New Executive health plan faces budgetary uncertainty

In December 2024, Health Minister Mike Nesbitt MLA launched a three-year strategic plan for health and social care. However, in the absence of budget certainty, its implementation timeline is anything but assured.

At 32 pages, A Three-Year Plan To: Stabilise, Reform, And Deliver is the Department of Health’s new strategic framework for health and social care. Amid the stark absence of detailed costings, the Minister for Health places significant emphasis on the role of “future budget settlements” and “successful partnership working in the Executive”. As such the pace of delivery of the plan is uncertain.

The three “high level priorities” contained in the report are:

1. stabilisation;

2. reform; and

3. delivery.

Stabilisation

In a ministerial statement to the Assembly on the same day the plan was published, the Minister emphasised “the incredibly challenging budget position” and indicated that stabilisation would be “a strong immediate focus” given the challenge of minimising the impact of over £200 million of savings delivered by the six health and social care trusts.

The Minister paid tribute to “the fantastic effort and commitment of our staff” and asserted that he is “absolutely committed to resolving the pay award for this year”. Nesbitt also recognised that the trade unions representing health professionals in Northern Ireland had found his language in previous discussions relating to the national pay parity awards unacceptable and would endeavour to use more “pleasing, or agreeable” language.

Reform

While acknowledging that the reform agenda is not a panacea, he suggests it is “what is needed to give our staff and the public hope that there is a bright future for our health and social care service”.

Reform, as a concept, is thematically covered under five headings:

1. population health, health inequalities;

2. adult and children’s social care;

3. primary and community care;

4. mental health; and

5. acute hospital care (including waiting lists).

Emphasising the need to be “realistic about what we can be achieved”, the intended outcomes of the reform are:

• improving public health;

• shifting left (reorientating care away from acute settings to the home/community);

• building a hospital network;

• quality and safety; and

• involvement and engagement (of the community and voluntary sector).

Each outcome is accompanied by a timeline commitment to deliver specific targets. For example, it states: “By April 2026, we will have advanced new policies and legislation to improve public health including a new Obesity Strategic Framework; the implementation of the Northern Ireland provisions in the Tobacco and Vapes Bill and brought forward proposals for minimum unit pricing for alcohol.”

“I have remained fully and absolutely committed to resolving the pay award for this year.”
Mike Nesbitt MLA, Health Minister

Delivery

Given growing healthcare need or demand, alongside a constrained budgetary context, the plan recognises that delivery must focus on optimal efficiency. This, it says, will be achieved through “a relentless focus on performance so that within the constraints that exist, we can be sure we are getting the best we can for our citizens”, including via innovation.

While long-term success will be tracked against “a strategic outcomes framework”, the Department is now piloting a new system oversight measures approach to measure short-term success across six metrics:

1. performance;

2. safety and quality;

3. finance and governance;

4. efficiency and productivity;

5. access improvement and tackling health inequalities; and

6. workforce.

The delivery outcomes, it notes, are as follows:

• increasing core capacity through new ways of working;

• delivering an additional 46,000 outpatient assessments and 11,000 treatments by 2027

• “year-on-year improved outcomes and increased service delivery” as per the Getting it Right First Time (GIRFT) Standards and British Association of Day Surgery day case rates by April 2027;

• implementing the recommendations of GIRFT reviews in adult and paediatric orthopaedics, urology, and gynaecology by April 2027; and

• commissioning further reviews in ENT services.

Tracking progress, a detailed implementation plan, the three-year plan states, will be published annually “following budget confirmation”.

Assembly response

Commending the three-year plan to the Assembly, he contends it is both “realistic and ambitious”, adding that the pace of delivery hinges on “budget settlements and, indeed, on successful partnership working in the Executive”.

In the plan, the word “seek” is used nine times and “could be” twice, alongside phrases such as “we will aim”, “we will strive”, “we will explore”. This is a theme seized upon by SDLP MLA Colin McGrath, who asserted, in the Assembly, that “we need a concrete, tangible, fully funded, time-bound programme that is supported by the whole Executive to make the changes that we need and to save our health service”.

In response, Nesbitt suggests, that his Assembly colleague is “clearly living in the ideal world” as opposed to “the practical world” in which, the Minister claims, he resides. Emphasising the realpolitik associated with a mandatory four-party collation, he then unpacks the plan’s target of an additional 46,000 outpatient assessments and 11,000 treatments by 2027as evidence of “concrete, time-bound detail”.

On the other hand, Committee for Health chairperson, Sinn Féin’s Liz Kimmins MLA, remarked that the plan is “certainly ambitious… and very welcome”, thanking the Minister for “listening” to the work of the committee. However her party colleague, Linda Dillon MLA highlights the absence of any specific mention of women’s healthcare.

The Minister in turn points to a forthcoming “women’s action plan” which, he hopes, will inform a future women’s health strategy in the future, should the funding to deliver it become available.

Highlighting a perceived inconsistency or “contradictions” in his statement relating to competition between prevention and cure, the Alliance Party’s Nuala McAllister MLA asks the Minister to outline his current priorities.

“It has to be both, because no matter how good you are at prevention and early intervention, people will still get sick,” he says, adding: “My ambition is clear: it is that shift left and getting care away from acute hospitals and delivering healthcare in the home, ideally, or, if not in the home, as close to it as possible.”

Unsurprisingly the UUP’s Alan Chambers MLA welcomed the plan published by his party’s sole Minister as “timely”, while DUP MLA Diane Dodds commented: “I believe that you are genuinely interested in improving services for our constituents. I also believe that you are interested in holding the trusts to account, which is really welcome; it is high time.”