Dear Mike, here’s the three things you need to do to fix the health service - Deirdre Heenan

Forget ‘show me the money’ - new health minister Mike Nesbitt needs to show us the plan

Deirdre Heenan

Deirdre Heenan

Deirdre is a columnist for The Irish News specialising in health and social care and politics. A Professor of Social Policy at Ulster University, she co-founded the Northern Ireland Life and Times Survey.

Mike Nesbitt speaks to the media at L’Arche Village, Belfast
Mike Nesbitt has ditched the funereal tone of his predecessor, Robin Swann, and has three years to show he can make a positive difference to health and social care

Mike Nesbitt is our new health minister and should be given a chance to prove his credentials. It’s early days but so far, he has ditched the funereal tone of his predecessor and adopted a more can-do attitude. But warm words butter no parsnips. It cannot be a case of a new name on the door but business as usual.

So how might the new minister go about demonstrating that he has what it takes to address the myriad of issues in his in-tray?

Firstly, and it is hard to overstate this point, he must avoid the temptation to address longstanding issues with reactive short-term measures merely aimed at reducing expenditure. These are extremely unlikely to deliver sustainable improvements and will further damage staff morale. A key challenge is to reduce waste, avoid duplication, make the most of the substantial available resources while maximising outcomes. Do we really need five trusts and an ambulance trust and now the nonsensical area planning boards?

Report after report has concluded that the north has too many hospitals with services spread too thinly across too many locations. Without radical reform this will get worse year-on-year. Staffing pressures are also linked to this fragmentation and without change the cost of agency and locum cover will continue to increase.

Nesbitt must stop demanding more money and lamenting about the impossibility of working within the current financial envelope. More money would help, but the key issue is addressing how the money he does have is actually spent. Pressing for additional financial resources without a detailed spending plan is simply la la land politics. The minister has agency. He must use it.

Secondly, he must address the social care system, which has historically lived in the shadow of healthcare. Current proposals to make catastrophic cuts to social care are counterintuitive and should be roundly rejected. They are a twin attack on the most vulnerable and those who care for them. In September 2023, a social care study reported that almost half (47%) of clients had home visits that lasted less than 15 minutes, with serious implications for the quality of their care. It would be perverse to cut social care which is already under massive strain. His predecessor passed the buck to the trusts, tasking them to identify the necessary “efficiency” savings. The scale of this challenge means difficult decisions need to be taken at a ministerial level. Grasping the social care problem and transforming a low-paid, low-status, largely female profession into a viable career is crucial.

More money would help, but the key issue is addressing how the money Mike Nesbitt does have is actually spent. Pressing for additional financial resources without a detailed spending plan is simply la la land politics

Thirdly, he must set out his priorities. I would suggest GPs, social care, cancer care, workforce and, without doubt, waiting lists. The health minister must be honest with the public about the waiting lists and the scale of the challenge. They are by far the worst in the UK, and the trajectory is upwards. In December 2023, patients in England waited a median of 15 weeks for planned treatment. In Northern Ireland the median wait for an outpatient consultation was 50 weeks, and for inpatient treatment 58 weeks. How has this become normalised?

Forget ‘show me the money’. Show me the plan. A detailed, waiting list strategy must be published as a matter of urgency. The overarching aim must be to maximise all the capacity available both within the NHS and the independent sector. To ensure accountability and timely implementation this plan should be spearheaded by a named individual.

Mike Nesbitt has nothing to lose and everything to gain. He has three years to make a tangible difference. Not long enough to solve all of the problems, but ample time to make meaningful progress. An opportunity to restore trust, by being bold, radical and ambitious.

The new minister has been resurrected from several political deaths. He must make it clear that he is in charge and that the buck stops with him, not the spin doctors, departmental officials or bureaucrats. The public are tired of hand wringing, empty promises, missed targets and feeble excuses. We have watched helpless, as our healthcare system has deteriorated to the point that in some instances it is no longer safe.

A lack of political courage has bedevilled health and social care for decades. Is Mike Nesbitt the man to change this? This role is a test of his personal and political mettle. There is no time for a honeymoon period. If he is serious, let’s see some action, not just photo opportunities and cutting ribbons.