Debate contribution: Maternity and Children’s Hospital: Delays

Debate contribution by Mr Mike Nesbitt on 26 November 2024.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

26 November 2024

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Maternity and Children’s Hospital: Delays

Assembly identifier

Official Report component 4677423

Read the official Assembly record

Text

Thank you, Principal Deputy Speaker. I have much more than 15 minutes' worth of comments, so it is unlikely that I will take any interventions. As ever, I am happy to come to the Chamber to debate healthcare, even when the motion is as self-serving and, frankly, in part, offensive as this one. The irony klaxon is sounding loud and clear, as it does every time Members denounce the consequences of their decisions. The motion encourages the Assembly to "deplore" the supposed lack of progress and action towards transformation, yet it fails to even acknowledge the enormous harm done to our health service through the extensive, self-inflicted political stalemate that immediately preceded it. I acknowledge that we have many deep-rooted and serious problems to address in health and, indeed, in public services, but it seems to me that there are two contrasting ways to approach them. We can tackle them collectively, as an Executive, united in our determination to achieve better outcomes; or we can stay in our silos and let individual Ministers sink or swim, all the while finger-pointing from the Benches. It seems that some in the House prefer a third way: maintain a pretence of joined-up government, with occasional photocalls and warm-sounding words, while, as the spokesman for the Opposition made clear, we see the reality on the Floor and in news releases and other statements. I can point out Members who are happy to vote for wholly inadequate Health budgets while, in almost the same breath, demanding more Health spending in key areas or in their constituencies. For example, almost daily, I respond to Members' letters asking whether I intend to reintroduce the Republic of Ireland reimbursement scheme. Oh, the irony. The bids for funds for that were rejected. The motion is not just shameless but, in part, factually wrong, so let us deconstruct the text. First, it:

"deplores the lack of progress, and action, towards"

transformation of healthcare delivery. That ignores the impact of multidisciplinary teams on primary care. It turns a blind eye to what is happening in secondary care with day procedure centres, elective overnight stay centres, rapid diagnostic centres and, indeed, mega-clinics, to name just some of the major reforms. It is simply not correct to state that there has been a lack of progress and action. There is then the old chestnut that the Department of Health budget absorbs so much of the block grant. It is as if the signatories to the motion expect that the health and social care system should handle demographic change, growing demand for care, increased acuity, and chronic and persistent underinvestment without recourse to additional funds. On the question of underfunding, I have heard Mrs Dodds use the word "obscene" to describe aspects of the health service. The first time that I heard "obscene" used in connection with healthcare was when her former party leader and First Minister Peter Robinson used the word in February 2011, when he said that it was obscene of the then Health Minister, Michael McGimpsey, to call out the gap in the health budget. Of course, Michael was right, and I would not be the only one to argue that underfunding at that time was the start of the problems that we have today. Here is where the motion lacks a little logic. In the negotiations with the UK Government that led to the restoration of devolution, the DUP repeatedly made much of the fact that it had successfully argued that the block grant should be based on assessed need rather than on a simplistic headcount, and it singled out Gavin Robinson MP as the person who led on that argument. When it comes to delivering healthcare, however, assessed need goes out the window, and the DUP reverts to a simplistic cry that the Department of Health gets over half the money. We then come to the truly offensive phrase, which is the claim that all the funding has the outcome that the people of Northern Ireland:

"have experienced little practical benefit".

In five simple words, the motion trashes the excellent work delivered day in, day out by health and social care workers right across Northern Ireland: 70,000 people rubbished in a single, short phrase. Every day, the vast majority of patients and service users enjoy excellent care from HSC staff. On the question of reform, my Department has published progress reports on 'Health and Wellbeing 2026: Delivering Together'. The most recent was published in July of this year. The progress reports set out examples of progress made across a wide range of areas: population health; primary and community care; social care; mental health; and secondary care. The scale and pace of reform is, of course, dependent on the amount of funding available, and we need to be realistic about what is attainable in the immediate future, considering the 2024-25 Health budget. Although the allocations in the June and October monitoring rounds were welcome, they failed to address fully the joint pressures of balancing the books in this financial year and delivering the national pay-parity awards that staff deserve. I have likened it to trying to be physically in two places at once, but now the signatories to the motion want me to add accelerated reform to those budgetary pressures: in other words, in three places at once. Given the Health budget, and the long-standing MO for how it is allocated, there is simply no choice but to make stabilisation and optimisation of existing services a dominant theme in our planning for this year. We are all aware that elective care waiting times in Northern Ireland have significantly increased in recent years. I have been clear that that is entirely unacceptable. I have, however, also been clear that many factors are contributing to the situation, not least the overall financially constrained environment and the scale of the gap between funded health service capacity and patient demand. Prior to the restoration of the Assembly and the Executive earlier this year, all parties spoke openly about their desire to put healthcare first, yet, although tackling waiting lists is one of its priorities, the draft Programme for Government makes clear that lists will get worse before they get better. All the earlier promises of genuinely prioritising health and the many thousands of people stuck on waiting lists fell away at the first opportunity. Not a single penny was allocated to tackling waiting lists this year. I, however, have approved investment of £76 million. The focus will be on supporting those red-flag and time-critical waiting lists: in other words, cancer and life, limb and sight issues. That £76 million is not sufficient to deliver work on patients who are waiting for a long time; it is just what is needed to stand still. My Department has continued to seek the provision of additional funding to assist with addressing those waiting lists. A £10 million bid was submitted as part of October monitoring, but, again, the decision, supported by Members, was that the bid should be unsuccessful. My Department estimates that, in addition to that £76 million, a further £80 million a year is required to support elective care and reduce the demand/capacity gap, and £135 million a year for up to five years is required to remove the waiting list backlog.

In May of this year, my Department published an updated elective care framework plan. It sets out a clear plan to address waiting times, with a focus on areas where the impact will be greatest. I have referenced elective care centres and rapid diagnostic centres as examples. I should add post-anaesthetic care units to reduce reliance on intensive care units, high dependency units and elective care. In addition, my Department is working continuously with trusts to increase productivity and efficiency through the use of a wide range of best practice service improvements. I am in the foothills of a debate on a new funding model for health, particularly for the geographic trusts. In my first remarks to the Chamber, I said that I would not criticise any former Health Minister because I did not think that doing so would improve the health outcome of a single patient or service user. I stick with that promise, but I equally believe that more radical reform is required and should have come before now. However, such realities do not sit easily with the political motivations of the motion, so I am not surprised to see that they are not reflected in it. The Department has also launched its public consultation, 'Hospitals — Creating A Network for Better Outcomes'. The document aims to describe our hospital system and provide a strategic context for future hospital reconfiguration. At its heart, that work is about how we can improve the sustainability of hospital services and, ultimately, provide an assurance that none of our acute hospitals will close. The framework is underpinned by a number of existing service reviews and strategies. Those were clinician-led and developed in partnership with those who use the services. I recall Mrs Dodds describing the document as "underwhelming". I could return the sentiment in respect of her discharge of her statutory duty as defined in section 29(1)(a)(ii) of the Northern Ireland Act 1998, which requires any member of the Statutory Committee to, "advise and assist" me. I am not sure whether deploring me is advice or assistance. I turn now to the part of the motion that touches on the maternity and children's hospital project to date. Let me be very clear: I am deeply, deeply, deeply uncomfortable with what has happened. The public purse deserves much better. Speaking frankly, I have called a number of very challenging discussions about what has happened and about the best way forward. Those discussions will continue; in fact, there was a very tense meeting in the Department early this morning. I want to know how all this happened; what went wrong; what was done; what was not done; and whether alternative actions were available, discussed and actioned. Importantly, the Belfast Trust needs to determine what needs to happen next to put all this right. Of course, there are wider issues. Taking a view as an Executive Minister rather than just a Health Minister, I point out that these delays and the overspend are far from unique across the public sector. The Audit Office's follow-up report on major capital projects, which was published in February and which the Member mentioned, did not make easy reading. It set out significant cost and time overruns on projects across different parts of the public sector, including transport, health, education and sport. In short, government here has a very poor record when it comes to delivering major capital projects. I want the Executive to address that collectively and to look again at previous recommendations from the Public Accounts Committee. That includes examining, again, the case for a single Northern Ireland oversight body with responsibility for the central monitoring of major capital projects. I have written to the First Minister and the deputy First Minister encouraging them to give fresh consideration to that proposal. A recent report that the Strategic Investment Board produced, 'The Root Causes of Delay and Cost Overruns in Major Capital Projects', states:

"The delivery system for major capital projects is growing increasingly complex."

It also states:

"This complexity is making the system slow, fragile and unpredictable."

Nevertheless, referring to the specific issue at hand, projects that are located on acute hospital sites are inherently complex, each being unique and bespoke, with complex building services, installations and systems having to be coordinated and commissioned. In addition, the projects making up the overall flagship maternity and children's hospital project are interdependent, with a delay in one enabling project having a consequent impact on subsequent projects. To date, the flagship maternity and children's hospital project has delivered the completed new maternity building, phase B1, and the associated enabling works; the office and logistics building, which is known as non-clinical support; the Bostock House demolition; and a series of demolitions and site clearance-enabling contracts, ducts and complex services on which the overall flagship project is dependent. Pseudomonas in the maternity hospital is a further and serious cause of delay on the project, and it is being investigated by independent experts. The new maternity hospital was handed over to the Belfast Trust in March this year. After a steady-state period post-handover, the trust sampled all outlets in the building and detected pseudomonas. As a result, the trust commissioned an independent expert to provide a report into the water systems in the building. As my time is running short, I will switch to the last part of the motion, in which the signatories ask that I commission:

"a full and independent inquiry into the handling of the maternity and children’s hospital project".

I have to say that, when I went to bed last night, I was not in favour of that, not least because the cost and time that are associated with a further independent inquiry could be in the order of £3 million per annum, with a significant time impact and no guarantee of improvement. It could also stymie progress. However, as of 8.00 am today, I have become aware of another issue. I know that Mrs Dodds is very well informed on those issues, so I will set her this challenge: I give her 24 hours to discover what the latest problem is with the maternity hospital. It is another totally shocking revelation. I will just say in conclusion that £1 that is wasted in delivering healthcare is a pound that could go towards tackling the social determinants of ill health in education, communities, rural affairs and the rest.

2,285 words. Text as published by the Northern Ireland Assembly.

Assessment

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Assessed 21 October 2026 at 11:36 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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