Health Minister Mike Nesbitt announces a series of initiative to cut waiting lists in the north.
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00:00Our members may be aware that I'm already on record with my analysis of my
00:04department's budget, an analysis which says it represents a quadruple challenge.
00:09Number one, I spend the money wisely on waiting lists. Two, mitigate the damage
00:16to other services from the executive's decision to ring-fence 165 million of the
00:22existing budget for waiting lists. Number three, press on with the reform of
00:27healthcare delivery and number four, balance the books. Today I put a primary
00:34focus on the first challenge. I'm sure every member of this house agrees we need
00:38to bring a sense of urgency to tackling the unacceptable waiting lists across a
00:43number of specialties. Far too many patients are waiting far too long for
00:49assessment and for treatment and that's right across Northern Ireland. Our
00:53waiting lists are truly appalling and a genuine desire to improve that was one
00:59of the motivating factors for the MLAs I represent as a party in wanting to take
01:05up the challenge of coming back into this department. When taking office as
01:10Minister of Health just over 11 months ago, I also stated that tackling those
01:15waiting lists was going to be one of my main areas of focus and I've been clear to
01:21executive colleagues that in order to deal with the backlog, it will take
01:25unprecedented levels of intervention, action, support, investment and it will
01:32take time. The plan to tackle our elective care waiting lists is the elective
01:37care framework that was updated and published again in May of last year. It
01:42outlines how we need to invest in capacity building and take action to clear the
01:47backlog of patients and it's in that context that I today announce a series of
01:52initiatives to reduce waiting times. The central focus of these plans is on
01:58reducing long waits for care and treatment that affect all of us here in
02:02Northern Ireland. Now we could devote time and energy today to discussing how we got
02:07here with roots stemming from a series of decisions taken over a decade ago but as I've
02:13said previously that will not improve the outcome of a single patient so let's
02:17instead focus on the future. Now while the budget for this year remains under
02:22extreme constraint, today's announcement reflects the executives ring fencing of up
02:27to 215 million pounds in this year's budget for waiting list activities. This
02:33investment is something which I of course welcome not least as it's what I and my
02:38immediate predecessor have repeatedly called for for over a year but to be
02:42clear the vast majority of this 215 million investment is not new it's not
02:48additional investment instead there's 50 million of additional allocation to the
02:53health budget and that 50 million is very welcome but the remaining 165 has had to
02:59be found from within existing allocation and this will inevitably have
03:04unavoidable consequences for wider health and social care provision and Deputy
03:09Speaker I must be honest my ability to both fund reform and balance the
03:15Department of Health's budget by the 31st of March next but as this was an
03:20executive-wide decision I hope to get the support of my executive
03:23colleagues in managing the challenge. So in the coming weeks my department will
03:28publish detailed plans and assessments on the financial pressures this year and the
03:33measures that will need to be taken in both the short and the medium terms. Let me
03:38make clear I fully support the executive's decision to prioritize waiting
03:43lists. I believe this provides a sharper focus targeted in a way to have an
03:48effective impact on waiting lists. It would have been preferable of course to do so
03:52through additional funding and in a much more strategic and planned manner but we
03:57are where we are and this statement is about setting an outline for the
04:01actions that we are proposing. I know members will rightly want more details on
04:06cost projections on outcomes for patients and on timetables and more detail will be
04:12provided later this month in an implementation plan for my department's
04:16elective care framework but I know there is significant interest already among
04:20not only MLAs but also patients and that's why I'm making this statement today ahead of
04:26the publication of that implementation plan. In general then we will invest across three
04:32areas. One red flag and time critical services, two capacity building and three
04:38backlog clearance. For red flag and time critical treatments investment will be made to
04:44expand core capacity across a number of high risk specialties. This will help make these
04:50services more sustainable and reduce reliance on the independent sector. For capacity building the
04:57initial focus will be on those areas where the infrastructure is already in
05:01place so that we can utilize all available resources. For example, on commissioned
05:07theatres or unused scanning sessions, significant reforms and improvements have
05:11already been made in recent years on the development of elective care centres
05:16right across Northern Ireland and I expect this investment will further accelerate that.
05:22With so many patients waiting for so long I've told my department I want every single
05:27opportunity and every single inch of capacity to be utilized. Given the current significant
05:34levels of waiting list initiative spend on endoscopy and diagnostic imaging, HSE core capacity
05:40in these areas will be expanded in the first instance. With further investment in other
05:45areas including urology, breast surgery, dermatology and cardiac surgery. Other areas where capacity
05:53will be expanded include trauma services. Expanding trauma capacity will improve performance against
05:59the 48 hour hip fracture target and the seven day access target for all other fractures. Increasing
06:05trauma capacity should have a benefit for orthopaedic capacity as one is often offset against the
06:11other in terms of crisis. Turning to the waiting list backlog, our first step in this journey will
06:18be a focus on our current weights of over four years for assessment and for treatment. Building
06:23the workforce and the infrastructure required to sustainably reduce the length of time patients
06:28are waiting will take time and clearly independent sector capacity will be required to help in this
06:34regard. The HSE will need to be sufficiently agile to allow the timely issue of contracts to existing
06:41and new independent sector providers. Partnership working with the independent sector will include
06:47outsourcing to their facilities and expansion of insourcing contracts across a number of general
06:53specialties including ophthalmology, cataracts, orthopaedics, general surgery, gynaecology and ENT. I also intend to expand primary care
07:03elective services where there are long waiting times for assessment and this is in areas such as dermatology,
07:10minor surgery and gynaecology. It's estimated £2.9 million would allow the service to see and treat
07:17approximately 16,500 patients this financial year. In addition, I've decided to allocate £10 million towards
07:27MEGACLINICS to help an estimated 20,000 additional patients. MEGACLINICS, as members will be aware,
07:34provide groups of patients with a one-stop shop which can involve, for example, surgical review and anaesthetic
07:40pre-operative assessment in a single appointment. Other initiatives for the year ahead involve targeting long waits of
07:47four years or more including hip, knee and other orthopaedic treatments, tonsillectomies, hernia treatment,
07:54gallbladder removal and colonoscopy. Funding will also be targeted at those specialist procedures
08:01where there are long waits impacting particularly for women or children. This would include women
08:07waiting on gynaecology mesh removal procedures and children waiting for procedures such as peg tube fitting,
08:13squints and scoliosis procedures. The role of the voluntary sector in healthcare cannot be understated
08:20and I'm pleased there's already a strong partnership between this sector and my department. This is
08:25something I'm keen to expand and build on further to promote and develop initiatives that provide support
08:30to those on waiting lists and in that context work is underway by my department to deliver a £500,000
08:38waiting well program to support those on waiting lists and a 1 million cancer charities program to
08:45deliver cancer work in the community to reduce pressures on statutory services. Addressing the
08:51current waiting times and the associated capacity gap will also require an increased focus on demand
08:57management, also an expansion of core capacity coupled with an increase in productivity and efficiency.
09:03And my department will work across the primary and secondary care interface to ensure patients are
09:09being managed in the most appropriate setting and capacity is being expanded on a sustainable basis
09:15across the HSC. While improvements in efficiency and productivity have been made by trusts in recent
09:22years, there still remains scope to secure further games by optimising the resource available to trusts.
09:28It's imperative trusts ensure that appropriate focus is given to deliver service improvements with
09:35implementation of good practice across the patient pathway to help drive improved quality, equity and
09:41efficiency. An expansion of pre-operative assessment capacity to ensure patients are fit and ready for
09:47treatment will be another important area for investment. I would remind members, Deputy Speaker, that
09:53investment at this level will need to be sustained for at least five years to bring hospital waiting
09:59times down to acceptable levels. Building our workforce and the infrastructure required to sustainably
10:05reduce our lists will take a collective effort. I also plan to establish a waiting list reduction
10:12reimbursement scheme. I know how important it is to have this scheme up and running as quickly as possible and for that
10:17reason the scheme will be initiated on a phased approach and an initial 10 million pounds will be invested.
10:26The scheme will commence in June of this year. It will give patients who are ordinarily resident in Northern Ireland
10:32and are on an HSC treatment waiting list. The option to seek and pay for treatment in the private sector and have the
10:41cost reimbursed up to the cost of the treatment by the HSC here in Northern Ireland. The first phase will allow
10:48reimbursements for treatment in the Republic of Ireland. The second phase will see the geographical scope of the scheme
10:54extended to all European Union countries. By opening up the scheme to the EU, patients will have a greater range of
11:01providers to choose from. I want to ensure the scheme targets those patients who have been waiting a long time for
11:07treatment. Therefore, in line with the strategic direction to target long waiters, patients will be able to access the
11:14reimbursement scheme if they have waited on an HSC treatment waiting list for two years or more. I hope the Assembly will
11:22enthusiastically support my focus on the longest waits and on delayed treatment for our youngest in society.
11:30Today's statement is the first in a series of announcements. As I've said, an implementation plan will
11:35follow later this month and I can assure members have relayed to my department the urgency, the urgency at which
11:42progress must be made. Deputy Speaker, we are only in the foothills of what will be a long uphill trek and it's long past
11:50time we began. So I'm very pleased to be the Minister to make this start, but it will require future
11:57Ministers, future Executives and future Assemblies to maintain the course. Deputy Speaker, I commend this
12:04statement to the House.