I beg to move

That this Assembly acknowledges the deepening crisis engulfing the health service; believes current hospital waiting times are unacceptable and must be urgently and sustainably addressed; notes with particular concern the 9·4% rise in the number of patients waiting for a first consultant-led outpatient appointment in the Northern, Southern and Western Health and Social Care Trusts between June 2023 and June 2024; reiterates support for the full and timely implementation of the 'Systems, Not Structures' report by Professor Rafael Bengoa in order to deliver a more effective, efficient and responsive health service; recognises the importance of transformation being clinically led, as well as the need to value and reward our dedicated front-line health professionals; expresses concern that the stabilisation package agreed with the Government in December 2023 is insufficient to enable the immediate sustainability of public services or to take forward the much-needed transformation agenda; further believes there is a need for a new, long-term financial settlement with the Treasury; calls on the Minister of Health to work with Executive colleagues to strongly make the case for additional funding from the Treasury; and further calls on the Minister to prioritise and allocate additional resources to tackle the backlog in hospital waiting lists in the delivery of the Executive’s forthcoming Programme for Government.

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 to propose and 10 minutes 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 the debate.

Diane, please open the debate on the motion.

Thank you.

The motion is one of the most important that we could bring to the Assembly. It will have a resonance in every family across Northern Ireland. We all know someone who is on a waiting list; we all know someone who is in pain; and we all know someone on the waiting list who will be diagnosed with an illness more serious than that had they been seen earlier. It is a significant yet difficult issue, but the Minister and the Assembly must grasp it in order to make life better for people in Northern Ireland.

Waiting for treatment has been a fact of life since the inception of the NHS, with statistics going back to 1949, believe it or not, on the number of patients waiting for routine treatment. The NHS's founding principle of care being largely free at the point of use means that the length of time we wait tends to serve as an indicator of the state of the service overall. We should reflect on that point, because it is significant: so many people are waiting because so many elements of the service need to be fixed in Northern Ireland.

I use the word advisedly, but the waiting times in Northern Ireland have become "obscene". Growing demand, funding constraints and staff shortages have contributed to the fact that none of the departmental waiting list targets has been met since 2014: that is 10 years, and those are the targets that I can verify. The result, tragically, is that people will have much poorer outcomes and many will die because their diagnosis or treatment is delayed.

For the debate, I looked at the cancer waiting times in Northern Ireland. There is a 62-day target for patients starting treatment following an urgent GP referral, and only 29·8% of patients with an urgent referral will start treatment for their cancer in that time frame. Imagine the terror and anxiety felt by a woman who discovers that she has breast cancer and realises that, in Northern Ireland, of the patients seen by a breast cancer specialist following an urgent referral — we are supposed to have a 14-day target for that — only 34·1% of women will be seen in the appropriate time. That is obscene and shocking; it is to our shame. It is something that needs to be fixed. Minister, this is not a get-at-the-Minister issue. We want to work to make sure that all of us — collectively — fix these issues.

Last year, there was an increase of 9·4% in the number of people waiting for an appointment with a consultant following their referral by a GP. In many specialities, there is a much, much longer waiting time than there is in others. We need to address those issues. They are very, very significant. We have heard for a long time that Northern Ireland has the worst waiting lists in the United Kingdom, but has the approach that we have tried so far brought us any closer to significant progress? We have made progress at the margins, but not significant progress that will help us to address the issue. Does anyone in the Chamber have confidence that we will see significant improvements if we continue to do the same thing that we are doing? I say this, to the Chamber: simply doing a little more and investing a little extra will not make enough of a difference, and continuing in the old way, with small contracts at the end of the year for the private sector, or when money becomes available, will only have minimal impact. Staff, busy in their NHS jobs, doing a little extra at the weekend or, perhaps, one day through the week, is only playing at the margins. We need a fundamentally different approach.

Officials have told the Health Committee that we are not far off having the appropriate capacity to be able to deal with the regular, anticipated workload of routine and emergency cases, year-on-year — that is good — and it is the backlog that is the massive challenge. We need a better answer than simply, "Give us more money" or, "We can't fix this until you give us more money". The motion specifically addresses the issue of money. I hope that money becomes available, although, I must say, as devolution was being restored, we were the only party that said we had insufficient amounts of money. However, we cannot simply sit about and do nothing until more money arrives: we need to look at the alternatives.

I have suggested seeking to partner with large national or international providers. There are renowned US non-profit organisations that should be encouraged to take an interest in Northern Ireland. Some already operate in the United Kingdom and the Irish Republic, and our political relationship with the United States should be able to assist us in trying to interest those people in helping us address the crisis in our health service. However, we would need to be willing to offer large enough bundles of procedures to release the efficiencies and ensure that those people would come.

Other areas that should be pursued include organising our waiting lists on a regional, Northern Ireland-wide basis to permit same-time access, regardless of where someone lives. There are far too many inconsistencies in the wait times across the trusts in Northern Ireland. I know that our Minister speaks about inequality in health service provision, but this is a structural inequality that needs to be addressed. We could include in that Province-wide centres of excellence for rapid diagnostics or scopes, and understand that the very expensive equipment that we use for that should not be simply switched off and shut at 5.00 pm. One of my local hospitals — Daisy Hill in Newry — is a classic example of where we need to ensure that we sweat the asset that we have. For many years, more and more staff have been added, but the number of appointments and procedures has not increased. I do not believe that that is the fault of the staff. The system is far too inefficient, and insufficient emphasis continues to be placed on prevention, leaving too many people with a preventable illness ending up requiring treatment.

One in four adults in Northern Ireland live with two or more long-term health conditions. When patients require treatment, they are not flowing through the system as they should. Staff cannot see as many patients as they would like, and they end up operating old and clunky technology that is unfit for the 21st century.

If there is a problem at the front end with too many patients, there are also problems at other parts. Hundreds of patients today who are fit to leave hospital have to stay there while taking up a vital bed. In mid-March, in a question for written answer, I asked the Minister of Health for the figures for those who were fit to leave hospital but were unable to do so: at that time, it was over 600 people. That is the equivalent of Craigavon Area Hospital and another of our smaller hospitals being consistently out of use. We cannot create an efficient system if that is the situation in our health service. I presume that, during the winter, that might have been much worse. Fixing waiting lists is a complicated issue and requires us to fix social care.

Lord Darzi's report last week stated that 13% of beds in England were lost through delayed discharges. What system can operate under that level of delayed discharge?

Mrs Dodds, time is up.

In England, the numbers of delayed discharges are published each day, and we should do the same in Northern Ireland.

Thank you for listening to this. I apologise that I did not get finished, but this is something that I am absolutely passionate about. I hope that the Assembly can support the motion.

Thank you. I call Nuala McAllister to move the amendment.

Thank you, Madam Principal Deputy Speaker, and thank you —.

Sorry, Nuala. Just move it, and then I will go through the rest.

I beg to move the following amendment:

Leave out all after "responsive health service;" and insert: "agrees that delivering the ambitions of health and social care transformation will require political leadership and an emphasis on service quality; recognises the importance of transformation being clinically led with genuine co-design and partnership working with the health and social care sector; further recognises the need to value and reward our dedicated front-line health professionals; expresses concern that the stabilisation package agreed with the Government in December 2023 and lack of multi-year Budgets is insufficient to enable the immediate sustainability of public services or to take forward the much-needed transformation agenda; further believes there is a need for a new, long-term financial settlement with the Treasury; calls on the Minister of Health to work with Executive colleagues to strongly make the case for additional funding from the Treasury; and further calls on the Minister to prioritise and allocate additional resources to tackle the backlog in hospital waiting lists in the delivery of the Executive’s forthcoming Programme for Government."

Thank you. Nuala, you will have 10 minutes to propose your amendment and five minutes to make a winding-up speech. All other contributors will have five minutes. Please open the debate on the amendment.

Thank you, Madam Principal Deputy Speaker, for keeping us right.

I rise to propose the Alliance amendment. I thank my colleague from the DUP for proposing the motion, which is of vital interest to everyone in Northern Ireland who either is waiting for treatment or has a loved one who is receiving treatment or waiting for treatment. It is important to all of us as elected representatives, it is important to the sector and, of course, it must be important to the Minister and his Department.

I will focus a little more on an area that has not been touched on, which is collaboration. Whilst we support the motion, we hope to highlight key specific issues that, we believe, were omitted from the original wording. We hope that people can support us on that. It is important to acknowledge that, if any progress is to be made on transformation, it must include partnership working across Health and Social Care (HSC). That means proper engagement and consultation with the relevant allied healthcare professionals, the healthcare workforce and the community and voluntary sector, all of which have a role to play in supporting the Department in its public health goals of preventative health, diagnostic treatment and ensuring that we can tackle the waiting lists.

On the subject of engagement and consultation, we have for too long relied on consultation as a box-ticking exercise. What we mean when we talk about "health transformation" is true engagement with the sector in order to create clinical-led, evidence-based policy to transform our health service. Unfortunately, whether it is through the Health Committee or engagement with stakeholders whom we meet individually and privately as parties, that is not something that we are getting truly from the Department. Too often, the collaborative approach to transformation is lacking.

In recent months, it has come up many times at the Health Committee, particularly on the issues of transformation and tackling waiting lists, that departmental officials and trust representatives have failed to engage with the relevant stakeholders. Just to be clear, there is some engagement across all sectors in Northern Ireland, but, if we were truly to listen to those who are working on the ground, we would see a much greater level of transformation. We can all agree that the surgical hubs, for example, are working and doing a fantastic job, and the Department must be commended for taking the lead on that. Many times, however, many royal colleges have said to us that they have proposals that could make surgical hubs more efficient, but, unfortunately, they are not being brought around the table. There is a difference between having someone sit on a collaborative forum as a box-ticking exercise and listening, engaging and responding in good faith. We saw that on the Health Committee when discussing the development of the reconfiguration blueprint with the Royal College of Surgeons (RCS). When Committee members from across all parties directly asked, "Has there been a level of engagement?", the answer, in short, was, essentially, no, unfortunately.

It is important that every party get behind the reconfiguration blueprint. Some organisations already have the blueprint, yet MLAs do not. My understanding is that it is out there and that many have seen it. My only hope is that the point of doing that was for true consultation and to listen to the clinicians, the experts on the ground and the management overseeing the service across all trusts in Northern Ireland. I hope that the reason that the reconfiguration blueprint was issued to those stakeholders was that feedback and engagement. I hope that, when the blueprint comes to the Assembly, there will be positive changes in it.

That is not the only example. The dental access scheme, on which we await further detail, was developed without engagement with the British Dental Association (BDA). That does not really weigh up. We need further information about how the Health Minister will truly collaborate within the sector.

To be fair to the Health Minister, who is new to the job, and the UUP in taking on the health portfolio, it is not just about one party. We need to ensure that there is true political leadership on the issue. We can all stand in the Chamber or sit on our Committees and talk about the need for health transformation, but, far too often here, we see the same parties standing on local picket lines, writing articles for local media and parroting misinformation when presented with transformation proposals in their own backyard. I will stand with the Health Minister when he tackles the issue. There are some, even in his party, who similarly argue against proposals. We all need to get behind the transformation. Whether you are a Member from my party, the UUP, Sinn Féin, the DUP, the SDLP or one of the smaller parties, we need to ensure that we all sing from the same hymn sheet.

I am proud to say that the Alliance Party is an evidence-led party in all aspects of its policymaking, and that includes health service reform. We will continue to listen to the evidence that comes from the health and social care sector and any advice about necessary changes. Our policy will be taken on board by the clinicians, professionals and stakeholders who are listening to the debate.

Another aspect that we touch on in our amendment is multi-year Budgets. If we are truly going to tackle waiting lists, we cannot do that on a year-by-year basis solely. We need multi-year Budgets to ensure that we have a long-term, sustainable plan. We support the Health Minister and all Ministers in ensuring that we have multi-year Budgets in Northern Ireland.

We also need political stability. We can all talk about health transformation, but we cannot see it if we continually have a stop-start Government in Northern Ireland. We need to reform our institutions to ensure that we can honestly hold our hands up and say that we will transform the health service. We cannot expect one Minister or all Ministers to do that if just one party can pull down the system. I say not just to the DUP but to Sinn Féin to join all the other parties today in committing to never again collapsing the institutions so that we can move forward collectively and truly transform the health service in particular.

I hope that all parties can get behind our amendment. It was tabled not to detract from the motion but to add to it. I look forward to hearing the Minister's response.

I support the motion and the amendment.

Eight years ago, Professor Bengoa launched his report 'Systems, Not Structures', which signified a turning point in the Assembly's intent to transform our health and social care system, with a clear focus on creating a safe, high-quality and sustainable service for people across the North of Ireland. I recently refreshed myself on the findings and the content of that report, particularly as I know that Professor Bengoa is due to visit here again next month. Despite almost a decade having passed since the report's publication, it could have been written yesterday, except that the key challenges have significantly worsened.

We are now in a situation where our health service is undoubtedly in a fragile state. Had the transformation been implemented as outlined in the Bengoa report and, indeed, in 'Delivering Together', which was introduced by my colleague the First Minister and then Health Minister, Michelle O'Neill, we would not be witnessing the impact of the "burning platform" that Professor Bengoa rightly predicted in 2016. We have not moved on from the reactive, acute-centred model of delivery that was operating back then, and that is clearly not delivering for patients and service users. In fact, it is contributing to increasingly higher costs, with an over-reliance on short-term solutions, including expensive agency and locum staff, not just in secondary and tertiary care but in primary care, as we continue to struggle to attract GPs into our local surgeries. We are at a point where this is no longer a tenable position, and maintaining those existing models is having increasingly negative impacts on the quality and experience of care for patients and service users.

Over the last decade, we have seen the symptoms of inaction, which, the wider public have often felt, was what was meant by "transformation", but let us be clear: the removal of services, such as emergency surgery from Daisy Hill and the South West Acute Hospital (SWAH), is not transformation; it is service collapse.

Go raibh maith agat

[Translation: Thank you]

to my colleague for giving way. Does the Member agree that transformation can truly be achieved only in consultation with communities?

The Member has an extra minute.

I thank the Member for her intervention. That is an important point, and I will discuss that in more detail later. We cannot impose decisions on the community, our staff or all the sectors that are critical components of our health and social care service. We must do it in genuine partnership and with co-design and co-production. The only way that we will deliver is by listening to the people who use the services and to those who deliver the services every day and know what the changes have been, whether they were societal changes or changes in the needs of patients.

That leads into my next point, which is the importance of proper workforce planning. We talked about service collapse, and my colleague will be aware of the impact of that in the SWAH. In order to avoid further such service collapse, we need to ensure that we have proper workforce planning, because we have seen that, where that has not happened, our highly skilled workforce has continued to see diminution and dilution as a result. That must be a starting point, and that is inevitably our biggest challenge if we want to see the proper transformation that, we all agree, is required. In this year alone, we have seen some of the dire consequences of a failure to invest in our workforce, and that is failing all our citizens. 'Delivering Together' envisioned the health and social care system as an attractive employer and one that enables staff to develop their skills in a working environment that allows them to do what they do best, and that needs to be our focus now. Staff are burnt out, and they are prevented from doing the job that they want to do by the constant firefighting and crisis management that they are required to do every day.

In 2016, Bengoa also highlighted the disproportionately high use of emergency and urgent care by people in the North, and that has undoubtedly increased significantly, as we see week in, week out the huge pressures on our emergency departments, with, as others said, some the longest waiting lists in western Europe and extremely long waits for access to GP services and treatment. That points to the need to turn the ship around from a focus on the latter stages of a patient's journey in acute or emergency care to a strong focus on primary care and early intervention where preventative and proactive care will ensure that our population will not only live longer but live a healthier and more active life with better outcomes. Primary care is undoubtedly the bedrock of a properly functioning health and social care system, and we therefore need to see concerted efforts to tackle the existing challenges across primary care so that patients can see the right person at the right time. As others have said, that work cannot occur in isolation. We need to see deliverable actions to tackle our waiting lists. That is not an easy task, given the current financial climate, but that does not mean that we should do nothing.

Those are just some elements of what we need to do to transform our health service. I am under no illusion that many components are required to fully deliver what was envisioned by 'Delivering Together' and the Bengoa report. We have seen chinks of light with the implementation of elective care hubs and the partial roll-out of multidisciplinary teams (MDTs), but we have some way to go. As others have said, we cannot do it without genuine partnership working, co-production and co-design with the people who use the services and those who deliver them. Our communities are anxious and fearful that they will lose services and that things are being removed. We cannot do business like that any more. Staff must not be the last to know about service changes. We must work together, and we are committed to working with the Minister to ensure that that happens in the time ahead.

We also support the motion and the amendment.

Years of inaction, underinvestment and political paralysis have pushed our health service into a state of emergency. For five of the past seven years, we have been without a functioning Government, unable to drive or fund the transformation that our health system so desperately needs. Instead of facing that truth, those in power attempt to obscure the harsh realities and shift the blame solely onto Westminster.

We waited for some time with bated breath for a Programme for Government (PFG). We knew that it would not fix the crisis in health, but we hoped that it would at least provide a costed framework with measurable and specific targets. Not only has the draft PFG not offered solutions, but Executive parties could not even get the detail right, with the Health Minister subsequently forced to clarify that the purported £76 million investment to address waiting lists this year was, in fact, old money to address critical categories and will not make a dent in the current waiting lists. It was more smoke and mirrors. Accountability is glaringly absent. The constant reference to budget pressures attempts to gloss over negligence and the lack of duty of care of previous and current leadership parties.

The need for transformation is more obvious than ever. One sometimes gets the sense that Bengoa is being used as a fig leaf for every collapse and closure across the health service, but it cannot be used like that. People want transformation that will mean that they can access treatment sooner. We support the motion and will do all that we can to ensure that transformation is funded. We need to invest to save. On publication, the Bengoa report, like 'Transforming Your Care' years before it, was heralded as a road map to better healthcare. At the time, I warned that a road map to a better destination is great but not much good if you do not have the money to put petrol in the tank. It is important that we get the money to fund actual transformation.

The Darwinian approach to transformation and health needs to be challenged. Recent cuts such as those to phlebotomy and vasectomy services — procedures that GPs delivered at a snip of the price — demonstrate a worrying trend. While I appreciate that some of the cuts have been reversed, the underlying issue remains. Newer, actually transformative and cost-saving services that truly make a difference are being sacrificed due to an apparent last-in, first-out approach. Enshrined services and the "way we do things" policy are being retained amid budget pressures. If I may be a wee bit parochial, the Western Trust is valiantly served by super health workers who are awfully served by the current capitation formula, which must also be reviewed before it becomes a formula for capitulation.

The current system is perverse. We have patients crossing the border in busloads from the South for procedures in the North such as cataract surgeries, while patients here cannot access the same treatment in a timely manner. Would you rather travel for two hours or wait for two years for healthcare? That is the question that we need to ask. Clearly, a more strategic, all-island healthcare model would benefit everyone, ensuring quicker access to vital treatment and better health outcomes across the board. The success of the ROI reimbursement scheme is testament to the need to drive cross-border solutions. I would very much welcome the return of that scheme as an interim solution to assist with the agonising wait for elective surgery.

People want an Executive that will do what matters most, not one that just says that they will. That means transparency on moneys that are invested and budget cuts that are applied and a workable framework that offers a ladder for our health service to climb out of the dark depths to which it has been consigned.

I welcome the fact that the Assembly has this chance to discuss one of the most important issues in Northern Ireland right now: the unacceptable health waiting times. Whilst enormous advances in health treatments and technologies have been made over recent decades, we must be honest and accept that too many people in Northern Ireland do not receive the quality of service that they need, deserve and, indeed, are entitled to. For some people, it may be OK to wait longer for treatment, but, for others, the risk of coming to further harm increases with every excessive wait. Cancer, for instance, is a disease that does not wait; instead, it often thrives during periods where interventions are delayed.

There may be many things that divide the Chamber, but there is political unanimity that patients and health workers deserve better. Lengthening waiting lists may be the current problem, but we must recognise that they have developed due to over a decade of underfunding, a reduction in training places and the closure of hospital beds. For some treatments, the waiting lists have been so long that individuals and families have been left feeling that they have no choice but to pay what are often huge sums of money to the independent sector. Whilst I want to stick by the mantra that our health service is there for everyone, based on need and not the ability to pay, that sentiment has become increasingly strained. Through our offices, I am sure that we all know of cases where people have borrowed money just to try to claim back some quality of life. It has only been in the past couple of years that we have been able to get sufficient numbers of staff into the workforce. Unfortunately, the damage had already been done, and there is a huge waiting list backlog.

It has been over three years since Robin Swann published the elective care framework, which was a detailed and realistic road map for tackling Northern Ireland's appalling hospital waiting lists. At that time, there was political unanimity for it. The framework had 55 clear action points and was endorsed by all Executive parties, and commitments were made to allocate the £700 million of funding that it required. Yet, within less than a year of its being published, the Executive collapsed, the deadlines for setting an overall multi-year Budget were missed and the damaging mistakes of the past were soon repeated. Instead of Health being prioritised, its opening allocation was cut in cash terms. Parties can call on the Minister of Health to invest in addressing waiting times, but, effectively, they are doing so having tied one arm behind his back.

I support the motion and the amendment on the deepening crisis in our health service. It is not just about numbers; it is about real lives, real communities and the future of healthcare across the North. The cracks in our system are most visible in social care, which forms the foundation of our healthcare services. Each and every one of the chief executives, when they gave evidence to the Health Committee, said that that was their single greatest challenge.

Without a well-supported social care system, our entire health service will continue to buckle under pressure. Carers who tirelessly provide essential services for our elderly, disabled and vulnerable citizens face increasing challenges. They are undervalued, underfunded and, too often, undersupported as they carry the weight of a broken system on their shoulders. As we all know, many of those carers are women, and women make up the backbone of paid and unpaid care in our community. It is high time that those women and, indeed, all carers are fairly compensated and that their work is recognised and respected.

The situation in rural areas such as those in my constituency of Mid Ulster is even more dire. The inequality of healthcare access between urban and rural areas is stark. People living in rural communities face a healthcare system that is harder to access, with fewer resources and longer waiting times. The distance to services and lack of transport options create additional barriers, leaving rural residents to struggle for the care that they deserve. That inequality is unacceptable. Everyone, regardless of where they live, must have equal access to healthcare services. Ensuring that we have infrastructure and accessibility needs to be part of the transformation process. However, solutions are available if we begin supporting, funding and using our primary care sector, GPs, community pharmacists, specialist nurses and, vitally, our community and voluntary sector, which is already underfunded and has its funding consistently reduced. Many of the answers and solutions are being pointed out to us every day, as Nuala McAllister mentioned. The Minister needs to work with clinicians, staff and, importantly, communities in order to implement the solutions.

There is also a need to seriously look at real and meaningful cross-border healthcare collaboration with the rest of Ireland. I do not mean having people head on buses to private hospitals; I mean serious cross-border collaboration. Sharing specialised services and creating joint facilities along the border could significantly reduce travel times for rural patients, alleviating the burden on local services while increasing access to much-needed care. We know that that is a possible solution for residents in places like Fermanagh and Derry and those right along our Western Trust area. Initiatives like the Cooperation and Working Together (CAWT) programme have already proven how successful collaboration can be. Expanding such partnerships is not just an option; it is a necessity if we are serious about addressing the healthcare crisis, especially for our rural communities.

In the context of social care, cross-border cooperation is equally critical. Many of our carers live and work in isolated areas and often lack the support that they need. By working across the border, we can ensure that carers receive better training, resources and support. Carers are the lifeblood of our healthcare system, and we must do everything that we can to support them.

We have a blueprint for change in the Bengoa report, 'Systems, Not Structures'. The report provides us with a clear road map for making our health service more effective, efficient and responsive to the needs of our people. However, as the Member said, you cannot do that without funding. You cannot take a car down the road without petrol. We all understand that transformation cannot happen without proper funding. The stabilisation package that was agreed last year was a step in the right direction, but it falls short of what is needed. We need a long-term financial commitment from the British Government to fund us to secure the future of healthcare in the North. As I have said before, the British Government must step up and properly fund the North, because if we do not act now and secure a long-term financial settlement from the British Treasury, we will see our healthcare system continue to deteriorate. The British Government must recognise their responsibility to ensure that the North's health service is adequately funded. We are not asking for special treatment. We were underfunded by the previous British Government, and the British Treasury has now acknowledged and accepted that. We cannot expect healthcare professionals to continue working in hospitals that are understaffed and do not have the proper facilities and resources.

The Member's time is up.

The issue can be addressed only with proper funding. We understand and accept that.

I again address the growing crisis in our health service — a crisis that touches every corner of Northern Ireland and affects every one of us in the Assembly and, more importantly, the people whom we all represent. Our health service continues to be at breaking point. As is said ad nauseum, urgent action and financial resources are needed to address it. Current hospital waiting times are simply unacceptable. We have reached a critical juncture where thousands of patients are being forced to wait far too long for their first consultant-led outpatient appointment.

Between June 2023 and June 2024, we witnessed a staggering 9·4% increase in the number of patients who are waiting for such appointments across the Northern, Southern and Western Health and Social Care Trusts. That is a reflection not just of the strain on the health system but of the human toll that it is taking on people. More than 340,000 people are now on a waiting list for a first outpatient appointment. That is just in four of the five health trusts. Families are being left in limbo, patients are left suffering and healthcare professionals are left with an impossible task. At the Health Committee, we have been told that one of the most difficult issues that a GP must face is referring someone onto a waiting list, knowing that their patient will be on that waiting list for many years to come and that they will be helpless to improve their chances of an urgent appointment.

Just recently, we received correspondence from a representative of a large group of parents and carers from across Northern Ireland who have children with complex medical needs. Those children are awaiting percutaneous endoscopic gastrostomy (PEG) insertion surgery. It can be done only at the Royal Belfast Hospital for Sick Children. That waiting list has now increased to five years. Around 90 children in the Province are awaiting that surgery. Many of those children are suffering the consequences of long-term nasogastric feeding. The fact is that they might not survive five years to get that particular surgery.

The stats on cancer care are equally concerning. As of the first quarter of 2024, the percentage of patients who were starting treatment following the decision to treat was 86·5%, which is significantly below the target of 98%. For urgent GP referrals, only 29·8% of patients began treatment within the target of 62 days, in stark contrast to the 95% target. The percentage of patients who were seen by a breast cancer specialist within 14 days was 34·1%, far below the target of 100%. Those figures are not just numbers; they represent patients, our constituents, who are waiting far too long for critical treatment.

We are all concerned that, despite the urgency of the situation, the stabilisation package that was provided by the Government in 2023 falls way short and will not take forward the transformation agenda that we all need. That has been borne out by the Fiscal Council, which has said that the package will be swallowed up by public-sector pay rises. The DUP is on record as saying that it fell short and did not provide for a long-term outcome. While we all want to see a long-term, fair funding plan, we also need to see a detailed plan from the Health Minister on the future of our hospitals, including the Causeway Hospital, which, on the face of it, looks to be a case of managing downgrade. The health service has always been the pride of our nation, built on the principle that no one should suffer because they cannot afford care. That principle is now gone.

Six months ago, in a previous debate on waiting lists, I said:

"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. ... [Some] part with money that they can ill afford, [but many] others cannot ... Those people descend into greater ill health, which, ultimately, becomes more complex and expensive to treat. Some even die. That is the stark reality".

— [Official Report (Hansard), 20 February 2024, p11, col 1].

It has got worse since I said those words six months ago.

I have also talked in the House about my own health issues. I suffer from chronic pain. I have been in and out of hospital constantly. I am on multiple waiting lists. The motion is timely because I stand here in extreme pain, even with potent tablets. I am on a waiting list for treatment. I have been on that waiting list for so long that I cannot even remember how long ago I was referred. It is now into years. I stand here with a condition that will not kill me. Thousands of our constituents are on waiting lists with conditions that, ultimately, without timely intervention, they will die from. We must turn that tide. I look forward to the Health Minister's comments.

Thank you for that, Alan.

I thank Diane and Alan for tabling the motion and the Alliance Party for the amendment that it has submitted. As we know, tackling hospital waiting times and the backlog of patients awaiting care requires long-term solutions, including the training and recruitment of more doctors, nurses and specialists, and, most importantly, tackling health inequalities and helping people to live healthier lives. However, how are we going to do that when, essentially, at the moment, the entire Health budget is spent on acute services and time-critical cases? If we want to move towards preventing illness rather than treating it, we need to invest in primary and community care.

Minister, we heard from your officials at the Health Committee last week about some really great examples of transformation that are in action at the moment, including elective care centres, rapid diagnosis centres and the mega clinics, but, like those clinics, longer-term reform must continue. Central to that reform is addressing the health inequalities and trying to improve our health through primary care and care in the community.

I am really pleased that the Minister has stated previously and publicly that his prime area of focus is health inequalities, but we need to see additional investment and physical interventions to really help to tackle them. We talk about health inequalities very often in the Chamber. The Minister recently gave us a shocking example of what a health inequality actually looks like and what it means in reality to our constituents and the people we represent: the unacceptable fact is that women in our most deprived communities can expect to live 14 fewer years in good health than those in the least deprived communities. I am sure that we all wholeheartedly agree with the Minister of Health that, a quarter of the way into the 21st century, that really is not acceptable. That is what transformation needs to be about. It is not about boxing it into one issue, such as the fact that women in the most deprived communities are living 14 fewer years in good health; it is about all the issues that we are talking about. That is what transformation and health inequalities are about.

What more can be done in the immediate future with the limited resources that we have available to us from the British Treasury to try to stop that depressing reality? I welcomed the Health Minister's announcement in July that covered the planned initiatives that we are going to see, hopefully, over the next few months, including the Live Better initiative, which is going to try to bring more targeted support to communities in terms of screening, vaccination, mental health, emotional well-being support, and blood pressure and cholesterol checks. However, if we are not moving forward in tandem with trying to support our primary care in the transformation process, how are we going to fully and genuinely implement all those great initiatives around screening and vaccination etc? The point was made to me by a GP in my local area recently that, if we try to put in place additional screening, mental health supports, additional services and targeted services, they still need to be backed up with the staff and personnel to try to meet the people who need the help and follow-up support.

GPs and primary care must be supported to lead on health reform and transformation. One way to accelerate that change and transformation is to deliver on multidisciplinary teams for all GP areas across the North. At the moment, only seven out of 17 have access to MDTs. We were made aware at the Health Committee last week that a transformation bid is going to be submitted to try to extend those MDTs across all areas. That is true transformation, and it is a good start to transformation. The Minister will be aware that the Health Committee has requested sight of the proposals for the hospital reconfiguration. Again, that is going to be a massive step forward in transformation.

I end my remarks by talking about one of the biggest missed opportunities around transformation, dealing with health inequalities and trying to help people to live happier and healthier lives: the continued and stark underinvestment in mental health, suicide prevention and addictions. I am not trying to bring a negative to the conversation; our underinvestment in mental health has been a legacy issue over many years, but when we are talking about trying to prevent harm and ill health —

The Member's time is up.

— and trying to support people, those issues really need to be looked at. Perhaps, even given the constrained finances, we could get an increase in that budget.

I cannot but begin by noting the irony of the motion. This motion has been proposed by one of the lead parties in the Executive, which tried just last week to sell us a Programme for Government as a great plan for the future of Northern Ireland. What do we find on waiting lists when we look at the glossy document? I will say one thing for it: the document is great at identifying the problem. On page 27, a wonderful graph shows us that, year-on-year, the waiting times for a first consultant-led outpatient appointment have increased under successive Health Ministers. Does that sound like delivery? I look at North Antrim, where we have the failure to reopen the Dalriada out-of-hours centre in Ballymena after COVID, meaning that urgent cases have to go to Antrim Area Hospital. Does that sound like delivery? Does launching a further consultation aimed at stripping away general surgery from Causeway Hospital sound like delivery?

Why should we believe that the Executive, made up of the same parties, will do any better than the previous Executive or the ones before them? We have endless millions for North/South bodies and an Irish language Act. Just yesterday, many in the House demanded another £400 million from Westminster, not to fix waiting lists but to build a GAA stadium. What solution does the motion propose? A demand for yet more money from London. If you are going to constantly argue that we are a special case and that we need additional money, please build a rational long-term case for doing so. Otherwise, you make Northern Ireland look like the Oliver Twist of the UK, always just asking for more.

There is, however, a rational case for arguing that, in the long term, Northern Ireland has been underfunded. As I told the House last week, in 2007, the Welsh Government appointed Professor Gerry Holtham to review the impact of the Barnett squeeze and to develop a metric for measuring what Wales needed in order to justify intervention to make sure that the squeeze did not take Wales below the level of service expected in the rest of the UK. Professor Holtham found that, because of higher need, Wales needed to spend £115 per head for every £100 spent in England. The equivalent figure for Scotland was £105 per head. In Northern Ireland, it was £121 per head. Why did the Executive parties not push for that before returning as protocol implementers? That was the time to agree the:

"new, long-term financial settlement with the Treasury" that the motion calls for. Professor Holtham even provided them with an off-the-shelf model, but the truth was that the rush to get back here was more important than the waiting lists.

I will raise an area that needs urgent attention. In July, I was contacted by a parent in my constituency whose young child with severe additional needs had been sectioned earlier that day, due to safety concerns for the child and for those providing care. No spaces were available at the Iveagh Centre. The initial response from the Belfast Health and Social Care Trust was that that was likely to be the case for several weeks. Social workers were deployed to the family home, where they had to provide round-the-clock care for eight days until a space became available. The trust staff were helpful, but their hands were tied due to a lack of facilities and psychiatrists at the Iveagh Centre and generally in Northern Ireland when it comes children with that child's needs. No family should have to go through the trauma of their child being sectioned in their home for eight days. Members throughout the House can, I am sure, cite examples from their constituencies.

Simply throwing money at the problem without a plan to fix it will not cut it. There is no point in grandstanding to demand additional money without having first made a long-term financial case to Westminster along the lines of that which Professor Holtham made about Wales.

I ask the Minister of Health to respond to the debate. Minister, I advise you that you have 15 minutes.

Perfect. Thank you very much, Madam Principal Deputy Speaker, and I thank the Members who tabled the motion and the amendment and everyone who contributed. It is not just an important issue; we should be really passionate about it.

I welcome the opportunity to respond to the debate. I will outline for Members the current position on waiting times; the actions that have been taken and the ongoing actions to address the issues, including, of course, service transformation; the importance of having an appropriately qualified and structured workforce; the complexities of working in a highly financially constrained and challenging environment; and, critically, what we need to do to ensure that we can deliver effective and sustainable health and social care services for all.

At the outset, I fully acknowledge that the people of Northern Ireland are not receiving the timely and effective care that they deserve. Far too many people wait for far too long. It is simply unacceptable that our waiting times lag so far behind those in the rest of the United Kingdom, and it is incumbent on me and on all of us collectively to ensure that we are doing everything in our power to address waiting times.

I do not intend to rehearse at length my position on the Budget, but suffice it to say that the Budget has imposed severe pressures on all parts of Health and Social Care. You do not have to take my word for it. The draft Programme for Government, approved by all Executive parties, explicitly states:

"It will not be possible to reduce our lengthy waiting times within the funding currently available."

I welcome that candour and the de facto acknowledgement that the health budget passed by the Assembly is entirely inadequate. My immediate predecessor as Health Minister remarked previously on the irony of Members repeatedly demanding more investment in health, having voted for that Budget. I will not labour the point, but the irony klaxon has been sounding quite a bit in the debate. Can Members really demand more health spending when they endorsed a Budget that gave the Department of Health less than it spent last year?

We are all aware that elective care waiting times in Northern Ireland have significantly increased in recent years, and I have been clear that that is entirely unacceptable. There are many contributing factors, not least the overall financially constrained environment but also the scale of the gap between funded health service capacity and patient demand and the residual effects of the impact of COVID-19, which had a devastatingly disruptive impact on our health and social care system. In that context, I am mindful of the fact that there was a rise in the number of people waiting for a first consultant-led outpatient appointment in the Northern, Western and Southern Trusts at the end of June. While I do not want to bombard Members with figures, it is important that I be clear about the full extent of the problem. I will therefore draw on the March 2024 statistics, which include four out of our five geographical trusts. At the end of March 2024, 356,000 patients were waiting for a first consultant-led outpatient appointment, 95,000 patients waiting for inpatient or day-case treatment and just under 165,000 patients waiting for a diagnostic test. Of the total number of patients waiting, almost 50,000 were waiting longer than 52 weeks for treatment. Those are eye-watering and, frankly, wholly unacceptable figures for a population of our size.

In addition to the growing backlog of patients waiting, new patients continue to be added, and, inevitably, the gap between demand and capacity exacerbates the problem and waiting lists continue to grow. While I fully recognise the severity of the situation and do not want to understate it in any way, I am encouraged to note that, in overall terms, we are beginning to see small but tangible improvements to the waiting list position. At the end of March, there was a reduction in the numbers waiting for inpatient or day-case treatment for the seventh consecutive quarter, with a 14·3% decrease in the numbers waiting since the same month last year. While that is good news, it only begins to scratch the surface of the problem. Those figures are, of course, not just numbers on a page; they represent individuals, family members and friends who are often waiting in pain for life-enhancing, life-changing or life-liberating treatments. It is understandable that there is a sense of urgency about the issue, but there is also a sense of frustration: deep frustration. The reality, however, is that the health and social care system is hugely complex, consisting of a wide range of varied and interdependent elements.

Members will be aware that, in May, my Department published an updated elective care framework plan. The framework built on the lessons learned from the first framework published in 2022. It sets out a clear plan to address waiting times, with a focus on areas where the impact would be the greatest: for example, areas where high volumes of patients are waiting for non-complex treatments. I am fully committed to delivering that plan and building on the good work that is already being done across Health and Social Care. It is important that I make it clear, however, that delivering on that plan will require sustained investment. The scope to do that is being severely hampered by the belt-tightening constraint of the current financial environment. As always, we strive to do what we can with the limited resources that we have, and, since publication of the initial framework in June 2022, we have seen the successful implementation of initiatives that have led to benefits for patients and, as I mentioned, a small but tangible start to improvements in waiting lists.

Notable achievements include two dedicated day procedure centres at Lagan Valley Hospital and Omagh hospital; elective overnight stay centres at Daisy Hill Hospital, the Mater Hospital and the South West Acute Hospital; the introduction of medical clinics to maximise patient throughput; the expansion of post-anaesthetic care unit beds across the region; an orthopaedic hub at Musgrave Park Hospital; two rapid diagnostic centres; and a programme of outpatient modernisation. It is important that we acknowledge and build on those improvements to ensure that that momentum is not just maintained but increased. It will only be through a continuous and sustained focus on ensuring effective implementation of all those arrangements that improvements will be secured. However, those alone will not address the backlog. We need immediate and sustained investment to secure additional capacity in the short to medium term.

The reality is that improved outcomes will be achieved only with significant recurrent investment to transform the delivery of elective care on a sustainable basis and address that gap between demand and capacity. Although the current financial position is extremely challenging, we must continue to do whatever we can with the budget available to improve the waiting list position.

I thank the Minister for giving way. He mentioned the South West Acute Hospital, which has the facilities to develop further and help to decrease those waiting lists. Will he ensure that it is utilised to its full potential in any future plans?

I thank the Member for his comment and can certainly assure him that that will happen.

Miss McAllister talked about the plan for hospital reconfiguration. It is at pre-consultation stage. I have asked officials whether it would be possible to bring that plan to the House as early as Monday week, and I await their response. I am keen to do it as soon as possible, and I assure the Member that the assessment of the reconfiguration will be clinically led.

In tabling the motion, Members asked that I work with Executive colleagues to make the case for additional funding to Treasury. I have made the point to the Secretary of State for Northern Ireland, the Secretary of State for Health and Social Care in London and the Prime Minister that poor mental health and well-being is a legacy issue of our conflict. Therefore, should the Government in London decide to invest in tackling that issue here, there will be no repercussive effect for England, Scotland or Wales. It is a population health issue only in Northern Ireland, so please be assured that I am fully committed to making the case for additional funding.

Some £76 million has been referenced as being invested this year to address waiting lists. It matches the additional investment of last year, but it is significantly less than what is required. It will be used for those with red-flag or time-critical waits: those with cancer or with life-, limb- or sight-threatening issues. The bottom line, however, is that £76 million is not sufficient to do any additional work on those waiting for long periods. It will simply help us to stand still.

We need a long-term collective effort, sustained and substantial investment through multi-year budgets, workforce development and system-wide transformation. Miss McAllister mentioned multi-year Budgets: it is my expectation that, when we get to the financial year 2026-27, we will finally reach the point where we will have a multi-year Budget, which, itself, will be transformational for the delivery of public services.

My Department estimates that, in addition to the £76 million that I referred to, there is a further requirement of £80 million per year to support elective care and reduce the demand/capacity gap and of another £135 million per year for up to five years to remove the waiting lists backlog and for investment across diagnostics, imaging and pathology. Members will recall that my Department submitted a bid for some or all of that £135 million earlier this year. That included a reinstatement of a form of the cross-border reimbursement scheme, which I am regularly urged to do. In the end, not a penny of that bid was met. The irony klaxon sounds daily in departmental headquarters.

On staff, the importance of an appropriately qualified, well-equipped and fit for purpose workforce to underpin all aspects of continuity and change in service delivery cannot be overstated. This is not just about numbers. It is about different ways of working to get the best services for patients from all available resources and having the right staff with the right skills in the right place at the right time. Work continues across the system to stabilise, expand and develop the workforce and to support the more effective use of staff across different specialities. However, progress in those areas has been hampered not only by the continuing pressure on the service but by the uncertainty about funding. We used to worry about losing staff to Australia; today, we worry about losing staff to Athlone.

Turning to transformation, the motion stresses the importance of the need for:

"support for the full and timely implementation of the 'Systems, Not Structures' report by Professor Rafael Bengoa in order to deliver a more effective, efficient and responsive health service".

One of my first actions as Minister was to meet the professor on a Zoom call and ask him whether he would travel back to Northern Ireland for one day, not to rewrite his report but to reboot and remind us and share his impression of the positive international initiatives that have occurred in the past eight years. I hope that the whole of the Northern Ireland Executive will again meet the professor and endorse his views when he is here on 9 October. I expect that he will acknowledge what we have done and that the report has not gathered dust on the shelf, and I refer to some of the advances that I mentioned.

My key areas of focus for the next three years include delivering reform, tackling waiting lists, improving cancer services, addressing mental health and confronting persistent health inequalities. That is how we deliver better outcomes, saving money, saving the health and social care system and saving lives. I will shortly launch a public consultation on the hospital reconfiguration framework: 'Towards a Northern Ireland hospital network'. I understand that, like politics, all healthcare delivery is local. However, healthcare has made magnificent advances. If I need a procedure that my local facility delivers once a day but I could travel a lot further to a facility that does it 10 times a day, five days a week, I know where I would want to go for that procedure. To be honest, we have to acknowledge that there is a tension between community consultation, co-design and co-production; MLAs' natural desire to preserve and promote local services; and clinical advice. We have to acknowledge that tension and work to overcome it.

Will the Minister give way?

Yes, if it is brief.

I thank the Minister for giving way. That point is important, because proper consultation and engagement are vital to bringing communities with us. If people understand what to expect and what the outcomes will be, they are more likely to appreciate the reason for change. Does the Minister agree, given his recent visit to Daisy Hill Future Group, where he saw the impact of proper co-design, that that is valuable?

I agree with the Member. I am simply acknowledging that that needs to be worked through.

I am heartened by the tone of the debate and look forward to working with Members over the next three years to deliver better outcomes.

Thank you, Minister. The Business Committee has arranged to meet at 1.00 pm today. I propose, therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The debate will continue after Question Time and the question for urgent oral answer, when Danny Donnelly will be called to wind on the amendment.

The debate stood suspended.

The sitting was suspended at 12.59 pm.

On resuming (Mr Deputy Speaker [Mr Blair] in the Chair) —