Debate contribution: Neurology Services

Debate contribution by Mr Mike Nesbitt on 9 December 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

9 December 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Neurology Services

Assembly identifier

Official Report component 5296359

Read the official Assembly record

Text

Principal Deputy Speaker, thank you very much for your indulgence: I begin by adding to the good wishes to Mr William Irwin as he steps away from the Chamber. From listening to the contributions, there can be no doubt how serious neurology and the issues surrounding it are. As Members are aware, my Department published a final report of the regional review on 7 May this year, and, in the context of ongoing challenges in the service, the review team was tasked with identifying the optimum configuration for neurology for the next 10 to 15 years. The review report sets out an ambitious vision for future services and is underpinned by priorities for improvement and associated recommendations. The focus of my comments this afternoon will be on how those priorities and recommendations address the issues that have been raised today. The first priority identified in the report is the need to ensure that neurology services are person-centred. The voices of people with neurological conditions and their carers have been central to the review, and that has been achieved by working closely with the Northern Ireland Neurological Charities Alliance and through direct engagement with people with neurological conditions. As Members have noted, I recently attended and spoke at an event organised by the Neurological Charities Alliance, which focused on the experience of people with neurological conditions. I had the opportunity to hear first-hand the devastating impact on the physical and psychological well-being of people while they wait for a diagnosis, treatment and support. That has to change. We can and must do better. The "House of Care" model set out in the report crucially recognises that people with neurological conditions are experts in their own health. By also ensuring that people have access to the right information and have a designated point of contact, we can ensure that the voices of patients are at the centre of neurology. The neurology workforce is the focus of the report's second priority, and there is no doubt that our workforce is made up of passionate and dedicated individuals who do their very best every day to deliver care and support to everybody with a neurological condition. However, it is clear from the report's comprehensive analysis that there are significant shortfalls in the current workforce. The report identifies that we are operating with only 60% of the recommended consultant and nursing capacity; 50% of the recommended allied health professions capacity; and only 20% of the recommended psychology capacity. Those shortages have a direct impact on the delivery of timely diagnosis, treatment, care and support. In that context, the report recommends substantial growth and development across the spectrum of the neurology workforce. That includes an additional 20 neurology consultants; 41 neurology nurses, including 12 advanced nurse practitioners; 38 allied health professionals and 22 psychologists. In addition to an increase in numbers, the report recommends the development of a broader skill mix. That will be achieved through extended roles, such as advanced nurse practitioners, advanced practice allied health professions and GPs with enhanced roles. All that will ensure that people are seen by the right person in line with their needs. Growth in the workforce will not only better align demand and capacity but, crucially, support new ways of working, which will make the system more responsive. It is clear from the personal accounts that I have listened to and those shared in the course of the review that, for many people, timely access to services is key. That is the focus of the third priority in the report: "Addressing gaps in current services". In order to better understand the extent of the challenges, a gaps and constraints assessment of current services was undertaken as part of the review. The assessment, much of which is reflected in the motion, identified significant variation in access to inpatient neurological care. In addition, a large proportion of patients are admitted to a hospital without a consultant neurologist on-site. More widely, access to some supporting services that sit outside neurology, such as mental health services, was also identified as a major gap. The report makes specific recommendations to address those gaps and promote equity. They include a recommendation to double the number of inpatient beds at the neurosciences centre at Royal Victoria Hospital. That will ensure that all patients have access to inpatient neurological care when they need it, regardless of where they live. The report is also clear that, where patients are admitted as a neurological emergency, access to specialist neurological opinion must be available in line with recognised standards of care. It is not acceptable that almost a quarter of neurology patients are admitted to a hospital with no neurologists available on-site. To address that issue, the report recommends that trusts must ensure access to specialist neurology opinion at all acute hospitals that receive unscheduled admissions. Where workforce constraints pose a challenge, trusts must consider alternative methods, such as tele-neurology, as an interim measure. Regarding access to ongoing care and support, the report notes the benefits of a multidisciplinary approach and care closer to home where that approach is sustainable. In that context, the report recommends the establishment of local neurology teams in each trust area to support that approach and ensure robust service delivery. The completion of condition-specific pathways within the first two years of implementation is noted as a priority recommendation. Pathways will set out the services and care that people should expect and ensure equity of access for all. Progress against that priority will be a key metric during implementation. The fourth priority focuses on opportunities to work more effectively with the resources that we already have. Recommendations include the roll-out to all trusts of innovative practices, such as referral management for outpatient appointments. Those are already present in the South Eastern Trust and the Southern Trust and have been shown to be a very effective way of working. In addition, there is a focus on trialling new ways of working, including the use of patient-initiated reviews and providing protected slots in neurology clinics for people experiencing a change in their condition. The drive for efficiency is further supported by recommendations to improve the use of data in neurology and for closer partnership working with our colleagues in the voluntary and community sector. It is clear that the implementation of the report's recommendations would drive improvements across the service. Workforce development, supplemented by working more effectively, would provide the basis for a more responsive, sustainable service that better aligns capacity with demand. That is critical to ensure that we are in a position to sustainably address the issue of unacceptable waiting lists for a first appointment and review appointments that Members have raised. The report estimates that an additional £65 million will be needed over the first five years of implementation, primarily to support growth in the workforce. While that amount will be refined as part of the development of the implementation plan, it is clear that the funding needed for reform is significant. Many of you — most of you — should be aware of the financial challenges that my Department faces, starting with a funding gap this year of £600 million. Today, we had December monitoring and another pressure in terms of pay that will materialise in the next financial year. In that context, while I would like to be in a position to commit the funding required to implement the neurology review recommendations, the current financial position means that, unfortunately, I am unable to do so at this stage. With regard to future years, the Finance Minister has indicated that he will bring forward recommendations for a multi-year Budget.

A multi-year budget will allow my Department to better plan for the next three years, and that will enable us to prioritise spending and investment. As part of the Budget process, my Department has submitted nine high-priority bids that are aligned to the health and social care reset plan that I published in July 2025. I will give way to the Member.

The current position is that it is all under review. Until I know what my three-year budget will be or what next year's budget is, I will not be in a position to make definitive, concrete commitments. We now know what the pressures are, and we have a pretty good idea of how we will end this financial year. We will be in deficit, and it will be a significant deficit. That money will have to come out of next year's budget, but, until I know what next year's budget is, I will not know how big the pressure of this year's deficit will be. It is just too early to make definitive commitments. I made a definitive commitment on the real living wage for social care workers, and I do not want to make that mistake again, having had to withdraw that promise. The neurology review recommendations are aligned to the neighbourhood focus and the commitment to reform that were set out in the reset plan, so the funding required is included in those bids. Depending on the outcome, the scale and pace of implementation may be adjusted in line with available future funding. That is a more positive and encouraging statement for the Member. My Department recently concluded a public consultation on the review report. An initial assessment of the responses indicates that the report adequately reflects the experience of people with a neurological condition. The impact on people who struggled to access the care and support that they need came out loud and clear. I look forward to receiving the final consultation analysis report in the coming weeks. That will inform the development of an implementation plan. It is intended that a neurology delivery team will be established to oversee the delivery of the review recommendations. The development of an implementation plan will be an initial priority action for the delivery team. In conclusion, I will touch on something that Mrs Dodds said when she opened the debate. She listed the specialists who are required to make the neurology service fit for purpose, and, indeed, I listed a number of them. She explicitly said that the service needs investment. The question is this: where do we get that investment from? I am often told in the Chamber that Health has over 50% of the Executive's Budget, and I recognise that that has gone up from 46% in recent years. That is an unsustainable direction of travel, which is why we have to reset and to go for the neighbourhood model. Mrs Dodds also had a specific question about waiting times in the South Eastern Trust. The waiting time for a neuromuscular first appointment is 19·1 weeks; for other conditions, it is a little longer. I am clear that the challenges faced by people with a neurological condition and those who care for them are unacceptable and are the product of a system under extreme pressure. I must also take the opportunity, however, to commend the committed and dedicated Health and Social Care workforce, who, in challenging circumstances, do their best for patients.

I assure you all of my commitment to deliver better neurology services and outcomes for the people of Northern Ireland. The challenges are significant in some cases, and there are no quick fixes. However, I am confident that the report's recommendations provide an opportunity to build neurology services that are equitable, timely, suitably resourced and centred on the needs of people with neurological conditions.

Principal Deputy Speaker, this is the last sitting day of the year, so I wish you and fellow Members a very merry Christmas. I believe that 2026 will be a highly consequential year for the delivery of health and social care in Northern Ireland, and it is my commitment to come back in January and begin with some good news.

1,977 words. Text as published by the Northern Ireland Assembly.

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