Health and Wellbeing 2026: Delivering Together and 'Systems, Not Structures: Changing Health and Social Care'

Private Members' Business – in the Northern Ireland Assembly at 12:00 pm on 14th November 2016.

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Photo of Robin Newton Robin Newton Speaker 12:00 pm, 14th November 2016

The Business Committee has agreed to allow up to two hours for the debate. The proposer of the motion will have 10 minutes in which to propose and 10 minutes in which to make a winding-up speech. One amendment has been selected and is published on the Marshalled List. The proposer will have10 minutes in which to propose the amendment and five minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I beg to move

That this Assembly notes the publication of Health and Wellbeing 2026: Delivering Together and 'Systems, Not Structures: Changing Health and Social Care'.

I welcome the opportunity to move this motion — the first opportunity that Members have to make substantive comments on the issue. I welcome, as I and my colleagues did on 25 October, the publication of the findings of Professor Rafael Bengoa and his panel. We had the opportunity to meet the panel at the health summit in the Stormont Hotel in February, and again for 45 minutes at the beginning of June.

The commitment of the expert-led panel was resolute, and I am sure we can all thank them for their many months of work. We welcome their conclusions, which, it must be widely noted, are similar to the findings of the three previous major health reviews in advocating a shift from acute to community care. The one thing that we can, with certainty, learn from history is that we never learn from history. I remember putting it to Professor Bengoa at the summit that reforming the health service was a little like repairing an airplane in flight. He and his panel have provided the Executive with the direction of travel. Therefore, the job of carrying out that reform lies with them.

The publication of Health and Wellbeing 2026: Delivering Together, and ‘Systems, Not Structures: Changing Health and Social Care’, marks just that: the publication of two documents. That is why the devil is in the detail, and, as yet, we have not been provided with that detail. I was somewhat surprised just how high-level the Minister's response was. She had the Bengoa findings for 10 weeks, yet even some of her more detailed actions referred only to further exploration and consultation. For instance, action point 12 announced the establishment of a transformation oversight structure by November. However, the Minister should really have been in a position to tell us, when launching the action plan, who was going to sit on the panel, how they would be selected and their terms of reference — an example of uncertainty and delay that could have so easily been avoided.

I still believe, however — and it is a point I have heard made several times since the publication of the documents three weeks ago — that it was galling that the very first action was, by January next year, to:

"Develop a comprehensive approach for addressing waiting lists".

I know that many were surprised at that.

No one disagrees that there is a problem, but most will have been shocked to learn that the Executive did not already have a plan in place to deal with it. Throwing money at it in-year, as happened in recent years, has not worked. Remember that £18·5 million of the £40 million last year was not spent on tackling waiting lists, because health trusts were not given enough time to spend it.

Following the publication of the two documents last month, there has been some focus on the centralisation of services, so let me make the Ulster Unionist Party position crystal clear. We agree with localising where possible and centralising where medically necessary. What does that look like in reality? It means that we support some services that are being delivered in an unsustainable and unsafe manner coming together when there is a clear and compelling medical case for them to do so, but we will not support the word "unsustainable" being manipulated to suit the Department's agenda, as clearly happened with paediatric congenital heart disease services in Belfast.

One example of a service that we want to see kept as it is is the provision of emergency departments. There are nine type-1 sites in total, including the units at the Royal Victoria Hospital, and they are all under immense strain as it is. We do not need to think back too long to remember what happened at Belfast City Hospital. In the year before the closure of its emergency department (ED) was announced, the hospital had 45,000 attendances, yet, after it was shut, there was only a minimal increase in capacity at the Royal and the Ulster Hospital. No wonder the four-hour A&E performance in the Royal was only 69%. In the July before the City Hospital's A&E closure, it was 78%.

I will give an example of where the present decentralised service relieves pressure on the main specialised unit. That is in nephrology. From personal experience, my son was treated in the Royal Belfast Hospital for Sick Children and then latterly in the nephrology unit at the City Hospital. That is a successful unit. Indeed, last year, it equalled the UK record for transplants performed in a single unit in a single day. Once successfully post-surgery and into a management regime of drugs, Mark was repatriated to the care of the Southern Trust at the nephrology unit in Daisy Hill Hospital in Newry, under the expert care of consultant nephrologists Dr John Harty and Dr Neal Morgan and their team. As a family and from our experience, we found this to be an excellent positive change for Mark. It also took pressure off the consultants and their team at the City Hospital, because, when we were attending the clinics in Belfast, immunosuppressive patients were effectively lining the walls waiting on their appointment. That is not a safe environment for patients who are susceptible to infection.

If the Minister is going to come forward with the business case, the funding and a plan to establish a centralised — I give this as one example — nephrology service, those plans will need to be funded and carefully planned, and the impact on patients, in the short term and the long term, will need to be taken into consideration. I give that as an example of precisely the level of detail that was missing from the Bengoa report and the Executive's responses. The principles are well established and widely supported, but the how, the when and the where have not been brought forward.

I will give a further example. When I was lobbying earlier this year on behalf of a constituent who needed an appointment with the regional immunology service, the Belfast Trust confirmed to me:

"With demand outweighing capacity, the current waiting time for an adult allergy appointment is up to 22 months."

That is 22 months during which patients risk coming to harm. Indeed, the latest information, from July, shows that 1,094 patients were waiting longer than 52 weeks for an allergy appointment, and that is already a centralised service. Workforce planning, long-term budgeting and actions are required to fix a broken service.

So far, we have a 12-month timeline for a 10-year plan, with budgets at worst for one year and at best for three to four. If I could make one plea to the Executive today it would be this: bring forward the detailed, costed plans for reform and back them up with long-term budget, as in other regions.

There was initial disappointment that the announcement of the Executive's plan was not met, on the same day, by an injection of funding through the October monitoring round. Officials have since confirmed that the 18 actions are being managed within existing resources. I would, however, be grateful for clarity from the Minister on the comments of her officials at the Health Committee last week. They indicated to me that no monitoring round had been commissioned for January and that, given the overcommitment of the Executive, they did not envisage getting any additional allocations in January.

Stable budgets are one thing, but a departmental culture that embraces change and nurtures, rather than suppresses, the talents of healthcare professionals will achieve the best outcomes. As I put it to Dr McBride at Committee, back in June, the Department must loosen its iron grip. Accountability, certainly, but a stranglehold that stifles individual thinking will ensure that real and meaningful change simply drips down slowly — far too slowly. The Minister stated last week that it will take strong leaders to take forward transformation, and I agree. I do not envy for one minute the task of repairing the airplane in flight.

In conclusion, the future holds many challenges for our people, not least type 2 diabetes, liver cirrhosis, lung and heart disease and, of course, cancer, but the past shows a litany of failed opportunities to support and strengthen our health service. We welcome and will support the amendment from the Alliance —

Photo of Robin Newton Robin Newton Speaker 12:15 pm, 14th November 2016

I ask the Member to conclude her remarks.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I therefore urge the Minister to tell us the how, the when and the where to lift that uncertainty and to begin tackling the issue.

Photo of Paula Bradshaw Paula Bradshaw Alliance

I beg to move

At end insert: "; further notes that these reforms are based on expert analysis and must be implemented in a holistic manner without delay; and calls on the Minister to provide a detailed action plan for the implementation of the proposed reforms over the current Assembly term.".

I rise to propose the amendment and to support the motion. I welcome the Health Minister's presence in the Chamber for the debate.

It is important to put on record that the Assembly needs to get behind the principles of the transformation process. To make an obvious but important point, reform is a complex matter. It will be natural for people to oppose aspects of it, but change is always uncomfortable. It is not enough merely to say why change is necessary but that does bear repeating. First, there is the financial issue, which is often referred to. If we do not reform, we simply will not be able to afford our health service, which is free at the point of access, in 10 or 15 years' time. Secondly and more importantly, the system is in some ways broken; it needs to be mended. We need to centralise specialised services, as my colleague Mrs Dobson said, to maximise available expertise. We need to ensure that more is done at the point of entry to the system, notably within primary care, to direct people to the appropriate places. We need to invest more in health and well-being through preventative work, not least in mental health, to support people to manage their own health and the health of those they are caring for.

Our amendment calls on the Assembly to recognise the value of reform and the need to support it in principle and without reservation. Otherwise, the health service simply will not be viable, and the brilliant and very committed people working in it will not be able to deliver the results that they want to.

I have said before, and I say again, that if the Minister proceeds with the transformation process, she will have my party's support, even where measures are challenging. This does not mean that we will commit to support the Minister in everything she does, because we have not had a chance to see what exactly it is that she proposes. Her announcements so far have lacked full detail, but that is not unreasonable at this stage. However, we do want more meat on the bones in the very near future. It has been said that the transformation process will take two Assembly terms. Again, that is very reasonable. However, it should not be an excuse for not making considerable progress in the current Assembly term. We need clarity in the form of a full action plan. Where are the resources, and who will be responsible for different aspects of delivering reform? Not everything will run perfectly, but we need an action plan that we, as Members of the Assembly, can assess to make sure that the reform process is taking place. We also need to remember that this is not just about MLAs in the Chamber; this is about the general public and the people who use the health service. The general public are the most important aspect of this.

What should be in the action plan? First, we must have absolute clarity, which, to be fair, the Minister has already indicated she is prepared to give, as to where the differences are between her own road map and the report of the expert panel chaired by Professor Bengoa. I echo the comments of Mrs Dobson: it was truly an expert report, and we would be foolish not to follow it. I certainly put on record my thanks to Professor Bengoa and his panel for their work on it. The Minister has said that hers is the only road map in town. That may be wise, but we do need to be clear as to what that relates to with regard to the expert panel's report.

Secondly, we need a clear indication of the resource requirements for the transformation. It is not just about financial resources but about personnel and the use of facilities. We need clarity, too, as to the resource that will be required throughout the Assembly term and beyond it. We need to recognise that it is necessary to know where it is coming from and that it has been guaranteed.

Thirdly, we need a series of actions and a commitment to clarity on how and, indeed, whether they will be delivered. Not everything will run smoothly, as I said. The implementation of the Transforming Your Care strategy was set back by uncertainty about what had been implemented. We know that things were implemented, but it was just not recorded very well. There was never any doubt that implementation was needed, but, as I say, people in the service were not sure what was happening a lot of the time.

Finally, we need clarity on who will be responsible for management of the transformation. Who will head up the transformation board that provides oversight and what level of expertise will be on the board? This issue of assigning responsibility goes further. We also need a recognition in the plan, in line with the report of the expert panel and indeed the Programme for Government framework, that this will not be solely a matter for the Department of Health. Children's health, the role of welfare and housing in health, well-being in the workplace and so on, fall to other Departments. Of course, many aspects of health, particularly health promotion, fall outside government altogether.

I think that this transformation is possible. However, it will take commitment, courage and clarity. Where those exist, my party will support the process every step of the way. Where they do not exist, my party will provide constructive challenge. I commend both the motion and the amendment to the House.

Photo of Paula Bradley Paula Bradley DUP

I thank the proposers of both the motion and the amendment, especially the proposer of the amendment on her very positive contribution. It is good to see that. I always think that I am the only optimist in the room; it is good to see that there is more than one here. I also thank her for the amendment because it puts a little bit more meat on the bones of the motion. We will also support it.

I welcome the commitment by the Executive in their unanimous support for the implementation of the Minister's plan for the future of health and social care. As Chair and a member of the Committee for Health, in recent months, I, along with others, have had the great pleasure of meeting many groups, whether that be the BMA or the RCN, all the various AHPs, social workers, and other people who work in health and social care. During that journey over the past few months, I have seen a real difference and optimism in all those disciplines in health and social care.

On Friday afternoon, I attended an event here for the College of Occupational Therapists. It was launching a report on reducing the pressures on hospital admissions, which is something that we very much want to look at in the future of health and social care. It showed us again the innovative work that is happening day and daily amongst allied health professionals here in Northern Ireland. At times, we look at health and social care and say that we have not done anything or that it has been at stalemate. As someone who came from that background and has not worked in it for over five years, I think very differently. I see so much innovative work taking place every day across primary and secondary care.

A couple of weeks ago, I had the pleasure of hosting a physiotherapy event. We heard from service users, who are probably the most important people to hear from in all this, especially with regard to self-referral in the South Eastern Trust, where, as I think that I have said here before, over 7,000 people have now used that initiative.

I would like the Minister to comment on rolling that out further. We have heard also in Committee about the pressures facing our GP services, and all our primary care services, and about how that vision for the future can make a real difference.

I want to pick up on a few points. I was glad that Ms Bradshaw said that change is often uncomfortable. I think that that is one of the major dilemmas that we, as an Assembly, will have as we go forward in this mandate, and in future mandates, when it comes to health and social care. Mrs Dobson talked earlier about the closure of EDs; she said that she did not wish that to happen. It is very comfortable for me, as a Belfast MLA, to look at everything else around the rest of our Province and think that we could do something better, that we should close or move something, or that we should make somewhere a special hub for something. I can say that with great comfort because I know that I have absolutely everything on my doorstep here in Belfast. I am so glad to have that. However, I know from my DUP colleagues on these Benches that we will face problems. I think that the Minister will also face problems from her colleagues. We have tough decisions to make; there are really tough decisions ahead of us. However, I think that there is momentum and will; I have heard from everybody in the Chamber that they want to see change and want to effect it.

As I said before, I am glad that Ms Bradshaw brought forward her amendment, because there needs to be an implementation plan. That uncertainty will lead to some people becoming cynical, and not just Members but service users and those who work in the service. We need to see progress; we need to have something more stable in place. That goes for the budget as well. We had a witness session last week at the Health Committee to do with the budget. Quite frankly, it was not good enough. We need to see more and to have more ideas written down.

As I said earlier, I know from meeting people who work in social care and many service users over the past five or six months that there is an appetite and a hunger for change. There is also an appetite and a hunger in the Chamber for change. I add my support to the Minister for her long journey ahead —

Photo of Robin Newton Robin Newton Speaker 12:30 pm, 14th November 2016

I ask the Member to conclude her remarks.

Photo of Paula Bradley Paula Bradley DUP

I support the motion and the amendment.

Photo of Catherine Seeley Catherine Seeley Sinn Féin

I thank my colleagues in the UUP for bringing forward the motion, as it signifies a mature enough approach from them. Over the last number of weeks, that party has failed to embrace the report and the Minister's vision, despite the fact that it has been welcomed and embraced right across the sector as well as in the media and, most importantly, by patients, carers and staff. This is the mother of all opportunities, but opening comments from the UUP suggest the same old negativity and, of course, a lack of any viable alternatives. The same old glass-half-empty approach will get us nowhere. We are extremely appreciative of the efforts, commitment and dedication of Professor Bengoa and his expert panel. Whilst our amendment reflecting that was not accepted, the Alliance amendment in some way attempts to acknowledge the expert analysis.

Bengoa's report administered a harsh dose of reality. In his report, he describes the health service as being on a burning platform and warns that change is inevitable. We have no choice but to implement change, but we have a choice as to the circumstances in which it is implemented: now, at a time when we can manage change whilst double-running our health and social care service, or later, following a system collapse, when we will be managing change in crisis.

The amendment states:

"reforms ... must be implemented in a holistic manner without delay; and calls on the Minister to provide a detailed action plan for the implementation of the proposed reforms over the current Assembly term."

The Minister has acted without delay: she has outlined the plan for the next 12 months and will build on that plan in January, and she has committed to reporting to the House every six months. It makes you wonder whether the parties sitting outside the Executive have been listening. That said, given that the Minister is already doing what the amendment calls for, we have no issue with supporting today's amendment as well as the motion.

Our demographics have changed so drastically in the last 20 years, yet our health and social care service has remained static. People are living longer but with much more complex needs. Therefore, it is vital that our health and social care service responds to that. The vision that the Minister has outlined aims to tackle waiting lists, improve access to GP services, achieve parity of esteem for mental health, raise the attainment of looked-after children, reform adult social care and support, develop a workforce strategy, fully realise the potential of community pharmacists, as well as avail itself of the many invaluable community services and good practices that are already out there. Her plans are ambitious; but then they need to be.

Professor Bengoa, in comments to the Committee, suggested that the implementation of the Minister's vision had the potential to result in the delivery of a world-class health and social care system. He said that the Minister had gone further than any other equivalent European Minister he had ever worked with. These words should inspire confidence across the political divide. Of course, there have been opportunities for change in the past, but change is a brave choice. It can be slow and frustrating and it is certainly not populist. That is why it is vitally important that we do not play politics with this. Countless Members will speak today and each of them will note the pending crisis in our health service but a Minister alone cannot deliver the change that is needed; we must all put our shoulders to the wheel. As politicians, we must lead this change and engage our communities early, most of whom are already ahead of us.

I urge Members to consider what is more important: populism or patient well-being; convenience or quality; cheap headlines or action. If we are serious about improving patient outcomes and tackling health inequalities, then we need to get behind this vision. In the short term, we must allow the Minister the space to engage meaningfully with health and social care staff and patients so that, in partnership, her vision can be built on, advanced and grow and develop to ensure that the end result is a world-class health and social care system that will be the envy of the world.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I welcome the opportunity to discuss the important motion today and the fact that my Ulster Unionist and Alliance colleagues have brought it to the House. Maybe the first thing to note is that in the interests of openness and transparency — something that this Executive is not particularly good at — it has taken an Opposition party to bring the substantive discussions here today.

Any effort to improve the health of people is essential and is required. I worry about reports that are published and then become bookends or dust gatherers. We have had Delivering Better Services, Transforming Your Care, the Donaldson report and now the latest, the Bengoa report. This series of reports is only useful if it provides a concrete blueprint for what must be done for the future of our health services and then our actions. It has been said that this report is more a direction of travel than defined proposals. I hope that it will not be interpreted as a report of wishy-washy aspirations and, instead, is something that will deliver.

Photo of Linda Dillon Linda Dillon Sinn Féin

The Member is right that we have had all those reports but none of them were under this Minister. I think that the Member will agree with that.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I thank the Member for her contribution. We are discussing the report, not the Minister, so we will stick to the topic.

I welcome many elements of the report but, again, it would be difficult to argue with any elements in the report. We want a healthy population, of course; we want people to live longer, of course; we want people to access proper, decent expert healthcare when they need it, of course; we want people to avail themselves of services at home where possible and not in hospital, of course; we want to challenge the root cause of many illnesses presenting to our health service by challenging poverty, dealing with obesity and improving a healthy and fit lifestyle, of course. Who would not?

I am a little concerned that this report tells us much of what we already know and not very much of what we have not yet got. What is it that we need? We need to see ambulance response times improved in rural areas; they get you to the hospital. We need emergency departments that can cope and do not have long queues. Maybe you could reopen the Downe accident and emergency unit, which would help. We need to stop seeing trolleys in the corridor as acceptable healthcare. We need more consultants who can screen and direct patients to the care that they need. We need beds available for patients who need them. We need elective surgery waiting times slashed. We need outpatient appointments in a reasonable time.

We need proper community care for people at home, not a 10-minute dash-and-run service that leaves our elderly bewildered rather than cared for. We need to treat staff with dignity and decency, pay them a fair wage and reimburse them for the costs of their work. It is not fair that some people in our health service are out of pocket when they go to work. I could go on and on.

I read the report and worry that Bengoa has said much, but I wonder whether he really said anything at all. Where are the concrete outcomes? Where are the timescales? Where are the measurables? Are they financed? Are they ready to go? I do not envy you your work, Minister; you have a mammoth task ahead. Help was sought and it produced this report, but I wonder whether it is really the help that we need.

I hope that we will not just be kicking problems down the line and that we have the plans to deal with them. It has taken years to build up, but to take 10 years to sort the problem out is a bit long. It is a disservice to our people and their healthcare workers to say that it will take that long, and we need something quicker in the short term.

The lack of clarity on the financial element of the report is also of concern. There is a complete lack of an estimate of the costs associated with the process and/or an indication of where the money will come from. With no money being requested by the Department of Health in the October monitoring round to deal with the urgent waiting list crisis that we are facing, the lack of detail on the costs of delivering the much-needed action plan promised in the report is a bit worrying.

I conclude by echoing the sentiments of my colleague Mr Durkan on the launch of the report and by reaffirming the SDLP's commendation and support of our healthcare staff on their vigorous work providing healthcare across the North. The work and effort of our healthcare workers is second to none, and it cannot be put on them that their efforts do not translate to a first-class health service. We remain optimistic that the process will begin to resolve the problems faced in Health and Social Care, and we look forward to seeing an action plan and detailed costs going forward. Of course we pledge to work constructively with the Minister.

Photo of Gary Middleton Gary Middleton DUP

I welcome the opportunity to speak today. I also welcome the publication of the reports from the expert panel and from the Minister. I thank the expert panel for the work that it carried out, and I also thank the Department for setting out a pathway for implementing this change.

The expert panel's report has a clear statement:

"The choice is not whether to keep services as they are or change to a new model. Put bluntly, there is no meaningful choice to make. The alternatives are either planned change or change prompted by crisis."

The Chair touched on the fact that, as members of the Health Committee, we meet with various groups weekly. Last week, we had a stakeholder event with a wide representation of groups. They made it very clear to us that they recognise the change that has to happen. It is very disappointing that, so far, the tone from the Opposition parties — I do not include the Alliance Party in this — has been very negative. The report has been out only for a matter of days, and they have not given it a chance. When you reflect on that and get behind the public and professional opinion —

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I thank the Member for giving way. I am somewhat surprised that the Member mentions our tone. We welcome the findings of the Bengoa report, but we are asking for the details of a costed and funded plan. Surely you agree that that is essential in putting patients first.

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Gary Middleton Gary Middleton DUP

Thank you, Mr Speaker. That is not the point that I was making; I was referring to the negative tone. It is unfortunate that there has been a knee-jerk reaction to the publications; we have seen it in the media. Unfortunately for some Members, they should reflect on the position of the media, get real with the facts and wait for a response from the Minister.

Photo of Gary Middleton Gary Middleton DUP

No, I am going to try to make some progress. The expert panel's report makes the challenges very clear, and it also makes it clear that we need to draw on the experience of those who already deliver care and take on their expertise to build on the existing foundations. We have to remember that much positive work is already happening in the health service, and we should not be running it down. We are here to make sure that the work continues while also reforming it and making it better. We need to communicate the plans, of course, and the Minister has done that so far by outlining the 12-month vision and the need for additional transitional funding. The transformation board will see all this through.

Innovation was touched on by my colleague, the Chair of the Health Committee, and I think that it is no longer acceptable that we keep doing things as they were, just for the sake of it or for the fact that we have been doing it for 20 years. We need to look at innovative ways of doing things and we know there is much innovation within our health service at this minute in time.

We need to address elective care performance, and we know that a strategy is going to be released in January on how we address that. Of course, the difficulty will be trying to address the waiting times and ensuring that we push forward with the transformation. That is where we need clear leadership, not only professional or clinical but political leadership. The Executive have given a clear commitment to showing that leadership, and we also need to see that from others outside of the Executive.

To keep staff on board, it is vital that the Minister keeps ensuring there are conversations happening with the staff and that they feel valued and are kept up to speed with the changes that are required. With all of the recommendations in the report, the clear outcome is that there is a willingness among the staff to make the change that is required. The Health and Wellbeing 2026 vision outlines the pathway and how we are going to make these changes.

We must recognise the challenges of population change and the health inequalities which exist within our communities. It is no longer acceptable that, if you live in a certain community, your access to services is going to be different or you are going to be disadvantaged. We know that, in some communities, you are twice as likely to die from smoking or you are three times as likely to die from suicide. These health inequalities are no longer acceptable.

These reforms will see that our communities get the health service that they deserve. We have to recognise that finance alone will not solve this. We need to fully implement what the report says, and we look forward to working with the Minister to ensure that it happens.

Photo of Ian Milne Ian Milne Sinn Féin 12:45 pm, 14th November 2016

I thank you for the opportunity to speak on the motion and in support of the tabled amendment. I commend the Minister, Michelle O'Neill, on launching Health and Wellbeing 2026: Delivering Together, a 10-year vision to transform the North's health and social care system. As we know, this is an opportunity for a fresh start supported by the Executive and is not just the will of one Minister or Department.

Minister O'Neill's vision was compiled after considering the report, 'Systems, Not Structures: Changing Health and Social Care', by a panel of experts led by the highly esteemed Professor Rafael Bengoa — a report which has received considerable support for the need for change from vast numbers of people working in our health and social care sectors, including the BMA and AHPS, who signalled general approval.

Our Health Minister has stated on previous occasions that the system itself is now at breaking point and facing a number of challenges, not least the demographic changes and considerable health inequities which continue to persist. It is well past the time to organise services in a way which does not constrain transformation or our ability to provide a higher-quality service. There can be no doubt that we need to support people to keep well in the first place and that, when we need care and support, services should be safe and of the highest quality.

I agree with the Minister that our focus must move from one which is based on action-based targets to one based on patient outcomes and co-production of services. Healthcare professionals and staff across the relevant sectors are working harder than ever to deliver high-quality care and support to patients and carers, but they have to work in a health and social care system designed to meet 20th-century needs that does not work in the 21st-century world.

Changing the health system is the right thing to do, this is the right time to do it and it is much needed by service users. Change must be planned, managed and incremental. It will not happen overnight. This will take time, resources and the support of staff as well as everyone who uses the health and social care services.

We must avoid playing politics with health. We all need to support evidence-based decisions when presented.

Photo of Roy Beggs Roy Beggs UUP

I, too, support the motion in the name of my colleague Jo-Anne Dobson and others and, indeed, the amendment proposed by the Alliance Party.

Health is not just about statistics; it is about real people's lives and how we must act to improve the quality of those lives. There are recommendations in the Health and Wellbeing 2026 report that are aimed at helping to stabilise, reconfigure, improve and transform the health service, but what we need is a much more detailed action plan on how that will be delivered and improved rather than just this high-level strategy. Until that is seen, there will not be a clear picture that will give the public the confidence that it will be followed.

The very first recommendation is to develop a comprehensive approach to addressing waiting lists. Why have our Executive allowed our waiting lists to deteriorate to such an extent? Totally unacceptably long waiting lists are causing stress and anxiety to constituents. Undue delays in patient treatment can sometimes mean greater likelihood of an individual coming to harm, with many facing a short-term adverse impact on the quality of their life, and there may even be longer-term impacts because of delays in treatment. There are additional visits to A&E and costly unplanned admissions to hospital. I can think in particular of one constituent who recently contacted me about her 111-week waiting time. She is a relatively young person who was working successfully and saving a little money, but, as a result of waiting for an operation, she has had to stop working and is unemployed. She is living life in pain, and, instead of contributing to our society, she is on a 111-week waiting list. That is unacceptable.

Going forward, we must learn from previous strategies. I look back in particular to the period 2011-15, when Minister Poots led with the Transforming Your Care proposal. I can see much of the content of that running over into the new document, which has the same general ideas. However, Transforming Your Care did not materialise in the way that was envisaged. New and improved services were often not supported and delivered. There was a significant proposal through invest to save to make new money from the Department of Finance available for improvements, but under former Ministers Edwin Poots and Simon Hamilton that money was diverted from those improvement schemes into the normal, run-of-the-mill activity. I want to know what the detailed action plan is. How can we ensure that, unlike Transforming Your Care, the improvements are deliverable and this is not just another high-level strategy?

Photo of Christopher Stalford Christopher Stalford DUP

I appreciate the Member giving way. He paints a stark picture of the situation confronting the health service. I am sure he will agree that the problems he identifies began way before 2011.

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Roy Beggs Roy Beggs UUP

The Member is right: Michael McGimpsey warned that, when the Executive were inadequately funding our health service, there would be problems. Exactly as he indicated, in the latter part of the last Assembly in particular, there were difficulties, and that is exactly when the waiting lists got out of control. The Member is right: it was predictable, and the Executive were warned about it by Michael McGimpsey.

I am aware that the Bengoa report aims to look at new models of care, and we eagerly await further details. Clearly, there is a need to improve local care in the community. Certainly, I am aware of difficulties with the current funding arrangement, with constituents frequently having difficulty getting support to allow their loved ones to live safely in their own home. I suspect that is largely because of the funding arrangements, whether imposed directly by the Department or ignored, which are unable to attract new staff into the agencies that provide that support.

In my constituency of East Antrim, we are, to a degree, bereft of secondary care. We do not have the support that exists in many other locations. East Antrim does not have an accident and emergency unit, a minor injuries unit or any of the new all-singing, all-dancing health and well-being centres. There is a need for investment in capital and resource to ensure that the new multidisciplinary teams that are being talked about can be delivered locally so that all health professionals can work closely together and improve the service. I hope that that will be delivered as a result of the proposal, but we need the detailed plan.

Photo of Robin Newton Robin Newton Speaker

I ask the Member to conclude his remarks.

Photo of Roy Beggs Roy Beggs UUP

I urge Members to ensure that it will be delivered and not just talked about, as previous schemes were. We need delivery, not just strategies and consultations.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

I could spend the whole of my five minutes talking about all the negative aspects of the health service, but there is no point in doing that. I prefer to accentuate the positive. Everyone in the House knows a good news story about the health service and of someone who has been helped. Sometimes we hear of almost miraculous recoveries of people who have had to be dealt with by the health and social care system. I can think of nothing more important than the health of our citizens, and that includes the delivery of health and social care to them. I pay tribute to all those who work in the health and social care system: the clinicians, the nurses and all the ancillary staff. The staff and the great work that they do is one of the most positive things that we could talk about.

In a sense, there is nothing really new in 'Systems, Not Structures' from Bengoa. There have been other reports — we have heard mention of the Donaldson report and Transforming Your Care — but none has been implemented, whether because the will, the resource or whatever else was not there, but what those reports do, along with the new report, is create a framework or route map through which the health service can be transformed. On this occasion, it is clear that there is a commitment to implement change and follow the direction of travel prescribed by Professor Bengoa. That commitment is evident from what we have heard from the Minister and the Executive.

Photo of Stephen Farry Stephen Farry Alliance

I am grateful to the Member for giving way. I want to tease out the implications of what he says. He said that there was now support from the DUP on the Executive for delivering this version of reform, but he also said that the report was very similar to other, previous reports under DUP Ministers. By implication, is he saying that Sinn Féin is at fault for failing to support the DUP Ministers and that we have missed the opportunity to get on with this over the past number of years?

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

I thank the Minister for his intervention. I am not so sure that that is the case. However, I do not want to hark back to the past. The Minister

Photo of Pat Sheehan Pat Sheehan Sinn Féin

The Member was on the Executive as a Minister, so maybe he is more informed on those issues than I am.

Professor Bengoa said in Committee a couple of weeks ago that many other regions and countries were trying to bring about change in their health system. Some are doing that by throwing resources and funding at it, while others are doing it by trying to transform the system while not providing resources. Professor Bengoa said that this region was unique, in that we are intent on having transformation and providing additional funding. If that is not a measure of the commitment of the Minister and the Executive, I am not sure what is.

I represent a constituency that has some of the worst health inequalities across these islands, and, unless there is transformation, those health inequalities will continue to grow, waiting lists will get longer and the percentage of the block grant going towards health and social care will increase. There is only one solution, and that solution is transformation.

Let us all draw a line here today. I have listened to a number of speakers so far, and I did not detect any opposition to the need for radical transformation of our health and social care system. In fact, health, in a sense, is a unique issue. Every one of us sitting here today and every person listening to the debate will be affected by ill health at some time, whether it is them, members of their families, their friends and so on. As I said in the debate last week, ill health does not discriminate along party political lines.

I make this appeal every time I talk about a health issue in the Chamber: let us all work together. This is an issue that affects all of us. It is absolutely right that the Minister should be held to account, as every Minister should. There is absolutely no doubt about that, but health is unique in that it affects us all, and, if we all work together, we can make more progress, not for ourselves but for the people out there whom we represent. I will leave you with that thought. Working together is the best way to resolve all these problems.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party 1:00 pm, 14th November 2016

I rise in support of the motion and the amendment. Mr Sheehan said that he did not detect any opposition to the need for radical transformation: that is fair enough, and it is because there is none. I do not think that anyone in here or anyone anywhere could oppose the notion that our healthcare system needs to be reformed. We see that every day, we hear that every day in our constituency offices, we might hear it around our kitchen tables and we hear it over the air waves.

Many people have to live with the fact that the healthcare system that we have allowed to evolve is far from perfect and is not fit for purpose, but, for some time, we have been promised a magic bullet that will cure all the ills in our health service. It is fair to say that, since May, any criticism or question that has been levelled at the Department of Health or, indeed, the Minister — I do not think that there has been much in the way of criticism of the Minister — has been responded to with almost a stock answer that the Bengoa report will sort that out.

Photo of Christopher Stalford Christopher Stalford DUP

I appreciate the Member giving way. He will also want to reflect, I presume, on the comments of his Opposition colleague Mr Beggs, whose stock answer any time the problems that existed prior to 2011 are pointed out is, "Michael McGimpsey asked for more money". The beauty of the Bengoa report is that it is institutional reform plus additional investment.

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Member for the intervention; I am not sure that I thank him for the extra minute that he has got me, right enough. I concur with his view that there is more to this than more money. It is about how we do things differently, not how we spend more money on doing the same old things.

A lot of expectation, anticipation and suspense was allowed to build up around Bengoa and then, when it was published, the fact that it was so similar in many respects to reports that we had received, read and seen before meant that there was almost a bit of an anticlimax. I found that to be the case very much among the media, in that they were almost searching for negativity in reaction or response to the report. I have to say in response to Mr Middleton's remarks that they did not really get much negativity from me nor, I believe, from my Opposition colleague, as he described Mrs Dobson. We asked questions around the lack of detail in the report, and it would be a dereliction of duty not just of us as Opposition MLAs but of any of us here, as MLAs and public representatives, not to ask questions about how the plan will be implemented and delivered and how it will improve healthcare for those out there who need it and those of us in here who, undoubtedly, will need it some day.

The problem with the past reports to which this is so similar has been the failure to implement them. Mr Farry made an interjection highlighting the fact that we have been told a lot that it is different this time because this is a report that the Executive fully endorse. I do not recall the Executive not endorsing Transforming Your Care, for example. Let us make sure that it is more than the Executive endorsing this plan.

Photo of Stephen Farry Stephen Farry Alliance

I am grateful to the Member for giving way. One of the most bizarre things about our system of government is that the issues regarding health reform were not brought to the last Executive. There was zero discussion on any occasion around Transforming Your Care or Donaldson; the discussion was purely around money. It is perverse in a society like ours that we do not discuss the big issues. Only the transactional business is brought to the Executive, and nothing strategic was ever discussed.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Member for his intervention. I assure him that it will be different this time, now that we have done away with those pesky parties.

A Member:

Hear, hear.


Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

We have certainly expressed a bit of concern about the lack of specifics in the report. The amendment calls for more meat on the bones, as I did on the morning of the report's publication. It is important that we see that soon and give certainty to people and to places that might have concerns about the future of facilities in their area. I think that that is inevitable, given the reconfiguration of services that is necessary and will, ultimately, whatever way it is dressed up, lead to the closure and withdrawal of services from areas. While Bengoa will form the foundation of the Minister's vision or the Minister's policy, we will not allow Bengoa to be a fig leaf for every difficult or unpopular decision that has to be taken by the Minister or any health trust, wherever it may be.

There is a need for so much. We spoke about the reconfiguration of services. There is a need for improved care in the community, improved primary care, an enhanced role for GPs and an enhanced role for community pharmacy and allied health professionals. Those enhanced roles have to be matched by enhanced resources.

I am conscious that I have not that long left, so I will touch on one more thing. On the morning of the Minister's statement, she said, in response to a question asked by Mr Carroll, that she was working towards a position where we did not need to use the independent sector. Is that applicable across the board? I think that she answered that on dealing with elective surgery and waiting lists, but is it applicable in social care too? Is it applicable to nursing homes and residential homes, where statutory provision is extremely poor and is currently being closed by stealth?

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

I thank the Members who brought the issue to the Assembly. In the aftermath of the publication of the strategy, there has been a lot of discussion about the Bengoa report itself. We all know that the health service is in crisis. We know that our hospital waiting lists are dangerously long. People wait years to be seen by a specialist or to be operated on; indeed, my nieces and nephews have, unfortunately, been sick in the last week and have waited long hours to be treated in the children's hospital. Recently, I was contacted by a father whose five-year-old child had been waiting for 18 months for an important operation on her mouth. That is completely unfair and unacceptable, but, unfortunately, it is a widespread problem that people have to wait long periods of time.

It is a shocking indictment of the current state of affairs that we have a postcode lottery whereby, if you are from an area of high deprivation and poverty, you have to wait longer to be treated. If you live in a place like West Belfast, you will wait longer than those in other, wealthier areas in the North. It is a shocking disparity that needs to be tackled. The reason people are stuck on the waiting lists is that we have seen systemic cutbacks over the last several years. We saw the City Hospital's A&E close, putting huge pressure onto the Royal. We saw a reduction in the number of beds available for patients. We saw a privatised recruitment selection problem, where there is a long and often complicated process to recruit staff.

Indeed, the shortage of staff is leading to the closure of the Meadowlands unit in Musgrave Park Hospital, which has been in the news recently.

Cutbacks and not enough staff are leading us down the road where services are being reduced or stopped altogether. Some say that it is intentional, others that it is bad workforce planning. Staff are doing tremendous work; they are the lions in our health service, but they are under huge pressures. Many health workers are working against the clock, working long hours and not taking breaks just to provide the service that they are so committed to. We are also seeing people retiring and either not being replaced at all or, increasingly, replaced by agency staff. This casualisation of the workforce must come to an end. Paying tens of millions of pounds to recruitment agencies, which are making an amazing fortune out of this process, needs to come to an end; it needs to be tackled immediately.

Millions of taxpayers' pounds should be put into the health service and not into the pockets of recruitment agencies or private companies for that matter. Just last week, we saw Richard Branson, a multimillionaire, get his hands on a huge section of the health service. We have to be clear that private companies that are designed to make profit at all costs should have absolutely no role in our health service. We have to ask this question today: will this strategy and the implementation of this document proposed by the Minister and backed by the Executive address the problems that we are experiencing, or will it lead to a further cutting back of our health service and a further encroachment —

Photo of Linda Dillon Linda Dillon Sinn Féin

I thank the Member for allowing the intervention. I accept what you are saying, and using private healthcare is certainly not the answer that we want to see. However, do you not accept that the child whom you spoke about who is having to wait 18 months will have to wait a lot longer if the Minister does not use these methods in the short term in order to reduce waiting lists?

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

I thank the Member for her point. However, the point is that the money should be redirected back into the health service and not into the hands of private companies. Recruit more staff into the health service and reduce waiting lists.

In the general debate, there has been much talk of the experts and the expert panel. Those people are no doubt highly qualified in their fields, but who knows better how our health service runs and can be improved than the people who work at the coalface? The trade union movement has been excluded from the process. It spoke at the Health Committee and said that it has had no representation on the expert panel. It is shocking that organisations that represent tens of thousands of healthcare staff have not been front and centre in this process. We hear the talk of the rationalisation of our health service. You can butter it up whatever way you like, but, for me, this is code for cutbacks. How can we improve our health service and cut waiting times by cutting our health service? It cannot be done. We need to put money in to defend our services. The underlying language in much of this report follows an NHS template from England, where we see daily reports of organisations —

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

I will not.

We see daily reports of organisational meltdown, financial crisis and privatisation surrounding these new structures, and that should cause us great concern. Nye Bevan, one of the key architects of the NHS, said that the NHS will survive if there are people around to defend it. I hope that, over the next few weeks, the people will get out and campaign to defend our NHS. They will have support from People Before Profit in that process.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

There is probably no sector more afflicted with all the buzzwords that have become fashionable, like "transformation", as if that is going to cover up the failures of the past and deliver a new utopia. We have to ask more probing questions. For example, did the previous Executive lead us in the right direction of providing basic healthcare by reducing the number of hospital beds by over 10% and then being surprised at the logjams — the near traffic jams — of people on trolleys in the corridors of our hospitals? The answer to all that now is, "Let us grab some nice buzzwords like 'transformation' and 'improving outputs'", from the very people who delivered much of the shambles that we have been afflicted by in recent times. I have to say that I see, essentially, in the Bengoa report and in the consultation document of last Friday, a stratagem for stripping out services from many of our hospitals that they presently provide, and it is being done on a well-tried template.

The consultation document is a perfect example and model of this. In order to obtain the preordained outcomes of reducing and stripping out facilities in hospitals, you have to build a case — as they built, sometimes in a quite phoney way, in respect of the Belfast City Hospital emergency department for example, the closure of which was meant to be temporary but which was to avoid a consultation. The words used were "It's not safe" and "We can't get the staff". We had an experience with the Causeway Hospital in Coleraine when it was going through a dark patch. There were those who were trying to diminish it, and the claim was, "We can't get the staff". Of course, that was rectified, because it could be rectified. However, very often, when the Government wants to do something, they set up the various criteria to fit into where they want to get to. That is why these criteria are so much about safety and about being clinician-led, as if that is the answer to everything. Most clinicians want a handy time in terms of if they can all work in the greater Belfast area then they will all choose to work in the greater Belfast area.

So, devising the consultation document in those ways is geared, I suspect, to producing a stratagem of stripping out services in many hospitals. Where that concerns me the most is in respect of our rural community. This is the Minister who, when she wore the agriculture hat, brought the Rural Needs Bill to the House. She told us during the debates on that that:

"The key principles of the Bill mean that rural issues will be embedded, as a matter of course, in the development and delivery of all government strategies and policies; ... government will take a joined-up and collaborative approach in taking account of rural needs when designing public services." — [Official Report (Hansard), 8 March 2016, p13, col 2].

It sounds great. Where did rural proofing come in the consultation that was issued on Friday? It was tucked in as a little afterthought on page 20. It was tucked in in terms in which it is quite clear that, "Yes, we will go through the motions, but we will not pay any heed", because it contains the key phrase:

"fully engage in consulting rural communities before finalising the service change."

In other words, "We are going to make the change, then we will consult with the rural communities, and then we will finalise the change.". Where is the embedding that was promised by this Minister in respect of rural proofing?

Photo of Robin Newton Robin Newton Speaker 1:15 pm, 14th November 2016

I ask the Member to conclude his remarks.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

Indeed, where is the rural proofing in Bengoa's report? Did he ever even consult with rural interests? So, I fear that all of that is feeding into a reduction and diminishing of services for many of my constituents who live in rural areas.

Photo of Robin Newton Robin Newton Speaker

The Member's time is up. I call the Minister of Health, Mrs Michelle O'Neill, to respond to the debate. The Minister has up to 20 minutes.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Go raibh maith agat, a Cheann Comhairle. I am a bit hoarse, so bear with me. I thank the Members who have contributed in a positive and constructive way today. I am very keen to keep talking and to keep coming back to this conversation as we transform our health and social care. The prize at the end of that transformation will be better patient outcomes, and that is the prize that we all need to work towards.

I very much welcome the fact that the Alliance Party has brought forward an amendment, because it puts a bit of meat on the bones, as the original motion merely notes the publication of the report. I will correct the Member who proposed the motion and said that this is the first time we have had the opportunity to debate the issue. I think you will find that it is not. I have been to the Health Committee — I know you were in China at the time — but we discussed it then, and we discussed it here on 25 October, the day that I launched the report.

I launched my ambitious 10-year approach to transforming health and social care, Health and Wellbeing 2026: Delivering Together, as well as the expert panel's report, 'Systems, Not Structures: Changing Health and Social Care'.

I am grateful, as I said, for the opportunity to set out once again the key elements of the approach. Many Members have read and had time to digest both documents over the last number of weeks, although I question whether some Members have read the report in its entirety. I have heard some of the contributions and comments, and I very much doubt that they have, because a lot of people are missing the point. I will take the opportunity again today to rehearse some of the key issues in order to make sure that Members are fully briefed and absolutely understand the direction of travel, but I will not rehearse all the detail that I have gone into on previous occasions.

We all agree that the case for change has been very well made. An ageing population is good news for us all and is testament to the hard work and dedication of all those working in our health and social care system, but it also presents capacity and demand issues. Our system was designed to meet the needs of a population in the 20th century, so it is logical that it is struggling to cope with 21st-century needs and expectations. Waiting lists have continued to grow — I have always said that that is totally unacceptable — but that is only a symptom of the problem that we face. Health inequalities, which some Members referred to, continue to divide our society. In 2016, it is absolutely unacceptable that our socio-economic status dictates our health outcomes, whereby those living in the centre of this city can expect to live nine years less than those who live a few miles up the road.

Like those who came before me, I have invested in front-line service development and improvement initiatives. While that has alleviated some of the pressure on the system, it has by no means fixed the underlying issues. Current delivery models continue to have a negative impact on the quality and experience of care across the North. Those models of care are not only outdated but unsustainable. If we continue to do more of the same, by 2026 the HSC will need 90% of the Executive's budget merely to stand still.

Photo of Christopher Stalford Christopher Stalford DUP

I am grateful to the Minister for giving way; I asked Mr Carroll from West Belfast to give way, but he would not. Does the Minister agree that, if you are going to stand and say that we should be investing millions more in the health service, it would be helpful to the debate if people gave us figures for the level of additional investment that they want to see?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Obviously, I totally agree with that. It is very easy to stand on the sidelines, chirp away and say, "This is what we should be doing", and write to me all the time about waiting lists and how unacceptable you find them. However, if we do not have real and meaningful transformation or concrete plans to transform the piece, we will not be able to assist all those people — mothers, daughters, sons — who find themselves waiting to be seen by our health service, so transformation is absolutely key.

It is not my intention to paint an overly pessimistic picture of health and social care, but I want to emphasise to Members that, if transformation does not happen, we can expect to see health and social care services in further significant decline. Health is a basic human right, and I believe in a universal health service based on need and free at the point of delivery. My overriding ambition is for all of us to lead long, healthy and active lives. I want a future in which people are provided with the necessary information, education and support to enable them to keep well in the first place. When care is needed, it should be safe and of a high quality. Those who use services and, indeed, those who provide them should be treated with dignity, respect and compassion. I listened to Mr Allister's comments about quality and safety. Patient safety has to be paramount and the first consideration in any service that we provide. I will very much be guided by that principle.

My vision, and the transformation journey that we have embarked on, is ambitious — rightly so. It will require whole system transformation across primary, secondary and community care, and a radical change to the way in which we plan, design and provide services. Holistic transformation will allow new and innovative ways of working and for patient-centred models of care to flourish. Moving away from a model of activity-based performance to one of performance measures based on patient outcomes will allow health and social care staff to provide the right care at the right time and in the right place. We will explore where all-island services can be further developed to bring mutual benefit for patients on this island. We have already initiated a programme of work with counterparts in Dublin to explore all-island services, including transplantation, rare diseases and perinatal mental health services.

By implementing new models of care and increasing our regional and all-island networks for specialist services, we will not only deliver better outcomes for patients but alleviate pressure on vital acute services. That will include reducing hospital admission rates, speeding up hospital discharges and reducing the lengths of stay for those patients who need to go into hospital. To begin this journey, I have already set out some key actions. I have agreed to increase the number of GP training places to 111 — 12 next year and 14 the year after that; commissioned five training places on the advanced nurse practitioners programme; and continued investment in practice-based pharmacists. I am also reviewing the role that physician associates could play in our system.

I am committed to investing in the workforce of the health and social care system. Our staff are our greatest asset, and I recognise that they are under significant pressure. I have witnessed over the last number of months the outstanding work of HSC staff and the positive impact they have on people's lives. I am, therefore, committed to developing a workforce strategy by spring 2017 and a range of other immediate actions to start to address some critical workforce challenges. However, I recognise that some of the long-term systemic workforce issues we face will take time, leadership and sustained effort to resolve.

Securing better health and well-being outcomes for patients and other people who use health and social care services will be at the centre of the transformation programme I have announced. The experiences and needs of service users and their families will, therefore, be at the forefront of shaping our new service model. I am committed to ensuring that the HSC works in partnership with service users to design and implement the lasting and meaningful changes we need to improve health outcomes for our population. That is what I mean by the term "delivering together".

This new way of engaging patients is built on the principle of co-production. That will underpin how we engage service users in the future in designing new services and treatment pathways or at the point of care. Patients and service users have a vital contribution to make to transformation. I have already embarked on a period of engagement with those who use services and with staff right across the HSC to listen to their views on the future of health and social care services.

We need greater collective clinical and professional leadership throughout the HSC supported by skilled and able managers. That is why I have asked my officials to develop a system-wide HSC leadership strategy to be produced by next summer and why resources will be invested to support staff and leaders to develop the necessary skills and behaviours that will be crucial as we move forward.

We must all accept that the role of hospitals will fundamentally change. Hospitals are not always the most appropriate place for all care to be received, and, where it is safe to do so, people should expect to be treated in a setting closer to home. For some, attending medical appointments or receiving treatment can be a daunting and sometimes stressful situation. There is strong evidence that concentrating specialist procedures and services in a small number of sites produces significantly better outcomes. It is the opposite in our current system, where emergency and planned care services are mixed together because they are located in the same facility. That perpetuates our long waiting lists, and system-wide backlogs are created. By further developing ambulatory assessment and treatment centres, we will allow health and social care professionals to assess, diagnose and, where appropriate, provide same-day treatment to patients. Elective care centres will be developed to carry out less complex planned treatments right across the North. The establishment of those dedicated centres will be a resource for the region, and the way they operate will be designed around patients. It is well-evidenced that that type of configuration of services can reduce waiting times and prevent the system backlog we experience today.

I want to see a health and social care system that is efficient and sustainable, where best practice is the norm and investment is made in areas that will positively impact service users. We should have a system that encourages innovation, and, where there are good pockets of work that are co-produced and show high-quality patient outcomes, we should be able to scale those up at pace.

I am determined to realise the potential that modern information technology provides. Making better use of technology and data is essential if we are to move forward to a model focused on service users, utilise our entire information resource to better inform the treatment of patients and free up health professionals' time to care.

I have said it before, and I will say it again: it is a privilege to be the Minister of Health, and I am committed to this programme of transformation and the principles of co-production. I am determined that Delivering Together should not be put on a shelf and forgotten about but is used as intended, which is as the road map for transformation. As the Health Minister, I will lead this work with energy, passion and pace. Last week, I launched the public consultation on the criteria for assessing the sustainability of health and social care services as recommended by the expert panel in its report. The consultation will run longer than the normal eight weeks to take account of the Christmas period and will include a series of consultation meetings right across the North to allow as many people as possible to contribute. Further information on the dates, venues and invitation arrangements for those meetings will be announced shortly.

This week, I will be launching my Department's paediatric hospital and community-based services strategy and the paediatric palliative and end-of-life care strategy. Those documents will set out the approach for further improving the delivery of services over the next 10 years, subject to securing the transformation investment required to implement the strategies. Both strategies will be taken forward fully aligned with the priorities and objectives for transformation set out in Delivering Together, with the clear aim of delivering better health and well-being outcomes for children in the North.

Later this month I will launch a new diabetes service framework that will realise a vision of care designed to transform services for people living with diabetes or at risk of developing diabetes, subject to securing the necessary investment. I will launch a public consultation on proposals to modernise the delivery of pathology services. That will involve building a sustainable, high-quality pathology service designed to support the vital area of diagnostics well into the future.

I have been really encouraged by the positive response that I have been receiving to the vision document 'Delivering Together', but I want to ensure that everyone has the opportunity to have their say on the criteria for the sustainability of services, which, if adopted by my Department, will be at the heart of informing future decisions about reconfiguring services. Since the launch, I have spent considerable time engaging with staff and service users across a range of locations and settings, including Craigavon Area Hospital, the Ulster Hospital emergency department and Old See House, an integrated community mental health centre. Their reaction to my vision and the expert panel's report have been overwhelmingly positive, and they tell me their appetite for change has never been stronger. That is only the beginning, as I plan to ramp up this type of engagement.

I have committed myself to chair an advisory board that will provide the strategic leadership and oversight required to deliver the transformation. Membership of the board will be drawn from the field of independent experts, unions and user representatives, along with the permanent secretary of my Department. The structure will also include a transformation implementation group responsible for driving forward the transformation programme led by my permanent secretary. I will continue to work with Executive colleagues and Members to secure the additional funding necessary to facilitate transformation, manage backlog and maintain current services. I reaffirm my commitment to update the Assembly every six months on the progress of the transformation process. We must all realise that change cannot happen without investment. Investment not only takes the form of pounds and pence but is about political and system-wide leadership, finding the time to change and making a conscious effort to break down silos to move to regional and all-island approaches where necessary.

All of us have an important role to play as we embark on this journey. I will not shy away from the difficult conversations and decisions. I ask all Members to match my resolve. In Delivering Together we have a once-in-a-lifetime opportunity to transform our HSC into a world-class service. I look forward to working constructively with all Members who want to deliver better positive health outcomes for all who may need our health and social care systems in the months, years and weeks ahead.

Photo of Stephen Farry Stephen Farry Alliance 1:30 pm, 14th November 2016

I thank the Minister for her comments and her commitment to work with the Assembly and give frequent reports to the Assembly and the Committee, setting a positive example in that regard. If we are to see this generational change in our health and social care system, we need to find as wide a political consensus as possible because there are some difficult decisions coming down the line.

I want to echo what my colleague Paula Bradshaw said at the start: we in Alliance are not interested in being simply opposition for opposition's sake. We are always constructive, and we are willing to support the Minister and Executive in delivering the new vision and ensuring that we see positive change in our health system — provided, of course, that the reports are followed through and expert advice is given its proper place and guides us in the way forward. I note the comments from Catherine Seeley, I think it was, about Sinn Féin opposing populism in this regard. That is an important statement, and we look forward to that being the way forward.

As many people have said, the current approach is not sustainable. That lack of sustainability applies in two respects. One is that we are not getting the best outcomes and results in the system. It is not as good as it could or should be. Secondly, our finances are in a difficult and challenging situation. On the basis of the current configuration of the health system, we are looking at healthcare inflation in the region of 5% to 6% per annum, which is well in advance of the ability of the Executive to invest resources. Therefore, we need to have a proper discussion of finances.

The need for the 10-year implementation plan has been well received by the Assembly — we certainly welcome and endorse the response — but it is important that we recognise the financial issues, which have not perhaps been teased out as much in this debate as I would have liked. We need to focus a bit on the finance. We have to accept that there is a need to invest further in our health and social care system in order for it to become more effective and sustainable. We have to invest in that transformation process, but how much it will cost and where we find that money are the key issues that will face us. Christopher Stalford and the Minister were right to challenge Gerry Carroll on how much he wanted to see invested in the health system, but, equally, they have a duty to spell out how much the transformation outlined in the reports will amount to and where they intend to find the money.

The DUP and Sinn Féin went into the last election with a commitment to spend an additional £1 billion on health by 2021. That is a nice round number that takes into account healthcare inflation, but we need to know today whether that commitment still stands and how they intend to separate that commitment from the wider financial context that we face. Even in the current financial year, in which the health system got, I think, a 2% increase, that still fell short of healthcare inflation, so the system is already facing challenges this year. Even that modest increase in health spending came at the expense of virtually every other Department facing a cut. We know that, over the mandate, our block grant is set to flatline at best, but we are now faced with the effects of Brexit, and the impact on the UK's public finances are very uncertain; indeed, there are warnings of an even bigger black hole opening over the coming years. The implications for Northern Ireland are unclear.

We also have the potential wider implications of funding a lower rate of corporation tax to help transform our economy. We may need to invest further in agricultural subsidies locally if that funding is cut off from Westminster. One thing is clear: we will not get our share of the £350 million a week repatriated from Brussels. There is also the uncertainty around the current in-year situation, in that healthcare inflation is running at 5% to 6%, with a budget increase of 2% and very little in monitoring round bids. That indicates the potential for a black hole to open during this financial year pre-reform, and we need to consider how we will manage it in-year.

Finally, in looking ahead to implementation, it is important to bear it in mind that this has to be a cross-cutting issue —

Photo of Robin Newton Robin Newton Speaker

I ask the Member to conclude his remarks.

Photo of Stephen Farry Stephen Farry Alliance

— that touches on all Departments. At this stage, the implementation plan solely deals with health issues. We need to see a lot more cross-cutting activity for all Departments.

Photo of Robbie Butler Robbie Butler UUP

I welcome the opportunity to wind on the motion brought to the House by my party colleague Jo-Anne Dobson. I find it encouraging that there has been such a wealth of debate today. That shows a real appetite to tackle the problems in our health service.

All of us in the Assembly agree that the health service needs to change for the better. Standing still is no longer an option. There are too many people on waiting lists, and those who are on them wait far too long. The absence of a strategic workforce plan is contributing to a building over-reliance on locum staff and to targets being stretched. The implications are felt across the board, whether in A&E or care in the community. The people of Northern Ireland deserve a fully functional health service that not only delivers but is sustainable, accessible and affordable. For those reasons, I am encouraged that the Executive appear to be moving to address the issues with a high degree of priority.

I will focus on a number of points. First, I am encouraged by the content of both reports that we are discussing today. That is at odds with a number of Members' points. The outworkings of Health and Wellbeing 2026 have the potential to become the basis of a new framework of sustainable healthcare provision in Northern Ireland. The Minister has heard us call for more detail, and I hope that, over the coming weeks and months, that detail will be forthcoming.

The Minister will not be surprised to hear me raise the issue of mental health again.

Northern Ireland, as we know, suffers from a disproportionately high level of mental ill health compared with other parts of the UK and British Isles. Not only do we suffer unduly high rates of mental illness in our more deprived areas, but there is significant evidence to show that the legacy of the Troubles has significantly contributed to our mental ill health. The Ulster Unionists have been campaigning for and championing adequate mental health care provision for many years, and so I am particularly pleased with the commitments in the report to tackle mental health issues, including the commitments to additional funding for mental health interventions in primary care and to make available early support services, such as mental health hubs.

I agree with the sentiment espoused by the Minister that mental health care should have parity of esteem, but I urge her to start putting in place some measures to actually deliver it. As a starting point, I once again call on the Executive to recognise the merits of appointing a mental health champion. I recognise that the Minister has said that she is prepared to take up the role of a champion, and I commend her for that, but the gravity of poor mental health is so severe that we need an independent champion to ensure that the Minister and Executive are genuinely responding to the need.

On page 15 of the health and well-being report, the Department rightly identifies acute care at home as a service ripe for reform. With advancements in technology and telemedicine, it is much easier than even a few years ago for patients to remain in their own home. I urge the Minister to stick to her word and better integrate care at home with social care in the next three years. My main point in this respect is that the trusts must ensure that staff on the ground have not only the support but the time to deliver that service. Specifically, I remind the Minister of the report last year by the Commissioner for Older People for Northern Ireland, which recommended that the NICE guideline NG21 be embedded into the standards for the delivery of domiciliary care, and that calls of less than 30 minutes' duration should not generally be used.

The Minister rightly identifies practice-based pharmacies as a means to alleviate some of the pressures facing general practice, but I urge her and her officials not to overlook the increasingly important role that community pharmacies can and do play in delivering a fully integrated service. Last week, I and many Members visited local community pharmacies, and we saw at first hand the role they play in, and the support they offer to, our communities. Therefore I sincerely hope that the Minister is not minded to follow the reductions in community pharmacies proposed in England. When they were recently debated at Westminster, members of the DUP surprisingly sided with the Government, which understandably raised some concerns in our constituencies.

Over the weekend, the Minister once again stated the importance of consultation and the necessity to take members of the public along on the journey with any proposed reforms. I urge her, however, not just to consult for consultation's sake, as Mr Allister said. I use the Lagan Valley Hospital as an example of when the local population was not treated with the respect it deserves. During summer 2011, Lagan Valley had its accident and emergency service reduced to daytime and weekends. At the time, staffing concerns were cited, and the people of Lisburn were assured that the decision was only temporary. Despite the supposed concerns of the Minister at the time, the opposite has happened, and the services have been further reduced. I use this only as an example of how —

Photo of Robbie Butler Robbie Butler UUP

Yes, indeed.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

Does the Member recognise that saying something is temporary is a wheeze by the Government to avoid consultation? When a permanent closure is proposed, there is a formal consultation process; when they dress it up as temporary, they avoid that. That is what happened at the City Hospital and at Lagan Valley.

Photo of Robbie Butler Robbie Butler UUP

The Member's point is well made; nobody in the House could argue differently.

At this point, I will recap some of the comments made by other Members. I commend my party colleague Jo-Anne Dobson for proposing the motion. A number of points stood out, none more so than her personal account as a mother of her family's experience of using today's overburdened and overstretched services, and the risks that sufferers and service users are exposed to. She talked about who, where and when, and the plan must get us to that level of detail.

Paula Bradshaw, in her amendment, called for recognition that care should be free at the point of access and that the service is broken and needs to be fixed. I agree. Paula also mentioned "the three Cs". I think that that is worth noting, especially by the Minister. She talked about commitment, courage and clarity. I can assure the Minister that she will get the commitment and courage from the House; all she needs to do is bring the clarity and detail.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Does the Member agree with principle of co-production and co-design and actually listening to service users and patients and ensuring that we give them ownership of the care pathway that they take?

Photo of Robbie Butler Robbie Butler UUP

I absolutely do. The core of this must be putting patients first. Nobody in the House will disagree with that. On the point about consultation, patients need to be listened to. That was the point that I made in my address.

I will pay very little time to this next bit, Mr Speaker. Two Members of the House wasted two of their five minutes to attack the Opposition. I thought that it was petty and very disappointing. I just wonder whether they wrote their speeches together: it could be another way in which the Executive are working collaboratively behind the scenes. It is incredible. That is all that I am going to say about those two Members.

Mr McGrath talked about openness and transparency — two fantastic words. They are turning into buzzwords, really. We have heard about buzzwords. We really do not want to be faced, in a grown-up, modern-day Assembly in 2016, when we have moved so far in the past 18 or 24 years, with having those words being beat about the House. I would be really disappointed if, at the end of these four years, never mind 10 years, we are still talking about openness and transparency.

Another good one that was raised by Mr McGrath was ambulance response times. There is a disparity in the provision of healthcare in this country depending on where you live. We talk about the postcode lottery. I would keep a particularly close eye on that with regard to response times and how that is addressed. Thank you, Mr McGrath, for that one.

Gary Middleton — no, I will not go there.


What I will actually do is go on to Pat Sheehan because what Pat said at the start of his comments was that he was not going to waste his five minutes. I commend him for that. He did not waste any of his five minutes. He got straight to the meat. I commend him for that. He talked about transformation. He talked about detail, which we all know.

Mr Durkan, thank you. I always like listening to you. You can do it without reading, which is admirable. That will come with experience. Mr Durkan talked about failure to implement in the past and reiterated Stephen Farry's earlier point about previous reports sitting on the shelf and not really addressing the issues. We must indeed learn from the mistakes of the past.

I am sorry that I did not mention anybody else. There were plenty of other good speakers. In conclusion, we have heard many good points being raised on the motion, some critical and some commendable. I put it to the Minister of Health that, whilst nine or 10 years might seem like a long journey, the reality is that without clear signposting and clear measurable targets, I fear that the time will slowly slip away —

Photo of Robin Newton Robin Newton Speaker

The Member must conclude his remarks.

Photo of Robbie Butler Robbie Butler UUP

— like my time is slipping away now. Thank you, Mr Speaker.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to. Resolved:

That this Assembly notes the publication of Health and Wellbeing 2026: Delivering Together and 'Systems, Not Structures: Changing Health and Social Care; further notes that these reforms are based on expert analysis and must be implemented in a holistic manner without delay; and calls on the Minister to provide a detailed action plan for the implementation of the proposed reforms over the current Assembly term.