I beg to move:

That this Assembly regrets that, since the restoration of the Assembly, challenges facing our health service have worsened, with extensive waiting times, an escalating mental health crisis and severe workforce shortages; acknowledges that these pressures are not solely due to a lack of funding, but the failure of successive Ministers of Health and Executives to implement meaningful reform; and calls on the Minister of Health to work with Executive colleagues to introduce a fully costed and time-bound health service rescue plan to be presented to the Assembly no later than September 2025.

The Business Committee has agreed to allow up to one hour for this debate. The proposer of the motion will have five minutes to propose and five 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 eight minutes will be added to the total time for the debate. Colin, please open the debate on the motion.

Thank you, Madam Principal Deputy Speaker, I will see how far my voice gets me through this.

One year ago, this place returned after two years of collapse. On the restoration of this place, we were told that health was a priority and that we needed to transform health. One year on, are we in a better position? Are people waiting less time for an appointment? Are they getting sick less? Are health service staff getting the right resources to meet people's needs? The answer to all these questions is a resounding no. I take no pleasure in saying that. It is simply a reality check.

Credit where it is due: there have been some wins, as the Minister stated in his video on Friday past, he is bringing "hope back into health delivery". These included: being on course to deliver pay parity, a women's health action plan and enhanced respite care for children with complex needs. Those are all good and positive outcomes. However, people are still waiting unacceptably long periods for appointments. They are not getting any less sick, and our staff do not have the full resources to meet people's needs. Our health service is situated along the edge of chaos, which is a precarious place between stability and collapse. I think that we can agree — at least I hope that we can agree — that none of us wants to see our health service collapse.

Every symbolic step that the Department takes towards stability, it asks our health trusts to make hundreds of millions of pounds of so-called efficiencies. We have to call those out for what they are: cuts. Waiting times remain unacceptably long. Primary care practitioners have been depleted, where the only thing that is shifting left is the workload, and our Ambulance Service is held up for hours outside emergency departments (EDs), forcing our valued ambulances to wait for hours before they can get back on the road and respond to those in need. These are all systemic and historical issues. How do we address them? The Minister tells us that he does not have any levers to pull, but a Minister without levers is like a doctor without medicine. Both can diagnose the problem, but neither can offer any real help.

As to the amendment, while we welcome the proposer's commitment to reform of the health service, regrettably the amendment removes accountability from previous Health Ministers. We have been talking about transformation for years. Do the authors of the amendment not believe that it should have been a priority for Minister Wells, Minister Hamilton and Minister Poots? They will undoubtedly say that it should have been a priority for Minister O'Neill, but that fault should never be found at their own door. Given that the challenges that we are facing are systemic and historical, we cannot support the amendment.

Will the Member give way?

Very quickly because I get no extra time.

I thank the Member. Does he also share concern about the amendment's talking about taking "difficult decisions", which usually means closure and running down services? Will he express concern about it for that reason also?

The Member has an extra minute.

Not necessarily, but we need to tease that out if we have conversations. I wish that we were at least having conversations.

If we are to effectively transform the health service and bring it to a place of genuine stability, it must be a continuous, proactive and strategic process. The Minister tells us that he does not have enough money to transform the health service, but the other Executive parties say that he has more than enough, with half of the total Budget. Can we, please, park the petty party politics? Plenty of people are getting sick, but let me tell you this: everyone I meet is sick to the back teeth of the squabbling, the mud-slinging and the lack of delivery from the Executive. What we need from the Minister is less media performance and more substance.

We have waited a year for the overall strategic plan for transformation, and we have not got it. It is not the job of the Opposition to deliver a government plan; it is our job to hold the Executive to account. When we call on the Minister to deliver the transformation plan by September, that is the latest that we want to see it. We feel that that is a reasonable task. We are at the edge of chaos. If the Minister cannot deliver the plan by September and still has no levers to pull then, the media mask will finally fall and our health service will move further away from stability and ever closer to total collapse. Whose responsibility will it be then?

I call Diane Dodds to move the amendment.

I beg to move the following amendment:

Leave out all after "regrets" and insert: "the significant challenges facing our health service, including extensive waiting times, an escalating mental health crisis, and severe workforce shortages; acknowledges that these pressures are not solely due to a lack of funding but the ongoing need to implement meaningful reform; recognises the need to invest in our health and social care workforce; calls on the Minister of Health to deliver digital capability, innovation and research, take difficult decisions about reconfiguration of services and address health inequalities through primary, community and social care; and further calls on the Minister to work with Executive colleagues to progress plans to cut health waiting times and introduce a fully costed and time-bound health service rescue plan to be presented to the Assembly no later than September 2025."

Thank you, Diane. You will have five minutes to propose your amendment and three minutes to make a winding-up speech. All other Members who are called to speak will have three minutes. Diane, open the debate on the amendment, please.

Thank you, Madam Principal Deputy Speaker. Lots of people, when asked for their opinion on devolution, say clearly that they had high hopes for change, particularly in the health system. The motion and the amendment reflect the frustration and, indeed, the cynicism out there at the pace of change. Minister, it is not a reflection on you personally. The system is difficult and ponderous. It is like turning a tanker a little bit at a time. However, the most significant paper that has been published is now subject to a long consultation period, and people struggle to understand why consultation is necessary. It is hard to find what is novel in the 'Hospitals - Creating A Network For Better Outcomes' document. We have had high-level principles many times. Everyone knows that change is required. Eight years on from the Bengoa report, the Minister's officials should be clear about what represents the best configuration of services for Northern Ireland. It simply requires the Minister and the system to get on and deliver that.

In Northern Ireland, we have the largest-ever number of people waiting for a first-time consultation. Frankly, waiting times are a disgrace, yet, sometimes, when officials appear before the Committee, it is a bit like there is an acceptance of long waiting lists and a sense that they are inevitable given the situation that we are in. Many of my constituents and, indeed, MLAs talk about a two-tier health system where those who can afford to go private can go private, but I think that it is more broken than that. There are deep structural inequalities in the health system in Northern Ireland, different levels of interventions in health trusts and different responses on social care, particularly respite care for young adults with complex needs.

Our workforce is organised to deal with the regular annual workload. That is fine, but it will not clear the backlog. We perhaps need more honesty in our debates about the unavoidable requirement for much of the elective backlog to be carried out by staff outside of our local trust staff. The Department's elective care framework envisages additional hundreds of millions of pounds still leaving waiting lists extending into years, yet normal business in the health service continues to grow. We really have no answer to how we will deal with that backlog so that people will not always be waiting for hip replacements or knee replacements or whatever it is.

The Minister has moved on breast cancer but only after performance against breast cancer waiting time targets had collapsed to indefensible levels. That was evident in the published figures in June of last year: in the South Eastern Trust, I think, only 4·6% of women were seen within the 14-day referral period for a first appointment after discovering something wrong that needed to be investigated. Those are time-limited and life-saving things that need to be done, and we need to get on and do them.

I have pointed out many times in the Chamber, in the Committee and in questions for written answer the need for greater productivity. That is evident when we talk to others. A couple of weeks ago, we had the Royal College of Surgeons at the Health Committee. They are frustrated by the lack of coherence in the system, which means that productivity in theatre sessions can sometimes be very curtailed. That is incredibly important.

I hope that the Minister's bid to the transformation fund is successful. However, the Northern Ireland Audit Office (NIAO) has said that, even if it is not successful, the Minister should reorganise in order to find the money for multidisciplinary teams (MDTs) in our general practices. Having listened to the raw emotion of GPs at the Committee last Thursday, we know how important that is. It is about not just workload but delivery for patients in Northern Ireland.

Finally, the predicted income at the start of the year —.

Sorry, Diane, your time is up.

Sorry. Thank you very much, Madam Principal Deputy Speaker.

I hate interrupting you; I appreciate that.

I thank the proposers of the motion and those who tabled the amendment for bringing the issue to the Floor.

We need to be solution-focused. As the proposer of the motion said, let us take the politicking out of this. I do not think that anybody in the Chamber has ever said, at any point, that the Health Minister has more than enough. I can absolutely stand over that. I start almost every debate by telling him that I understand that he does not have enough. That is clear and has been made clear in the Chamber by all who speak on health. He does not have enough. Yes, he has a significant budget — over half of the Budget — but it is still not enough. What is important is how we spend what we have. Whilst what he has is not enough — this is not the first time that I have said this — what is important is how it is spent and how we use those limited resources.

I totally understand that the Minister needs an increase in the Health budget in order to recruit more staff and to modernise facilities and technology to improve our health service. Whilst the Health budget has had a funding uplift and inflationary increases, the increased service cost and significant increases in demand have placed pressures on our resources. How do we spend what we have? We have talked about winter pressures, but they are no longer winter pressures; they are all-year-round pressures.

Social care needs to be seriously looked at and invested in. I know that there is a lot of work going on in that space. It is our job to support that work and to look at where we can offer solutions. I would like to see the implementation of a targeted recruitment and retention strategy. That is important, because we know that we are failing miserably in recruiting and retaining, particularly in the social care aspect of our health service. We need to look at how we will improve that. We need to address the staffing shortages across our health service. That is everything from social workers to doctors, GPs, nurses and domiciliary care — all healthcare workers across the piece. We need to ensure that we have a better recruitment and retention strategy.

We need to introduce measures to streamline patient pathways. When I speak to people, it seems that that is a really difficult part of the health service for them. It is clunky. It is going to your GP, returning to your GP, going back to your GP, going somewhere else and going back to your GP. We are finding that there are not clear pathways. Again, that is often a resource issue or not being able to get people off a waiting list. We need to look at innovative ways of reviewing the situation. Some patients on waiting lists should no longer be on them. We are not having the type of review to make sure that people are not on waiting lists that they should not be on.

Your time is up. Sorry, Linda.

I thank the Opposition for tabling a motion on the most critical issue that we face: the crisis in our health service. We have just discussed how important devolution is for Northern Ireland, and the repetitive cycle of institutional collapse has had a devastating impact on our democracy and on the public's trust in our political institutions.

Let us look at the practical impact of having no Assembly and no Executive in place. No Health Minister meant no progress on many of the issues raised in the motion; no action on tackling some of the worst waiting times in Europe; no capacity to address the growing mental health crisis; and, as the amendment states, no further progress on the potential for "digital capability, innovation and research".

The motion rightly states:

"these pressures are not solely due to a lack of funding".

I respect and acknowledge the difficult position that Minister Nesbitt, like all Ministers, is in. He is dealing with not only an extremely challenging financial settlement but the loss of time that could have been spent developing vital strategies and legislation. We have had a Health Minister in place for only three of the past eight years, two of which were occupied by the COVID pandemic. That left our health service without the necessary leadership and accountability and led to the development of a two-tier health service, with many people in Northern Ireland now paying huge amounts of money for healthcare from their savings, from borrowing or from their family.

I agree with the SDLP motion that a key problem is:

"the failure of successive Ministers of Health ... to implement meaningful reform".

To date, my party and I have been disappointed by the Department of Health's slow progress on addressing the urgent need for transformation. We have to acknowledge, however, that several parties in the Chamber are failing to support the need for transformation in their constituencies. They often do so for short-term, narrow purposes when they should be looking at what might be successful in the long term. I will give one example. In November last year, Lisburn and Castlereagh City Council members debated the closure of the out-of-hours GP service at the Knockbreda Wellbeing and Treatment Centre, which is set to move to the Mater Hospital. The current model leads to significant overspending, and that transformation is in line with the Department's No More Silos policy. Transformation will never be delivered, if it is not allowed to start. The proposer of the motion spoke about the fact that we have been talking about transformation for years, so it will be telling for us all to see whether Members from certain parties in the Assembly join protests at healthcare facilities that are earmarked for transformation.

Northern Ireland is not a large place, and we need a more efficient health service. That will not be possible if all parties do not commit to the Bengoa principles from nearly a decade ago. I support the motion and cannot disagree with it in principle, but it is disappointing that the party that tabled it has a history of calling for Executive parties to make difficult decisions at Assembly level while opposing such difficult decisions at a local level.

Finally, we welcome the call in the amendment for a "health service rescue plan". As it states, it should include:

"plans to cut health waiting times" as an urgent priority, but it should also encompass transformation more widely. We also need to invest —.

Danny, your time is up. Sorry about that.

Opposition parties have a crucial role in any parliamentary democracy in scrutinising policies and, when necessary, proposing alternative ones. An effective Opposition is to everyone's benefit. Unfortunately, on the 1st anniversary of the restoration of the Executive and the Assembly, the motion falls short of what I would expect from a constructive Opposition.

I will focus my initial remarks on the motion's final line and its call to introduce a further plan by no later than September this year. Frankly, I was surprised to see such a demand, especially from the Opposition. I thought that they would have believed that enough reports had been written and strategies published. Instead of more reports, patients and staff, I am sure, would much prefer to see the multitude of existing reports being delivered in full, including the three-year plan, the publication of which was announced by the Minister in the Chamber less than two months ago.

The motion, aided and abetted by the amendment, calls for the implementation of "meaningful reform". It is clear that people in different parties have different interpretations and definitions of reform, but they rarely, if ever, set out what they mean in practical terms. Equally, when the signatories to the amendment called for the delivery of digital capability and efforts to tackle:

"health inequalities through primary, community and social care", they must have done so while apparently being unaware of the progress that has already been made in that area.

Not one patient or health worker will benefit from the motion. The debate smacks of political parties trying to score misguided political points.

The health and well-being of our society are far too important to be used in such a manner.

I wish to focus my remarks on a local issue in my constituency of North Antrim, which I believe falls within the scope of the motion.

In September 2024, I spoke about a mental health charity in my constituency that provides an invaluable service in crisis intervention, counselling and family support. As of today, Turning Point NI in Ballymena remains without secure long-term funding, despite continuing to provide an essential service across North Antrim. At the end of March, the National Lottery funding that directly pays four members of its staff will stop. The next round of allocations will not be assessed and awarded until September 2025, which puts the vital charity at risk of closure.

Turning Point specialises in tier 3 and tier 4 cases, which include those with complex diagnoses, often dual diagnosis, and those who, sadly, present as wishing to end their own lives. The crisis intervention and de-escalation front-line service that it provides is essential and cannot be left by the wayside. Indeed, it is often referred the most complex of cases by the community mental health team, under the banner of the Northern Health and Social Care Trust, child and adolescent mental health services (CAMHS) and other public bodies. Yet, none of these agencies has directly offered or provided funding for that work to continue. Last September, it was estimated that the work carried out by Turning Point has saved the trust in the region of £70,000 —

Mr Gaston.

— and that figure continues to rise.

Mr Gaston, will you return to the scope of the motion? I appreciate that you have mentioned much-needed services in your constituency, particularly around mental health and de-escalation, but will you please return to the scope of the motion for the remainder of your time?

The motion before us talks about how we fix the health service and issues with mental health services. I believe that my comments about that charity fall within that. To me, it is clear that the Northern Trust is simply not well enough resourced to deal with the most complex mental health needs. Yet, it is expected that a charity in my area will continue to pick up the slack for free.

I dread to think what will happen to the people who are failed by the system should Turning Point disappear from the landscape. To where will they turn, who will care for them and where will the almost 100 people currently on its waiting list go? Who will intervene when they are most vulnerable? Perhaps, we could look at other trusts that are doing crisis intervention and de-escalation, and, after raising the issue in the House for a second time, along with the other letters of support from elective representatives, local authorities and statutory agencies, it might finally be taken seriously.

I invite the Minister to visit Turning Point NI to understand the issues and address them accordingly before it is too late. That charity was based and created on the back of too many lives being lost in the Ballymena area. I trust that we will not get to the point at which we see the number of lives being lost increasing because that charity has run out of money.

It is abundantly clear that our health and social care system is in crisis. For the past decade, waiting lists for an initial outpatient appointment have risen by more than 200%, which is totally unacceptable. Our waiting lists are by far the worst on these islands. Compared with England, in the North, we wait seven times longer for hospital care. The morale of health and social care workers has plummeted almost as low as their pay in real terms. At the same time, attacks on healthcare workers have risen.

Since the Assembly was restored last year, we have debated ambulance waiting times, delays to the maternity and children's hospital, social care reform, mental health provision, funding for health transformation and much more. To be frank, all that talk has not made a bit of difference. In fact, a year on from the Executive's restoration, the crisis facing our health service has only got worse.

It is undeniable that something needs to change. First and foremost, we need investment in our health and social care workers, who should be paid a decent wage and be employed under good terms and conditions. We also need to listen to those who are working on the front line when proposals for change are being developed. They are the experts, but engagement with workers is, too often, nothing more than a tick-box exercise. Any plans for reform that see a growing role for privatisation should be explicitly rejected. Outsourcing health and social care to the private sector is astonishingly poor value for money, yet some parties are content to pump millions each year into the private sector in the hope that multimillion-pound companies somehow have a sincere interest, which is not motivated by profit maximisation, in solving our waiting list crisis.

The amendment calls on the Minister to:

"take difficult decisions about reconfiguration of services".

Too often, that is simply code for the closure of local services. For that reason, I will oppose the amendment. People should protest against those forms of service reconfiguration. Shutting down maternity units, minor injuries units and urgent care centres before clear and safe alternatives are put in place shows a complete lack of care for the communities that work in and use those services.

Finally, the small but growing private healthcare sector in the North is a massive red flag for where the crisis is headed. Between 2019 and 2023, private hospital admissions in the North more than tripled. Those who have the means to pay out of their pocket or through private insurance plans are fast-tracking their way to treatment. Those who cannot afford to go private languish on waiting lists whilst their conditions worsen, and many will die waiting for treatment. The health crisis has a real human cost, and that cost is death and disease, especially for those who do not have the wealth and privilege to pay for private care.

The Minister of Health, Mr Mike Nesbitt, will respond to the debate. Minister, you have up to 10 minutes.

Thank you, Madam Principal Deputy Speaker. I will not hang about, then.

I normally welcome debates in the House but not so much today. The tone and content were a bit disappointing. I have never, ever argued that it is all about the money. Many of the issues are the result of over a decade of Tory austerity, repeated instability and stalemate in this place and, frankly, decisions that were made in the Division Lobbies, such as voting for the 2024-25 Budget despite being warned of the consequences for health delivery.

Will the Minister give way?

You are a bit quick.

I know; I thought that, Minister.

For clarification, we both sat at Hillsborough Castle many times when Health was not just a priority for all the other parties but the priority. Will the Minister reflect on the things that the other parties have said?

I am aware that, before the restoration of the Executive, all the parties appeared to prioritise Health. I heard Jayne McCormack of the BBC say this morning that, in her first conversation with the First Minister and deputy First Minister, they said that if they could achieve anything and do one thing well in this mandate, it would be childcare, which is not part of Health.

The motion calls for yet another plan. I am surprised at that. I thought that Members, especially those from the Opposition, have had enough of plans. I certainly have. From the day that I entered the Department, I have made it clear that I want the focus to be on delivery, not on plans, promises and strategies that do not have the budget for the annual delivery plans. To be clear, I already have a plan. My three-year plan was published less than two months ago. It outlines my ambition for the health service for the remainder of the Assembly mandate. Moreover, there are several other detailed plans in place: for example, the elective care framework, the cancer strategy and the mental health strategy.

As for costings, those, too, have been produced.

Will the Minister give way?

I am going to make some headway now.

For the three-year plan, I am committed to publishing an annual implementation plan once budget allocations have been agreed. I previously identified my priorities for the mandate, which are delivering reform, tackling waiting lists, improving cancer services, addressing mental health and, above all, confronting persistent health inequalities. Those priorities are based on three pillars, which are driven by the finances in the budget.

Stabilisation comes first. Can we preserve what we already offer, and then can we achieve reform and delivery? That will require more investment in all parts of the system: primary; community; social care; and secondary care. Stabilisation of services includes mitigating the inevitable challenges as a result of budgetary pressures.

I will give way to the Member briefly.

Thank you. Does the Minister agree that the mental health strategy cannot help to combat the mental health crisis that we are in when it is not being funded adequately?

I absolutely agree. This year's action plan has provision for a spend of £42 million. The actual spend is £5·9 million. I have to warn Members that, next year, the gap between what we can spend and what we are hoping to spend will widen. We might get up to just over £6 million, but the plan is for delivery of over £75 million in the financial year.

Members will recall that, last October, I welcomed back Professor Bengoa, and he reflected on whether Northern Ireland was on the right trajectory. Some Members think that the Bengoa report has sat on the shelf since 2016: it has not. His view is that we are heading in the right direction. Hearing from him that Northern Ireland is not an outlier in international terms was heartening, but I am very clear that it is not an excuse to relax or take the focus off what needs to be done. I am focused, and it is important to be clear that root-and-branch reform is not something that can happen quickly. We need to involve those who use the services and those who deliver them when we develop and implement changes. I will return to Diane Dodds's comments in a moment.

My Department has already taken further action to deliver my ambitions. For example, in elective care, we have established more mega-clinics and more elective care clinics, and we are investing further in two rapid diagnostic centres. We are driving forward targeted measures to ensure that trusts are delivering 100% of all commissioned sessions and that efficiency and productivity across the elective care centres is maximised. Members will recall that I have already said that we took £2·3 million off a trust for the non-delivery of 100% of commissioned sessions. In the most recent plan, I have challenged health and social care trusts to deliver 46,000 additional outpatient assessments and 11,000 additional treatments annually by the end of the mandate.

Somebody talked about pathways. Mrs Dillon talked about two things that she wanted to be prioritised: recruitment and retention. I absolutely agree with her, and that is one of the reasons why I am committed to introducing, within this calendar year, the real living wage to social care. That will have a significant impact on recruitment and retention. Mrs Dillon also mentioned pathways, but I have to say to her that we already validate waiting lists. That does happen. As for going to your GP and going back and the pathways being overcomplicated, GPs are already beginning to direct patients to urgent care units, not acute hospitals, so bypassing EDs. The Regulation and Quality Improvement Authority (RQIA) report on the temporary dislocation of general emergency services, moving them from the South West Acute Hospital (SWAH) to Altnagelvin, made the point that we have to move away from double ED assessments. If you get assessed at the SWAH and sent to Altnagelvin, you should not have to go through a second assessment in the Altnagelvin ED; you should go straight to the part of the hospital that you are supposed to.

Mr Carroll surprised me by talking about the closure of urgent care centres. I have been at only the opening of urgent care centres. If there are any that have closed on my watch, I will be very happy to hear about them.

Let me stress that we are not unique in the United Kingdom. The Westminster Government recently published a health service plan that reflected similar themes and challenges to ours. This opens up great opportunities for cross-jurisdictional working. I have already met counterparts in England, Scotland and Wales, and the Government of Ireland, to discuss mutual concerns and share issues, and I will continue to do so, with regular engagement at official level as well.

As I have said, reform is already happening. However, it is inevitable that the pace of reform is going to be impacted on by the level of funding available. Although cutting waiting times is included in the Programme for Government, I hope that Members have noticed that no additional funding has been made available for that purpose — not a single penny. Indeed, the narrative from the draft Programme for Government makes it clear that things will get worse before they get better. When MLAs from all parties write to me, as they do daily, asking for things such as the reinstatement of the cross-border reimbursement scheme, I ask them to realise that their decisions on the Budget have unavoidable consequences. Just for the record, I would love to bring back the cross-border reimbursement scheme: it works.

Mrs Dodds talked about too much consultation. I say to her, gently, that it is not possible for me to do what she suggested, because these changes are effected by the trusts, not by the Department, and the trusts have a legal obligation to consult.

If you look at the resistance to change in the Northern Trust over one proposal to move one service from the Causeway Hospital to Antrim Area Hospital or the resistance in Fermanagh to the temporary closure of one service that was being moved from the South West Acute Hospital to Altnagelvin Hospital, you get a measure of how difficult it is to achieve reform. When you listen to Mr Gaston pointing out the really invaluable service delivered by a community and voluntary sector group in his constituency, he emphasises the fact that all healthcare is not just personal but local. People want everything locally, but we cannot do that because we cannot afford to do it, and nor is it the right thing to do, because we need areas of specialism. When you need a service, you will go somewhere where they do it daily.

Finally, the proposer of the motion said that efficiencies were cuts: what an extraordinary statement. If none of the £200 million saved this year by the trusts is not an efficiency, no efficiencies are needed. The debate is worthless because the Health and Social Care system is perfect. Who would go for a cut before an efficiency? Yet, you say that they are all cuts.

That is why I have found the debate a little disappointing. Some of the comments that I have heard do not stand up to first contact with logic; in fact, I will have a glass of what you are having, without the water.

I call Alan Robinson to make a winding-up speech on the amendment. Alan, you have three minutes.

OK, thank you, Madam Principal Deputy Speaker. I am on pretty safe ground today when I say that the crisis in the health service is not a new challenge that has just appeared on the horizon. It has been building for many years not just in the Province but across the UK. We have multiple debates in the Chamber about our health service, but, so far, we have not seen a lot of the changes that we wish to see.

The facts for this place speak for themselves. Waiting lists in the Province are the worst in the UK. There are half a million people on waiting lists to have a first appointment and tens of thousands of people have been waiting for more than a year — some much longer — for treatments and surgeries. Our constituency surgeries are crammed with examples of people who are living in pain, parents who are unable to care for their children or individuals faced with having to leave their job because of their health needs. We have debated that, but, so far, we are not seeing the changes that we need.

Our mental health services in Northern Ireland are in a dire state. The Province has the highest rate of mental illness in the UK. We have young people who have been waiting for months and even years for mental health interventions. What about the health workforce? There are nurses, doctors, paramedics and care staff who are exhausted and demoralised. There are staff who are overworked and stretched to the very bone. People will even say that the health service is surviving on goodwill. Some staff are being asked to do the impossible every day. I speak to staff, and some are leaving the profession because they cannot take any more or because they can receive better pay and working conditions elsewhere. We have debated that too, but we are not seeing the big changes.

Access to a GP is in crisis, as is access to A&Es. Through no fault of its own, the Ambulance Service is in crisis. Social care is in crisis. Millions of pounds have been lost on the new maternity and children's hospital project, and there are new revelations about millions being spent on consultants, and so the circle continues. We are not seeing the changes that we need to see, and the health service is awash with multiple reviews — reviews on top of reviews, strategies and consultations, including the Bengoa report. They have all outlined the changes that we need.

Members will have been a little bemused to see the Department complaining that over £8·4 billion in resource in next year's draft Budget will be insufficient and hundreds of millions short. It may be one thing to argue that you are under pressure to make sure that you come in on budget for the end of the current financial year, but that is £8·4 billion up to the end of March 2026. There ought to be ample time to prioritise spend. Not everything that the Department invests in is in front-line care. Professor Bengoa put it relatively politely when he was here in the autumn: if there is not a changed approach, the Department will soon be asking for 100% of —.

The Member's time is up.

OK. Thank you, Madam Principal Deputy Speaker.

Thank you, Alan. I call Daniel McCrossan to conclude and make a winding-up speech on the motion. Daniel, you have five minutes.

Thank you, Madam Principal Deputy Speaker.

As many colleagues have said, it is a year today since the Assembly and Executive returned. It is clear that there is absolutely nothing to celebrate, given the critical issues that face our people. Indeed, what people forget, when they talk about the return of the Assembly a year ago, is that we should have been here three years ago, when we were originally given a mandate by the people across Northern Ireland to come here and do the work that we are elected to do, which is to fix the problems in the health service and a wide range of other serious issues. In fact, if health were such a priority for the two parties that were culpable for collapsing the institutions on separate occasions, they would never have collapsed at all. That speaks to the truth. Health is not a priority for some parties. They talk about it and react to it, but there is no proactivity whatever when it comes to bringing about solutions to the critical issues facing our people.

The truth is that the health service is in crisis. That is a word that we hear a lot in the House. However, it is also a fact that, since the Executive returned, the situation has worsened. The Executive parties point at each other instead of sitting down and asking, "What can we actually do to resolve this problem?". We talk about a lack of funding. Yes, we all agree that there is a funding issue, but that is not the only issue. There are wider issues in relation to management. There are things that can be fixed. There are things that we could see more progress on.

I know that the Minister is frustrated, because I hear it in his voice. I know that he is frustrated with us and with the tone and content of the motion. However, the fact is that we are reflecting the feelings of the people across our constituencies who are sitting in hospitals and suffering on waiting lists. People are dying, when they should have received treatment in a timely fashion. Those people are taxpayers. They make their contributions every month and work tirelessly to pay into a system that is, in truth, failing them. That adds to their suffering.

It is not good enough to sit in the House time and again and listen to the same old excuses. As the Minister rightly points out, it is eight years since Bengoa. He says that that report has not sat on a shelf, but it is frustrating for anyone in the House who remembers that the concerns that the Minister raises today are the exact concerns that were raised by the then Health Minister, Michelle O'Neill, when the Bengoa report was launched in the House eight years ago. The now First Minister forgets to mention that.

Yes, the problems that we face may be similar to those in other areas, but they have been worsened by a lack of political responsibility and leadership. Parties here duck and dive around the critical issues, but health does not discriminate. Every Member in the House will be affected. In turn, the lack of action and resolution of some of the problems that we face is having a direct impact on the health and well-being of the very people whom we rely on to help us — our healthcare workers, who are burnt out and exhausted.

I listened to Members across the House, and I agree with their various frustrations. This is an issue that unites us and that we want to resolve. Let us stop talking about these things and get down and do it. This is a small place: it is six counties, 11 council areas and 18 constituencies. It is not rocket science. If there were the political will to resolve the problems in the health service in this place, it would be done. That is why I am so disappointed by the DUP amendment. Instead of facing up to the emergency, some want to water down the motion with a weak amendment that does nothing but give the Executive an easy way out. For too long, the Executive have had too many easy ways out.

A total of 400,000 people are on a waiting list, suffering daily. Countless people are sitting in emergency departments for over 20 hours. People who are struggling with mental health and addiction sit, today, in desperate need of an intervention. Whilst all that suffering continues and our people plead with us as their elected representatives, turning to us in desperation, all we say to them is, "It's being looked at. We recognise the problem". It is not good enough. People demand better.

There was a plan for transformation: a £200 million reform budget. If it were such a priority for the Executive, why did that entire budget for reform not go to the Minister of Health to help him to reform our health service? The Minister knows what the problems are; Mrs Dodds knows what they are; Linda Dillon listed what they are. We all know the problems. The Minister of Finance, along with the First Minister and the deputy First Minister and their Executive colleagues, need to put the funding where it needs to be in Health and help to drive a reform agenda to fix the problems.

Our people have suffered enough. They have listened to the excuses. They have seen the failures of this place. We have one opportunity. It needs to be fixed now, before others continue to suffer.

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

Main Question, as amended, put and agreed to.

Resolved:

That this Assembly regrets the significant challenges facing our health service, including extensive waiting times, an escalating mental health crisis, and severe workforce shortages; acknowledges that these pressures are not solely due to a lack of funding but the ongoing need to implement meaningful reform; recognises the need to invest in our health and social care workforce; calls on the Minister of Health to deliver digital capability, innovation and research, take difficult decisions about reconfiguration of services and address health inequalities through primary, community and social care; and further calls on the Minister to work with Executive colleagues to progress plans to cut health waiting times and introduce a fully costed and time-bound health service rescue plan to be presented to the Assembly no later than September 2025.

Members, please take your ease.

(Mr Deputy Speaker [Dr Aiken] in the Chair)