Debate contribution: Home Care Provision

Debate contribution by Mr Mike Nesbitt on 12 May 2026.

MLA: Mr Mike Nesbitt
Party at the time: Ulster Unionist Party
Date: 12 May 2026
Type: Debate contribution (made as a minister)
Business: Private Members' Business
Heading: Home Care Provision
Assembly identifier: Official Report component 5528725

Text

Once again, I emphasise that my accounting officer told me that it was unaffordable and that I could not do it. I note that the Member, who is Chair of the Committee, is reneging on his duty to assist and advise me by telling me that it is my problem. I will move on, because I am mindful of the ongoing concerns raised by independent sector representatives. I acknowledge their dissatisfaction. As part of the fair work forum, they worked with us in good faith to establish a case for paying the real living wage in the independent social care sector. On that basis, their expectation that it would be paid was reasonable. However, critical as pay is, it is only one part of the answer to the wider pressures that are facing social care, a point that has been made already in these discussions. Participation in a debate about the longer-term sustainability of the sector is equally important, and it is regrettable that some key representatives have withdrawn from those wider reform discussions and fora. I genuinely hope that that can be rectified, because sustainable reform requires partnership working. I assure the sector and Members that my commitment to introducing the real living wage in line with the fair work forum criteria remains absolute. However, I need the funding and the financial flexibility to make that happen. The financial pressures that face Health and Social Care are becoming even more constrained with each passing year. Today, we believe that our shortfall is £760 million. That is unprecedented and potentially unmanageable. As I have said previously, pay alone will not resolve all the challenges facing the home care sector. What is required and what the motion rightly calls for is a comprehensive, sustainable and future-focused approach to strengthening home care. That will require further investment in staff. The social care workforce strategy sets out our ambition to attract, retain, grow and develop the workforce. The social care fair work forum, which is made up of trade unions, employers and statutory partners, also continues to work to improve terms and conditions and to embed fair work principles across the sector. Strengthening home care will also require changes in how we deliver that care. We cannot simply continue doing more of the same and expect different outcomes. We know that current approaches will not be capable of meeting future demand. That means that we must explore new solutions, embrace innovation and empower people to live well and live independently for longer. Importantly, any future reform must be shaped by those who provide care and by those who receive it. We are working with the Patient and Client Council (PCC) and the Northern Ireland Social Care Council (NISCC) to ensure that engagement is meaningful, practical and capable of delivering real improvement. Home care cannot be viewed in isolation. It exists within a wider adult social care ecosystem, and many of the pressures that affect home care are symptoms of wider systemic pressures across social care itself. That is precisely why we developed and published a 10-year adult social care reform strategic plan and an initial three-year delivery plan earlier this year. The strategic plan identifies six core priorities and 33 delivery actions. Those plans strike what, I believe, is a careful balance between ambition and realism in an exceptionally difficult financial climate. We have prioritised actions that are either immediately necessary or capable of delivering the greatest impact. A new approach to home care is identified as one of the central commitments in that reform agenda. Work has already commenced through a sustainable systems implementation group, which is examining how home care is commissioned, funded and delivered.
The group is also considering whether existing legislative, policy and procedural frameworks remain fit for purpose. That work builds directly on the home care round-table discussions that were conducted between August and December last year. Those discussions reached broad agreement that the future of home care must involve moving away from rigid time-and-task models towards taking a more flexible, person-centred approach that is focused on outcomes. They also highlighted the importance of re-enablement, ensuring that short-term support helps people recover independence wherever possible, while also ensuring sustainable, long-term provision for those who have ongoing needs. The round-table meetings also identified examples of best practice already operating across the statutory and independent sectors. Where we know that approaches are working, we should not wait years to replicate them elsewhere. Another key part of reform is prevention and early intervention. Part of addressing demand for home care must involve finding ways in which to reduce delay or to remove the need for statutory intervention altogether. Work is already under way on a preventative framework that is focused on strengthening local community supports to help people remain safe, well, connected and independent. Many of those supports already exist, and they are delivering excellent outcomes. I have visited organisations and community groups that deliver precisely that kind of preventative support, which is helping older people remain active, resilient and connected in their communities. We have also seen evidence from elsewhere in the United Kingdom that such approaches can improve outcomes while reducing pressures elsewhere in the system. In other words, it is not simply the right thing to do but the smart thing to do. We must also make greater use of existing community assets and, where possible, scale them. That approach aligns directly with the wider ambitions of the neighbourhood model. We must also fully explore the role that technology can play. Assistive technology and digital supports are already demonstrating significant benefits elsewhere in the United Kingdom through improving independence and delivering greater efficiency. Another important priority is to increase the uptake of self-directed support in all its forms. As a result of the self-directed support round-table meetings, work is already progressing to streamline processes, reduce democracy and develop managed budget pilots. I will give way to the Member.
I absolutely do. That is the analysis that I brought to the House when I first became Minister of Health. In the first winter in which we talked about such pressures, the discussion was all about what was happening and not happening in EDs. The House now realises that it is about flow and that the problem is a lack of community capacity, so I agree with the Member. Finally, I remain mindful of the concerns that some independent-sector providers have raised about the balance to be struck between in-house and independent provision and about whether the true cost to care is fully recognised. I am out of time, Mr Deputy Speaker. I welcome the fact that we have debated the issue today.

1,113 words. Text as published by the Northern Ireland Assembly.

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