Debate contribution: Health Crisis

Debate contribution by Mr Mike Nesbitt on 3 February 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

3 February 2025

Type

Debate contribution (made as a minister)

Business

Opposition Business

Heading

Health Crisis

Assembly identifier

Official Report component 4774547

Read the official Assembly record

Text

I am aware that, before the restoration of the Executive, all the parties appeared to prioritise Health. I heard Jayne McCormack of the BBC say this morning that, in her first conversation with the First Minister and deputy First Minister, they said that if they could achieve anything and do one thing well in this mandate, it would be childcare, which is not part of Health. The motion calls for yet another plan. I am surprised at that. I thought that Members, especially those from the Opposition, have had enough of plans. I certainly have. From the day that I entered the Department, I have made it clear that I want the focus to be on delivery, not on plans, promises and strategies that do not have the budget for the annual delivery plans. To be clear, I already have a plan. My three-year plan was published less than two months ago. It outlines my ambition for the health service for the remainder of the Assembly mandate. Moreover, there are several other detailed plans in place: for example, the elective care framework, the cancer strategy and the mental health strategy. As for costings, those, too, have been produced.

I am going to make some headway now. For the three-year plan, I am committed to publishing an annual implementation plan once budget allocations have been agreed. I previously identified my priorities for the mandate, which are delivering reform, tackling waiting lists, improving cancer services, addressing mental health and, above all, confronting persistent health inequalities. Those priorities are based on three pillars, which are driven by the finances in the budget. Stabilisation comes first. Can we preserve what we already offer, and then can we achieve reform and delivery? That will require more investment in all parts of the system: primary; community; social care; and secondary care. Stabilisation of services includes mitigating the inevitable challenges as a result of budgetary pressures. I will give way to the Member briefly.

I absolutely agree. This year's action plan has provision for a spend of £42 million. The actual spend is £5·9 million. I have to warn Members that, next year, the gap between what we can spend and what we are hoping to spend will widen. We might get up to just over £6 million, but the plan is for delivery of over £75 million in the financial year. Members will recall that, last October, I welcomed back Professor Bengoa, and he reflected on whether Northern Ireland was on the right trajectory. Some Members think that the Bengoa report has sat on the shelf since 2016: it has not. His view is that we are heading in the right direction. Hearing from him that Northern Ireland is not an outlier in international terms was heartening, but I am very clear that it is not an excuse to relax or take the focus off what needs to be done. I am focused, and it is important to be clear that root-and-branch reform is not something that can happen quickly. We need to involve those who use the services and those who deliver them when we develop and implement changes. I will return to Diane Dodds's comments in a moment. My Department has already taken further action to deliver my ambitions. For example, in elective care, we have established more mega-clinics and more elective care clinics, and we are investing further in two rapid diagnostic centres. We are driving forward targeted measures to ensure that trusts are delivering 100% of all commissioned sessions and that efficiency and productivity across the elective care centres is maximised. Members will recall that I have already said that we took £2·3 million off a trust for the non-delivery of 100% of commissioned sessions. In the most recent plan, I have challenged health and social care trusts to deliver 46,000 additional outpatient assessments and 11,000 additional treatments annually by the end of the mandate. Somebody talked about pathways. Mrs Dillon talked about two things that she wanted to be prioritised: recruitment and retention. I absolutely agree with her, and that is one of the reasons why I am committed to introducing, within this calendar year, the real living wage to social care. That will have a significant impact on recruitment and retention. Mrs Dillon also mentioned pathways, but I have to say to her that we already validate waiting lists. That does happen. As for going to your GP and going back and the pathways being overcomplicated, GPs are already beginning to direct patients to urgent care units, not acute hospitals, so bypassing EDs. The Regulation and Quality Improvement Authority (RQIA) report on the temporary dislocation of general emergency services, moving them from the South West Acute Hospital (SWAH) to Altnagelvin, made the point that we have to move away from double ED assessments. If you get assessed at the SWAH and sent to Altnagelvin, you should not have to go through a second assessment in the Altnagelvin ED; you should go straight to the part of the hospital that you are supposed to. Mr Carroll surprised me by talking about the closure of urgent care centres. I have been at only the opening of urgent care centres. If there are any that have closed on my watch, I will be very happy to hear about them. Let me stress that we are not unique in the United Kingdom. The Westminster Government recently published a health service plan that reflected similar themes and challenges to ours. This opens up great opportunities for cross-jurisdictional working. I have already met counterparts in England, Scotland and Wales, and the Government of Ireland, to discuss mutual concerns and share issues, and I will continue to do so, with regular engagement at official level as well. As I have said, reform is already happening. However, it is inevitable that the pace of reform is going to be impacted on by the level of funding available. Although cutting waiting times is included in the Programme for Government, I hope that Members have noticed that no additional funding has been made available for that purpose — not a single penny. Indeed, the narrative from the draft Programme for Government makes it clear that things will get worse before they get better. When MLAs from all parties write to me, as they do daily, asking for things such as the reinstatement of the cross-border reimbursement scheme, I ask them to realise that their decisions on the Budget have unavoidable consequences. Just for the record, I would love to bring back the cross-border reimbursement scheme: it works. Mrs Dodds talked about too much consultation. I say to her, gently, that it is not possible for me to do what she suggested, because these changes are effected by the trusts, not by the Department, and the trusts have a legal obligation to consult.

If you look at the resistance to change in the Northern Trust over one proposal to move one service from the Causeway Hospital to Antrim Area Hospital or the resistance in Fermanagh to the temporary closure of one service that was being moved from the South West Acute Hospital to Altnagelvin Hospital, you get a measure of how difficult it is to achieve reform. When you listen to Mr Gaston pointing out the really invaluable service delivered by a community and voluntary sector group in his constituency, he emphasises the fact that all healthcare is not just personal but local. People want everything locally, but we cannot do that because we cannot afford to do it, and nor is it the right thing to do, because we need areas of specialism. When you need a service, you will go somewhere where they do it daily. Finally, the proposer of the motion said that efficiencies were cuts: what an extraordinary statement. If none of the £200 million saved this year by the trusts is not an efficiency, no efficiencies are needed. The debate is worthless because the Health and Social Care system is perfect. Who would go for a cut before an efficiency? Yet, you say that they are all cuts. That is why I have found the debate a little disappointing. Some of the comments that I have heard do not stand up to first contact with logic; in fact, I will have a glass of what you are having, without the water.

1,395 words. Text as published by the Northern Ireland Assembly.

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