for that procedure. To be honest, we have to acknowledge that there is a tension between community consultation, co-design and co-production; MLAs' natural desire to preserve and promote local services; and clinical advice. We have to acknowledge that tension and work to overcome it.

Yes, if it is brief.

I agree with the Member. I am simply acknowledging that that needs to be worked through. I am heartened by the tone of the debate and look forward to working with Members over the next three years to deliver better outcomes.

2,116 words. Text as published by the Northern Ireland Assembly.

Assessment

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Assessed 21 October 2026 at 11:10 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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