Debate contribution: Tackling Waiting Lists — Investment Plan

Debate contribution by Mr Mike Nesbitt on 6 May 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

6 May 2025

Type

Debate contribution (made as a minister)

Business

Ministerial Statements

Heading

Tackling Waiting Lists — Investment Plan

Assembly identifier

Official Report component 4929418

Read the official Assembly record

Text

Members may be aware that I have already put on record my analysis of my Department's budget, which is that it represents a quadruple challenge. Those are, first, to spend the money wisely on waiting lists; secondly, to mitigate the damage to other services from the Executive's decision to ring-fence £165 million of the existing budget for waiting lists; thirdly, to press on with the reform of healthcare delivery; and fourthly, to balance the books. Today, I will put a primary focus is on the first challenge. I am sure that every Member agrees that we need to bring a sense of urgency to tackling the unacceptable waiting lists across a number of specialities. Far too many patients are waiting far too long for assessment and treatment right across Northern Ireland. Our waiting lists are truly appalling. A genuine desire to improve that situation was one of the motivating factors for the MLAs whom I represent as a party to take up the challenge of coming back into the Department. When I took up the office of Minister of Health just over 11 months ago, I stated that tackling the waiting lists would be one of my main areas of focus. I have been clear to Executive colleagues that dealing with the backlog will take unprecedented levels of intervention, action, support, investment and time. The plan to tackle our elective care waiting lists is the elective care framework that was updated and published again in May last year. It outlines how we need to invest in capacity building and take action to clear the backlog of patients. It is in that context that today I announce a series of initiatives to reduce waiting times. The central focus of the plans is on reducing the long waits for care and treatment that affect all of us in Northern Ireland. We could devote time and energy today to discussing how we got here, with roots stemming from a series of decisions taken over a decade ago, but, as I have said previously, that will not improve the outcome for a single patient, so let us instead focus on the future. While the budget for this year remains under extreme constraint, today's announcement reflects the Executive's ring-fencing of up to £215 million in this year's Budget for waiting list activities. I welcome the investment, not least because I and my immediate predecessor repeatedly called for it for over a year. To be clear, the vast majority of the £215 million investment is not new or additional investment; instead, there is £50 million of additional allocation to the Health budget, and that £50 million is very welcome. However, the remaining £165 million has had to be found from within the existing allocation, and that will have unavoidable consequences for wider Health and Social Care (HSC) provision and, I must be honest, my ability to fund reform and balance the Department of Health's budget by 31 March next. However, as that was an Executive-wide decision, I hope to get the support of my Executive colleagues in managing the challenge. In the coming weeks, my Department will publish detailed plans and assessments on the financial pressures this year and the measures that will need to be taken in the short and medium terms. Let me make this clear: I fully support the Executive's decision to prioritise waiting lists. It provides a sharper focus that is targeted in a way to have an effective impact on waiting lists. It would have been preferable, of course, to do that through additional funding and in a much more strategic and planned manner, but we are where we are. The statement is about setting an outline for the actions that we are proposing. I know that Members will rightly want more details on cost projections, outcomes for patients and timetables. More detail will be provided later this month in an implementation plan for my Department's elective care framework. However, I know that there is significant interest already, among not only MLAs but patients, and that is why I make the statement today ahead of the publication of that implementation plan. In general, we will invest across three areas: red-flag and time-critical services, capacity building and backlog clearance. For red-flag and time-critical treatments, investment will be made to expand core capacity across a number of high-risk specialties. That will help make those services more sustainable and reduce reliance on the independent sector. For capacity building, the initial focus will be on areas where the infrastructure is already in place so that we can utilise all available resources — for example, uncommissioned theatres or unused scanning sessions. Significant reforms and improvements have already been made in recent years on the development of elective care centres right across Northern Ireland, and I expect that this investment will further accelerate that. With so many patients waiting for so long, I have told my Department that I want every single opportunity and inch of capacity to be utilised. Given the current significant levels of waiting-list initiative spend on endoscopy and diagnostic imaging, Health and Social Care core capacity in those areas will be expanded in the first instance, with further investment in other areas including urology, breast surgery, dermatology and cardiac surgery. Other areas where capacity will be expanded include trauma services. Expanding trauma capacity will improve performance against the 48-hour hip fracture target and the seven-day access target for all other fractures. Increasing trauma capacity should have a benefit for orthopaedic capacity, as one is often offset against the other in crisis. On the waiting-list backlog, our first step on the journey will be a focus on our current waits of over four years for assessment and treatment. Building the workforce and infrastructure required to sustainably reduce the time that patients wait will take time, and, clearly, independent sector capacity will be required to help in that regard. The HSC will need to be sufficiently agile to allow the timely issue of contracts to existing and new independent sector providers. Partnership working with the independent sector will include outsourcing to their facilities and expansion of insourcing contracts across a number of general specialties, including ophthalmology, cataracts, orthopaedics, general surgery, gynaecology and ENT. I also intend to expand primary care elective services where there are long waiting times for assessment in areas such as dermatology, minor surgery and gynaecology. It is estimated that £2·9 million would allow the service to see and treat approximately 16,500 patients this financial year. In addition, I have decided to allocate £10 million towards mega-clinics to help an estimated 20,000 additional patients. As Members are aware, mega-clinics provide groups of patients with a one-stop shop that can involve, for example, surgical review and anaesthetic preoperative assessment in a single appointment. Other initiatives for the year ahead involve targeting long waits of four years or more, including hip, knee and other orthopaedic treatments, tonsillectomies, hernia treatment, gallbladder removal and colonoscopy. Funding will also be targeted at specialist procedures where there are long waits impacting particularly on women and children. This will include women waiting on gynaecology mesh removal procedures and children waiting for procedures such as percutaneous endoscopic gastrostomy (PEG) tube fitting, squints and scoliosis procedures. The role of the voluntary sector in healthcare cannot be overstated, and I am pleased that there is already a strong partnership between the sector and my Department. It is something that I am keen to expand and build on further to promote and develop initiatives that provide support to those on waiting lists. In that context, work is under way by my Department to deliver a £500,000 waiting well programme to support those on waiting lists and a £1 million cancer charities programme to deliver cancer work in the community to reduce pressures on statutory services. Addressing the current waiting times and the associated capacity gap will also require an increased focus on demand management and an expansion of core capacity, coupled with an increase in productivity and efficiency. My Department will work across the primary and secondary care interface to ensure that patients are being managed in the most appropriate setting and that capacity is being expanded on a sustainable basis across the HSC. While improvements in efficiency and productivity have been made by trusts in recent years, there remains scope to secure further gains by optimising the resource available to trusts. It is imperative that trusts ensure that appropriate focus is given to deliver service improvements, with implementation of good practice across the patient pathway to help to drive improved quality, equity and efficiency. An expansion of pre-operative assessment capacity to ensure that patients are fit and ready for treatment will be another important area for investment. I remind Members that investment at this level will need to be sustained for at least five years to bring hospital waiting times down to acceptable levels. Building our workforce and the infrastructure required to sustainably reduce our lists will take a collective effort. I also plan to establish a waiting list reduction reimbursement scheme. I know how important it is to have the scheme up and running as quickly as possible. For that reason, the scheme will be initiated on a phased approach. An initial £10 million will be invested. The scheme will commence in June 2025. It will give patients who are ordinarily resident in Northern Ireland and are on an HSC treatment waiting list the option to seek and pay for treatment in the private sector and have the cost reimbursed up to the cost of the treatment by the HSC in Northern Ireland. The first phase will allow reimbursements for treatment in the Republic of Ireland. The second phase will see the geographical scope of the scheme extended to all European Union countries. By opening up the scheme to the EU, patients will have a greater range of providers to choose from. I want to ensure that the scheme targets the patients who have been waiting a long time for their treatment. Therefore, in line with the strategic direction to target long waiters, patients will be able to access the reimbursement scheme if they have waited on an HSC treatment waiting list for two years or more. I hope that the Assembly will enthusiastically support my focus on the longest waits and on delayed treatment for our youngest in society. The statement is the first in a series of announcements. As I have said, an implementation plan will follow later this month. I assure Members that I have relayed to my Department the urgency at which progress must be made. We are in only the foothills of what will be a long, uphill trek. It is long past time we began. I am very pleased to be the Minister to make this start, but it will require future Ministers, Executives and Assemblies to maintain the course. I commend the statement to the House.

1,822 words. Text as published by the Northern Ireland Assembly.

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