Health: Vision Statement

Ministerial Statements – in the Northern Ireland Assembly at 1:00 pm on 3 June 2024.

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Photo of Steve Aiken Steve Aiken UUP 1:00, 3 June 2024

I have received notice from the Minister of Health that he wishes to make a statement. I want to say, however, that Standing Orders require Ministers to provide written copies of their statement at least 30 minutes in advance of its being made. Standing Order 18A(2) states:

"Where this has not been possible he ... shall state to the Assembly the reason."

Photo of Mike Nesbitt Mike Nesbitt UUP

I begin by apologising for the tardy release of the statement. As you know, Mr Deputy Speaker, the Order Paper indicated that I would not be on my feet until 4.00 pm. I was in a series of meetings, culminating in one with the Finance Minister, and I was unaware of the supreme efficiency with which the Chamber was discharging its business since it first sat earlier today.

Before I get into the subject of the Department of Health and health and social care, I offer my profound condolences to our colleague Colm Gildernew, who has so tragically lost his nephew. A very good friend of mine drowned 25 years ago this year, and it never leaves you. My thoughts are very much with Colm.

I am grateful to be able to come to the House at the earliest opportunity to offer Members a sense of my vision as Minister of Health. I assure Members that, having served in this place for 13 years, I am happy to affirm that the House is the ultimate authority and decision-making body of devolution, and I commit to giving it its place. As a minor example, I decided to make these remarks in the Chamber before speaking in any detail to the media, and I look forward to forging good relationships with the Health Committee, albeit my first act was to bring the Chamber to a standstill for a quarter of an hour.

I begin by offering profound thanks to my immediate predecessor, Robin Swann, who not once but twice stepped forward to undertake the enormous and multiple challenges of being Northern Ireland's Health Minister and providing stalwart leadership. I also acknowledge all those who came before Robin: Bairbre de Brún, who, like Robin, served two spells in office; Michael McGimpsey; Edwin Poots; Jim Wells; Simon Hamilton; and our current First Minister, Michelle O'Neill.

From the start, I state that I have no intention of engaging in criticism of any previous Health Minister, because I do not see how such criticism improves the prospects of a single patient. I am sure also that each and every one of them had at the forefront of their mind, as I will, improving patient outcomes, along with promoting and advancing a respectful, positive working environment for each and every member of the Health and Social Care (HSC) family.

I refuse to accept the fatalistic narrative coming from some that the National Health Service is spiralling towards inevitable failure. In three short words, my ambition is this: for better outcomes. Obstacles to better outcomes include short-term challenges, the current unprecedented funding shortfall, excessive waiting times and damage to public confidence, as well as a workforce that has suffered much too much from the regular absence of supportive leadership coming from this place.

Then comes my longer-term ambition, or what David Trimble famously called "the vision thing." In his speech accepting the Nobel Peace Prize with John Hume, David said:

"Some critics complain that I lack 'the vision thing'. But vision in its pure meaning is clear sight. That does not mean I have no dreams. I do."

So do I, and my "vision thing" goes like this: I invite Members to close their eyes, virtually, and imagine a blank map of Northern Ireland. Imagine that there is no health service. Imagine that there are no hospitals, GP surgeries or ambulances. The health map is blank. Now ask yourself a series of questions. First, do you want a health service? I am pretty sure that it is a yes to that from everybody. The next question is a little more challenging, and it is this: why do you want a health service? There are at least two answers to that: to heal the sick, and to keep healthy people healthy. Both of those are, of course, valid aspirations. Neither are they mutually exclusive. It is not one or the other; it is, of course, both. Immediately, however, we have introduced the question of balance. Balance will inevitably lead to a debate, a judgement call and an element of subjectivity. Even in an ideal world, in which we had limitless budgets and resources to keep people healthy, others would still get sick, so we would still need healthcare professionals, who would need facilities, equipment and medicines. I want to populate that blank map with the best projection of the ideal health service for today and tomorrow, including the people, the resources and, yes, the budget required to keep as many people healthy for as long as possible and offer whatever care and support they require. If we were to superimpose today's map of health provision, it is certain that you would not have a match. The long-term challenge is to figure out how to get from A to B in manageable and affordable steps. That is my "vision thing". That is my direction.

I say from the get-go that reform means many different things to many people, but it is primarily about securing better outcomes for our population by changing the way in which Health and Social Care works and meeting the needs of our population better. There are, of course, key enablers, such as developing the full range of roles in our workforce and using digital technology to improve the safety, quality and capacity of our system. It is not primarily about cutting costs or saving money, but if that is the by-product — in some cases, it should be — that is all well and good. Cutting costs is not the primary objective. In addition, I make it absolutely clear that it is not about closing hospitals.

Meanwhile, there is the here and now, which is my second great challenge. I have been asking myself a couple of key questions. Is the health and social care system in Northern Ireland the best that it can be in respect of the service that it delivers and its value for money? Are the people who are the health service — the doctors, nurses, social care staff, allied health professionals and the multitude of important support staff — as respected and rewarded as they should be? On the first point, the current 2024-25 Budget assessment, which was published last week, clearly indicates that the answer is no, in the service that is delivered. I shall return to the Budget in a moment. On the latter point, I promise that I shall value every single member of the HSC family who is working to deliver good outcomes for patients. Everybody working in our health service has a place, and every place should be valued. I want them to feel that they are making a positive difference and that they are appreciated and valued. I understand from my initial meetings with senior HSC figures and a number of the royal colleges that workforce planning and workforce remuneration are issues that continue to need urgent attention. I intend to build on Robin Swann's transformational work in that area.

For me, the job of Health Minister, which I am honoured and humbled to hold, is personal. My life, like those of so may others, has been bookended by health challenges that have been met by great people in good jobs in our health service. As a young man, I had significant breathing difficulties. I remember many sessions at the Ulster Hospital, trying to unblock my lungs. I hope that you accept that it is not a boast but a testament to the sheer brilliance of the health professionals who helped me that I left school with an Irish international athletics vest. OK, it is a boast.

In recent years, I developed a heart condition. I do not think that I am being melodramatic in stating that it was my GP who started a process that may well have saved my life. I stand here today with two stents, a pacemaker and a defibrillator, so some could call me the bionic Minister. My mother passed away in March 2020 in the Ulster Hospital after a short illness, from which I gained a huge insight into the professionals who are the health service. I saw a young doctor who perched herself on the edge of my mother's bed, took her hand and, with beautiful professionalism, made sure that Mum knew that she was not going to recover from her condition. What I did not see was the staff member who came back on rota after a week off and burst into tears when she saw how badly my mother had deteriorated in the intervening days. Those are two very different roles — a doctor and a member of catering staff — but both of them were totally committed to performing their roles in what they clearly and rightly define as "good jobs".

I have to say that I am glad that my mother passed away before I made one of the worst decisions of my life — the decision to disregard COVID regulations. I can only continue to repeat the apology that I offered at the time. As I said last week, it is a stain on my record that I cannot wash away.

As indicated, I have begun my conversations and consultations on the future of the health service in Northern Ireland. I have three years to make a difference. My key areas of focus should not be a surprise to those who know me. The most stubborn challenges are these: delivering reform; tackling waiting lists; investing in social care; addressing mental health; and confronting persistent health inequalities. Of course, those are not mutually exclusive categories, and they will need primary care and social care as much as they will need secondary care.

We have detailed plans in place for waiting lists, and where those have been funded, the proof is there that they work. I will continue to drive through those improvements forcefully, wherever and whenever possible. That includes reform, and reform needs funding that yields a long-term, irreversible impact. That needs, frankly, parallel funding to reduce lists and to ensure that they do not grow again by addressing the fundamental issue of closing the gap in demand versus capacity.

Sadly, the impact of cancer on our fellow citizens is growing, not least because people are living longer. It is projected that, by 2040, rates of cancer will rise by 45% among men and by 58% among women. I will pause for a moment to allow the House to think about how many family members, friends and constituents will be affected by that.

When I started campaigning for better mental health and well-being provision after first being elected in 2011, the response was, frankly, underwhelming. Some MLAs were not entirely convinced; many others simply did not get it. My motion to appoint a mental health champion was defeated in the House. I am happy to acknowledge that that has changed. The battle for awareness has been won. Now we need to fund the action plan to make a difference. Having spoken recently to the mental health champion, Professor Siobhán O'Neill, I know that the budget meets only one eighth of this year's delivery plan. Mental health is also a personal issue for me. My wife endured an episode of clinical depression many years ago. The answer was not merely pills and tablets; human engagement with skilled professionals was critical to her recovery.

Both as a broadcast journalist and when I served as a Commissioner for Victims and Survivors of the Troubles, I saw the horrific impact of poor mental health as a legacy of what we so euphemistically call "the Troubles". Again, if you take a map of the hotspots of the conflict, measured by bombings, shootings and murders, and you superimpose a contemporaneous map of hotspots for mental issue issues, measured by attempted and completed suicides and by drink and drug addictions, you will see a match. It is no accident that those hotspots are often areas of deprivation, where health inequalities are most pronounced. I am therefore working to develop an initiative that I expect to be able to announce in the very near future.

For me, health inequalities represent the overarching issue for so many of the critical challenges facing Health and Social Care. I do not want a two-tier system where timely access to treatments is the preserve of those who can afford to go private. I do not want to live in a society where those who live in deprived areas have such pronounced lower life expectancy, greater health struggles and worse outcomes. That, of course, is a challenge for all parts of government. I want to work with my ministerial colleagues and the resources that I have to develop a plan to do more to address health inequalities at a community level. I will bring back more detailed plans in due course.

In conclusion, I must return to the Budget. The main parties of the Assembly have all argued, with some success, that the UK Government should review our block grant and fund us based on need, rather than on population.

It is a matter of regret that, when it comes to the Department of Health's budget, need is not mentioned. The argument becomes, "But, sure, you are getting over half of the total funds."

We need to remember that health and social care is about the service to the public, not the party designation of the Health Minister. I knew, coming into the role, that the financial outlook was dire, but I have been stunned by the budget briefings that I have received. I encourage MLAs to engage with their respective trusts; the chief executives would welcome that.

I fear that the House or parts of it may not fully understand the consequences for healthcare. The stark reality is that, if I implement the current budget, the consequence will be that many patients will suffer harm. Indeed, I note the joint letter from the collective HSC chairs in which they state that the potential that some cutbacks:

"would impact damagingly on the whole community in Northern Ireland, particularly the most vulnerable."

I am afraid that I have added an unwelcome phrase to my lexicon in the last few days: joining the assessment of cuts with low, medium or high impact come cuts whose impact will be "catastrophic". Again, those are not my words or the words of my party: that is how our health trusts have categorised them.

In my first few days, I have met senior trust and departmental officials and have heard at first hand about the rigorous, ongoing work to deliver hundreds of millions of pounds' worth of savings that will have a low or medium impact. Of course, we will continue to strive to do more, but those savings are at an unprecedented level. They will be challenging to deliver and will have some impact on patients and service users. I warn MLAs that some will not be without significant controversy. Even then, my Department calculates a very significant gap once those savings are made, and the only way that the gap can be closed is to deliver a break-even budget through taking the high- and catastrophic- impact decisions. That is the reality of the Budget that the House passed less than a week ago. Those decisions would require reductions in acute beds, home care hours and care home beds, all having significant and sustained consequences for elective care, hospital discharges, patient flow, emergency department overcrowding and ambulance handover times. In short, catastrophic cuts will simply make the situation worse. Pressures on services and staff, already at severe levels, will be significantly intensified. It also means that, as we stand, there is no feasible route to affording pay awards.

I recognise that I must play my part, alongside all Executive colleagues, to help deliver a hugely challenging Budget, but, for that to work, they and the Members of the House also need to be willing to look at the real challenges facing Health and Social Care and, therefore, the most vulnerable in our society. Let me be clear: cuts with catastrophic impacts? Not on my watch.

Meanwhile, I am also actively planning for reform, building on the work already done, and will bring forward more detailed proposals as soon as I can. I have a dual purpose: to offer Members a realistic assessment of the challenges but to try to meet those challenges by working with them. The situation is far from ideal for my Department or that of any other Minister. As the novelist, Ivan Turgenev, puts it:

“If we wait for the moment when everything, absolutely everything is ready, we shall never begin.”

Deputy Speaker, I have begun.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party 1:45, 3 June 2024

I thank the Minister for his statement. I welcome him to his post and wish him well. As the Opposition, we continue our offer to work constructively with the Minister in his work.

The trusts are under serious pressure. As mentioned, the chief executive officers have today warned of catastrophic impacts with potential impacts on bed closures, operating lists, domiciliary care and nursing care packages. Is a plan being devised by the Minister, with his Executive colleagues, to deliver the finance that is needed to make sure that our trusts are fit for purpose going forward?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for his question and for his welcome, and I very much look forward to working with the Health Committee.

The Member asked about discussions that I have had with the Executive. He will understand that I have been in post for less than a week. I have met just one other Minister, and that was the Minister of Finance, whom I met earlier today. I impressed on her the fact that I want to work in a collective manner to deliver both for Health and a full Programme for Government. I have always been a fan of the idea of a results-based Programme for Government, and, in order to do that, we have to get out of departmental silos and think about cross-departmental working.

The one area that I discussed, albeit briefly, with the Minister of Finance this morning was the role of Health in trying to boost the economy. I think particularly of people who are economically inactive. As the Member will know, our rates of economic inactivity are shocking, at 26%-plus. There are a number of factors for that, one of which is the lack of accessible, affordable childcare, but top of the list of inhibitors for people being in a position where they are neither in nor seeking work is health issues, both physical and mental.

I look forward to early engagement with not only Minister Murphy but other Executive colleagues to look at what our priorities will be and at how we can all input our resources, thoughts and energies to make these things happen so that we can finish the mandate with Northern Ireland and its people in a better place than they were when we began it.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I welcome the Minister to his role and congratulate him. I look forward to working with you, Minister. I welcome the statement. Despite the difficult picture, there is a lot in the statement that is definitely encouraging, and I am keen to work with you on that in the time ahead.

Everyone is affected by this — our families, friends, neighbours and constituents — so it is in all our interests to get the best outcome. Your key priorities are positive, Minister. They are certainly what we would like to see done, but everything is underpinned by workforce. Can the Minister advise when we can expect to see a plan around workforce to bring those priorities forward?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Chair of the Committee. I enjoyed our engagement earlier today, and I very much welcome your good wishes, Chair.

On your specific question, I cannot give you a time frame, but I can certainly commit to trying to establish a time frame. I assure you that it is a priority for me. I have already met some of the trust chiefs and their financial directors, and it is clear to me that there are some really intractable problems with workforce. I think particularly of the Southern Trust and the Western Trust, which are closest to the border, the impact of Sláintecare and the fact that there are consultants, for example, who can easily migrate not a huge distance and certainly without spending an awful lot of time travelling to find themselves in a good post on the other side of the border earning considerably more money. It is not just about attracting the workforce; it is about making the environment attractive to people and making sure that the remuneration is as good as it can be. I want everyone who works in the health and social care sector to be as well paid as they can be.

There has been a debate in the Economy Committee and the Department about what constitutes a "good job". I was fearful that there might be a kind of elitist definition of that. I do not think that there will be, by the way. From my point of view, a good job is a job that means that, when you wake up, you look forward to going to work to do your shift, you feel valued, your terms and conditions are good and you feel that your job is worthwhile. That is a broad definition of what I would want every job to be for everybody working in the HSC in Northern Ireland. That needs a strategy, and, as I said, it will be a priority for me. I look forward to bringing it to the Committee in due course.

Photo of Phillip Brett Phillip Brett DUP

I congratulate Mr Nesbitt on his appointment. I also congratulate him on his vision and positivity. Across Northern Ireland, people want to hear from our Ministers about what they can deliver and not constantly about what they cannot deliver.

With that in mind, the Member will be aware that the Northern Ireland Children's Hospice is particularly close to my heart and the hearts of my constituents across North Belfast. The previous Health Minister refused to put in a bid for additional funding for that amazing charity, despite requests from the Finance Minister. Can the Health Minister give a commitment in the Chamber that he will look at exhausting all options to give the Northern Ireland Children's Hospice the funding that it needs?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for those comments and look forward to working with him in the remainder of the mandate. As I said, I came here because I wanted to give the House its place before engaging in any substantive way with the media. However, I hope that Members will understand that, as this is day five of my being in post, I am not down into the weeds and the great detail. I am still receiving pretty high-level briefings. It will be a short number of weeks before I am across the fine detail, so I am reluctant to make any substantive decisions. However, I understand that the Member asks me simply to commit to looking at it, rather than to come to a conclusion, and, on that basis, I am absolutely more than happy to make that commitment.

Photo of Danny Donnelly Danny Donnelly Alliance

I thank the Minister for his statement. It is good to hear about his priorities for the rest of his tenure. We all want better outcomes, but everyone in the House knows that many serious issues require urgent attention.

I welcome the Minister's comments, particularly about avoiding the two-tier health system in Northern Ireland, but the reality is that that already exists. Many people across Northern Ireland, including my constituency of East Antrim, languish on waiting lists for years, while those who can afford to pay — some of them may be using huge amounts of their life savings or even borrowed money — are able to get timely treatment. That is a sad state of affairs and one that we should work to rectify.

The Minister will be aware of the workforce pressures and the ongoing industrial action, especially the upcoming second strike by junior doctors. I hope that the Minister will meet that group of workers urgently to try to avert that.

Photo of Steve Aiken Steve Aiken UUP

Will the Member come to his question, please?

Photo of Danny Donnelly Danny Donnelly Alliance

What is the Minister doing about community pharmacies? Twelve community pharmacies have closed in the past year due to financial pressures. It is vital that people are able to receive medication across Northern Ireland. I would like to hear the Minister's plans for community pharmacies, but I appreciate that he is only in the role a couple of days. As a Member of the Health Committee, I look forward to working with him.

Photo of Mike Nesbitt Mike Nesbitt UUP

I do not want to frustrate the Member by again saying that it is a little early for me to lay out a definitive plan, but, during the short period building up to taking over the Ministry, I visited a community pharmacy in Killyleagh, which is in my constituency, and got a good briefing from a practitioner on the issues and some suggestions for potential solutions.

With regard to what the Member said about tackling health inequalities, I am passionate about that subject. When people want a health service, we tend to go to that service: to a GP surgery, a hospital or some other facility. I am starting to pose this question to colleagues: to what extent can we reverse that direction of travel and take the facilities and resources to the community? Members will probably be aware that, during the COVID crisis, at times, the uptake of vaccinations was quite low, and people had to go to the likes of a GP surgery. When vaccinations were taken into the heart of the community, the uptake rate went up. There are precedents for what I am thinking about. I do not think that I am reinventing the wheel; it is more a question of emphasis. It is about making sure that people, particularly in communities that are perceived to be in areas of deprivation, get the services as close to where they live as possible and that those services are as accessible to them as possible. I suspect that that will make a real difference.

Photo of Steve Aiken Steve Aiken UUP

Questions on the Minister of Health's statement will continue after the question for urgent oral answer. I ask Members to take their ease. The next Member to speak on the Minister of Health's statement will be Mrs Dillon.

(Madam Principal Deputy Speaker [Ms Ní Chuilín] in the Chair)