Debate contribution: Endometriosis Care

Debate contribution by Mr Mike Nesbitt on 29 September 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

29 September 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Endometriosis Care

Assembly identifier

Official Report component 5139464

Read the official Assembly record

Text

Thank you, Principal Deputy Speaker. I am sure that you think that I will start by thanking Members because that is the standard procedure, but I do not think that this was a standard debate. It was a particularly important debate, and I thank Linda Dillon in particular for setting the tone. I am going to read her remarks when they are published in Hansard not because I was not listening but because I was, and I think that they are well worth a second airing. You probably think that I am going to say, "I am well aware of the need to do better in this area", but I know that your reaction to that will be, "Forget the words. Give me actions". We have 20 actions in the GIRFT gynaecological report from last year. They have all been accepted in principle, so they are departmental policy. I want to see them implemented, but I acknowledge that some will require additional funding, which does not currently exist, and there will be a lead-in time for delivery. For example, I am fully supportive of clinical e-triage, but additional funding will be required to expand consultant sessions to provide the initiative and ensure that patients are seen in the right place at the right time by the most appropriate person. Initiatives such as direct to test, advice and triage will ensure that slots that are available in secondary care are used to their maximum benefit, particularly for complex conditions such as endometriosis. Regional, standardised clinical criteria and standard operating procedures are being developed. Those will support e-triage and maximise consultant capacity and time. Additional investments are also required to develop gynaecology ambulatory hubs in secondary care. Those hubs will provide consultant and nurse practitioner procedure clinics and will also manage rapid access for women who require assessment and treatment within a short time frame.

I thank the Member for her intervention. Every day is a learning day, and this is a big learning day for me on this issue. I also advise that gynaecology services in primary elective care have been re-established. They are now at 100% capacity as of 1 April 2025. An additional £1,730,986 of funding has been committed out of the £2·9 million recurrent funding for primary care elective gynaecology pathways. That additional investment will enable over 6,000 patients to be managed by 16 gynaecology GPs with enhanced skills, and that will be across 18 host practices.

As of 31 August, 1,683 patients have been assessed and treated through that service. It is expected that that activity will incrementally increase, with full activity to be delivered by 31 March next year.

Further work is ongoing to explore the transfer of some of the longest waiters in secondary care who meet the criteria for management in the primary care elective service. That work is being undertaken in partnership with the strategic planning and performance group (SPPG), the Gynaecological Collaborative and the GP Federation Support Unit. That pilot will start in the South Eastern Health and Social Care Trust and Belfast Trust areas in the near future, and it will be implemented more widely, should it prove successful. SPPG is also working with the GP Federation Support Unit to map out training requirements. That will enhance the gynae GP enhanced services (ES) workforce to enable additional activity to be delivered in primary care and further reduce pressure on secondary care. Gynaecology services across the region will need to increase their workforce to allow that service reform to take place. GIRFT recommends that robotic gynaecological surgery should be considered in the management of complex cancer cases. It is envisaged that that will be a regional resource and that sessions will be available for gynaecologists across the Province to enhance their skills and help attract newly trained consultants. Nuala McAllister made a point about medical misogyny. A gynae robot is in the process of being approved regionally, so that will be a regional resource. It is different from the device in the Belfast City Hospital, which is a urology robot. The use of the gynae robot will be particularly important for complex endometriosis and other gynaecological procedures.

I thank the Member for her intervention. She has put that on the record. The SPPG has established a regional forum with trust, primary care, Public Health Agency, policy and professional representation. That body will take forward the recommendations. A regional engagement forum is to be established to ensure that patients' voices are heard. Eight regional clinical pathway groups have been established as part of the GIRFT regional group. Those groups will promote consistency and standardisation across gynaecology services. One group is focused on the delivery of the endometriosis pathway and the service needs of patients who present with the condition at primary, secondary and tertiary level. Members should be aware that the Belfast Trust and the Western Health and Social Care Trust previously held provisional accreditation as a British Society of Gynaecological Endoscopy (BSGE) endometriosis centre and that that accreditation was impacted during COVID. Part of the group's remit will be to determine how quickly accreditation can be achieved again in Northern Ireland, recognising the need to balance theatre capacity for urgent or cancer surgeries with acknowledging our funding constraints. The accreditation of endometriosis centres is a critical aspect of providing high-quality care for patients with that complex condition. The BSGE accredits centres where gynaecologists work in appropriate clinical teams, audit their outcomes and maintain their surgical skills. The accreditation process is designed to maintain high-quality standards of care and ensure that patients have access to specialist treatments. The regional endometriosis task and finish group is working with GP gynaecology enhanced services to consider which patients can be managed by their GP or transferred to be managed via the gynaecology enhanced primary care service. The activity located in the service will depend on direct access to scanning and procedure facilities. Work is ongoing in each gynaecology condition pathway to set the criteria for referral into the GP enhanced clinics, including for endometriosis. Discussions are also under way to provide secondary care specialist nurses who will in-reach to GP ES that provide procedures such as pessary clinics. In April this year, the National Institute for Health and Care Excellence (NICE) published an update on the management of endometriosis that recommends the use of relugolix for treating symptoms of endometriosis in adults of reproductive age who have had medical or surgical treatment. I am pleased to advise that that treatment is now available in line with the criteria set out via the process for the managed entry of new medicines on a cost-per-case basis. Individuals who require access to treatment should discuss the matter with their hospital consultant in the first instance, who will then decide whether it is appropriate to make a cost-per-case application. Current waiting times in secondary care also need to be equalised, with recent information still showing significant variation across the region. That is one area that the newly appointed regional clinical director for elective care is determined to tackle. Examples of scaling up practice include the expansion of additional nurse-led ambulatory and procedure clinics and clinical e-triage protocols, ensuring that women are directed to the right place or diagnostic test at the right time. Improvements in gynaecology services, including the endometriosis service in the short, medium and longer term, will be aided by my recent announcement of 6 May. At that time, I outlined how funding in this year's budget had been invested across three areas of waiting list activities: to expand core capacity to reduce the red flag time-critical gap; to increase core routine capacity; and non-recurrent funding to start tackling the backlog of patient waiting lists. Gynaecology patients will benefit from the additional package of measures within that investment, as the service plans to target long-waiting patients in gynaecology via mega-clinics, waiting list initiatives and additional theatre sessions, as well as targeting red flag and time-critical patients. Between April and July 2025, an additional 1,968 women on secondary care waiting lists have been assessed or treated using waiting list funding at a cost of nearly £1 million. More activity is planned. The elective care framework implementation and funding plan sets out proposals for how we will systematically tackle the backlog of patients and how we plan to transform services to meet anticipated future demand. Trusts are working with my officials to develop plans for the medium and longer term that will expand gynaecology capacity from primary care through to secondary and tertiary care. That work will take forward the GIRFT recommendations as well as service models, such as integrated gynaecology hubs, that will provide sustained additionality, modernising our services and addressing waiting times. It will also provide additional theatre capacity to ensure that we meet the requirements to secure the two endometriosis centres in Northern Ireland. Work has commenced with trusts to determine what services are available for the psychological and emotional support of women diagnosed with endometriosis. The role of clinical nurse specialists cannot be overestimated in providing the complete holistic approach that is required. Nurse specialists will signpost patients to services in the community or to their GPs. There are also pathways to refer patients to general, psychological and pain services for further support. The Southern, South Eastern and Northern Trusts have more limited psychological and emotional support services available. However, they also have the ability to refer general psychological and pain services for women who are suffering from endometriosis. In principle, I am open to exploring cross-border collaboration where there is a clear population health need and a feasible, sustainable proposal that can benefit patients and health systems in both jurisdictions. However, my current preference is to focus on improving capacity and performance in the HSC by implementing the GIRFT recommendations that I referred to. I recognise the need for improved public awareness, information and education on all women's health issues from an early age across the life course. While it is not possible to commit investment to any public awareness campaigns, it is envisaged that the Public Health Agency will work with my Department to deliver what is possible in the area through other means. That will be a key part of the women's health action plan that is being developed. That plan will seek to bring together the range of ongoing developments in women's health. The ongoing work on the GIRFT recommendations and on endometriosis specifically will be an important part of the plan. It will also include other actions and ongoing developments ranging from maternity safety to sexual and reproductive health and cardiovascular health, as well as links with my Live Better initiative, which is trying to address health inequalities. I know that we have a long way to go to improve gynaecological services in Northern Ireland, with over 54,000 women waiting to access gynaecology outpatient services and over 5,000 women on inpatient and day-case waiting lists. As the Minister, I am determined to deliver significant improvements in that area. I am also determined to deliver the women's health action plan. I would love to give Members a timeline and a deadline for its publication, but I will not do so until I am sufficiently confident that we will deliver on that deadline. I have too long a list of broken deadlines to do that to the House.

1,895 words. Text as published by the Northern Ireland Assembly.

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