Debate contribution: Cancer Waiting Times

Debate contribution by Mr Mike Nesbitt on 12 May 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

12 May 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Cancer Waiting Times

Assembly identifier

Official Report component 4937822

Read the official Assembly record

Text

Principal Deputy Speaker, thank you. I have a lot to get through in 15 minutes. Mr McGuigan kindly referenced the fact that today is International Nurses' Day. I join him in thanking nurses for everything that they do. He was too modest to say that he was at the Stormont estate on Saturday to take part in the Stormont parkrun. The parkrun was dedicated to International Day of the Midwife, which was last Monday, and International Nurses' Day, which is today. Mr Donnelly also took part in the parkrun, as did Minister Muir. I commend all three. For the avoidance of doubt, I agree that cancer waiting times are completely — completely — unacceptable. Mrs Dodds made the point that they have been that way since 2012. I could list all the Ministers who have been in post over the past 13 years. I could say, "Let us have a witch-hunt to see the lost opportunities", but I will not. The reason why I will not do that is because it would not improve the potential outcome for a single patient who is on a cancer waiting list today. Let us be future-focused about it. That is where my mind is. I have been clear that, in order to clear the backlog of patients, we need recurrent, sustained and significant effort, as well as sustained intervention and funding that will be required over a period of five years. As I announced in the House last week, we have made a start. I fully support the Executive's decision to prioritise waiting lists, and I welcome the ring-fencing of up to £215 million in this year's Budget for activities in waiting list reductions. That includes £50 million of additional allocation to the Health budget. However, that, of course, means that £165 million has to be found from within the existing allocation. As I highlighted to Executive colleagues, that will inevitably have consequences for wider provision, and, if I am being honest, that means my ability to fund reform and to balance the budget by the end of March. As that was an Executive-wide decision with which I fully agreed, I hope to get the support of Executive colleagues in managing all the challenges. The £215 million breaks down into £85 million for red-flag and time-critical care; £80 million for building capacity to address long-standing mismatches; and up to £50 million to start tackling the backlog. As I promised last week, my Department will provide later this month an implementation plan for the elective care framework. It will set out the details of how up to £215 million will be invested. The motion highlights the:

"grave concern at ... cancer waiting time statistics"

and, in particular, the fact that in quarter 3 of last year:

"less than a third of patients were seen within 14 days following an urgent referral for breast cancer".

Those same figures also illustrated the wholly unsustainable levels of variations across the trusts. The waiting times for breast cancer services have been a particular concern. To address that, I announced a review in September last year. That review is considering how regional breast cancer services can be reconfigured and developed to deliver timely and appropriate care for patients. The first phase of the work was the creation of a regional waiting list for red-flag breast cancer assessments to address disparities in times across the geographic trusts. I am pleased to announce that the new regional booking system went live across all five geographically defined trusts last Thursday, 8 May, for patients referred with suspected breast cancer. The new system will ensure that everybody referred for breast assessment across the region experiences a similar wait. Most people will still be seen at their nearest hospital, but some may be offered an earlier appointment at another acute venue. That will equalise the waits. I acknowledge that there is still more work to be done to address the demand/capacity gap and increase the number of breast assessment clinics across Northern Ireland, but I consider this to be a positive advancement. Trusts will continue to work with the Department to address the backlog of waits through the provision of additional waiting-list clinics, and further capacity will be sought from the independent sector. I expect to publish the next phase of the breast review later this year. It will consider whether changes are required to how breast services are structured in order to ensure that those who are referred with suspected breast cancer are seen quickly and that those who are diagnosed are treated in a timely manner. That will ensure that we can deliver the best possible outcomes for those with breast cancer. I acknowledge the profound impact of poor cancer waiting times on patients and their families, but I can do that no more eloquently than Mr Dickson already has. Regrettably, he knows what he is talking about. It is important to be clear about the full extent of the problem. The most recently published statistics on cancer performance waiting times, which were for the quarter ending December 2024, reported that, against a target of 95%, 34·2% of patients began their first definitive treatment within 62 days following an urgent GP referral. I join Members in asking the question that Mr Dickson asked: why? The poor performance in general is due to several interrelated factors. First, regional red-flag referral trends show a significant increase of approximately 39% in the five years from 2017-18 to 2022-23, without the required resource to meet that growing demand. The ring-fencing of approximately £85 million will allow health and social care (HSC) investment, and that will be in core services that previously relied on non-recurrent waiting list initiative funding to help bridge the gap. There is a significant demand/capacity gap across elective care, imaging and endoscopy services that delays the initial diagnosis. The increase in unscheduled care has further strained the system. Additionally, the phased introduction of Encompass since November 2023, as expected, has had an impact, but it is now expected to deliver greater benefit as the system embeds and provides opportunity to work more effectively on a regional basis. I welcome the fact that Encompass is now live in all five geographically defined trusts. Together, those challenges have compounded the difficulties that we face in providing timely access to diagnosing patients. To tackle the challenges, we must focus on improving the entire pathway from referral to diagnosis, including endoscopy, imaging and pathology as well as treatment. If patients wait beyond two weeks for an imaging test, the chance of meeting the 62-day standard is reduced. Plans are in place within the Department's 15-year capital plan for a significant investment over the next 10 years to expand the equipment base, which includes additional MRI scanners. Again, that will be subject to funding approval. My Department is aware that the imaging workforce in Northern Ireland is constrained. A costed workforce plan for imaging services, including diagnostic and interventional radiology, has been developed. A multi-professional imaging training academy for Northern Ireland will address the radiology and advanced practitioner radiographer workforce deficit. The imaging academy will deliver an overall increase in imaging capacity in HSC for the benefit of all clinical specialists and support the reduction of excess waiting lists for diagnosis and treatment, as well as meeting the demands for unscheduled care. In the difficult financial environment, we continue to tackle our lengthy waiting lists with the resources that are available to us, and we strive to improve the effectiveness and efficiency of the service. In May 2024, we launched the updated elective care framework, which outlines the strategic direction for the development and implementation of effective and sustainable elective care services in HSC over the next five years. Today, we have two dedicated day procedure centres at Lagan Valley Hospital and Omagh Hospital. Those centres have increased access to endoscopy for all trusts, supporting the diagnostic part of the cancer pathway. We have three elective overnight stay centres at Daisy Hill Hospital, Mater Hospital and South West Acute Hospital, which have increased access to diagnostic tests and to procedures. We have two rapid diagnostic centres (RDCs) at Whiteabbey Hospital and South Tyrone Hospital, which will enhance regional CT and MRI diagnostic capacity. Service reviews of general surgery, urology and gynaecology aim to set the direction for improvement in key tumour sites under significant demand and capacity pressures. Furthermore, we have the introduction of mega-clinics, which are designed to maximise patient throughput and efficiency. We have the development of in-house HSC capacity and continued investment in staffing, building our internal capacity and investing in our workforce. That is essential for sustainable improvements. The rapid diagnostic centres aim to provide faster diagnosis for patients with suspected cancer. Those centres currently offer the vague-symptom pathway with several clinical pathways under consideration. Funding was secured for a CT and MRI scanner at each RDC location in order to support a portfolio of diagnostic pathways. The MRIs are anticipated to be operational from the summer of this year and will provide an estimated 6,920 MRI scans during the 2025-26 financial year. CT capacity is estimated to provide an additional 9,000 scans. Those collaborative efforts aim to alleviate pressures on the cancer diagnostic pathways overall, ensuring that patients receive the care that they need as efficiently as possible. I hope that Miss McAllister will greet that as good news, given the questions that she put during her remarks. While I recognise the fully unacceptable performance and do not want to understate that in any way, I note that, once diagnosed, 88% of patients received their first definitive treatment within 31 days and that the overwhelming majority of patients received an excellent standard of care. I must pay tribute to our medical and nursing staff and all those who provide the service, who have been working tirelessly to meet the increased demand. Workforce vacancies limit the system's ability to respond promptly. The reliance on non-recurrent funding and the need for substantial and sustained investment in core service provision and equipment also contributes to the challenges. A recent report that was published by the Northern Ireland Cancer Registry, 'Routes to diagnosis of cancer', reported that only one third of those who were diagnosed between 2018 and 2021 presented via a GP red flag referral. Other routes included urgent and routine referrals, emergency presentation and screening programmes. Therefore, a whole-system approach will be required. Miss McAllister mentioned that too many people were presenting at emergency departments. The latest stats, for the financial years 2018 to 2022, reveal that of the most common routes to diagnosis amongst cancers, excluding non-melanoma skin cancer, the highest was 33·5%. The next highest was via the emergency presentation route, at 23·3%, which is far too high. Cancer treatment is frequently and rapidly changing, not least by way of new medicines, with approximately 50 drugs per annum, alongside merging technological advancement and innovations in gene therapies, as well as earlier diagnosis and interventions. That makes it a very dynamic clinical space, which requires a robust workforce strategy and training programmes that keep pace with advancements and service demands. Investment in cancer services is required in order to enable transformation to more-sustainable models of care that will be resilient to more-effectively meet current and projected demand. I have always been clear that the implementation of the strategy is a priority for me. In a few weeks' time, I expect to publish the next three-year cancer strategy implementation plan for 2025 to 2028. That will further the reforms that are needed in order to modernise and enhance cancer services.

The level of funding will, of course, determine the speed at and the extent to which the reforms are taken forward.

Finally, the motion calls on me to engage proactively with the Executive's delivery unit on how best to apply ring-fenced funding. We submitted three bids to the public-sector transformation fund, and the one for multidisciplinary teams was successful. I welcome all opportunities to work with Executive colleagues and, indeed, the delivery unit, but, as Professor Bengoa reminded us, it is systems, not structures, that matter. A couple of other questions were asked of me, one of which was about elective theatres in Belfast City Hospital (BCH). I believe that there are a total of seven theatres in BCH. Theatres 1 and 2 were refurbished 18 months ago, and the plan is to continue to roll out refurbishment over the next two to three years. Mrs Dodds asked about skin cancer. The ongoing challenges are with consultant recruitment for dermatology, which, sadly, has resulted in a long wait for red-flag outpatient appointments across most trusts. The Western Trust in particular is reliant on a single-handed consultant. The Belfast Trust has seen a significant reduction due to leavers. Recruitment exercises have been undertaken but have generally been unsuccessful, I am afraid to say. Finally, I know that Mrs Dodds is no fan of the waiting list reimbursement scheme. She is absolutely wrong to say that it is not about providing additional procedures, because it will. I imagine that there will be over 1,000 procedures, if all the money is spent. She may want to get her DUP team in order, because, since I made the announcement and since she made it clear that she is not a supporter of the scheme, one of her MLA colleagues has written to me asking for more details about it, as has her Member of Parliament, Mrs Lockhart. Indeed, if I had time, I could quote Mrs Dodds's support for bringing in external help.

2,264 words. Text as published by the Northern Ireland Assembly.

Assessment

Not flagged

Jev’s structured answers

Assessed 21 October 2026 at 12:23 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

Disagree with this assessment?

Classifications can be challenged. A person reads every challenge, and any change is recorded publicly above with its reason.

Challenge this classification