Debate contribution: Cancer Services and Outcomes

Debate contribution by Mr Mike Nesbitt on 18 November 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

18 November 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Cancer Services and Outcomes

Assembly identifier

Official Report component 5244922

Read the official Assembly record

Text

Thank you, Mr Deputy Speaker. I begin by echoing your sentiments of thanks to all Members who have spoken, but particularly those who shared highly personal experiences. I often say that all healthcare is personal, but that is particularly so when it comes to such a condition as cancer. I am heartened, because I get a sense that nobody thinks that the health and social care workforce is anything other than fully focused, committed and dedicated to doing better on timely outcomes. However, let me cut to the chase: it always comes back to funding. We have a cancer strategy, and since the 2024-25 financial year, £10·6 million has been invested, recurrently, into the implementation of that strategy. That is not an insignificant sum of money, but it is when one considers that the strategy funding plan assumed a recurrent investment of £55·7 million by year 4 and of £145 million by year 10, the final year. Therefore, gently, I say this to Members: if you accept the validity of the strategy, and you support it, can you accept that the budget for Health should be based on objective need and not on a crude percentage of the Executive pot? There is a significant gap in available funding, and that stands up against what is required to ensure the implementation of the strategy. It is simply not possible to deliver all the activity that is envisaged under the strategy with the £10·6 million that is allocated. I have said on the record that this area, along with other key areas of health and social care, requires substantial additional investment. Mr Dickson mentioned some of the capital costs for machinery. Some of that machinery is really creaking; in fact, one machine, in a very important area, needs replaced urgently. In that context, of course I acknowledge that cancer patients are waiting far too long. Nobody in the Department takes that lightly. The performance on waiting times is clearly unacceptable. I will not rehearse the figures; many Members have. Starting treatment within a targeted time frame from diagnosis is so important in delivering the best outcomes and increasing the likelihood of a successful treatment. Yes, I want to reduce waiting times across the system, and I want to embed the changes that will lead to those better outcomes. As part of that, a revised elective care framework (ECF) was published in May of last year. It set out a five-year road map to reduce waiting times. If fully funded, the actions will help close the demand-capacity gap and tackle the long waiting lists. In line with the Programme for Government, the Executive earmarked funding in the Department's 2025-26 budget to support waiting list activities. Mrs Dodds mentioned the breakdown. I will get into more detail on that. She said that the Executive ring-fenced £215 million. In fact, if you check the paperwork, particularly that coming out of the Department of Finance, you will see that it was "up to" £215 million. It was broken down into three pots: £85 million for red-flag and urgent cases; £80 million to build capacity; and £50 million to tackle the waiting lists. Only that £50 million was new: the other money was ring-fenced. The Department of Finance made it clear from the get-go that the £80 million for building capacity was not ring-fenced and that the Department would look at alternative uses for it if we did not feel that we could spend it in a timely manner in this financial year, or if there was something even more significant to be done. The significant thing, as the Member will know, is the existing gap, which we have brought down from £600 million to a lot lower. However, I still have a real concern that we will not balance the budget by 31 March. She is right to say that over £70 million of that £80 million is going against the deficit. The elective care framework implementation plan, which was published in May of this year, details how the money will be spent. There is £85 million for red-flag cancer. That funding is not new, as I said, and it has to be redirected from other areas of healthcare.

The ECF plan describes a combination of measures to tackle our waiting lists, including maximising the existing infrastructure, the expansion of core capacity in a range of specialties and partnership working with the independent sector. Notably, there has been investment in cancer services. To answer Mrs Dodd's question, £13 million has been devoted to endoscopy, and that should resource sessions to cover all uncommissioned sessions by March 2026, followed by subsequent expansion into evening and weekend working thereafter. Some £12 million has gone on diagnostics, which will potentially deliver continuous multi-annual expansion of CT and MRI sessions until March 2029. Multiple specialties, including urology, breast, dermatology and gynaecology, will receive investment to reduce waiting times for red-flag and time-critical patients. Systemic anti-cancer therapy (SACT) funding will close the long-standing 20% gap against haematology and oncology stabilisation plans and support improved performance against the 62-day target. We are also increasing the number of cancer nurse specialists (CNSs), and those posts are absolutely essential to supporting patients and ensuring that every individual receives expert guidance and continuity of care throughout their journey. Recognising the need to make services more accessible, we are funding the expansion of phlebotomy hubs across Northern Ireland to allow patients to receive essential blood work closer to home, help reduce pressure on cancer centres and streamline access to SACT clinics. In this financial year, £1 million has been allocated to the third sector for a new cancer charity grant scheme.

I absolutely recognise that. It is not just nurses but the entire gamut of work provided by the charities. I was in Enniskillen for the opening of Cancer Focus's new drop-in centre, which has proved at least as successful as it had imagined. When I was first briefed about the centre, I thought, "Are they being ambitious?". No, they were not. Cancer Focus knew its market. Cancer charities know their market, whom they serve and what they need. Since April of this year, more than 122,000 red-flag or time-critical patients have been seen, diagnosed or treated across the trusts and through partnerships with the independent sector. On the basis of current plans, the figure is expected to rise to around 226,725 patients. It demonstrates the scale and ambition of our response to ensuring quicker access for those requiring time-critical care. It does not solve the problem, but a quarter of a million patients is something to be acknowledged. Earlier this year, as Members will know, we moved to the regional list for breast assessment. I believe now, as much as I did at the time, that it was the right thing to do. However, it is about doing two things: first, removing the postcode lottery, where, depending on which trust you reported to, there was a significant variation in waiting times; and, secondly, getting the waiting lists down across Northern Ireland. Through further focus and prioritisation, additional breast assessment clinics last month delivered 374 appointments. That saw the waiting times on the regional list reduce from the high of 10 weeks, which was absolutely unacceptable, to a less unacceptable seven weeks and two days. That was on 7 November of this year. We have gone quite rapidly from 10 weeks to 7 weeks and two days. As long as we continue that journey, I will remain convinced that the regional list was the right thing to do. Reducing the waiting lists demands long-term, collective responses from across government. It requires sustained and substantial investment through multi-year budgets, workforce development and system-wide transformation. Work has been taken forward under the elective care framework to reform and improve the efficiency of Health and Social Care (HSC) here. Notable progress related to cancer includes the regional endoscopy centres established as part of the wider reform. They play a significant role in tackling lengthy waiting times. Focused work in that area is delivering results. In August, waiting lists were 62% lower, which represents 24,410 fewer patients than were on them at their peak. Patients also benefit from that regional service. They can undergo their diagnostic endoscopy procedures sooner than in their local trust. Those centres have carried out 17,025 procedures since their inception. Members mentioned the two rapid diagnostic centres delivering a streamlined regional vague symptom pathway for patients with complex, non-specific symptoms who would not otherwise be eligible for a red-flag referral. I have visited both the RDCs. Within hours of checking in, you will have your diagnosis and your result. If the result is bad news, you will immediately be put on a pathway. The RDCs have created additional CT and MRI imaging capacity. In this financial year, that is expected to provide an additional 8,973 CT scans and 4,913 MRI scans, targeting patients who have been waiting longest following red-flag and urgent referrals. I have visited the mega-clinics, and they are really efficient. They are a key component of transformation. They offer significant benefits to the HSC, alleviating pressures across the system by targeting large cohorts of patients in a one-stop shop. When I went to see one earlier this year, people who had been on a waiting list for a long time were coming in. They were validated, and, if they still needed the procedure, they were put on a list to be seen — at the Mater Hospital, as it happened — within a couple of weeks. Those are really efficient, transformative procedures, but we need to continue to be proactive. We need to be ambitious in delivering the equitable, resilient cancer services that our people deserve. By the way, mega-clinics have maximised patient input: they saw 22,866 patients between January 2021 and September of this year. Transformation is key: it is happening, but we have a long way to go. In that context, early prevention and detection are more important than ever, and our aim is to improve the health and well-being of our citizens while reducing the pressures that our Health and Social Care services face. That is especially true of rare cancers, such as pancreatic and ovarian cancer, because the symptoms are non-specific, often appearing only in the advanced stages, when the cancer has spread. Early detection is crucial for survival as it increases treatment options and leads to better patient outcomes. The Public Health Agency works closely with the Department, trusts and other partners to support a range of activities to raise awareness of cancer symptoms and routes to earlier diagnosis. I accept, however, that we no longer spend money on paid advertising. The effect of that is certainly questionable, and, at times, I wonder whether it is a false economy. In my remaining time, I will touch on the cancer research strategic framework. Members have said that it is overdue. I accept that it is a day late, but it is not a dollar shy. It was delayed because, when I was presented with the draft for publication, which would then have been in a timely manner, I was made aware that key stakeholders were not happy. I did not see the point of publishing a strategy that the key stakeholders could not properly buy into, so we have done a lot of work on it. Officials have done a lot of work with the key stakeholders — you will know people such as Mark Lawlor and Cancer Research UK — and I am told that they are now broadly happy and are willing to endorse it. We will publish the cancer research strategic framework on Thursday. I will finish on one other thing. Mr McNulty mentioned CAR T-cell treatment in the Republic of Ireland. That treatment is available in the Republic of Ireland but not to us. We have asked, and we were told that they have no capacity for us. By developing the new haematology ward at the City Hospital, we will have that capacity before the Republic can build it, so let us not keep talking about —

— Dublin as an option this year.

2,029 words. Text as published by the Northern Ireland Assembly.

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