Waiting Lists: Action Plan

Private Members' Business – in the Northern Ireland Assembly at 10:30 am on 20 February 2024.

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Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin 10:30, 20 February 2024

The next item in the Order Paper is a motion on an action plan on waiting lists. Before I call Diane Dodds to move the motion, I inform Members that a question for urgent oral answer on the junior doctors' strike has been accepted by the Speaker. No decision has yet been made on the other questions.

Photo of Diane Dodds Diane Dodds DUP

I beg to move

That this Assembly believes it is deplorable that none of the formal waiting time targets for health and social care services in Northern Ireland have been met since 2014; notes with concern a recent Northern Ireland Audit Office report that indicated that the number of people currently on health and social care waiting lists is equivalent to 26·3% of our population, more than double the figure in England; further notes regional inequalities within Northern Ireland and the urgent need for same-time access regardless of where anyone lives; acknowledges the need to turbocharge investment towards tackling the waiting list backlog over the remainder of this Assembly term; stresses the value of partnering on a much larger scale with national and independent providers to maximise existing capacity; and calls on the Minister of Health to publish an updated action plan to tackle the waiting time crisis within six weeks.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Business Committee has agreed to allow up to one hour and 30 minutes 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. As an amendment has been selected and is published on the Marshalled List, the Business Committee has agreed that 15 minutes will be added to the total time for debate. Diane, please open the debate on the motion.

Photo of Diane Dodds Diane Dodds DUP

Thank you, Madam Deputy Principal Speaker — or whatever way round that is.

I am pleased that we have the opportunity to discuss this important topic, and I thank the Health Minister for his attendance in the Chamber. I am sure that every MLA in the House can attest to the fact that, every week, we meet constituents who are ill, in pain and on a waiting list. They have lost hope and faith in the very NHS that was meant to look after them from the cradle to the grave. Let me reinforce my belief that a well-funded, properly functioning NHS, free at the point of delivery, is my sincere goal. It saddens me that we are very far from that objective. Tackling waiting lists is one of the pivotal issues on which the success or failure of the Executive will be judged. We cannot fudge the issue or talk about everything else but not address that most fundamental of issues that impacts on our constituents every day.

Photo of Diane Dodds Diane Dodds DUP

I would like to make some progress.

Minister, I understand and appreciate that you have a challenging brief, and I hope that, in highlighting the issue in the Chamber today, we will lend weight to your arguments for resources to tackle the problem. Equally, Minister, the issue will not go away, and we will hold you and your Executive colleagues to account on the progress in tackling it.

In bringing the motion, I want to be clear on the uncomfortable truths about waiting lists. The Northern Ireland Audit Office (NIAO) report of 2023 makes for stark reading. No formal waiting time targets have been achieved since 2014. Between March 2017 and 2023, patient waiting lists exceeding maximum waiting time targets have increased exponentially. The equivalent of 26·3% of the Northern Ireland population is on a waiting list compared with 12·4% in England. That means that, compared with England, more than twice the proportion of our population are on health and social care waiting lists. In Northern Ireland, 51% of those on a waiting list were waiting over 52 weeks for assessment or treatment compared with 5·4% in England. From the Department's waiting time statistics, we know that 87·9% of patients diagnosed with cancer received their treatment within 31 days versus the 98% target, with gynaecology having the poorest outcome of 78·1%.

There are huge regional variations in the statistics, with some trusts performing much better than others. That postcode lottery of treatment is unsustainable and unfair. In the Southern Health and Social Care Trust area, the wait for a routine urology assessment is 153 weeks. There is a potential further wait for treatment of 151 weeks. The wait for a rheumatology outpatient assessment is 201 weeks, and, for neurology, it is 172 weeks. I have used figures from my local trust; other figures are available, and the wait times are just as shocking.

It is long past the point where we can call this a service. It is clear that very poor waiting time performance is significantly increasing the number of patients at risk of developing serious conditions and illnesses. Their quality of life will have been reduced by spending protracted time waiting on tests, treatment or surgery.

There is deep concern about the prevalence of late diagnosis. Between 2012 and 2017, one quarter of cancer diagnoses were made in emergency departments and not in primary or elective care. It is morally unacceptable that we are allowing patients to reach that stage in their journey before serious illness is detected.

Minister, we all know that that is not a sustainable position. We know that Northern Ireland has the worst waiting lists in the United Kingdom. Simply doing a little more or investing a little extra will not make a significant difference. That is why it is imperative that you and Executive colleagues have a clear plan to reduce waiting times.

In their latest funding offer, the UK Government said that they will grant an additional £34 million to tackle waiting lists. However, the Northern Ireland Audit Office report indicates that £909 million would be required to reduce waiting times substantially. The elective care framework estimated that £707 million is required to ensure that, by 2026, waiting times do not exceed one year. The Department has now conceded that those targets cannot be met. I know that you are very soon in post, Minister, but is that still your view?

Stabilising this fundamental public service will require significant investment. Minister, we need your Department to provide robust figures on the cost of stabilising the service, and we will be watching the future budget proposals for investment. However, funding is not the only solution. Recruitment and investment in staff are vital. I hope, Minister, that you will be able to reverse the decision taken last year to halt the recruitment of nurses onto university courses. We trust that you will be able to reach satisfactory agreements on pay so that staff can feel valued, and that you will work with trusts to ensure that staffing levels are safe and appropriate.

While there is a need to increase the number of staff, that must be accompanied by an overhaul of inadequate, out-of-date and poorly maintained physical and digital infrastructure. Those investments will lead to more efficient delivery of services. Other options that must be delivered include the use of primary care for routine elective procedures and tackling the extreme pressures on social care.

We need to be realistic about the extent of progress that the system in its current form can achieve. Clearly, we do not have sufficient capacity, and all the training and recruitment efforts in the world will not turn that around in the short term. We need to find partners who can assist us, and we need to look beyond our usual local providers. The small independent sector in Northern Ireland will undoubtedly have a role to play, but it is dwarfed by the volume of the additional capacity that is needed.

Photo of Diane Dodds Diane Dodds DUP

I will shortly, if you just let me finish this point.

Continuing in the old way, with small contracts at the end of the financial year, will have only a minimal impact. I was very concerned when I was contacted by one private sector provider who indicated that patients who it had been anticipating this month for urgent red-flag endoscopies had not been forthcoming due to trust financial concerns. They had made arrangements to carry out 2,000 endoscopies and 1,000 urology procedures in the six weeks leading up to the end of the financial year. Have those red-flag patients simply ended up on another waiting list? I can only imagine their fear and concern.

I will give way to the Member now.

Photo of Daniel McCrossan Daniel McCrossan Social Democratic and Labour Party 10:45, 20 February 2024

I thank the Member for giving way. I share her concerns in relation to waiting lists, and I believe that they firmly impact on the lives of each and every one of us. Does the Member appreciate and agree that the absence of these institutions for two years — and for three years prior to that — has contributed to the devastation that has been inflicted on people and to the huge and growing waiting lists that we face in Northern Ireland?

Photo of Diane Dodds Diane Dodds DUP

I thank the Member for his intervention. I am not interested in playing politics on this one today. It is extremely important for Northern Ireland that we go forward with a plan to sort out this issue. Every day those people, who are in pain, want us to do that.

Northern Ireland can only do so much by itself. We must seek to partner, on a much larger scale, with national or global providers that can work alongside us to provide the additional skilled staff that are required in the short term, as we enhance our capacity. Let me be clear: investing in our own staff and infrastructure is my preferred option, but the needs of our waiting lists and the urgent requirement to address capacity will take radical short-term solutions. Some in the Chamber may have an aversion to considering working alongside the independent sector, but I am not necessarily suggesting that we have to pursue private providers. There are a number of non-profit organisations from the United States, for example, that operate internationally. The University of Pittsburgh Medical Center is a global non-profit health enterprise with 92,000 employees internationally, 40 hospitals and 70 cancer centres. It has partnered with a number of hospitals in the Republic of Ireland, providing state-of-the-art radiotherapy treatment in Cork and Waterford, and is also involved in hospitals in Kildare and Kilkenny. There is undoubtedly a political and broader interest from the US in Northern Ireland's affairs, and perhaps there are ways in which we can encourage that and harness it for genuine practical benefit and for the welfare of our patients.

We should not underestimate the anxiety that people experience when waiting for a diagnosis, nor the impact on loved ones. We recognise that additional money alone is far from being the answer, as Northern Ireland already has the highest per capita spend in the whole of the UK, but we must maximise the outcomes from investment. We must see more procedures proceed. It is surprising that that can happen in the private sector but not in our NHS. There must be clearer separation between emergency and planned care.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Will the Member bring her remarks to a close?

Photo of Diane Dodds Diane Dodds DUP

Yes. I had assumed that I would get an extra minute because of the intervention.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Not when you are moving the motion.

Photo of Diane Dodds Diane Dodds DUP

Oh, right. Sorry. Thank you.

We need to sweat our assets. Can I take two seconds, Madam Principal Deputy Speaker —.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member's time is up, sorry.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I beg to move the following amendment:

Insert after "maximise existing capacity": "including the immediate reinstatement of the cross-border healthcare directive;"

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Colin, you will have 10 minutes in which to propose and five minutes in which to make a winding-up speech. Please open the debate on the amendment.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

No greater issue has highlighted how sick our health service more than that of the waiting list debacle. The fact that we are raising this issue and discussing it so early after the Assembly's return is therefore welcome.

People have been languishing on waiting lists for too long. It is probably too simple to point to COVID and say that that was the cause of any of those lengthy lists; it certainly did not help, but the genesis of the problem goes back much further than that. To find the real answer, we need to delve into the strategy storage room in Castle Buildings, for it is there that we will find the real cause of the problem. It is in that room that we will find many undelivered strategies. Many of those strategies would have helped the waiting lists, had they been implemented. It is in that room that we would find many announcements about reorganising our health service, and it is in that room that we would find plans that would have reorganised and helped, had they been enacted. It is the inactivity of Health Minister after Health Minister and Executive after Executive that has led us to where we are today, with some of the longest waiting lists in Europe.

Photo of Robin Swann Robin Swann UUP

Will the Member give way?

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I will not, because you will have your chance, and I will not get any extra time.

How bad is the problem? Last September, 116,000 people were waiting for an in-patient or day-case appointment and 429,000 were waiting for a first consultant appointment. That is 545,000 people out of a population of 1·8 million — nearly one in three — who were waiting to see a doctor. The Sinn Féin-DUP duopoly of power-sharing, with stop-start government, began when they took over in 2007; since then, waiting lists have become five times longer. That is not a success but an abject failure in government. It is an embarrassment. In Scotland, the figure is 627,000; Scotland's population is three times that of here. In Wales, the figure is 734,000; there are a million and a half more people there. Before we hear any excuses, the Tories fund them as much as they fund us. Let us therefore not trot out the old lines so quickly but, rather, have a look at our own actions.

More than anything else, it is political inability to solve the problem that is causing and feeding the waiting lists. Stop-go politics is the major harm of our health service. Having a health service that is crippled and unable to take decisions because there is no Minister is causing the real problem.

Solving the waiting list crisis will require a two-pronged approach. One side will deal with those who are on a waiting list now, who need to be seen and sorted. The other will make sure that we never again end up with lists as long as they are and have been. I will come back to that shortly.

On the issue of political inactivity and having no Assembly, no Executive and no Minister of Health, I am somewhat surprised that the party opposite is raising the issue of waiting lists, given that it collapsed the Government in this place for the past two years. An Executive partner collapsed it three years prior to that. I am in no doubt that that hiatus, or double hiatus, saw many people die while they were on a waiting list. They will have died with their health issues unaddressed, left in pain, suffering and a burden on their family, because their health issues could not be addressed in a timely manner. It is a bit of an embarrassment that, of all the parties that could have tabled a motion on the state of our health service, the party opposite — it collapsed the Government here for the past two years, paralysing our officials, preventing them from managing the health service properly and causing the environment that has driven up the waiting lists — has done so. If you cannot draw the line between inactivity, having no Executive and no Government, and the driving up of our waiting lists, that shows a major disconnect from reality.

We are where we are, however. We have waiting lists, and, as I mentioned, a two-pronged approach is required. We must seek a cash injection that will allow the backlog to be cleared. The figures need to be driven down, down, down. That will happen only by asking our already overstretched staff to do more, which is not possible because many of them have been driven to the edge, or by using our private sector. It is there, and we will have to use it, but let us not fool ourselves: such places are often staffed by medics who work in the NHS as well. How many of our constituents have said, "I went to the doctor, and he said that I cannot be seen by a consultant for another six or eight months, but he told me that, if I go privately, I can be seen next week."? Often, it is the same consultant.

We need to clear the backlog, and we will have to use the private sector. That is where our amendment comes in to help, by explicitly calling on the Health Minister to re-fund the cross-border healthcare directive to allow patients to utilise hospital and health services that are often closer to their home than the places to which they have to travel. The scheme was successful and was used by hundreds, if not thousands, of people. There is an opportunity for that to help. If we did something right in the past, let us do it again.

The second prong of the approach that is required is the need to sort out the mess in order to see true and meaningful transformation. It is only through transformation of our health service that we will ensure that waiting lists never again grow to such lengths. We must transform so that patient flow improves. Just a few months ago, 4,000 people were waiting on a domiciliary care package. How many of them lay in hospital when they did not have to? They could not get home because there was no care package. That backlog goes out of the ward, down into the emergency department, out into the ambulances that are parked outside and ends up with people dialling 999 but not being able to get an ambulance to come and help them. The backlog has a chain effect, and we have to break that chain. To do that, investment is needed. It means recognising and valuing our workers in domiciliary care so that it becomes a career that attracts people.

Our cancer waiting times are also horrific, with many of the established targets not being met. Breast cancer patients is just one example. The target is for 100% of referrals to be seen within 14 days. We have not reached that target in 12 years: 12 years. Another example, which people probably do not think is at the top of the list, is dental waiting times. Before we talk about dental waiting times, let us talk about accessing a dentist. Many in our community struggle to get a dentist with whom to register. They struggle to get an appointment, and if they are NHS, forget about it. What is the problem? It is that we do not fund our dental sector properly. It literally costs dentists to deliver NHS work. Who would go to work if it would cost them to do their job? That is not a real-world model. It is not working, and when it is not working, it is people who suffer.

We therefore need to see a transformation plan, with a budget, an action plan and a timescale for implementation of that transformation. We need to see what the changes will be, and, crucially, we need to hear what the benefits will be. The public need to be engaged with and informed so that they can see that the loss of a service from one medical centre, the gaining of another service from somewhere else and the inclusion of a different or changed one will mean better services, better delivery, shorter waiting times, improved outcomes and happier, healthier people. Then the waiting lists will come down. If this is an effective, proper, legitimate scrutiny Chamber, we will never again let waiting lists get to the lengths that they have.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I welcome the opportunity to make some remarks as Chair of the Committee for Health, before speaking as my party's health spokesperson.

Tackling waiting lists will be a key priority for the Minister of Health in the coming years. The Audit Office report 'Tackling Waiting Lists', published in October 2023, outlines some of the key challenges for the Department and the Minister. It states that waiting time targets have not been achieved since 2013-14 and:

"The Department has already stated that the current Framework will not achieve its waiting time targets by 2026".

We therefore cannot keep doing what we are doing and expect lists to get shorter.

As of the end of September 2023, 428,858 patients were waiting on a first consultant-led outpatient appointment. That figure is up from 127,095 in March 2014. That means that, in nine years, almost one in four of our population is waiting on a first consultant-led outpatient appointment. We have 115,929 patients waiting for inpatient or day-case treatment, which is up from 49,341 in 2014. That is one person in every 16 of our population waiting for treatment. We have 188,850 patients waiting for diagnostic tests. That is over twice what the number was in 2014, which was 69,042. That is one in 10 of our population waiting for tests.

Owing to the size of the lists, it can be easy to get lost in the statistics, but, in reality, each of the numbers is an individual in our families and communities. Each case is on a list for a reason and needs to be seen by the experts as quickly as possible.

Unfortunately, due to the size of the lists, people are waiting for record times. The number of people who have to wait over 52 weeks for an initial appointment or treatment is at an all-time high. The figure for people waiting over 52 weeks for ear, nose and throat treatment is as high as 69·8%. As individuals wait on the lists, their conditions get worse. People experience pain, and they are understandably concerned about their condition. That has an effect on well-being and mental health.

Waiting times can be a bit of a postcode lottery. For example, if you live in the Belfast Health and Social Care Trust area, 33·8% of people will wait longer than 26 weeks for diagnostic tests, whereas it is only 13% in the Northern Health and Social Care Trust area. We need transformation of the health system and long-term investment in the health service to allow the capable and committed surgeons, doctors and nurses to deliver the services that they want to deliver. We need to ensure that we have the right infrastructure and resources to treat our most vulnerable people.

We cannot allow people to go on waiting lists and get progressively worse while they wait for the treatment that they need, but that means that we need to take tough decisions on services. It will mean learning from best practice across our trusts and from further afield. It will mean the need for a fully resourced multi-year budget. It will mean training and recruiting more surgeons, doctors and nurses.

In the coming weeks, the Committee will hear about waiting lists from the Minister, the Department, the trusts and other key workforce stakeholders. The Committee will undertake its scrutiny role, and we look forward to considering any action plan that is brought forward by the Minister to address the issue.

I will now make some remarks as Sinn Féin health spokesperson. As we have discussed, waiting lists have continued to soar, particularly in the past years. We have seen some shocking figures over a short time. People face unprecedented waits for the surgeries and treatments that they badly need, inevitably causing their overall physical and mental health to decline further and creating additional pressures on our already struggling health service.

In 'New Decade, New Approach' (NDNA), commitments were made to prioritising tackling waiting lists, yet five years later, not least due to cuts to the fund by over £30 million in an effort to manage budgetary pressures and as a direct impact of the COVID pandemic—

Photo of Sinéad Ennis Sinéad Ennis Sinn Féin 11:00, 20 February 2024

I thank the Member for giving way. When she was talking, I could not help but think of Daisy Hill Hospital, which is close to both our hearts, given that our constituencies are Newry and Armagh and South Down. Does the Member agree that Daisy Hill Hospital is strategically placed on the Belfast to Dublin corridor? Roughly 3 million people can access it within 90 minutes. Does she agree that, while it is positive that Daisy Hill Hospital is now an elective overnight surgical hub, it can do so much more to play its role in tackling waiting lists and that we need the Minister to publish a plan for investment in Daisy Hill so that it can help to address some of the issues with waiting lists that we are speaking about?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Member for her intervention. That point is critical. As she said, Daisy Hill is a hospital that is close to both our hearts, but it is a very important hospital in our hospital network. It can offer so much to tackle the issues that we are dealing with today, with the fantastic staff and services and, most importantly, its key location in an all-island respect. That is a very important point.

Fundamentally, if we are to tackle the huge problem of waiting lists, we need to address the workforce crisis impacting across our health and social care system. If we do not have the staff required to deliver the services that are needed — that means the domestic staff in our hospitals, theatre nurses and doctors, specialist surgeons and consultants, auxiliary staff, domiciliary care staff and rehab staff; all those staff, who cover a wide variety of roles, with whom a patient will come into contact on their journey before, during and after they receive the surgery or treatment that they have been waiting for — the problem will only get much worse.

It is positive that the Executive have prioritised public-sector pay, and I hope that that will go some way to ensuring that we can retain the fantastic staff that we have and, in the longer term, attract staff to fill the thousands of vacancies that continue to exist in every corner of our health service.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Will the Member bring her comments to a close, please? Time is up.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

Do I not have an extra minute? Sorry.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

I call Danny Donnelly, who is the Deputy Chairperson of the Health Committee.

Photo of Danny Donnelly Danny Donnelly Alliance

I thank Mrs Dodds and Mr Robinson for tabling the motion. I look forward to working with both of them as fellow members of the Health Committee. My party will support the motion.

The current waiting times in Northern Ireland are deplorable and unacceptable. As stated in the motion, none of the formal waiting targets for health and social care services in Northern Ireland have been met since 2014. Some of the more specific statistics are truly shocking.

The Northern Ireland Audit Office report has highlighted just how rapidly the number of people on waiting lists has risen. For example, from March 2014 to March 2023, the number of people waiting for an initial outpatient appointment rose by 216%; the number of people waiting for hospital admission rose by 147%; and the number of people waiting for diagnostic tests rose by 151%.

The same report highlights how, without imminent action, those numbers will only get worse. For example, the Department of Health's elective care framework has projected that outpatient waiting numbers could grow by 91%, from 335,000 in 2021 to 640,000 by 2026, and the inpatient waiting list could grow by 206%, from around 100,000 in 2021 to 306,000 in 2026. Those numbers are surely not sustainable in a population of approximately two million. Those are huge numbers, but it should not be lost on any of us that they are our families, our friends, our neighbours and people in our communities. People are living in pain, losing their mobility and suffering from mental health issues and loss of well-being while they wait for tests to see whether they have a serious illness.

Previous attempts to reduce waiting times have not been successful. A previous departmental initiative, the elective care plan in 2017, had a target of ensuring that all patients would be seen within one year but did not meet its prescribed targets. On the basis of the aforementioned 2026 projections, the Department will not meet its targets as set out in the elective care framework from 2021.

We need to ask why waiting lists are so long in Northern Ireland, especially when compared with the rest of the UK and Ireland. Many of the issues facing Northern Ireland and our health system have been national or international in nature, such as the impact of austerity, Brexit and, especially, the COVID pandemic. However, we do not see such devastating numbers in England. We cannot ignore or forget the damage done by political instability in this place, particularly the fact that we have not had an Executive, a Health Minister or a Health Committee for five of the past seven years. In the two years when those positions were filled, the people in them, understandably, had to prioritise managing the pandemic, which made meaningful reform impossible.

It is welcome that we are back in the Chamber debating this and other vital issues, but, until we have a truly sustainable political system, we will not be able to deliver the transformation that is urgently needed. With that in mind, we must reform the institutions to ensure that one party can never again hold down the entire political process. It will not be lost on anyone that waiting lists got much worse during the period when the Assembly was not functioning.

There are key issues specific to the health system that I encourage Minister Swann and the Department of Health to consider. One of the reasons why our waiting lists are so long is that too many people are referred on to them in the first place rather than being diagnosed or treated quickly along a more appropriate pathway. As highlighted in the Bengoa report, the majority of HSC resources are invested in delivering acute care, and, as a result, some services have been delivered suboptimally. The evidence is clear: specialised procedures concentrated on a smaller number of sites and dealing with a higher volume of patients will improve outcomes. We support such reforms, focusing on providing diagnostics and treatments far more quickly, especially in primary care. That will assist in bringing down waiting lists.

Another issue that remains is the difficulties in recruiting to the workforce and, in particular, vacancy levels. On 30 September 2023, there were 6,920 HSC vacancies across Northern Ireland, which is a vacancy rate of 8·2%. That represents a 14% increase when compared with September 2018. A major issue remains the lack of legislation on safe staffing and adequate pay. Those are two very important issues, and I encourage the Minister to legislate on them before the end of the mandate.

There are other issues that are specific to Northern Ireland. For example, the higher wages available in the Republic of Ireland have led many consultants to work there while continuing to live in Northern Ireland. That has exacerbated consultant vacancies. On top of those factors is the intensity of the COVID-19 pandemic, which our health service has not fully recovered from. I know that those issues are well known to the Health Minister, and I look forward to his plan —

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Will the Member bring his remarks to a close?

Photo of Danny Donnelly Danny Donnelly Alliance

— for beginning to address and progress transformation.

Photo of Alan Chambers Alan Chambers UUP

I welcome the chance to participate in this important debate. It has been two and a half weeks since the restoration of the Assembly and the Executive, and today's debate will, I hope, act as an important early opportunity for all parties in the Chamber to put on record their commitment to making tackling waiting lists one of their greatest priorities.

The position with Northern Ireland waiting times is utterly abhorrent.

It is as outrageous as it is morally intolerable that we have so many people on waiting lists. We must never forget that it is recognised that, with the passage of time, some patients come to even greater harm while they endure the stress and pain of delay. I am sure that every MLA will know a friend or family member who is on a list for a consultation, a test or a procedure. Similarly, we will all have been shocked by the stories, experiences and, sometimes, delays that have been encountered by our constituents.

As the motion rightly puts it, waiting times have been falling behind for the past decade. There are lots of reasons for that, but I will mention only two. The first is that decisions were consciously taken at that time by previous Ministers and senior officials to no longer bridge the gap between limited capacity and increasing demand with additional funding allocations.

Photo of Steve Aiken Steve Aiken UUP

Will the Member give way?

Photo of Steve Aiken Steve Aiken UUP

Does the Member agree that the issue has been support not being given to the Health Minister previously and that what we need now is a dedicated commitment from all Executive parties and everybody around the table to support our Health Minister in his difficult task?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Alan Chambers Alan Chambers UUP

I absolutely concur with those remarks.

Whilst I understand that the Executive were facing financial constraints of their own, such unilateral cessation of funding put many waiting lists into a tailspin. As I said during the Budget debate yesterday, what would benefit the health service most is longer-term funding certainty, but, in the absence of that, specific waiting list initiatives would have been critical in slowing the tide.

Secondly, an equally damaging slate of decisions or steps was taken on workforce. Critical training positions were either reduced in number or did not keep up with the necessary rate of expansion. Unfortunately, that left the workforce too small and fractured to be in a position to reverse what quickly became a rapidly deteriorating waiting list position.

Whilst I note that the motion asks for an action plan within the next six weeks, with respect to the Members who tabled it, we do not need any more words down on paper; we need focused and targeted delivery of what has already been said to be deliverable, to which all political parties previously gave their support.

The proposer mentioned the capacity that is available in the private sector. I suspect that the Minister would love to take up the offer over the next six weeks, if he had the money. Whilst, every so often, there is a glimmer of hope, such as the restoration of pay parity in January 2020 or a big expansion in training numbers, sadly, the failure of politics often gets in the way of permanent improvements, and regression creeps back in.

I am fearful that, in the time ahead, we will look back to the most recent two-year period of political stalemate and the three years from 2017 to 2020 and see just how much enormous physical and mental harm was inflicted on so many of our people. Whilst there has been some hugely welcome progress made with the strategies and action plans that were published in 2021 and 2022, like so many other important areas of work, they have suffered as a result of funding uncertainty.

Of course, it is not just the people who are stuck on waiting lists who have to endure the fear and concern of delay. We should never forget the moral distress being felt by clinicians. They can see the needs of their patients, yet, all too often, they know that the patient is not getting the support that they need and that, their skills and judgement tell them, is necessary. That is why it would be unforgivable if we did not maximise every opportunity that is available to us in and outside the health service.

The proposer, in her opening remarks, referred to "uncomfortable truths". There should be no doubt that our absence from the Chamber for five of seven years has not been helpful to any of our public services. We owe it to the people of Northern Ireland to work together to pull our health and social care system back from the brink. We will achieve that only by working together and not making health a political football. However, I have a sense that we may drift into that situation. The public of Northern Ireland will not thank us for doing so.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin 11:15, 20 February 2024

I will speak in support of the motion and the amendment. We all know that the current situation with waiting lists is completely untenable for patients and for our staff.

Other Members mentioned cancer, domiciliary care, gynaecology and oral health, but we know that mental and physical health are intimately linked. Long waiting lists for mental health services are also unacceptable. Aside from elective care and physical health, poor mental health alone costs the economy here £3·4 billion each year. At any time, one in 10 of our children and young people are experiencing anxiety or depression. We heard recently — this was carried in the media last week or the week before — that 10,000 children sought mental health support last year and that a third of them were still waiting for their first appointment at the end of 2023.

The motion also refers to the fact that people need to receive that same-time access, regardless of their postcode or where they live. We all know that, at present, that is clearly not the case. The children's mental health story that was covered the other week shows how waiting times vary between trusts. Average waiting times went from five months in the Belfast Trust to fewer than nine weeks in the Southern Trust area. That is definitely an issue that we need to grapple with, because it is not fair. Some children wait years for mental health supports. The longest wait was in the Belfast Trust, where some children waited nearly two years. Obviously, in protecting our young people and looking out for children, those waits are just wrong, and no family or child should be that long on a waiting list.

At the moment, child and adolescent mental health services (CAMHS) funding is approximately £20 million to £25 million per year, which is between 6·5% and 8·5% of the overall mental health budget. I know that, in the mental health strategy, the hope is to increase that percentage of the budget to 10%. I hope that that will be the case, because it will help with overall waiting lists.

The recent workforce review on mental health showed that we need almost 2,000 additional workers to provide adequate mental health services. Again, when we talk about an addition to funding for waiting lists, which is absolutely an immediate priority, we also need funding for additional training places and for our workforce. In mental health, that would be specifically for psychology and psychiatric services.

Photo of Deborah Erskine Deborah Erskine DUP

I thank the Member for letting me intervene. I know that mental health is a real passion of hers. Does she agree that we also need to ensure that the community and voluntary sector are included in mental health provision in our communities?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

I thank the Member for the intervention. I completely agree. My next point was coming on to early intervention and how, in some avenues, we can get in more quickly with children to prevent them going on to different waiting lists for different issues when they grow into adulthood. The community and voluntary sector is critical to all that as well, so thank you very much for that.

It is important that people are provided with the right support at the right time. Regardless of whether you start with a mental illness or a mental health problem, the longer you have to wait to be seen will have an impact on your physical health, and, vice versa, if you are on a waiting list for a physical health problem and you have long delays in being seen, that can impact on your mental health. We need a two-pronged approach to support people with both physical and mental health issues.

From stats on the waiting lists for adult mental health services, we know that those lists have almost doubled over the past four years. The number of young people who are waiting for access to CAMHS has tripled over the past four years. As someone mentioned, we need to make sure that it does not come down to people's personal finances in terms of how soon they can be seen or treated. We know that not everyone can afford it. The people who can least afford and pay for it are, sadly, those who live in our most deprived areas. Again —.

Photo of Danny Donnelly Danny Donnelly Alliance

I agree with the Member. It should be noted that Northern Ireland households have the lowest disposable income in the UK as a whole. We have lower capacity to access private medical healthcare. I am aware of people who have used large chunks of their savings or have even borrowed money to access medical care. Does the Member agree that that has created a two-tier health system?

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

Absolutely it has. It is completely unfair to expect any family, especially families who do not have the means or finances, to have the additional pressure of paying to get their loved ones seen and treated for their healthcare.

Am I out of time, Madam Principal Deputy Speaker?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

No, you have another few seconds.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

OK. To finish off, we recognise the impact on patients' mental and physical health, but we also know that being on a waiting list is having a massive impact on the lives of people who are watching this debate. On the amendment, any practical steps that we, the Minister and the Executive can take to help with waiting lists need to be made a priority for everyone. I support the motion.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Since this is Alan Robinson's first opportunity to speak as a private Member, I remind the House that the convention is that a Member makes their first speech without interruption.

Photo of Alan Robinson Alan Robinson DUP

Thank you, Principal Deputy Speaker. I congratulate you on your recent elevation in the House.

Before I begin my remarks on this very important topic, I will step back two years to offer my appreciation to those across East Londonderry who ensured that there would be two members of my party to represent their interests. I also pay tribute to George Robinson MBE, whom I replaced in the seat.

Some Members:

Hear, hear.

Photo of Alan Robinson Alan Robinson DUP

George served for 18 years in this place. He began his almost two-decade stint here at the very youthful age of 62.


Unfortunately, having enjoyed only 11 months of retired life, he was struck down by ill health. Typical of the man that George is, however, he has fought his way back. He is living independently again, he is back driving and he is back enjoying following Irish League football. I am sure that the House, and especially those Members to my right, will extend good wishes to him as he returns to good health.

Some Members:

Hear, hear.

Photo of Alan Robinson Alan Robinson DUP

That this is my maiden speech allows me to speak a little from a very personal perspective. It allows me to express my frustrations, as someone with long-standing health conditions who has been on multiple waiting lists and who has just recently been put on yet another. Today, we will all be able to share stories of constituents who have visited our offices seeking assistance in the hope of climbing a lengthy waiting list. All of us can give accounts of people whom we represent who have no other option but to part with their life savings or to borrow many thousands of pounds for urgent treatment, forcing themselves into a world of debt. These are good, decent, salt-of-the-earth people who may have worked themselves to the bone all their days and paid into the NHS only to be let down. I mean this with the greatest of respect, but, while they part with money that they can ill afford, others cannot do that. Those people descend into greater ill health, which, ultimately, becomes more complex and expensive to treat. Some even die. That is the stark reality that we are dealing with.

While we could all fill today's business with examples of human suffering, we must also deal in the hard facts. We heard earlier that, as of September 2023, 429,000 people were waiting on a first outpatient appointment, of which half were waiting for a year. Some of those people will die; at best, their quality of life will be poor. Those waiting times are the worst in the UK and amongst the poorest outcomes in Western Europe. We also heard earlier that one quarter of all cancer diagnoses between 2012 and 2017 were made in emergency departments (EDs). A postcode lottery is being played out in cancer treatment waiting times, with the Western Trust seeing much better performance towards meeting targets than other areas.

I could go on and on, but I simply do not have the time. When it met last week, the new Health Committee heard the stark reality that we all must bear. The £34 million from the British Government to tackle waiting lists is nowhere near enough. Indeed, it would take hundreds of millions of pounds and many years to properly address the situation. Those are not my words, but those of senior health officials.

That brings me to my personal experience with one such waiting list on which I was placed several years back, when my GP initially told me that I would have an 18-month wait. Eighteen months came and went, then 19 months, 20 months and 21 months. When I became aware that the consultant also carried out work in the private sector, I queried, merely out of interest, how soon I could be seen. The answer from the consultant's PA was, "Can you attend next Thursday?". The take-home message for me was that the wealthy can stay healthy while the rest of us just have to wait. The right to health should belong to everyone.

It also showed me that the capacity in the private sector should be grasped. The use of private hospitals and providers across the British Isles and further afield is critical and looks like the only short-term option. This should not be focused just on surgery but on the full suite of professional skills and services needed to reduce the current backlog. I accept that there have been gains in recent times with the ongoing development of dedicated elective sites, including regional day case and overnight stay centres. However, significant further expansion is required if we are to see better progress in dealing with waiting list backlogs. We must maximise outcomes from additional investment. Continuing with the same level of small contracts with independent providers cannot deliver the tangible progress that we crave. The Department of Health must be seizing opportunities to —

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Will the Member bring his remarks to a close?

Photo of Alan Robinson Alan Robinson DUP

— forge larger national and local partnerships with the NHS in other parts of the UK and independent providers to crack down on waiting lists.

Photo of Alan Robinson Alan Robinson DUP

We owe it to the thousands upon thousands of our constituents —.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Time is up. Thank you.

Photo of Nuala McAllister Nuala McAllister Alliance

I support the motion and am grateful to the Members who tabled it. Indeed, at our first Health Committee meeting last week, all the members shared this issue. We look forward to having the Minister at the Committee to discuss plans to tackle waiting lists soon enough. As I said last week about the women's health strategy, we recognise, Minister, that you have only been in your post for a number of weeks, but you were the Minister for a number of years before suspension, so I do not doubt that you can really hit the ground running and that you will come back to us, maybe not in six weeks but, hopefully, soon enough, to set out what actions it will take to drive those waiting lists down.

Today, we have heard from many Members that, despite our spending more per head in Northern Ireland than anywhere else in the UK, we have by far the longest waiting lists. Often, those who have the means to pay go private, further exacerbating the problem, as Mr Robinson said. I assume that he was referring to the same consultant who he was waiting to see through the NHS but could pay privately to see them quickly. Where is the equity in that for the people of Northern Ireland? As many Members have said, we really need an NHS that is free at the point of entry, from the cradle to the grave.

One of the reasons why the waiting lists are so long that I want to focus on is that there are no spaces in our hospitals, because their bed capacity is maxed out because people cannot be discharged on time. In recent years, especially around the Christmas period, when times are really tough, families have been asked to come and pick up their loved ones or maybe look after them at home. Really, in this day and age, we should not have to rely on loved ones to take on the care of people who deserve it, whether in hospital or in their home. Why are we at that situation? It is because domiciliary care is not sufficiently funded. Also, how we appreciate that service is not sufficiently tackled. When we pay people the lowest of wages, what do we expect? They are not going to stay. They are going to go elsewhere, further exacerbating the problem. We need to invest in the domiciliary care workforce so that those who can enter, either through short stays at rehabilitation or at home, can be sufficiently targeted to do that.

At the Health Committee last week, I raised the options around domiciliary care and where we go with the future, particularly the 15-minute wait. We all know elderly loved ones who do not want to have people come into their home to take care of them, but they need that and so they accept it. However, when they have people coming in, dropping and going — just doing a check, 15 minutes and out — that is not the service that we expect. I raised the issue of the 15-minute visits and whether we can we get to a point where we move on from that. Investing in that service and in the workforce and upskilling people will really help to create that bed capacity and get people off the waiting lists.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Member for giving way. She raises a very important point, and it comes back to the workforce. Therein lies the problem. To start to address the workforce crisis, we first need a plan to do this, and we need to see that plan. I understand that there are reviews going on, but we need to see a plan published, and we need the proper funding to support this. That is why we need to continue making that case to the British Government to be properly funded here so that we can deliver on all these things.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Nuala McAllister Nuala McAllister Alliance 11:30, 20 February 2024

I agree, and no doubt the Minister also agrees that the British Government should fund us to our level of need. We will continue, like all Executive parties, to make that case.

I was just coming to the issue of the 2023 Audit Office report on tackling waiting lists. A number of Members have mentioned it today, and I hope that the Minister can give us an update on where we are with nine of the recommendations from the report. A number of organisations in Northern Ireland do a lot of work for people in the sector, whether that is Carers NI, the Royal College of General Practitioners or the Royal College of Surgeons, and they all have their thoughts on how we can actually move forward. We need to listen to them. They are the experts who work with people every day. In fact, the Royal College of Surgeons said that, over the next four years, 91% of surgeons could retire. Where is the succession planning? Where is the workforce training to ensure that there is not a huge gap that will further exacerbate the waiting lists?

I want to talk about where we should go. The Alliance Party would like to see policies such as those implemented in some of the Nordic countries. Sweden has the 0-7-90-90 rule for non-emergency care. You see your GP within seven days, a specialist consultant and diagnosis within 90 days and treatment for that within a further 90 days for non-emergency care. That is the long-term vision, and I recognise that there is a lot of work to get there. I recognise that this will not be done just by parties speaking up in the Chamber. It needs to be done by leadership from the outside too.

I call on all parties, not just those in the Executive but the Opposition parties too, to get behind reform in health care. I understand what the Members in the Opposition said, but when Members such as Justin McNulty stand up at meetings about Daisy Hill Hospital and mock Bengoa, what does that say about the Opposition's credibility in leading on healthcare reform?

Photo of Nuala McAllister Nuala McAllister Alliance

I will because I mentioned you, but I am running out of time.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

How can the Member dare to deride me for standing up for the people that I represent and who deserve equality and a good healthcare system? How can you possibly dare stand here and deride me for standing up for the people that I represent and the patients who are struggling with the inability to access healthcare systems the way that everyone else can across the North? That is very unreasonable.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member's time is up.

Photo of Gary Middleton Gary Middleton DUP

I congratulate you on your elevation to the position of Principal Deputy Speaker. I also congratulate my colleague Alan Robinson on his excellent maiden speech today.

Some Members:

Hear, hear.

Photo of Gary Middleton Gary Middleton DUP

I will begin my remarks by paying tribute to the fantastic and dedicated health and social care staff across Northern Ireland. Many of them are working in conditions that are very difficult and stressful. I want to put on record our thanks to them, first and foremost.

As others have mentioned, it is a sad reality that here, in Northern Ireland, our waiting times are not only the worst across the United Kingdom but, indeed, are some of the worst across Western Europe. Over a quarter of Northern Ireland's population is on a waiting list. It is also a sad reality that a growing number of people in our communities are dying while languishing on waiting lists.

The findings of the Northern Ireland Audit Office report send a stark signal of the need to urgently address the missed targets and the evergrowing waiting lists across the board. Of course, I have particular concerns about cancer targets. The latest figures that I have show that only the Western Trust met its target for patients diagnosed with cancer receiving treatment within 31 days. As an MLA for Foyle, I welcome this particular position and the target being met in the Western Trust, but the reality is that there are many different pictures across other trusts in Northern Ireland. Just 34% of patients with suspected cancer who were urgently referred by a GP began treatment within 62 days. That is against a 95% target. The Western Health and Social Care Trust's figure was 44%, whereas the Belfast Trust had the lowest percentage, at just 22·6%. Of course, there are big disparities across the various specialisms within the sector. Just 52·9% of patients were seen within 14 days of their urgent referral for breast cancer, against a target of 100%. Unfortunately, no trust achieved that target.

The postcode lottery for services is simply not sustainable. Yesterday in the Chamber, we spoke about the economy and the need to address regional imbalance. We need to ensure that regional imbalance and regional inequalities are addressed across the health sector. There are similarly concerning statistics across all levels of the health and social care system. We have heard today about how people are waiting an extraordinary amount of time to access mental health services and drug and alcohol services that would, no doubt, go towards improving their life, or even saving their life.

Photo of Deborah Erskine Deborah Erskine DUP

I thank the Member for giving way. I am glad that he mentioned drug and alcohol services. While people are on a waiting list, their mental health deteriorates, and some turn to drug and alcohol abuse, which will mean more of a cost to our health service. We are therefore seeing problems in other services as a result.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Gary Middleton Gary Middleton DUP

I thank the Member for her intervention. It is a very timely point. The Member touched on the community and voluntary sector earlier and mentioned the various organisations that help alleviate pressure and ensure that there is not a greater cost down the line. The problem that I have, and the concern that many of us have, is that the cost could ultimately be a life, and that is something that concerns us all.

I also raise the need to address urgent and emergency care in our emergency departments. There is a frustration at the number of people who unfortunately cannot access their GP. In the statistics that I have, it is stated that almost 20% of people attending have been referred to our emergency departments by GPs. That accounts only for those who were referred, however. There are also many people who unfortunately cannot get through to a GP. They therefore present at the emergency department, even though that may not be the most appropriate place for them to be.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Member for giving way. His time is running out, so I will make just a quick point about access to GPs. As other Members have said, when people are on a waiting list for a long period, they start to develop other conditions that will require them to present to their GP or at an emergency department more often. Does the Member agree that we should use all the tools that are readily available to reduce waiting lists in the here and now, including the reinstatement of the cross-border healthcare directive, which we know has been very successful and works well for our constituents right across the North?

Photo of Gary Middleton Gary Middleton DUP

Absolutely. We need to look at every type of initiative. In our GP services, we see the use of multidisciplinary teams. There are various mechanisms that we need to use, and we cannot rule things out. We need to be looking for the best possible outcomes for our constituents.

The Audit Office report sets out a number of recommendations. I agree with other Members that we have had a lot of strategies. We now need an action plan. We need something that we can point to and say, "This is now the course of action that we are going to take". We have waited far too long for our waiting lists to be addressed. Now is the time to bring forward an action plan and ensure that we can deliver for our constituents.

Photo of Paula Bradshaw Paula Bradshaw Alliance

I support the motion and the amendment. I will focus on what we have learnt from the Audit Office report, and from other reports and evidence, about how we can do things differently.

The Audit Office report refers to the need for extra money, and we need to be clear about one thing, which is that the Department of Health already spends approximately £4,000 for every person in Northern Ireland. I appreciate that we have an ageing population with multi-morbidity and therefore more expensive treatments, but we have to recognise that we cannot continue to have a greater percentage of the overall budget share, so we need to use our money more efficiently. Can the Minister outline — if not today, at some time in the future — how he will ensure greater financial accountability of commissioned services in our trusts?

Those who sat on the previous Health Committee, and others who are watching the debate, will know that if a trust is given a certain amount of money for, for example, 30 orthopaedic surgeries, and it delivers only 20, it does not have to give back the money for the 10 that it did not deliver. I have no doubt that the trust then uses the money efficiently and for good ends, but there is no accountability and transparency of its use of the money.

That leads me on to my second point, which concerns the use of locums. I met the former chief executive of the Belfast Heath and Social Care Trust in, I think, 2016. He said at that time that we needed legislation here in Northern Ireland to put a cap on the amount of money that is spent on locums. That was eight years ago. I very much take Colin McGrath's point about the stop-start nature of our politics here, but we need to look at the amount that we are spending on our locums.

My third point is about the effective use of our consultants' time. As people will be aware, consultants are given a certain number of slots each week that they have to deliver. If they use one of those slots to travel to Enniskillen, and then spend some time doing work there before travelling back, two slots that week will have been lost. We need to look at the better use of our consultants' time.

We have heard a lot of figures being quoted today about how many people are on waiting lists, but we are talking about cases rather than people. Some people may be on three or four waiting lists. I would appreciate it if the Minister could tell us how he is going to use that information and bring it forward so that we have a far clearer picture. It is ludicrous that such a percentage of our population is on waiting lists. We need better clarity around how that information is collected and presented.

My party will support the amendment about the cross-border healthcare directive, but people need to be clear: that means that we will be using public money from Northern Ireland to pay private hospitals in the South. I have many constituents who are delighted about that scheme and want it to be brought back. I want to see it being brought back as well. However —.

Photo of Nuala McAllister Nuala McAllister Alliance

Will the Member take an intervention?

Photo of Paula Bradshaw Paula Bradshaw Alliance

No, I am going to allow an intervention from the proposer of the amendment. Is he also in favour of extending that scheme so that anybody who is on a waiting list can use any private provider across the island, North or South? Is that what the amendment is about?

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

It is about making sure that we drive down those lists by using any opportunity that there is and any weapon at our disposal. People cannot be on waiting lists for any longer than they currently are.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Principal Deputy Speaker.

Will the Minister refer to that? I have never received a straight answer about that from the Department of Health. If we are OK with sending money to the South — I have no problem with that if it gets people from my constituency off waiting lists — why do we not afford the same opportunity to private providers in the North to drive down our waiting lists? I would like an answer on that.

There are two final areas that I will focus on. My colleague Nuala McAllister briefly referenced them. These are very crude figures, but it costs £700 a month for domiciliary care, £700 a week for a place in a care home and £700 a night for a hospital bed. I would like the Minister at some stage — probably not today — to bring forward his plans for how we are going to bolster our social care sector here in Northern Ireland. I have no doubt that that needs a lot more investment, but I would like to see those plans. We had Power to People in 2016. Although great work has been done by the departmental officials etc, we need firm action. I agree with Alan Chambers's point in that regard: let us stop talking about it and get on with it.

We, as a party, want to see transformation. We want to see Bengoa delivered. We have always very much supported the elective care framework, but we want to see the long-awaited hospital reconfiguration design plan. We need that consulted on, and we need to bring forward the plans. We need action, not words.

Photo of Sinéad McLaughlin Sinéad McLaughlin Social Democratic and Labour Party

I imagine that everyone in the Chamber knows someone who is waiting on a health procedure, whether they are a family member, a friend or a colleague. We have all seen people waiting for an interminable time for operations that they should be able to expect in a matter of months. I have lost count of the number of constituents whom I have met who are wrecked with stress and anxiety from waiting for years on an appointment that could be life-changing but which feels like it may never arrive.

Last week, we debated the priority that is given to women's health. One area of waiting lists is for gynae services. Responding to a survey that I delivered last year on women's experience of accessing care, a woman told me about her long wait. She said:

“It’s taken me almost four years to get some form of outcome even though I still believe they have misdiagnosed me. I am worse now than when they tested me but I am told a long waiting list is ahead again”.

That is a moral outrage in 2024. It is a fundamental failure of government.

I welcome the urgency of the motion, but, with the greatest respect, never mind six weeks from now, we should have been here to deliver two years ago. The consequence of the latest collapse and, indeed, the one before it, has been that we have let more people wait in agony in a two-tier system, where only those who can afford to be seen get through the door. Those are the human consequences of constant collapse. It is yet another reason — in case we need any more — why we should commit to never collapsing this place again.

The transformation of our health service will take time and much longer than it could have otherwise taken. In the meantime, we need to follow what works, and that includes restoring the cross-border healthcare directive. We are one island, and we all know that health problems do not stop at borders. Brexit was a serious blow to our health service, not only because it removed the cross-border healthcare directive but because, under freedom of movement, we had the ultimate cross-border healthcare directive for our medical professionals. That is something that we all feel and all regret, and it has added to the waiting times. The very least that we can have is an arrangement again with our closest neighbours. That is a sensible and practical step that could make a real difference to people across our communities. I know that it has served many of my constituents really well.

Photo of Sorcha Eastwood Sorcha Eastwood Alliance 11:45, 20 February 2024

I thank the Member for giving way. Does she agree that the UK Government's announcement yesterday about care workers and others not being able to bring their family members with them is utterly punitive and flies in the face of any realisation of the struggle in health and social care across the UK and in the North? Does she agree that that needs to be rescinded at the earliest opportunity?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Sinéad, you have an extra minute.

Photo of Sinéad McLaughlin Sinéad McLaughlin Social Democratic and Labour Party

Thank you.

I absolutely agree with the Member. It is self-sabotage. It is unbelievable that any Minister would take that tone and direction when the health service is in complete disarray due to the Tory Government. That is all I can say.

In the Western Trust alone, more than 700 patients benefited from the Republic of Ireland reimbursement scheme. Restoring it is common sense, and I hope that Members from across the Chamber will support that. Of course, that is just one measure that we can take while we grapple with the longer-term transformation of our health service so that we can bring down waiting lists once and for all. It will not solve the crisis overnight, which is the product of decades of underfunding, political collapse, dysfunction and poor accountability, but it will make a difference to some patients.

The motion rightly draws attention to regional disparities in access to our health service. It is true to say that there are huge imbalances in our health outcomes. Although the crisis affects almost everyone, it does not affect everyone equally. In recent years, the figures have shown that male life expectancy has declined in the most deprived areas of Belfast and Derry. In the Western Trust, male life expectancy is almost seven years lower than the trust average, and 24 of our health outcomes are worse than the Northern Ireland average. In my city and region, we have a crisis of addiction and poor mental health, driven by poverty and the failure of government to address that poverty. It appears that our health service provision has been regionally blind, failing to step in to address disadvantage. No weighted deprivation formula has been apparent, and that has fuelled the poor health outcomes. We need a different approach that prioritises disadvantage and directs investment where it is most required.

Photo of Sinéad McLaughlin Sinéad McLaughlin Social Democratic and Labour Party

I want to get this finished, sorry.

I hope that the motion is supported across the House and, more importantly, that it leads to change for patients who are desperately in need.

Finally, I thank our healthcare workers across the Province who do amazing work in difficult circumstances. I call out to our community and voluntary sector, which has lost funding over the years, for stepping in.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member's time is up.

Photo of Sinéad McLaughlin Sinéad McLaughlin Social Democratic and Labour Party

It also deserves our grateful thanks.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Before I call the next Member to speak, who is Sorcha Eastwood, I will just say that Sorcha Eastwood, Justin McNulty and Gerry Carroll are being included on the Speaker's list in what is known as the "grace period", so, if any of you take an intervention, you will not get an extra minute. If that is understood, I call Sorcha.

Photo of Sorcha Eastwood Sorcha Eastwood Alliance

I want to take the opportunity to speak on behalf of my constituents who are impacted by cancer, which impacts on everybody across Northern Ireland. At the minute, we deal constantly with emails from people who are on red-flag referral waiting lists, particularly for breast cancer, and are living in utter anxiety.

Many families know what it is like to get that call, letter or email — whatever the form of communication — to say, "We think you may have cancer". Let me tell you this: those are the longest hours and minutes that you will deal with in your life. We have condemned people across the North to waiting unnecessarily by smashing through the targets that we set for them. We need to get really serious about the fact that that causes people hurt and harm. It would be remiss of me not to speak on behalf of those people today.

The other thing that is crucial in addressing the crisis for all waiting lists — not just elective but every unction that we have — is the workforce. I sit on the Committee for the Economy, and I have raised that at every turn in the road, saying that the Health Department cannot do this alone; it needs support from across the aboard. When it comes to the Department for the Economy, the wee bit of a difference that I can make is asking, "What are we doing to make sure that we have enough training places in our universities? What are we doing to make sure that health and social care workers are valued, that they have career progression and career pathways and that we, as a society, value that work and consider it important?" Let us be honest: in the past, far too many people have been content to sit back and regard that work as requiring low or no skills, unimportant and worthy of little pay. Yet those are the people who pick our families up off the floor when they are at their most vulnerable. Those are the people who go into our families' homes at 2.00 and 3.00 in the morning to help with PICC lines or drivers, and those are the people whom we are not respecting and giving those pathways and that prestige to.

As I said, we will not counter this problem through one Ministry, but I know that Alliance will not be found wanting when it comes to supporting and working with the Health Minister, and we will do so with an open hand and an open heart.

We talk about transformation, and I get that it is not easy. However, when you have a loved one sitting in hospital facilities for three and four months at a time in accommodation that, if it were anywhere else, would not be fitting, you understand that that is why we need to transform. We need to do that so that my family member does not have to go through what your family member went through.

It is easy to say, "We want everything", but the only way that we will get that is by being realistic and honest and doing things in a structured and strategic way that means that everyone can get what they want. However, we need to do it together; it cannot be just one Department in isolation. The Minister will have my support and that of my colleagues.

I thank the Principal Deputy Speaker for giving me time in the grace period to make my points.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

I support the motion and the amendment.

This is an extremely important debate. I thank Mrs Dodds and Mr Robinson for tabling the motion. I also thank my party colleagues Colin McGrath, Sinéad McLaughlin and Patsy McGlone for their important amendment.

Let us make no mistake about it: waiting lists and waiting times for health and social care services in the North are not just a crisis; they are a scandal. Throughout today's debate, let us endeavour to reject any assertion that the crisis has been brought about as a consequence of the pandemic. As the motion rightly points out, we have not met a formal waiting-time target in the North since 2014. That is six years prior to the onset of the pandemic.

The statistics are startling, scary and sad. People and families are languishing while trying to manage their pain and despair. However, I want to guard against the urge to complain about the problem and instead focus on identifying solutions. One of the most obvious and inescapable solutions to the need to revive our health service and address the crisis in waiting lists centres around pay and conditions for health service staff. Whether it is on burnout, sickness rates, attrition levels, forced migration, patient and staff safety or the inability to attract necessary personnel, health service workers are being failed. I have seen that clearly in my constituency, where there was an exodus of medical specialists from Daisy Hill Hospital because the Southern Trust stonewalled them after they raised legitimate concerns about management decisions and genuine grievances about the terms and conditions of their working arrangements.

The most critical part of the debate centres around our NHS staff. Without them, nothing works. If they are not looked after, patients and their clinical outcomes will be impacted. With that in mind, the Assembly and Executive should tackle the most fundamental issues first. We know that staff are at breaking point. That is why junior doctors have voted for strike action, why more nurses leave the system every year than enter it and why bright brains and hard workers take their qualifications and go to practise in the UK, the Republic, Australia, Canada and elsewhere. I wholeheartedly welcome the Executive's commitment to fund the public-sector pay award, but we need to do better than play catch-up with pay packets. We need decisive action and ambition from the Executive to make the North the most rewarding place on these islands to be a healthcare worker. I fully appreciate that that will be a long-term and considerable undertaking for the Executive, but there is no escaping the fact that we need radical action to address the crisis in our health service.

If we need radical action in the long term, we need sensible action in the short term. The most effective step that the Executive can immediately take is to reinstate the cross-border healthcare directive, as stated in my party's, the SDLP's, amendment. That would allow people languishing on Northern Ireland's waiting lists to access treatment in the Republic as a matter of urgency. It would help to remove pain and restore patients' dignity and quality of life far more quickly than if we were to try to muddle through on solutions that have already been tried or that are rehashed.

Waiting lists in the North are not just a crisis; they are a scandal. Everyone is watching this place with hope and goodwill. The people we represent expect an awful lot more than the same old Stormont solutions branded differently and trotted out for show. We have heard and will undoubtedly hear more about the transformation and fundamental reform of the health service. I respectfully contend that fundamental reform should begin at the fundamental level of pay and conditions and with care and compassion shown for our health service staff. If we get the basics right, we will have a foundation to build on, but, if we continue to pay our health service staff poverty wages and expect them to get excited when we sign off on a pay rise that is two years late, none of us can be surprised when doctors, nurses, allied health professionals (AHPs) and medical specialists vote with their feet and take themselves and their talents to a jurisdiction that will pay them what they are worth. Who could blame them?

I will finish by saying go raibh míle, míle maith agaibh

[Translation: a thousand, thousand thanks]

to our Health and Social Care workers.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

A lot of people, health workers in particular, will see today's motion as an admission of guilt from those who have gutted our health service. Three parties from the current Executive — the DUP, Sinn Féin and the UUP — have held the health portfolio for the last decade, and all three have overseen the growing waiting lists, unsafe staffing levels and attacks on health workers' pay.

I will emphasise workers' pay, because we cannot hope to deal with waiting lists unless we pay health workers properly. We need to pay them properly so that we can recruit and retain staff in our health service. We need to pay them properly because they deserve it. They deserve to be able to provide for themselves and their families. They deserve it, because it is their self-sacrifice that has kept our health service afloat in the face of Stormont's negligence. It is not by accident that there are thousands of vacancies in our health service. Those vacancies exist because successive Health Ministers have cut health workers' pay in real terms and funnelled money away from our health service and into the private sector. I stress and emphasise that the Minister should immediately move to bring private health facilities into public ownership in order to help to tackle the waiting lists.

I agree with the sentiment of the motion, but the sentiments ring hollow when they come from parties such as the DUP and its Executive colleagues. Health workers, like all public-sector workers, are tired of their performative nonsense. They are tired of listening to politicians who bemoan the skyrocketing health waiting lists while implementing the cuts that fuel the same crisis. People who are languishing on health waiting lists not only want their concerns to be heard but action to be taken to deal with them.

We are under no illusions about the Tory Government. They have no interest in protecting our health service. They have stripped it of resources time and again. Indeed, Tory policy is the greatest threat to public health on these islands. As far as I can see, the problem is that, instead of standing with our communities and challenging that policy, parties here followed the Tories into the mire, time and again. They accepted the Tory logic that there is no money for our health service and implemented some of the most brutal cuts in accordance with that warped logic. Worse still, the parties here accepted the Tories' supposed solutions, which are no solutions at all. While refusing to invest in public services and public-sector workers, they handed record sums to private agency firms and private healthcare facilities that are profiting from the mess that Stormont made. They surrendered domiciliary care to the private sector, which provides 80% of domiciliary care, giving it carte blanche to exploit health workers and to bleed the public purse dry at the same time.

I would love to say that those are things of the past, but, between last night and, probably, later today, the Executive parties will have rammed through another austerity Budget, with no qualms, no scrutiny and no opposition from the so-called official Opposition. Make no mistake: the Budget Bill that is likely to be passed today will add to the waiting lists that the Executive claim that they want to address.

I wonder whether the Executive parties truly believe their own propaganda or are deliberately trying to deceive the public. I will leave it to health workers and others to decide, but they should know this: the conversation is taking place primarily because 170,000 public-sector workers took strike action more than a month ago and demanded a pay rise and investment in our public services. Junior doctors are already prepared to strike over the pitiful sum on offer, and I fully support them. It is unfortunate that those life-saving workers have been forced to take strike action on the picket line, but that is the surest way for their demands to be delivered. If the Executive are intent on cutting services, adding to waiting lists and impoverishing public-sector workers, they must be met with an organised response. That includes workers taking strike action.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin 12:00, 20 February 2024

It is time for the Minister to respond to the debate. Minister, you will have 15 minutes.

Photo of Robin Swann Robin Swann UUP

Thank you, Principal Deputy Speaker. I welcome you to your post and look forward to working with you.

I welcome the opportunity to speak to the motion, not only to address all the many important issues that have been highlighted but to thank colleagues for the positive, collegiate approach that has been taken to the motion and its important topic. I thank Members for their contributions, and I look forward to working with the Health Committee and the Opposition as we tackle the issues together.

I fully agree that it is deplorable that the waiting list targets have not been met since 2014. The people of Northern Ireland are not receiving the care that they deserve on a timely and effective basis. The Opposition Member would not take an intervention when he was talking about 2014 and all the programmes and strategies that were set in place. I wanted to point out to him that the Department of Health has not had a recurrent budget since 2015. We have been working on single-year budgets for the entire time since then, which has not allowed many of the strategies to be fully implemented. It is not that they are sitting there, doing nothing, but that the recurrent funding has not been there to support them.

Over the years, a lot of words have been written and spoken about the state of our waiting lists. I do not intend to repeat all of those, but I agree with many of them. It is a matter of deep worry for me and should bring real inner reflection to all who serve in this place that so many people have been waiting for so long for diagnosis, treatment and support. As Members have said, those are real people. They are our constituents, our friends, our families and, indeed, our Assembly colleagues.

When someone joins a waiting list, their condition does not stand still — Mrs Erskine addressed that point in her intervention — and additional complications and additional needs come with being on a waiting list that is not fully resourced or supported. It is incumbent on me as Health Minister and, collectively, on us all to ensure that we do everything that we possibly can to address our waiting lists. Fundamental to that is having a clear, time-bound, deliverable action plan. I agree with the Chair of the Committee that it should be fully resourced, with a multi-year budget. In that context, Members will recall that, in June 2021, I published an elective care framework, which detailed a five-year plan that had that dual focus on reducing waiting lists and, at the same time, closing the gap between capacity and demand. That framework, costed at £707 million, contained a range of actions — 55 in total — aimed at reducing waiting lists and improving capacity across our elective care system. It also set out how we would invest in and transform services to allow us to meet the population's demand in future. I made clear that delivering on that plan would require sustained investment to tackle backlogs and increase overall capacity in our health and social care system.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Minister for giving way. I know that he has a lot to get through, and I take his point about investment. Does the Minister agree that the proposal by my colleague the former Finance Minister, Conor Murphy, of £1 billion as part of a three-year health budget would have gone some way to tackle the situation that we find ourselves in today?

Photo of Robin Swann Robin Swann UUP

I thank the Chair of the Committee for her intervention, and I look forward to working with the Committee. The £1 billion that was promised was also in the party manifesto of the proposers of the motion. I have already made it clear that that £1 billion financial gap is also what my Department is highlighting for next year to allow us to stand still. I genuinely look forward to working with all my Executive colleagues on honouring the commitments that they have publicly made.

I also made it clear then that delivering on that plan would require sustained investment to tackle the backlogs and, as I said, increase the capacity in our health and social care system. I was heartened by the fact that the framework was agreed by all Executive parties and that commitments were made that the necessary resources, as set out in the accompanying funding plan, would be made available.

While there has been some progress, which I will touch on in a moment, no one, including the proposers of this important motion, can have missed the damage that the subsequent further political stalemate and interruption have inflicted. On my last day in office in October 2022, after six months of a non-functioning Executive, I said that patients and staff were being badly let down by the politics of this place. I hope that we will see a renewed focus from the outset on where we move in regard to supporting health.

In the absence of an Executive and, critically, the absence of any budgetary certainty, the framework has since been starved of the political leadership and the funding that it required. Regrettably, as we were halfway through the five-year time frame, my Department announced last year that its targets were no longer within reach. The situation that we face at present is terrible. At the end of September 2023, as has been said, according to the most recent validated figures, 430,000 patients were waiting for a first consultant-led outpatient appointment, 115,000 patients were waiting for inpatient or day-case treatment and just under 190,000 patients were waiting for diagnostic tests. Those are eye-watering figures for a population of our size.

In addition to the backlog of patients waiting, new patients, of course, continue to be added. The gap between demand and capacity inevitably means that waiting lists continue to grow. That said, I want to put it on record that there has been some progress. The fourth interim report on our elective care framework, which was published in January, highlights the start of small but tangible improvements in the waiting list position. As of September 2023, inpatient or day case treatment waiting lists have seen some promising improvements. While they are still at unacceptable levels, there has been decrease of 8·4%, which is just under 11,000 people, in those waiting compared with the same month a year earlier. There has been an improvement in the number of people waiting more than 13 weeks, with 78·6% of patients waiting more than 13 weeks for admission compared with 79·8% on 30 September 2022. Over-52-week waits have also been reduced regionally, although they still remain far too high.

It is important to acknowledge and build on improvements to ensure that any momentum is not just maintained but increased. Those improvements alone will not address the backlog.

Photo of Linda Dillon Linda Dillon Sinn Féin

I thank the Minister for giving way. There is an issue, particularly in the Southern Trust, with MRI scans for paediatric patients. I am not aware of whether it is at the same level across the region, but will the Minister look at that issue, because it is serious? I am told that the wait time for a child who needs anaesthetic is 51 weeks. I know a family who have been told that it is 18 months. Those children are in their formative years, and their capacity and development is going backwards, because they are not getting the MRI scans that they badly need.

Photo of Robin Swann Robin Swann UUP

The Member will appreciate that I do not have a direct answer today, but I will write to her about that.

Tackling our lengthy waiting lists is undoubtedly a long-term issue that requires sustained and recurrent funding. It requires workforce development and system-wide transformation. Our health and social care system is complex, and waiting lists are just one component, as has been said today when we expanded the debate to include domiciliary care, care homes and GPs. That whole-circle approach to health has to be addressed. As such, our waiting lists cannot be addressed in isolation. Other fundamentals of the system must be considered and addressed simultaneously. That includes dealing with issues such as workforce pay and the pressures and capacity in secondary, primary and community care, and ensuring that we maximise the capacity that we have in the system.

When we see those shocking figures and the appalling waiting times, there is an understandable desire to see them reduced immediately. That requires a whole-system approach and not just piecemeal interventions that can only deliver small improvements in the short term or in isolated areas. That does not mean that there are no short-term measures that can be effective, but the key is achieving the appropriate balance between the short-term effective measures and those longer-term sustainable developments that bring about the optimum effect.

We know that we need to transform our health and social care system to become more effective and efficient, and we know what is required. It includes reform and innovation in such areas as our treatment capacity, outpatient reform, imaging, pathology and workforce, along with the protection of elective care from unscheduled care demands. That work is already well under way, and elective capacity has been enhanced through the continued development of our elective care centres. I highlight to Members key examples that are already in place: two dedicated day procedure centres at the Lagan Valley and Omagh hospitals; three elective overnight stay centres at Daisy Hill Hospital, the Mater Hospital and South West Acute Hospital; the expansion of 22 post-anaesthetic care unit beds for elective care across all trusts; three speciality centres for cataracts at the Downe Hospital, South Tyrone Hospital and the Mid Ulster Hospital; an orthopaedic hub at Musgrave Park Hospital, including the Duke of Connaught unit, which is a dedicated orthopaedic day procedure centre; two rapid diagnostic centres at Whiteabbey Hospital and South Tyrone Hospital; a regional extracorporeal shock wave lithotripsy centre in Craigavon Area Hospital; service reviews in general surgery, orthopaedics, urology and gynaecology, which will set the direction of travel for improvement; the introduction and the maintenance of our mega-clinics to maximise patient throughput; outpatients' assessments delivered by GP federations in primary care settings; the development of in-house health and social care capacity; and the continued investment in staffing.

The Members who tabled the motion asked me to acknowledge:

"the need to turbocharge investment towards tackling the waiting list backlog".

I not only acknowledge that but stress that investment is fundamental to the whole backlog problem that we face. The initiatives, for which confirmation of sustainable funding would allow further development, include the enhancement of that sustainable workforce capacity through expanding the skills mix and the development of specialist nurse roles and the allied health professionals across a range of specialities.

Other initiatives are the expansion of our preoperative assessment service to improve theatre productivity; building our own diagnostic capacity to reduce the reliance on independent sector capacity; and building capacity and throughput across regional elective care services such as urology, paediatrics and orthopaedics.

Today's motion asks that I:

"publish an updated action plan to tackle the waiting time crisis within six weeks."

The action plan to tackle waiting lists in the health and social care system already exists. I do not want to waste time replicating what is already clearly set out in the elective care framework, because enough time has already been lost. It is, however, almost three years since the plan was published, and, as with all plans, it is important that it be reviewed to ensure that it takes account of relevant changes in our overall Health and Social Care environment and is updated to reflect those changes. It is for that reason that I have tasked officials with reviewing the framework. That review is ongoing and will be completed by June of this year.

The motion also stresses:

"the value of partnering on a much larger scale with national and independent providers to maximise existing capacity".

That is essential. We must take all measures and use all resources within our means to ensure the effective delivery of services, and that includes the use of our independent sector. That is what we have been doing with the limited additional resources that have been deployed for waiting list initiatives. We need greater investment in this area, and we want to achieve results and the impact on waiting lists that the people of Northern Ireland need and deserve. Maximum efficiency in the use of the independent sector can, however, be achieved only with multi-year contracts or at least contracts for three years from when they are agreed. That will also provide better value for money.

As Members will be aware, as part of the elective care framework, I introduced the Republic of Ireland reimbursement scheme (RoIRS) on 30 June 2021. In June 2022, I announced that the scheme would be extended beyond the planned deadline until an additional £5 million of new funding had been committed. The scheme closed to new applicants on Wednesday 21 September 2022 when that additional £5 million of funding had been exhausted. I assure Members that I will leave no stone unturned as part of my broader consideration of resource investment to reduce waiting lists. I will invest what limited funding there is wherever it will have the greatest possible impact. The task ahead will be much easier, however, if all parties do all that they can to support adequate and multi-year funding settlements.

In the meantime, work is under way to provide further building blocks to tackle waiting lists. That includes plans for service reviews in —

Photo of Robin Swann Robin Swann UUP

— paediatric orthopaedics.

I thank the Principal Deputy Speaker for her support in bringing the motion before the House. I also thank the Members who tabled the motion and the entire House for its support.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Thank you, Minister.

Cara, you have five minutes to make a winding-up speech on the amendment.

Photo of Cara Hunter Cara Hunter Social Democratic and Labour Party

Thank you, Madam Principal Deputy Speaker. I thank the Minister for his contribution today, and I hope that I can get through this in five minutes. I thank every Member who has spoken today, and I will touch on some of their contributions and reflections.

I thank Liz Kimmins, who touched on the importance of urgency in making tough decisions. Mr Donnelly mentioned the dramatic increase of 216% and highlighted how our lists worsen without intervention and the issues that that causes. Mr Chambers talked about the pain that our patients endure while waiting to be seen, and Gerry Carroll touched on the importance of paying our workers fairly, which is a view that I wholeheartedly share.

Last week, we debated the vital need for a women's health strategy, and I acknowledge Mrs Diane Dodds's contribution about gynaecology waiting lists. I have spoken with many women in my constituency office, many of whom have awful cramps and heavy bleeding and are bent over in pain, yet they cannot be seen by a specialist. They cannot work, and it has completely ruined their life. As we have talked about before, that can be indicative of endometriosis or, worse, potentially cervical cancer, and they are left with the mental agony of that: the unknown and the uncertainty. Thousands of our constituents are waiting on lists and oftentimes left untreated and unmedicated.

Sinéad McLaughlin touched on the importance of the postcode lottery aspect, as did Mr Robinson, and the issue of regional imbalance. Órlaithí and Deborah touched on the importance of children's mental health, an issue about which, I know, both of them care deeply. I, too, have talked previously about delays in the Northern Trust for access to CAMHS and the impact that that has on children and families. Waiting lists impact on the whole family.

I am thinking of a mother in my constituency who has a child with special educational needs. The child had a mouth abscess and was left for months without being seen to receive oral healthcare. No one in the house was sleeping. The child was in agony. That is the real, family impact of those waiting lists. I also recall a lovely young woman with cancer whom I met in my constituency office. She had had cancer surgery, and there was an issue with her bowel. She came out of the surgery and was told that the surgeons would go back in and rectify the issue within a matter of weeks, but it was months. She was in agony. She could not sleep either. It is important that we touch on those personal stories here when we are given the opportunity. Ms Eastwood spoke eloquently about the challenges that face cancer patients.

How have we got here? More importantly, what can we do to get out of this situation? That brings me to our amendment. The Minister rightly talked about maximising every opportunity that is given to us. We have seen that cross-border initiatives are extremely positive. Reinstating those cross-border schemes is a real step in the right direction, a positive direction, especially for people in my constituency who are waiting for hip and knee surgery.

We also want to ensure that there is communication and that patients on health waiting lists are told where they are on their list and how long they will potentially have to wait. That issue has been raised with me. That will help them to understand where they are on the list and when they will be seen, because that impacts on their mental health.

I congratulate my East Derry colleague Mr Robinson on his maiden speech. He really touched on the two-tiered approach: those who can pay do, and those who cannot suffer. In 2015, I went to America for surgery. I had had sepsis twice in a short period and was told by a specialist in Altnagelvin Area Hospital that, if I had sepsis a third time, it would not be good. I was also told in the same breath that I could be waiting three or four years for surgery. Thankfully, I have a very good mummy who paid out so that I could go to see family in America and have surgery. Thankfully, my health has been relatively good ever since. That is just my personal story about the uncertainty that is present when you do not know when you will get the healthcare that you desperately need.

We cannot have the debate without a discussion about this place being up and down. Sometimes, I refer to the Assembly as being like a bouncy castle, it is up and down so often. We cannot deny that that has a direct impact on our constituents who, as we stand here today, are sitting in agony on waiting lists. Minister, if you have any opportunity to utilise cross-border schemes, my party, as a constructive Opposition, will work alongside you in the House to ensure that we deliver for our constituents and essentially alleviate their pain in any way that we can. I thank those who will support the amendment.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

I call Deborah Erskine to make the winding-up speech on the motion. Deborah, you have 10 minutes.

Photo of Deborah Erskine Deborah Erskine DUP

I welcome the debate on the motion, which calls for action on waiting lists. As has been said in the Chamber, we are contacted daily by constituents who are sitting on waiting lists in Northern Ireland. Many simply do not know how long they will be on those waiting lists. That is an unsustainable situation. We have to be realistic about the challenges.

It has been pointed out — my friend, the Member for Upper Bann Diane Dodds pointed it out — that, whilst money is important and extra investment is needed, we must also work to increase the training of students and the recruitment and retention of surgeons, doctors and nurses to ensure that there is a sustainable workforce going forward. We are competing with higher pay in the likes of the Republic of Ireland, which Danny Donnelly pointed out in his contribution. That can affect health trusts, such as the Western Trust, in areas like mine that are closer to the border. We have to tackle that issue.

An holistic approach to care must also be in place, as I pointed out in my interventions, not just to drive down waiting lists but to stabilise the system. We need a root-and-branch plan going forward. We need to maximise our existing capacity by, as the Health Minister pointed out, designating more sites as dedicated elective centres; having seven-day theatre schedules and multidisciplinary mega-clinics; and establishing regional diagnostic centres and rapid diagnostic centres.

There will also be the need to make sure that we organise our services in the most appropriate way through our transformation. That will also take a change of mindset among the public. We must realise that travelling to another site outside our trust area may be needed. It is on all of us to step out of the Chamber and make that point to the communities that we represent. I say that as somebody who comes from a rural area.

A Member:

Will the Member give way?

Photo of Deborah Erskine Deborah Erskine DUP

I want to make progress.

Our public transport and roads must reflect the transformation that is needed once we talk about this, so there is a cross-departmental element.

Moving to some of the comments that were made by Members, I thank Diane Dodds, who mentioned the stark waiting-time figures and the postcode lottery. She also mentioned ways in which we could find solutions.

Moving to Colin McGrath's contribution, I hope that I have seen a Damascus road conversion for the SDLP today — I really do — because he talked about plans and strategies that sit in rooms. When they come out of those rooms and get dusted down, I hope that the SDLP will step up and stand by those plans and will not go on picket lines to be parish-pump on health issues. I hope it will act with all of us in the Chamber to implement transformation.

Photo of Deborah Erskine Deborah Erskine DUP

I want to make progress.

I thank Liz Kimmins for her contribution as Health Committee Chair. She said that we cannot keep doing the same thing and expecting different outcomes. I welcome that, as Chair of the Health Committee, she will use her voice to drive forward some of that change. I mentioned Danny Donnelly's contribution, and I thank him for pointing out the differences in pay, which are causing issues. Alan Chambers mentioned the stress and pain of those who continue to be on waiting lists. Addressing that will take further intervention from our health service, as was pointed out. I thank Órlaithí Flynn for her mention of mental health services.

I congratulate Alan Robinson on his maiden speech and ask him to please pass on the good wishes of all in the Chamber to George Robinson. We wish him well in his retirement. I thank Alan and Cara Hunter for sharing their personal stories of being on waiting lists, which are not easy places to be.

I thank Nuala McAllister for raising the issues of equity of service and discharge times, which are also important. She also raised succession planning and how we go forward with consultants and surgeons. It takes a while to train people in our health service, so we need to be realistic and start planning for some of that stuff now.

I thank my colleague Gary Middleton, who paid tribute, as did a number of people in the Chamber, to our dedicated health staff who are at the heart of all this.

Photo of Deborah Erskine Deborah Erskine DUP

I want to move on.

Paula Bradshaw raised important points on investment and timing and on consultants' time. I agree with her that, if we are taking funds and putting them elsewhere to shape our waiting lists, surely that can be invested in Northern Ireland. That is a fundamental point.

I thank Sinéad McLaughlin for raising gynae issues, following our women's health debate, and Sorcha Eastwood for specifically mentioning cancer. We send our good wishes to her family and her husband. She raised a deeply personal thing in the Chamber, and I thank her for that.

Justin McNulty talked about burnout among trust workers, and it is important to note that in this debate.

Regrettably, in relation to health, Gerry Carroll again let party politics creep in. I agree with him about fair pay for workers, but let us strip politics out of health. If we take away anything from the Chamber today, let it be that we work collectively to deal with the issues. As I said, we will all have to walk out of the Chamber and try to put the message to our communities that we need to change and reshape our health service. I regret the fact that some are party politicking on issues where there are people behind the statistics, as has been stated in the Chamber today.

Photo of Deborah Erskine Deborah Erskine DUP

I would like to move on. The Member has had enough time to make his comments today.

Lastly, I thank the Health Minister for coming to the Chamber to respond to the debate. I welcome his commitment to tackling this issue: he pointed out his elective care framework. I am pleased to see that he reads DUP manifestos: he referred to the £1 billion that we would like to see invested in healthcare. I welcome the fact that he will review the waiting list framework, which was published three years ago. While he said that the review will conclude in, I think, June, my plea is that, from that point on, we see action in relation to that action plan. Certainly, from my point of view and that of my party, there was a collective view in the Chamber today that we want to see action on that. I thank everybody for their comments in the debate today.

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

Main Question, as amended, accordingly agreed to. Resolved:

That this Assembly believes it is deplorable that none of the formal waiting time targets for health and social care services in Northern Ireland have been met since 2014; notes with concern a recent Northern Ireland Audit Office report that indicated that the number of people currently on health and social care waiting lists is equivalent to 26·3% of our population, more than double the figure in England; further notes regional inequalities within Northern Ireland and the urgent need for same-time access regardless of where anyone lives; acknowledges the need to turbocharge investment towards tackling the waiting list backlog over the remainder of this Assembly term; stresses the value of partnering on a much larger scale with national and independent providers to maximise existing capacity, including the immediate reinstatement of the cross-border healthcare directive; and calls on the Minister of Health to publish an updated action plan to tackle the waiting time crisis within six weeks.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

I ask Members to take their ease so that we can change the staff at the top Table.

(Mr Deputy Speaker [Mr Blair] in the Chair)