Debate contribution: Healthcare: Integrated 111 Service

Debate contribution by Mr Mike Nesbitt on 18 May 2026.

MLA: Mr Mike Nesbitt
Party at the time: Ulster Unionist Party
Date: 18 May 2026
Type: Debate contribution (made as a minister)
Business: Opposition Business
Heading: Healthcare: Integrated 111 Service
Assembly identifier: Official Report component 5548817

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I am referring to the rising demand for healthcare generally. Claire Sugden just made the point that other sections of Health and Social Care (HSC) tend to push people towards emergency departments, but I do not contest what the Royal College of Emergency Medicine is saying. That constrained community capacity is where I would wave my magic wand, if I had one, because until we deal with the fact that the DTAs — decisions to admit — are heavily outnumbered by the number of patients who are in hospital beds despite being deemed medically fit for discharge, we are not addressing the fundamental problem. Everything else is just around the edges. It is important that we deal with those things as well, but that is fundamental. I agree with Mr McGrath that a 111 service has the potential to play a significant and enabling role in transforming how people access their urgent care. That is why I included it in my three-year plan in 2024. A 111 service would provide a single, simple point of access — a front door, if you like — through which patients could receive consistent advice and be directed quickly to the right care in the right place. It is not a replacement for existing services; it is a coordinating layer, supporting better navigation by triaging patients and, crucially, directing them, where possible, away from EDs to where their needs can be met more appropriately, be it through primary care, community care or urgent care services. In doing so, a 111 service aligns directly with the shift-left agenda, as many Members pointed out. It would help us move away from a system that is overly reliant on hospital-based care and towards one that prioritises prevention, early intervention and the provision of care closer to home. To be clear, however, establishing a fully operational regional 111 service is a major system change. It would require not just a telephone platform but workforce, clinical governance, pathway development and supporting digital infrastructure. That requires detailed planning and sustained investment. In my three-year plan, I made clear that the delivery of a 111 service was not possible without resources and a plan. Without that plan, a programme of work and investment, there is a real risk that we could create a substandard service that generates additional demand without the proper tools to meet it. Members have already made that point. It could ultimately increase, rather than relieve, pressure on front-line services. I do not need to repeat the funding pressures that face my Department. They are well known and well documented, but, put simply, the development of a 111 service requires resources that I do not currently have. However, in the absence of a confirmed Budget, we are not standing still. As a system, we are continually focused on strengthening, better integrating and enhancing existing services and pathways, and on improving patient flow within the existing resources. I must emphasise that people who need access to advice or urgent care can continue to contact their local Phone First services, which are already in place in all geographic trusts. While I recognise that Phone First is not the same as a regional HSC 111 service, statistics indicate that it plays an important part in diverting people from ED services towards services that are more appropriate for their needs. I encourage everyone who needs it to make use of the current Phone First service. In addition, our GPs and the services that they provide for their communities, in and out of hours, are critical in supporting patients. Community pharmacies also play a key role in supporting patients with minor illnesses and reducing unnecessary demand on GP and emergency services. No single lever will fix ED waits, and no individual reform, service or policy can, on its own, eliminate overcrowding, delays and corridor care. Progress will depend on taking a whole-hospital, whole-system approach that provides appropriate alternatives to emergency departments, addresses capacity and demand issues in them and supports patient flow through timely, appropriate discharge of patients to free up beds for those who need them. My Department continues to act to improve hospital flow, reduce ED congestion and ensure that patients receive timely, safe and effective care. Urgent care centres, minor injury units, Phone First and GP out-of-hours services are fully operational across the region, helping to divert appropriate demand away from EDs. In relation to the Ambulance Service, we are strengthening Hear and Treat and See and Treat pathways. Members will also be aware that the Ambulance Service implemented its Release to Rescue protocol on 27 April. The protocol is designed to ensure that ambulance crews are able to hand over patients into the clinical care of ED staff within two hours of arrival at hospital so that those crews are available to respond to further calls.
I thank the Member for the intervention. Release to Rescue is going into its fourth week. I believe that it has been, by and large, successful. It has by-products and consequences, such as the one that the Member mentioned. I intend to make a statement much more specifically about Release to Rescue in the coming days, so, if the Member will forgive me, I will stand by for that. I think that I have already told the House that, in the first four days of operation, the number of ambulances that had to wait for over two hours and breach Release to Rescue was eight. That is a phenomenally good number, but I think that everybody in HSC is a bit nervous about going too fast too soon and saying, "This is a success story". The early indications are pretty good, with the proviso of the additional pressures within the confines of hospital settings. The motion rightly highlights the shift-left agenda. It is about prevention, early intervention and strengthening care as close to home as possible. As my permanent secretary said to the Health Committee on 7 May, although work is in its early stages, Northern Ireland can be a "trailblazer" when it comes to implementing the neighbourhood model. I fully endorse that view. We are a small country with a strong ethos of collaboration across professions, organisations and sectors. We can support patients in accessing the care that they need in the most appropriate setting. I have already said that the solution to reducing ED pressures requires a whole-hospital, whole-system approach. It is not just about the front door but about the back door, including, as I have said, timely discharge. Early review teams continue to demonstrate tangible benefits, such as releasing home care capacity, with a significant proportion of individuals requiring reduced or no ongoing packages of care following review. The introduction of regional protection for home care packages on hospital admission further supports timely discharge once patients are medically fit. Digital enablers have been progressed to improve transparency and efficiency across social care pathways. CareLineLive has been implemented across all the trusts, delivering measurable efficiencies in home care hours, although I accept that some Members have concerns about the squeezing of the time that is devoted to service users at home. I recognise the core importance of community capacity, which requires a long-term solution. I absolutely agree that social care workers must be appropriately paid, in recognition of the work that they do to support some of the most vulnerable people in our society. I wanted to do that last September. I remain committed to doing so. Given current financial pressures, it will be a priority in planning for the 2026-27 Budget, which, as we know, the Executive have yet to agree. I reiterate the fact that there is no quick or easy fix to the challenges that are faced in our emergency departments. Achieving the improvements required will involve a complex interplay of services in and across the wider HSC system. I recognise and support the ambition regarding a regional 111 service, as set out in the motion. I am committed to bringing forward system and service reforms that are practical, deliverable and aligned with our wider reset agenda, subject, of course, to the necessary funding's being made available. Mr McGrath raised a couple of points. The Department is a bit nervous about your cost estimate. It has looked at the systems in Scotland and Wales and wants to look a bit more deeply, but it fears that it may be a bit more expensive than £6 million. Having said that, with a shortfall estimated at £760 million, it will be challenging, to say the least, to get the permanent secretary to agree that any new service is affordable. However, it is well worth continuing to look at that. I read the SDLP's news release about the proposals. It included a promise to ask to meet me. I did not hear Mr McGrath mention that in his speech, but I emphasise that my door is open.
Finally, Mr McGrath said, "Let's get it going by September 2026", and a couple of Members said that that was, to paraphrase, ambitious. I think it is, but there are only 311 days left before purdah. You are looking at a man and a Minister in a rush to get things done, so let us be ambitious.

1,544 words. Text as published by the Northern Ireland Assembly.

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