Debate contribution: Health and Social Care: Three-year Plan

Debate contribution by Mr Mike Nesbitt on 10 December 2024.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

10 December 2024

Type

Debate contribution (made as a minister)

Business

Ministerial Statements

Heading

Health and Social Care: Three-year Plan

Assembly identifier

Official Report component 4715426

Read the official Assembly record

Text

Mr Speaker, thank you for the opportunity to make a statement today on the publication of the health and social care three-year plan. When Professor Bengoa visited Northern Ireland in October, I was clear that I intended to publish a plan setting out my ambitions until the end of this mandate. The publication today of the strategic three-year plan does exactly that. I recognise that our health and social care system continues to be under severe pressure, and, with the onset of winter, the coming weeks and months will not be easy. Despite that challenging context, I believe that it is important to rise above the day-to-day and embrace the opportunity for reform.

We continue to face many interconnected challenges, which have been widely rehearsed, not least during the Bengoa event in October. Our waiting lists are simply unacceptable, and we continue to experience high and persistent levels of health inequalities. I have been clear on many occasions that it is for everybody, including my Department, the health and social care system, the Executive and the wider public sector to support people to stay well and live healthy lives. That is because our population’s health is, to a large degree, impacted on by factors such as housing, education, employment and the broader socio-economic environment. Of course, behaviours and health and social care interventions also play a part, but these issues need a robust cross-government approach. Before I go into the detail of the three-year plan, I want to acknowledge the fantastic effort and commitment of our staff. They really are our health and social care service. Without the excellent care that they provide on a daily basis, we would not have a service at all, nor could we bring about the changes that we need to improve services for the benefit of all. That is why I have remained fully and absolutely committed to resolving the pay award for this year. Stabilisation is one of the key pillars of my three-year plan, and central to that will be ensuring that staff are properly recognised and rewarded for the great work that they do. I shall retain a major focus on the recruitment and retention of our staff. I advise the Assembly that I will be meeting unions later today as part of ongoing work to secure pay settlements for the 2024-25 financial year. I go into those discussions committed to stabilisation, to getting a good deal over the line and to fair and equal pay, which, I hope, remains the policy position of the entire Executive. With progress on that important issue, I turn to the detail of the plan. It is structured around commitments in the three key areas of stabilisation, reform and delivery. With the incredibly challenging budget position, stabilisation is inevitably a strong immediate focus, not least in minimising the impacts of the £200 million-plus of savings that have been delivered by trusts this year. As I have mentioned, a critical plank of the stabilisation agenda will be to continue to deliver the pay awards that our health and social care staff deserve. That extends to staff working in the independent adult social care sector. My ambition is to make that sector a real-living-wage sector. I am determined not to be found wanting in that regard, especially given the importance that that has for our ability to successfully recruit and retain sufficient levels of staff. Progress on the reform agenda continues. Despite the pandemic and the difficult budgetary environment, we have made tangible progress across multiple areas. There is, of course, much more to do, and the plan published today sets out my reform ambitions. It is important to be clear that reform is not a silver bullet that will solve everything. It is, however, what is needed to give our staff and the public hope that there is a bright future for our health and social care service. I am determined to support people to live healthier lives and to tackle health inequalities. That is why I intend to embed the Live Better initiative into our mainstream way of working; develop a new obesity strategic framework; implement the Northern Ireland provisions in the Tobacco and Vapes Bill; and introduce proposals for minimum unit pricing for alcohol. Subject to funding, I also intend to put in place a new lung screening programme and an expanded bowel screening programme. A lot has been said about the "shift left", meaning to provide services closer to people's homes. A number of measures in the three-year plan will support that shift. First, by April of next year, I will publish a plan for the completion of implementation of the multidisciplinary team model across all areas of Northern Ireland. Subject to additional funding being secured, we will be much closer to that objective by April 2027. By that point, phased implementation will be under way, with anticipated investment of £19 million to expand the model to a further five new GP federation areas with a combined population of 670,000 people. That will mean that approximately 50% of the population will be covered, compared with about 30% today. The rest will follow as a priority. Secondly, again subject to funding, I am keen to invest a further £15 million in our community and GP pharmacy services and an additional £17 million in our mental health services to support greater integration with the voluntary and community sector. Thirdly, I plan to implement within this mandate — again, as far as funding allows — new models for delivery of home or domiciliary care services, learning disability services and children’s social care services and a regionally consistent contract for care home placements. Finally, I want to see reform of dental services progressing in the coming years. Turning to hospital services, I have launched a public consultation on a new network approach, and I look forward to seeing the outcome of that consultation next year. Good progress has been made on implementation of the elective care framework with the roll-out of elective care centres and rapid diagnostic centres. Whilst the day procedure centres and elective overnight stay centres have had a positive impact on waiting times, as a result of our wholly intolerable waiting-time position, it is essential that we drive through further improvements in productivity levels to maximise the number of patients being cared for. The Department has been driving forward targeted measures to ensure that trusts are delivering 100% of all commission sessions and that efficiency and productivity across the elective care centres are maximised. The most recent published statistical information, as of 30 September 2024, for inpatient or day-case treatment waiting lists across the Northern, Southern and Western Trusts shows that there has been a 20% decrease in numbers waiting since the same month last year. That is 12,115 cases in real terms. Taking into account the data available for the Belfast and South Eastern Trusts, that represents a decrease of 5·5% in the number waiting since the same month last year. However, whilst there are some areas of improvement, I am mindful that, overall, our waiting times remain unacceptable. There are still far too many people waiting for far too long for outpatient assessment, for example. As I have said, reform is necessary, but it is not sufficient to address the many deep-seated issues that are impacting on our health and social care services. Therefore, in addition to significant additional funding, we need a relentless focus on performance and productivity. To that end, I have challenged the health and social care trusts to deliver 46,000 additional outpatient assessments and 11,000 additional treatments annually by 2027. One in two of us will receive a cancer diagnosis in our lifetime. That is the harsh reality that we face today. Currently, cancer services cannot meet that level of need, and the cancer strategy clearly outlines the need to transform the way in which we deliver cancer services for people throughout our community. We must deliver new and innovative ways of preventing cancer, supporting early diagnosis and delivering better care for cancer patients. Over the past two years, we have seen good progress on the delivery of a wide range of key cancer strategy actions. Key examples of progress to date include the development of services to provide genomic testing for cancer patients, investment in an oncology and hematology implementation plan and work to review patient pathways. Also, we have established minimum standards for adolescent and young adult cancer services. The rapid diagnostic centre model will ensure quicker access to red-flag services, and it will increase the survival chances of those patients. I have commissioned strategic reviews of breast cancer and radiotherapy services. The reviews will inform how those services should be delivered in the future, allowing equity of access for all patients across the region. The actions identified in the next phase of cancer strategy implementation, which is for the period 2025-28, provide a real opportunity to deliver positive change and service outcomes that everybody expects and deserves. That, along with the actions emerging from the strategic service reviews, will provide the basis for cancer service transformation. I am confident that that will provide a more sustainable approach for the delivery of cancer services and ensure that the early detection and treatment of cancer are at the core of our future response. The implementation of the Encompass programme should help to enable those improvements in productivity. I am determined that the health and social care system maximises the benefits that can be had from digital reform. That will include making full use of the rich data that will be available to us. I anticipate reform of neurology and stroke services, the outcome of which will be subject to consultation and funding availability. There is a need to reform pathology services, and I intend to have a single management structure for all pathology and blood transfusion services. I also intend to deliver a regional imaging academy to increase the supply of suitably trained clinicians. I will continue with the important implementation of the urgent and emergency care review, and I will move ahead with strategic initiatives on quality and safety. Those will include bringing forward a consultation on replacing the current serious adverse incident process, and that will happen early in the new year. Today, I am pleased to launch a 14-week consultation — slightly extended to take account of the Christmas break — on a new Being Open framework, and on the issue of duty of candour in Northern Ireland.

I am determined to advance proposals for an organisational duty of candour as well as considering proposals for an individual duty of candour in the coming months. Being open and honest is critical to safe and effective healthcare. We want to create a culture in which our health service staff feel safe, supported and empowered to speak up when things go wrong in the certainty that their concerns will be listened to and acted on. We want to create a culture in which the public can have confidence that, if mistakes are made, they will be informed quickly and accurately about what has happened. The Being Open framework seeks to put in place the necessary support and systems to enable and nurture a truly open culture and help to prevent patient harm. I encourage the public to get involved and have their say.

The three-year plan is realistic and ambitious. Of course, the pace of progress will depend on future Budget settlements and, indeed, on successful partnership working in the Executive. If we all work together, we can meaningfully improve population health, support people to live healthy lives and provide the conditions for our health and social care system to thrive. I commend the three-year plan to the Assembly.

I thank the spokesman for the Opposition for his comment. He is clearly living in the ideal world. I live in the practical world, where we have a four-party mandatory coalition. I am doing what I can. As for definites, you will notice that I said that I have set a target of an additional 46,000 outpatient assessments and 11,000 treatments by 2027, so there is some concrete, time-bound detail in the plan. Of course I would like more — everybody would like more — but this is the real world.

First, I join in offering condolences to the friends of Jody Gormley, who, as you say, has tragically passed away in the past 24 hours. Full funding is one of the major challenges that we face. You have heard me say it before on the mental health strategy: we have about one eighth of the money that, we thought, we would require to implement the action plan for this year. Red flag and critical is where we are, and where we are is talking about sustainability, because the budget is not where we would like it to be. I welcome the fact that you think that it is an ambitious plan, but it is also a realistic plan. I hope that my officials and I can continue to work with the Committee through some of that detail, because we are listening and you have that statutory ability to assist and advise the Department and me in our work. I hope that we can continue to do that in delivering on the plan.

That is a broad ambition, and the outworkings are still to be developed. What you will see in the coming weeks and months will be detailed annual plans, the first of which should be published shortly after the Budget for 2025-26 is agreed. I will make a more general point, if I may, on something that I alluded to in Question Time yesterday, I think: challenging the trusts. We have commissioned scheduled lists of surgery in our acute hospitals, and we are monitoring those. A few months ago, I put the trusts on notice that I wanted to see them make a strenuous effort to achieve 100% delivery. As of a couple of days ago, we have, for the first time, told trusts that we are taking money back for elective surgeries that were on the lists but not performed. To my mind, that is the vision of the future over the rest of the mandate. If the Department of Health is paying for and commissioning services, those services either get delivered or we take the money back and use it for some other service. A pound wasted in one area is a pound that could be devoted somewhere else, not just within Health. It could be devoted to tackling the social determinants of bad health in education, housing and all the rest.

2,449 words. Text as published by the Northern Ireland Assembly.

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