Debate contribution: Craigavon Area Hospital: Redevelopment

Debate contribution by Mr Mike Nesbitt on 1 April 2025.

MLA: Mr Mike Nesbitt
Party at the time: Ulster Unionist Party
Date: 1 April 2025
Type: Debate contribution (made as a minister)
Business: Private Members' Business
Heading: Craigavon Area Hospital: Redevelopment
Assembly identifier: Official Report component 4876667

Text

Deputy Speaker, thank you very much, and I thank Mrs Dodds for proposing the motion. Buildings, of course, are important for healthcare delivery, but I gently suggest that the workforce is even more important, so I begin by putting on record my eternal admiration for and thanks to the workforce at Craigavon Area Hospital. The motion principally deals with three topics, namely, first:
"That this Assembly stresses the importance of sustained capital investment in Northern Ireland’s hospital network;"
secondly, that the Assembly:
"notes ... the growing need to address inequalities in the allocation of funding ... between health and social care trust areas;"
and thirdly:
"expresses ... concern that the redevelopment of Craigavon Area Hospital has not yet commenced".
It also calls on me to:
"approve and provide finance for the trust’s programme business case"
for the Craigavon Area Hospital redevelopment project to come forward. I will take each of those in turn, beginning with "sustained capital investment". I fully support sustained capital investment, of course. We all agree that a modern, well-equipped health service is essential for delivering high-quality care. However, it is crucial that infrastructure investments are strategic, and that is why I consulted the public on the idea of looking at our hospitals as a network. We clearly cannot afford to fund every hospital to provide every procedure. We must demonstrate clear value for money and be shaped by evidence-based policy, because we want to deliver the best possible outcomes for all. Ultimately, our capital investment ambitions will be dictated by budget allocations, and we will need to make allowances for emerging considerations, such as net zero requirements, which have not been mentioned in this debate. My Department's future capital plans must align with our policy vision, such as in Delivering Together, the strategy to transform how care is provided, with a focus on efficiency, sustainability and patient outcomes and an emphasis on providing care in a community setting wherever possible. The Bengoa report and resulting elective care framework make clear that hospital investment must support a system that reduces waiting times, makes better use of resources and prevents duplication. That means that capital funding may go towards not just traditional hospital expansion but innovative solutions such as regional elective hubs, improved digital infrastructure and community-based alternatives that reduce pressure on our acute services. I trust that Members are with me in wishing to see real movement in the drive to shift left, putting more emphasis on prevention and early intervention through primary and community care rather than our hospitals. I opened a public consultation on hospitals, Creating a Network for Better Outcomes. It aims to describe our hospital system and provide a strategic context for future hospital reconfiguration decisions. I recognise the importance of the investment strategy for Northern Ireland, which stresses that capital projects must be planned with long-term sustainability in mind. The focus should be on creating modern, energy-efficient facilities that are adaptable to future healthcare demands. Ensuring that we have a sustainable and resilient healthcare system in Northern Ireland will require balancing our commitment to high-quality medical infrastructure with the ambitious targets set by the Climate Change Act and our net zero strategy. As we move towards a legally binding net zero goal by 2050, new healthcare capital investments must align with stricter carbon reduction measures, energy efficiency standards and sustainable construction practices. Those requirements will present challenges, and the Assembly must ensure that funding frameworks, planning policies and procurement strategies support those environmental obligations while maximising delivery impacts. Ultimately, while I support investment in our healthcare infrastructure, it has to be strategic, transparent and accountable. Every project must demonstrate that it enhances patient care, improves efficiency and delivers genuine public benefit. Our healthcare infrastructure must not just grow; it must evolve in a way that secures the best possible outcomes for the people of this place. That means that investment cannot simply be funnelled into traditional hospital buildings. It has to be diversified into other assets and technologies that can keep people fit and healthy and, thus, mean that they do not require to be in a hospital setting. We must also provide assets that are efficient and flexible enough to have the ability to meet the changing future healthcare needs of our population. My Department has invested £2·88 billion of capital funding during the 10 financial years from 2014-15 to 2023-24. The draft capital budget allocation for 2025-26 is £391 million. That is less than what is required to fund all our envisaged Executive flagship projects, meet our current contractual commitments, progress projects in design and development and fund the continued maintenance of our existing assets. The draft budget allocation does not provide the funding that is needed in order to commence work on all the projects required to protect health services. The increasing pressure on capital investment budgets means that my Department must carefully prioritise proposed schemes, progressing those that demonstrate the most urgent need and the best use of public money in order to deliver better outcomes within budgetary constraints. It would be remiss of me not to advise Members that my Department has established a strategic investment committee, which is made up of senior officials, spanning various directorates in the Department, who will review the current capital plan in light of capital and resource funding constraints. I will now address the part of the motion that asks the Assembly to note:
"the growing need to address inequalities in the allocation of funding for projects between health and social care trust areas".
When it comes to allocating investment across Northern Ireland's trusts, the Department must prioritise health outcomes over geographic equality. It is not simply a matter of dividing funding equally among the five geographic trusts. Instead, we must target investment at where it will have the greatest impact on patient care and system-wide efficiency. My focus is on maximising the efficacy of the entire health and social care system to deliver the best outcomes for the whole population within the constrained budget. That is why I talk of a hospital network in which not every hospital delivers every procedure. Budget allocations are issued to health trusts based on need, as is evidenced by approved business cases rather than by being based on regional allocations. The Department has historically invited the trusts to submit bids for their capital priorities. The Department scores those capital project bids against criteria that are used to prioritise the projects in each category. Review groups have been established, with representatives from finance, the healthcare commissioners, policy leads, nursing, the Public Health Agency (PHA) and our health estates carrying out the exercise. The strategic investment committee that I referenced, because there is not sufficient capital or resource available to deliver all requirements, is now having to carry out an overall prioritisation exercise across the spectrum of the previous categories. Capital bids are considered alongside other capital investment priorities and are dependent on budget availability, value for money and affordability. That means that some trusts, owing to their population size, demand pressure or outdated facilities, may require more funding than others. It must also be recognised that, although specific trusts lead on them, many of our flagship capital projects are regional in nature, serving the entire population of Northern Ireland. A good example is the new children's hospital that is under construction at the Royal site in Belfast. That regional facility will be a state-of-the-art, 10-floor building to enable the delivery of comprehensive paediatric care. It will offer the full range of services, including a dedicated emergency department, multiple operating theatres and specialised diagnostic and treatment units that are tailored to meet children's unique needs. With 155 beds planned, the hospital is expected to provide high-quality care for a significant number of young patients — up to 45,000 annually — thus ensuring timely and effective treatment across the variety of paediatric specialities. Of the £2·88 billion of capital investment made in the past 10 years, £2·23 billion was allocated across the six health trusts, including the Ambulance Service, representing over 77% of the capital investment. During that period, the Southern Health Trust received capital budget allocations totalling £257·1 million, so, on average, the Southern Trust has received 9% of the available capital budget over the past 10 years. In acknowledging the fact that Craigavon Area Hospital has not benefited from a major redevelopment, my Department and the Southern Trust have been proactive in making investments to keep the hospital operational. A total of £8·9 million was invested in the new paediatric ward, which opened in 2018. A new aseptic pharmacy suite costing £3·6 million was opened in 2020. There was investment of £7·6 million in a new dual CT scanner suite, which opened in 2023. The Department has invested £5·8 million in upgrading the hospital's low voltage electrical infrastructure, which is an ongoing project that will be completed this year. Finally, I turn to the part of the motion that expresses concern that the development of Craigavon Area Hospital has not commenced, and calls on me:
"to approve and provide finance for the trust’s programme business case for the project in the next financial year."
I appreciate that Craigavon Area Hospital is one of our long-standing healthcare facilities. With its construction commencing in the 1960s, the main acute block is now over 50 years old. An outline business case for the redevelopment of the Craigavon Area Hospital site was submitted to the Department of Health in 2016. As Members have made clear, that was not progressed to the point of approval, and that was because of capital budget constraints. Recognising the developments in the policy landscape, construction price inflation and changes to service delivery models since the previous master plan was completed, my officials have been advising the Southern Trust on the development of a programme business case that should clearly establish the need for investment in Craigavon Area Hospital. The Department hosted a productive workshop with trust colleagues at the end of February, and the programme business case is being updated by the trust to reflect those discussions. It is important to acknowledge that the programme business case is not designed to articulate definitive costs and timescales for the entire redevelopment. Rather, it should make the case for expending capital money up front on investigative activities, including the establishment of the trust's programme team, healthcare planning activities and the procurement of a design team to assess feasibility. That initial work will inform the strategic service needs at the Craigavon site and how those can be accommodated. The output of that initial stage will inform the redevelopment strategy, including estimated capital and revenue costs, and the timescales, which will then be further refined through appropriate business cases for each subsequent phase of work. That phased approach to implementation, beginning with that initial exploratory phase, will allow the Department and the trust to take stock at key checkpoints before committing further resources to the programme. When the trust commits the programme business case to the Department, it will be reviewed by officials. The proposed expenditure on those exploratory activities will be subject to normal value-for-money and affordability considerations. I am unable to approve or provide funding for that programme business case until that process has concluded. Undoubtedly, the positive engagement that has taken place between officials in my Department and the Southern Trust will help to expedite approvals. However, no assumption should be made that Craigavon Area Hospital or any other hospital will retain its current role or clinical service provision, as my ambition is for the entire hospital structure across Northern Ireland to be clinically efficient to ensure the best outcomes for the entire population of Northern Ireland.

1,952 words. Text as published by the Northern Ireland Assembly.

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