Health and Social Care: Three-year Plan

Ministerial Statements – in the Northern Ireland Assembly at 11:15 am on 10 December 2024.

Alert me about debates like this

Photo of Edwin Poots Edwin Poots DUP 11:15, 10 December 2024

I have received notice from the Minister of Health that he wishes to make a statement.

Photo of Mike Nesbitt Mike Nesbitt UUP

Mr Speaker, thank you for the opportunity to make a statement today on the publication of the health and social care three-year plan.

When Professor Bengoa visited Northern Ireland in October, I was clear that I intended to publish a plan setting out my ambitions until the end of this mandate. The publication today of the strategic three-year plan does exactly that. I recognise that our health and social care system continues to be under severe pressure, and, with the onset of winter, the coming weeks and months will not be easy. Despite that challenging context, I believe that it is important to rise above the day-to-day and embrace the opportunity for reform.

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

We continue to face many interconnected challenges, which have been widely rehearsed, not least during the Bengoa event in October. Our waiting lists are simply unacceptable, and we continue to experience high and persistent levels of health inequalities. I have been clear on many occasions that it is for everybody, including my Department, the health and social care system, the Executive and the wider public sector to support people to stay well and live healthy lives. That is because our population’s health is, to a large degree, impacted on by factors such as housing, education, employment and the broader socio-economic environment. Of course, behaviours and health and social care interventions also play a part, but these issues need a robust cross-government approach.

Before I go into the detail of the three-year plan, I want to acknowledge the fantastic effort and commitment of our staff. They really are our health and social care service. Without the excellent care that they provide on a daily basis, we would not have a service at all, nor could we bring about the changes that we need to improve services for the benefit of all. That is why I have remained fully and absolutely committed to resolving the pay award for this year. Stabilisation is one of the key pillars of my three-year plan, and central to that will be ensuring that staff are properly recognised and rewarded for the great work that they do. I shall retain a major focus on the recruitment and retention of our staff. I advise the Assembly that I will be meeting unions later today as part of ongoing work to secure pay settlements for the 2024-25 financial year. I go into those discussions committed to stabilisation, to getting a good deal over the line and to fair and equal pay, which, I hope, remains the policy position of the entire Executive.

With progress on that important issue, I turn to the detail of the plan. It is structured around commitments in the three key areas of stabilisation, reform and delivery. With the incredibly challenging budget position, stabilisation is inevitably a strong immediate focus, not least in minimising the impacts of the £200 million-plus of savings that have been delivered by trusts this year. As I have mentioned, a critical plank of the stabilisation agenda will be to continue to deliver the pay awards that our health and social care staff deserve. That extends to staff working in the independent adult social care sector. My ambition is to make that sector a real-living-wage sector. I am determined not to be found wanting in that regard, especially given the importance that that has for our ability to successfully recruit and retain sufficient levels of staff.

Progress on the reform agenda continues. Despite the pandemic and the difficult budgetary environment, we have made tangible progress across multiple areas. There is, of course, much more to do, and the plan published today sets out my reform ambitions. It is important to be clear that reform is not a silver bullet that will solve everything. It is, however, what is needed to give our staff and the public hope that there is a bright future for our health and social care service. I am determined to support people to live healthier lives and to tackle health inequalities. That is why I intend to embed the Live Better initiative into our mainstream way of working; develop a new obesity strategic framework; implement the Northern Ireland provisions in the Tobacco and Vapes Bill; and introduce proposals for minimum unit pricing for alcohol. Subject to funding, I also intend to put in place a new lung screening programme and an expanded bowel screening programme.

A lot has been said about the "shift left", meaning to provide services closer to people's homes. A number of measures in the three-year plan will support that shift. First, by April of next year, I will publish a plan for the completion of implementation of the multidisciplinary team model across all areas of Northern Ireland. Subject to additional funding being secured, we will be much closer to that objective by April 2027. By that point, phased implementation will be under way, with anticipated investment of £19 million to expand the model to a further five new GP federation areas with a combined population of 670,000 people. That will mean that approximately 50% of the population will be covered, compared with about 30% today. The rest will follow as a priority.

Secondly, again subject to funding, I am keen to invest a further £15 million in our community and GP pharmacy services and an additional £17 million in our mental health services to support greater integration with the voluntary and community sector. Thirdly, I plan to implement within this mandate — again, as far as funding allows — new models for delivery of home or domiciliary care services, learning disability services and children’s social care services and a regionally consistent contract for care home placements. Finally, I want to see reform of dental services progressing in the coming years.

Turning to hospital services, I have launched a public consultation on a new network approach, and I look forward to seeing the outcome of that consultation next year. Good progress has been made on implementation of the elective care framework with the roll-out of elective care centres and rapid diagnostic centres. Whilst the day procedure centres and elective overnight stay centres have had a positive impact on waiting times, as a result of our wholly intolerable waiting-time position, it is essential that we drive through further improvements in productivity levels to maximise the number of patients being cared for. The Department has been driving forward targeted measures to ensure that trusts are delivering 100% of all commission sessions and that efficiency and productivity across the elective care centres are maximised.

The most recent published statistical information, as of 30 September 2024, for inpatient or day-case treatment waiting lists across the Northern, Southern and Western Trusts shows that there has been a 20% decrease in numbers waiting since the same month last year. That is 12,115 cases in real terms. Taking into account the data available for the Belfast and South Eastern Trusts, that represents a decrease of 5·5% in the number waiting since the same month last year. However, whilst there are some areas of improvement, I am mindful that, overall, our waiting times remain unacceptable. There are still far too many people waiting for far too long for outpatient assessment, for example.

As I have said, reform is necessary, but it is not sufficient to address the many deep-seated issues that are impacting on our health and social care services. Therefore, in addition to significant additional funding, we need a relentless focus on performance and productivity. To that end, I have challenged the health and social care trusts to deliver 46,000 additional outpatient assessments and 11,000 additional treatments annually by 2027.

One in two of us will receive a cancer diagnosis in our lifetime. That is the harsh reality that we face today. Currently, cancer services cannot meet that level of need, and the cancer strategy clearly outlines the need to transform the way in which we deliver cancer services for people throughout our community. We must deliver new and innovative ways of preventing cancer, supporting early diagnosis and delivering better care for cancer patients. Over the past two years, we have seen good progress on the delivery of a wide range of key cancer strategy actions. Key examples of progress to date include the development of services to provide genomic testing for cancer patients, investment in an oncology and hematology implementation plan and work to review patient pathways. Also, we have established minimum standards for adolescent and young adult cancer services. The rapid diagnostic centre model will ensure quicker access to red-flag services, and it will increase the survival chances of those patients. I have commissioned strategic reviews of breast cancer and radiotherapy services. The reviews will inform how those services should be delivered in the future, allowing equity of access for all patients across the region.

The actions identified in the next phase of cancer strategy implementation, which is for the period 2025-28, provide a real opportunity to deliver positive change and service outcomes that everybody expects and deserves. That, along with the actions emerging from the strategic service reviews, will provide the basis for cancer service transformation. I am confident that that will provide a more sustainable approach for the delivery of cancer services and ensure that the early detection and treatment of cancer are at the core of our future response.

The implementation of the Encompass programme should help to enable those improvements in productivity. I am determined that the health and social care system maximises the benefits that can be had from digital reform. That will include making full use of the rich data that will be available to us.

I anticipate reform of neurology and stroke services, the outcome of which will be subject to consultation and funding availability. There is a need to reform pathology services, and I intend to have a single management structure for all pathology and blood transfusion services. I also intend to deliver a regional imaging academy to increase the supply of suitably trained clinicians.

I will continue with the important implementation of the urgent and emergency care review, and I will move ahead with strategic initiatives on quality and safety. Those will include bringing forward a consultation on replacing the current serious adverse incident process, and that will happen early in the new year.

Today, I am pleased to launch a 14-week consultation — slightly extended to take account of the Christmas break — on a new Being Open framework, and on the issue of duty of candour in Northern Ireland.

I am determined to advance proposals for an organisational duty of candour as well as considering proposals for an individual duty of candour in the coming months. Being open and honest is critical to safe and effective healthcare. We want to create a culture in which our health service staff feel safe, supported and empowered to speak up when things go wrong in the certainty that their concerns will be listened to and acted on. We want to create a culture in which the public can have confidence that, if mistakes are made, they will be informed quickly and accurately about what has happened. The Being Open framework seeks to put in place the necessary support and systems to enable and nurture a truly open culture and help to prevent patient harm. I encourage the public to get involved and have their say.

The three-year plan is realistic and ambitious. Of course, the pace of progress will depend on future Budget settlements and, indeed, on successful partnership working in the Executive. If we all work together, we can meaningfully improve population health, support people to live healthy lives and provide the conditions for our health and social care system to thrive. I commend the three-year plan to the Assembly.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

We have a three-year plan that is packed with statements such as, "opportunities to reform", "I am committed to", "There is more I can do", "I will publish", "I will review", "I want to see" and all of it subject to funding that is yet to be allocated. Does the Minister agree that we need a concrete, tangible, fully funded, time-bound programme that is supported by the whole Executive to make the changes that we need and to save our health service? Regrettably, this statement is not it.

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the spokesman for the Opposition for his comment. He is clearly living in the ideal world. I live in the practical world, where we have a four-party mandatory coalition. I am doing what I can.

As for definites, you will notice that I said that I have set a target of an additional 46,000 outpatient assessments and 11,000 treatments by 2027, so there is some concrete, time-bound detail in the plan. Of course I would like more — everybody would like more — but this is the real world.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Minister for his statement. It is certainly ambitious, but it is very welcome. There is so much in it that we have been working on in the Committee, so I am pleased to see that the Minister is listening. Thank you for that.

I turn to the piece on cancer services. We would all agree that improvements are much needed and much welcomed. It would be remiss of me not to mention the formidable Jody Gormley, who, sadly, lost his life and his battle with cancer just last night.

Minister, you alluded to the cancer strategy in the statement, so will you indicate whether that is based on full funding of the strategy? If possible, will you elaborate a bit more on the lung screening programme? We have been speaking about that recently in Committee, and we had the event in Stormont on it.

Photo of Mike Nesbitt Mike Nesbitt UUP

First, I join in offering condolences to the friends of Jody Gormley, who, as you say, has tragically passed away in the past 24 hours.

Full funding is one of the major challenges that we face. You have heard me say it before on the mental health strategy: we have about one eighth of the money that, we thought, we would require to implement the action plan for this year. Red flag and critical is where we are, and where we are is talking about sustainability, because the budget is not where we would like it to be.

I welcome the fact that you think that it is an ambitious plan, but it is also a realistic plan. I hope that my officials and I can continue to work with the Committee through some of that detail, because we are listening and you have that statutory ability to assist and advise the Department and me in our work. I hope that we can continue to do that in delivering on the plan.

Photo of Alan Robinson Alan Robinson DUP

I thank the Minister for his statement today. Minister, in your statement, you say that you have challenged the health trusts to carry out an additional 11,000 treatments a year by 2027. Will you provide more detail to the House? Is that for cancer treatment, or what area of healthcare are you referring to?

Photo of Mike Nesbitt Mike Nesbitt UUP

That is a broad ambition, and the outworkings are still to be developed. What you will see in the coming weeks and months will be detailed annual plans, the first of which should be published shortly after the Budget for 2025-26 is agreed.

I will make a more general point, if I may, on something that I alluded to in Question Time yesterday, I think: challenging the trusts. We have commissioned scheduled lists of surgery in our acute hospitals, and we are monitoring those. A few months ago, I put the trusts on notice that I wanted to see them make a strenuous effort to achieve 100% delivery. As of a couple of days ago, we have, for the first time, told trusts that we are taking money back for elective surgeries that were on the lists but not performed. To my mind, that is the vision of the future over the rest of the mandate. If the Department of Health is paying for and commissioning services, those services either get delivered or we take the money back and use it for some other service. A pound wasted in one area is a pound that could be devoted somewhere else, not just within Health. It could be devoted to tackling the social determinants of bad health in education, housing and all the rest.

Photo of Nuala McAllister Nuala McAllister Alliance

I thank the Minister for the statement. We respect the fact that there is a difficult budgetary environment, but we also recognise that, since 2003, our spending in health per head has risen faster than it has in any other nation in the UK, so, clearly, something is going wrong, because we are not having better outcomes. Unfortunately, the statement reads full of contradictions. The Minister says that he wants to implement greater lung and bowel screening, subject to funding, but, later in the statement, he says that he wants to move more towards preventative measures. What is the priority? It costs us more to do nothing or stand still; it costs us more when we do not put the money into prevention. Will the Minister outline his current priorities and what he can do to give a bit of hope that health inequalities will be tackled by way of preventative measures?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for her question and comments, but I see no contradiction. You need to do both. As I said in my first comments here as Health Minister, if you took a blank map of Northern Ireland and asked yourself, "Do you want to design a health and social care system?", the answer would, I think, be yes, but then you get into judgement calls about whether it is about prevention or cure. Of course, it has to be both, because, no matter how good you are at prevention and early intervention, people will still get sick. Therefore, you still need your acute hospitals and the screening programmes that she referred to.

My ambition is clear: it is that shift left and getting care away from acute hospitals and delivering healthcare in the home, ideally, or, if not in the home, as close to it as possible. That means investing more in GP surgeries, Community Pharmacy and community health initiatives such as my Live Better initiative. That has always been my ambition and where I want to shift to, but that does not mean that we will be closing acute hospitals because we do not need them. I just hope that we would need them less and that people would stay healthier for longer.

On health inequalities, look at the difference between two women growing up maybe a mile apart in this city — one in the area of least deprivation and one in the area of most deprivation. Their healthy life expectancy varies by 14·2 years. Those are my ambitions; that is where I am trying to get to.

Photo of Alan Chambers Alan Chambers UUP

My party and I welcome and support this timely plan. Our Health and Social Care (HSC) workforce will be critical in the delivery of many of the ambitions set out in today's plan. I wish the Minister well in his discussions later with the trade unions. Does the Minister hope that, moving forward, it might be possible to avoid the constant uncertainty and destabilising effect that delays in honouring the annual pay awards inevitably contribute towards?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for his question. I am meeting unions later today. We have had previous discussions about how I would hope to honour the national pay parity awards, and it was made clear to me by the unions that my language, which included such words as "ambition" and such phrases as "using best endeavours", was not acceptable. When I meet them later today, my language, I hope, will be more pleasing, or agreeable — let me put it that way.

The Member referred to future activity. It is my ambition — rather, it is my intent — that, all things being equal, when the pay bodies make their pay recommendations for the 2025-26 financial year, I will accept them and begin implementing the awards with immediate effect.

Photo of Linda Dillon Linda Dillon Sinn Féin

I thank the Minister for his statement. Minister, there is much in the statement that will be beneficial to all genders in our community, but I am a bit concerned that there is no specific mention of women's healthcare. We know that we lag way behind in actioning women's healthcare. I would like a bit more detail on that.

Is the single management structure for pathology services a recommendation that came out of the serious scandal in my area — the Southern Trust area — where 17,500 women had to be recalled for smears? Will doing that give confidence to women that, when they go for a smear — I encourage everybody to go for one — they will get the right result at the other end?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for the questions that she poses. Is having a single authority a product of that? To an extent, yes, it is. As the Member alluded to, it is very important that, among women, we restore confidence in the service and in its ability to deliver. She will be aware that there has been a move from cytology to HPV screening, which is a much more robust assessment.

Having that kind of single authority sits with my idea that, although we have five geographic trusts regionally, I look at them as one. I am looking for regional excellence by taking best practice wherever we find it and making it common practice so that we have that kind of consistency and get away from a postcode lottery.

On women's health, the Member will be aware that we are bringing forward a women's action plan. That is where the detail will be. I hope that that action plan will eventually inform the creation of a women's health strategy. I know that we are not doing one at the moment, but is a strategy that does not have the funding to back it up really worth anything, if we cannot deliver on it? We are starting with a action plan, but I support, in principle, the development of a strategy in future times.

Photo of Deborah Erskine Deborah Erskine DUP

I thank the Minister for his statement. I have so many questions that it is hard to pick which one to ask. First, however, I welcome the announcement about lung screening. Along with colleagues, I sponsored an event here at which Cathy Brokenshire really adequately made the case for the need for lung screening in Northern Ireland. I am keen to see the detail on that.

What does the Minister mean by "dental reform"? We have a crisis at the minute because of the number of dentists who are moving from NHS to private work. Will that reform look at the funding models? Will it look at dentists' pay? In my area, we do not have a proper out-of-hours emergency dental service, so that needs to be looked at. I want to see detail on what "dental reform" means.

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for bringing up the subject, because it is raised with me daily, not least by Members on behalf of their constituents. She will be aware that my predecessor, Robin Swann, put several million pounds into dental treatment, but we still have a problem with dentists deciding that they will focus on private work. The issue is therefore becoming very challenging and extremely difficult.

When I talk about reform, I do not want to scare the horses, but we may need to do something radical, because dentists have a lot of power within their grasp to decide whether to do NHS work or private work. We can presume that the private work is very profitable and agreeable to them. The reform therefore has to be something really fundamental that encourages that shift to reverse so that there are more dentists and more time being spent on NHS dental work. The detail remains to be worked out. I am simply identifying the issue as a large challenge that has to be tackled, because so many people need the service to change.

Photo of Danny Donnelly Danny Donnelly Alliance 11:45, 10 December 2024

I thank the Minister for his statement. There is a lot to digest in it and, like Mrs Erskine, I have a lot of questions. The Minister will be aware that the number of people in Northern Ireland recorded as waiting for an appointment with a hospital consultant recently reached its highest ever level. As of the end of September, 506,612 people were waiting to be seen. The statement mentions a decrease in waiting times, but the trajectory appears to be going in the opposite direction. How many of the people mentioned in the decrease in the statement have left the lists altogether in order to go private or for some other reason rather than being seen? When will people in Northern Ireland who are on those waiting lists start to see a difference in waiting times?

Photo of Mike Nesbitt Mike Nesbitt UUP

Some of the waiting times have improved. I emphasise again that, overall, the picture is not acceptable and needs a lot more work. However, when we talk about specific numbers and we say that the total number of people who are waiting for an appointment is x, that is not necessarily accurate, in that I could be on three different waiting lists. Disaggregating that might make a difference, but it might only be marginal, so I only mention it in passing. Some of the lists are getting better.

Our direction of travel includes rapid diagnostic centres, mega-clinics and the separating of elective and emergency care. Those are all going to help. However, we still need to have a laser-like focus on efficiency and productivity. When I go to the trusts, I am very aware that I am asking them to do two things at once: save me a lot of money and be a lot more efficient and productive. In the next financial year, I hope that the focus will be on being efficient and productive. As I said, we are looking at the funding model. If we are doing the equivalent of ordering 10 items online and only seven arrive, we will only pay for seven. Currently, we are paying for 10, so that has to change. Addressing that will help with the waiting lists.

Photo of Colin Crawford Colin Crawford UUP

I very much welcome the publication of the Minister's plan. How important will certainty and clarity on future funding levels be for the delivery of today's commitments, and does the Minister believe that there is now a greater recognition around the Executive table that, compared with multi-year funding, the worst way to plan and deliver a health service is through short-term and constantly shifting in-year settlements?

Photo of Mike Nesbitt Mike Nesbitt UUP

It has certainly been a remarkable year for in-year shifts. We started the year by voting against the Budget because we anticipated the problems that were going to arise. I acknowledge that there have been two major investments through the June and October monitoring rounds, but we are still left with a very challenging position for the rest of the financial year, and that is having an impact on the speed with which we can try to settle the outstanding pay parity issues.

Everybody around the Executive table would very much welcome a multi-year Budget, and I believe that we are going to get there, not in the next financial year but in 2026-27. We are, of course, dependent on the UK Government taking a lead in that regard, but I feel confident that that is what is going to happen. With a multi-year — let us say a three-year — Budget, a lot more is possible, not just around stabilisation but in producing the reform that we need. We should bear in mind that, in October, Professor Bengoa warned that if we do not reform, Health will absorb the entire Northern Ireland block grant by 2040, which is not that far away. That would be the opposite of sustainable.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Minister, for your statement. I want to pick up on your point about the anticipated reform of stroke services, the outcome of which will be subject to consultation. You will be aware that there was a pre-consultation in 2017 and a public consultation in 2019, and that an action plan with key actions was published in 2022. Your predecessor said that we did not need a strategy and that we needed an action plan. We know what needs to be delivered, yet there is no real progress on delivery. Are you able to provide us with an update on that matter?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for raising that point, which is an area of some frustration for me. You detailed the long and, to some extent, winding road that we have been on. We should be at the point where we are making ultimate decisions on the reform of where stroke services are delivered and which hospitals will become areas of specialism. I will certainly take that away. If it can be done without consultation, it should be, because speed is now the critical factor.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

I begin by paying respects to my fellow Gael Jody Gormley, his wife, Deirdre, daughters, Aine and Niamh, and son, James. In recent weeks, we were all blown away by the heroic bravery and strength that he demonstrated on 'The GAA Social' podcast with Thomas Niblock and Oisín McConville. I measc na naomh go raibh sé.

[Translation: May he rest in peace.]

Minister, further to your statement, what would you say to the nurse who contacted me in the early hours of this morning — at 2.36 am — saying that, at present, she works three to four nights a week on a medical ward. She told me, "On a majority of those nights, I can be working with eight-plus agency staff. There is no continuity of care, and patients could have three different nurses looking after them in a day, which means 21 different faces in a week. Tablets can be left sitting in front of patients. They do not check to ensure that they have been taken. Patients who are mainly elderly and hard of hearing struggle to understand what is being said, leaving them unwilling to ask for assistance. Care assistants, again mainly agency staff, are coming from England, yet, when there are extra shifts"—

Photo of John Blair John Blair Alliance

Mr McNulty, will you complete your question?

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

— "none are being offered to trust staff or local agencies".

Photo of John Blair John Blair Alliance

Mr McNulty, will you complete your question and resume your seat?

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

"Infection control is jumping on nurses for having rings or nail polish on while" —

Photo of John Blair John Blair Alliance

Mr McNulty, resume your seat.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

— "they turn a blind eye to patients trying to

[Inaudible]

"—.

Photo of John Blair John Blair Alliance

Mr McNulty, please resume your seat.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

— "or patients sitting on a commode".

Photo of John Blair John Blair Alliance

Minister, if you can recall some of that, go ahead with the answer.

Photo of Mike Nesbitt Mike Nesbitt UUP

It was a very emotive start, and I certainly join the Member in expressing sympathy for the loss of Jody Gormley. When we think about the dignity of Sir Chris Hoy, who now faces a terminal illness, it is remarkable how some of our sportspeople give examples to all of us to follow.

As to the Member's substantive point, he should not imagine for one second that the workforce is not an extreme focus. Although we have more doctors and nurses than ever before, we have severe workforce challenges. I assure the Member, however, that, by and large, every day, when somebody has to go to hospital and stay as an inpatient, they are well looked after. I am not sure that what was actually a rant advances anything.

Photo of John Blair John Blair Alliance

Before we move on, I will address Mr McNulty. What began with a fitting tribute and an appropriate question became something other than that. I have referred to this before, but I want to remind you — this is an initial warning — that Members should not allow their conduct to become disorderly at any time.

Photo of Stewart Dickson Stewart Dickson Alliance

Thank you, Minister for your statement, which included references to cancer. Do you recognise that cancer patients cannot wait and that cancer certainly does not wait? I express some disappointment that the statement is full of aspirations but short on detail. In respect of cancer services, Minister, can you tell us what you mean by "good progress", given the appalling waiting lists across Northern Ireland? Can you back that up with clear, measured evidence of the outcomes for cancer patients?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for his question. The most appropriate thing that I can do is take that away and get you the sort of detail that you are looking for, rather than trying to recall it on the hoof. I take your point: what you quoted from the plan is a generalisation; you want the specifics. I accept that, and you have a right to request them.

Photo of Pádraig Delargy Pádraig Delargy Sinn Féin

I thank the Minister for his statement. Minister, I want to touch on the point that you made about dentistry. A number of dentists are in touch with us regularly, and I stress that the fact that they do private work is about sustainability, because they find that the funding model does not sustain their dental practice. You mentioned radical reform. Will you commit to reviewing the funding model, so that patients who access NHS dentistry are able to do so in a timely and efficient manner?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member. Of course, any review will look at the financing. We are very aware of the pressures, and not just in dentistry. We used to worry about nurses or doctors going off to Australia; now we worry about their going to Athlone, because, if you are talking about just salaries, it is very difficult to compete with Sláintecare. However, I gently say this to the Member: your party voted for the Budget. The Budget is a key factor in how much money we are able to devote to dentistry, GPs, rolling out multidisciplinary teams and all the rest.

Photo of Diane Dodds Diane Dodds DUP

Thank you, Minister, for the statement. I believe that you are genuinely interested in improving services for our constituents. I also believe that you are interested in holding the trusts to account, which is really welcome; it is high time. We have all been concerned about the performance of the cervical screening programme in the Southern Trust. Will you inform the House of whether the Belfast screening lab had its accreditation withdrawn last year, after an unannounced inspection by the United Kingdom Accreditation Service (UKAS), relating to the years 2013 to 2023? If that was an issue, why did the PHA give the centralised screening contract to the Belfast Trust?

Photo of Mike Nesbitt Mike Nesbitt UUP

I am entirely unaware of what the Member is stating, but clearly it is something that, if true, is very serious. I will take it away immediately after this session and ask the appropriate questions.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Minister for his statement. It contains some ambitious targets. He has told us of plans to take money back from trusts that are unable to meet targets. What analysis will there be, or is there, of why trusts are not able to meet those targets? It may be due to staff shortages, for example, in border areas, where the retention and attraction of staff is more difficult. How will the Minister ensure that the approach does not perpetuate those problems and widen the disparity that exists between some trusts and others that are struggling through no fault of their own?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for his question. There will be an analysis. Let us say that there is an elective list that is scheduled for this afternoon. If, for reasons beyond the trust's control, a key member of the workforce, such as the anaesthetist or the surgeon, is unable to attend — perhaps they have been involved in a road traffic collision — it would be unfair to penalise the trust for that situation. However, there are other situations in which the trust has some control. For example, it may have a week's notice that the anaesthetist will not be available next Tuesday. We would expect the trust to take action to try to make sure that that list goes ahead and is completed. We are going to take a very practical and reasonable approach to those things.

(Madam Principal Deputy Speaker in the Chair)

I acknowledged to Mr McNulty that the broader workforce challenge is a daily one for us. Although it is up to the trusts to manage those workforce challenges daily, it is up to us, as the Department, to look at a five- and 10-year plan, to anticipate what the needs are going to be, and to make sure that the training place numbers are right and that the universities and the other teaching areas have the facilities and the courses that we need to ensure that we have a workforce for the future and that we future-proof our workforce as much as we can.

Photo of Diana Armstrong Diana Armstrong UUP

Minister, I welcome the publication of today's plan, and I am pleased to hear about the "significant progress" that is being made on tackling waiting lists across more and more areas of our health service.

Overall, however, the Minister is clear that there is still much more to be done. Therefore, is he satisfied that trusts have a clear understanding that challenges with productivity and activity levels will be monitored and tackled robustly by his Department?

Photo of Mike Nesbitt Mike Nesbitt UUP 12:00, 10 December 2024

I thank the Member for the question. Yes, I am satisfied. I meet periodically with the chairs of the geographic trusts — in fact, the chairs of all the arm's-length bodies, including the Ambulance Service. I do not think that anybody in that group is unaware of the need for reform. Part of the measure of success of reform will be increased efficiency and productivity.

Photo of Brian Kingston Brian Kingston DUP

I thank the Minister for his statement and answers so far. His statement commenced by referencing the pressures that are on our health system and the likely difficulty over the winter period. That pressure will be felt particularly in accident and emergency departments, yet I see only a single sentence mentioning the urgent and emergency care review. When an ambulance is parked outside A&E, as well as the ambulance vehicle itself, there is a staff ratio of three, maybe four, people caring for the one patient.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Is there a question, Mr Kingston?

Photo of Brian Kingston Brian Kingston DUP

I just want to mention that I have had experience of that with a family member. What fundamental change — more physical space, staff or beds — is required to address that inefficiency and increase capacity in A&E departments?

Photo of Mike Nesbitt Mike Nesbitt UUP

The reason for the lack of detail on winter preparedness in the plan is that a statement on winter preparedness has already been issued.

On the substantive issue, one thing that we are trying to do is provide alternative pathways to EDs. For example, there are ambulatory services in many of our acute hospitals and specific respiratory areas to which people can be signposted without having to go through the ED. There is the same for cardiac services. We are trying to get to a point where a GP who would currently assess a patient and refer them straight to the ED might be able to refer them so that they do not have to go through the ED and have a second assessment if that assessment is not needed. Let us say that a GP assesses that a patient has respiratory problems and there is a respiratory unit that is probably approximate to where the ED is geographically. The GP will refer the patient straight to the unit. That is how you take a bit of pressure off EDs, as well as, of course, trying to make people healthier and keep them healthier for longer.

Photo of Andy Allen Andy Allen UUP

The Minister will, no doubt, recognise my regular communication with his Department on behalf of my constituents who are languishing on waiting lists. Indeed, I welcome his comments on waiting lists and the actions and initiatives that he is taking, but it is clear that much more work needs to be done. Can the Minister advise the House how much funding the Executive have allocated to his Department for specific waiting list initiatives?

Photo of Michelle Guy Michelle Guy Alliance

I thank the Minister for his statement. I welcome the consultation on serious adverse incidents. My constituents report to me that their issue is the fact that they do not feel heard and that it takes years for them to get any response. Will that actually change as a result of the consultation exercise?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for bringing up a very important issue. The serious adverse incident process is supposed to be a learning process. It is far too slow and is not fit for purpose. That is why it is under review. It will be reviewed within the broader context of the introduction of a duty of candour.

The House has debated whether the duty of candour should be organisational or individual and organisational, and, if it is to be individual, whether there should be criminal sanctions where people have not been open and candid. The proposed Hillsborough law that will come from the UK Government will also play into that. They are promising that legislation before the next anniversary of the Hillsborough disaster, so by April 2025, which is ambitious.

Here are the opportunities as I see them. There is an opportunity to be open and to have a Being Open framework, which I am about to publish for consultation. It is about looking at a duty of candour that might be placed on all public servants, not just those who are in the health service. Part of that is recognising that, if there is a serious adverse incident and something goes wrong, you and your family deserve to be told at pace what went wrong, why it went wrong and what we are doing to try to ensure that it never happens again. Yesterday, I met a family who lost a loved one to cervical cancer in the Southern Trust. This is my duty, and it is a privilege that those families feel that they can share their experiences with me. I say this to the Member: I would like to get to the position where I never have to meet another family in that situation.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

Minister, you have said quite a lot about health inequalities in the past few days, which is welcome. Like others, I am very concerned about health inequalities in NHS dentistry. There is a class divide, in that, quite often, wealthier people are able to get access to dentistry while working-class people are literally left to rot. You talked about the reform of dental services. Will that include the expansion of NHS dentistry?

Photo of Mike Nesbitt Mike Nesbitt UUP

I thank the Member for his comments. He will be aware that the Live Better initiative, which will come on stream very soon, has two demonstration areas, one of which is in West Belfast. When we spoke with people in that area about the services that they want, their feedback put dentistry on the list. That will be important, because if we can get better results and show empirically that the Live Better initiative in West Belfast has delivered better dentistry outcomes, we can use that evidence to roll it out further across Northern Ireland. Ultimately, it comes back to this: can we reform in a way that encourages dentists to do more work in the health and social care system rather than to use their time to offer private services, as is the trend at the moment?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

That concludes questions on the statement.