Debate contribution: Inquiry into Access to Palliative Care Services

Debate contribution by Mr Mike Nesbitt on 2 December 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

2 December 2025

Type

Debate contribution (made as a minister)

Business

Committee Business

Heading

Inquiry into Access to Palliative Care Services

Assembly identifier

Official Report component 5272255

Read the official Assembly record

Text

Thank you very much, Deputy Speaker. I will begin, as I must, by congratulating the Committee on its very detailed piece of work. I also congratulate it on the speed at which it got a debate in the Chamber. The debate was opened, I think, before the report was officially launched: that could be a first. Genuinely, I thank the members of the Committee for undertaking the inquiry. I am particularly aware of the personal insights that were provided by people with lived experience, and I am pleased to see them reflected throughout the report. The impact of those personal stories and experiences has been acknowledged by the Chair, and that chimes with my view that all healthcare is personal; in fact, it is as personal as life gets. I also express gratitude for the dedication of our palliative care workforce, who demonstrate professionalism and compassion: professionalism based on their training and experience and compassion based on their empathy and humanity.

That is a wonderful combination.

My Department and I will wish to consider the report fully, and we will, of course, respond in detail to the Committee in the new year. In the meantime, I want to outline some of the work that is already under way, which, I hope, will fulfil some of the report's recommendations, including the ongoing scoping exercise. It is important to note, though, that some of the recommendations call for significant additional investment in palliative and end-of-life care services. Some are not costed, and that is fair enough, because the Committee does not have a full Department and its resources behind it. If I am being a bit cheeky but honest, however, I had a bit of a Victor Meldrew moment when I realised that Diane Dodds had signed up to uncosted recommendations. However, I recognise that she was called away for an unavoidable reason, so I will not take the hand on that any further. It was acknowledged in the debate that access to quality palliative and end-of-life care when it is needed is something that we all wish for those who are important to us and, indeed, for ourselves. Over recent years, we have seen significant improvement in palliative and end-of-life care. We have a partnership programme that is co-led by my Department's strategic planning and performance group (SPPG) and the Public Health Agency (PHA). Through a collaborative ethos in bringing together stakeholders, including service users, carers and Voices4Care, which the Chair mentioned, the partnership has been at the forefront of shaping holistic and person-centred palliative care services for adults at regional and local level. While we have undoubtedly seen progress, we cannot escape the fact that, as we look to the future, we need to ensure that we have in place the policies, the practice and the workforce that will allow us to respond to the projected growth in need. To do that, we have to have a fuller understanding of the palliative care landscape and the evidence base that will allow us to plan for where we need to be in the years to come. That is why, at my request, my Department is undertaking a baseline scoping exercise to consider existing services across the region and whether they meet the palliative and end-of-life care needs of the populations that they serve and those that they will need to be prepared to serve in the future. That extensive programme of work will include a population-based palliative and end-of-life care needs assessment, as well as engagement with service users and those important to them. I want to understand the experience and quality of palliative and end-of-life care. Our ultimate goal is that the outcomes of the exercise will better inform the future planning and commissioning of palliative and end-of-life care services and will have direct benefits for people with palliative care needs and those who are important to them.

I thank the Member for her point. Obviously, we are just very recently in receipt of an advance copy of the report. We will now see where there is an overlap so that we do not duplicate. The Member's point is acknowledged. I also acknowledge the concern expressed by the Committee about the pace of progress. I assure Members that that does not reflect a lack of focus or prioritisation on the part of my Department. This is a significant and complex project that involves working across our system. The outcomes will provide the robust evidence that we need to plan for, commission and deliver adult palliative care and end-of-life services into the future. To that end, good preparation is essential, and my officials have been taking time to engage with stakeholders. I want to ensure that we get the foundations right. Work is under way. The task and finish group is leading on the scoping of existing services, staffing and contracting of all providers. That will be part of a review at a workshop planned for next month. The Committee has stressed the importance of access to community-based palliative care services, including out-of-hours, and ensuring that services are rural-proofed. Those are all important issues. In September, as part of Palliative Care Week, I spoke at a Hospice UK event on the particular challenges of accessing care services in rural areas. Having access to those services is important for everybody. It is right, therefore, that people with palliative care needs who live in our rural communities should be able to expect to receive the care and support that they need. Access to services closer to home is very much in line with the vision that I set out in my recently published reset plan. That included a commitment to develop a model for primary, community and social care that will deliver greater levels of care for citizens in their communities, alongside a funding plan to support delivery, starting in April 2026. The model will see a range of stakeholders working closely together in formal partnership to provide integrated care. I hope that it will facilitate a preventative approach to healthcare and help manage demand more effectively. Officials have commenced work to develop the new neighbourhood model, which is an important enabler for the commitment to shifting left. Building a neighbourhood model will require providers from across Health and Social Care to work in new ways to deliver services to people. That will be an important cultural change, as well as a planning and commissioning challenge. Palliative and end-of-life care providers will play a key role in developing the new model; indeed, there was a lot of interest and engagement from the hospice sector at our recent stakeholder event with the voluntary, community and social enterprise sectors. A central principle of the neighbourhood model will be providing better care to people in their homes and communities, thereby reducing attendance at hospitals and emergency departments. It is important that people who have palliative care needs do not inappropriately have to attend an ED when their care is better supported at home or in the community. An example of palliative care support that is currently provided in the community is the community pharmacy palliative care service model. Under that model, a network of 60 pharmacies builds on the support offered by all pharmacies, providing advice and access to supplies from a regionally agreed list of specialist medicines that aims to ensure that the needs of vulnerable patients are met at the end of life. My Department's winter preparedness plan outlines how work is already under way to review and consolidate the model. My Department has worked in partnership with Community Pharmacy NI and the Pharmacy Forum NI to encourage community pharmacies to sign up to the Marie Curie Daffodil Standards for end-of-life care and to do so ahead of this winter. That will support pharmacy teams to build on existing palliative care provision and improve the care that is already provided to patients and their families. One of the best ways to prevent patients from needing to seek urgent access to medicines out of hours, in the evenings or at weekends is to further develop access to anticipatory prescribing so that patients have medicines at home when they need them. "Just in case" boxes have already improved access to anticipatory medicines in some areas. I am keen to see the learning from that pilot applied across the whole region. My Department is also actively progressing the scale-up of other areas of best practice, such as the roll-out of urgent community prescribing pathways for patients receiving care in the community from hospice providers. That builds on the successful pathfinder in Foyle Hospice that has had a positive impact in allowing patients' families and friends to be where they are needed most: with their loved ones. It has also afforded the additional benefit of reducing pressure on the healthcare system. I note that the Committee has called for increased funding for hospices, recommending that, over the next five years, my Department move to 100% funding for all hospice services, with the introduction of 50% funding for actual costs from 2026-27. That is a big challenge, but we all asked to be elected in order to overcome challenges, so let us face those challenges and not let them become insurmountable obstacles to progress.

Yes.

I thank the Member for the intervention. He understands that I do not make policy on the hoof in the Chamber, but that is certainly something that I will take away and consider. The Member will know that there are many moving parts. The "invest to save" rationale could be applied across the Health and Social Care system, but it is about finding that initial investment. The transformation fund could, perhaps, be a source in the area that he identified. Since I have taken up post, I have visited hospices and met representatives, service users and families. I fully recognise the role that hospices play in supporting people who are living with life-limiting conditions and the difference that they make to the quality of life not just for the patients but for the families and carers. I am also aware of the funding challenges that hospices face, so I acknowledge the Committee's desire to see changes in funding. My Department has undertaken work to ensure that current adult hospice funding is in line with existing commissioning arrangements to secure that 50:50 funding for hospice inpatient beds and commissioned community specialist palliative services for 2025-26. I acknowledge that the Committee's report states that that is not good enough. My Department has also engaged with the Northern Ireland Children's Hospice to understand the costs incurred in delivering procured services and to benchmark against similar services. I want to ensure that we get value for money and that the funding received is in line with the level of service provided. I anticipate that that work will conclude within the current financial year. The Committee has also highlighted the need to implement the advanced care planning policy as a matter of urgency. I assure the Chamber that implementation of that policy remains a strategic priority. The associated benefits are evident and understood across the HSC system. Importantly, that includes the adoption of the recommended summary plan for emergency care and treatment (ReSPECT), which will enable a standardised approach to recording all recommendations about a person's care and treatment, including "Do not attempt cardiopulmonary resuscitation" (DNACPR) orders. As further evidence of my commitment in the area, the policy has been included as one of the work streams for consideration under the HSC "Big Discussion" winter preparedness programme. It involves consideration of the short-term benefits that may impact winter pressures this year and the longer-term benefits from a system-wide roll-out. Those are important early steps and have helped build momentum. It is equally important that the wider implementation of advanced care planning is done in a coherent and managed way. That will require collaborative engagement across the system that involves multi-professional teams in all care settings for a sustained period. It will also require a societal shift to ensure that advanced care planning becomes a routine part of healthcare, with discussions becoming the norm rather than something that is often put off until later. There is common agreement that advanced care planning is the right thing to do, primarily for the individual but also for the wider system. I am confident that progressing implementation in that way represents the best chance of success. The Committee's recommendations reflect the breadth of its ambitions for palliative care in the immediate and longer term. I assure Members of my commitment and desire to ensure that quality palliative care services are available and accessible to people wherever they live in this country. That is a basic tenet of how, as a society, we value and care for people when they are often at their most vulnerable. I am aware of calls for new palliative and end-of-life care strategies. In a recent meeting with hospice representatives, my Department indicated that it would support a new palliative care strategy to replace Living Matters, Dying Matters. However, it is important to recognise, as reflected in the report, the wide-ranging aspects of palliative care that are not restricted to Health. In the context of increasing demand for palliative and end-of-life care, the Committee's report can provide a road map that will inform a strategic direction now and into the future. In looking to the future, the Finance Minister has indicated his intention to bring forward recommendations to the Executive for a multi-year Budget, as Members will be aware. I very much support and welcome that drive. A multi-year settlement would allow my Department to plan for the next three years, enabling us to prioritise spending, investment and workforce planning much more effectively. However, we will still be constrained by the funding allocation that we receive. While it will not be possible to provide a definitive assessment of our future funding position until that final budget settlement for future years has been reached, it is likely that we will not have all of the resources to do everything that we want to do or, indeed, everything that needs to be done. I am determined to drive forward the reform that we need for the medium-to-long term.

I want to create, in the next three to five years, what I believe can be a world-leading health and social care system. To do so, I need the support of my Executive colleagues, I need the support of the Chamber and I need a multi-year budget that prioritises the health of the people of Northern Ireland. You have got to give me the capability to deliver.

I thank the Committee for its comprehensive inquiry report. I thank Members for the dignity and empathy with which the debate has been conducted. I will have to take time to carefully consider the Committee's findings and recommendations, and I will respond when I have done so. I guarantee that I will not leave the report on a shelf. Finally, I mentioned visiting the Children's Hospice. My first visit was a real surprise to me, because I discovered something that I did not expect to discover, and I saw it in the children, the parents and the staff. It was joy, and, to me, that is a motivation to do better in this area. Once again, I thank the Committee for putting it on my radar and giving me a focus.

2,575 words. Text as published by the Northern Ireland Assembly.

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