Throwing money at waiting lists won’t fix health crisis insists Minister

In an interview with Belfast Live, Mike Nesbitt set out his vision for the health service

When Mike Nesbitt took on the role of Health Minister last year, he inherited a system in perpetual crisis. Waiting lists were at record highs, recruitment was faltering, and every attempt at reform seemed to stall before it began. Yet, amid the familiar gloom, the Ulster Unionist leader insists there is a way forward, one built on prevention, reform, and a willingness to change how care is delivered.

Mike Nesbitt speaks about health as something that touches every household in Northern Ireland. He doesn’t downplay the scale of the challenge, but he’s clear that the old approach of throwing short-term cash at waiting lists won’t work. Reform, he argues, must go deeper than that.

Now, one year into his second term leading the UUP and into his tenure as Health Minister, he is focused on delivering what he calls “a neighbourhood model of healthcare.” It’s an idea that focuses on shifting care closer to home, focusing on prevention, and ensuring resources are spent where they make the greatest long-term difference.

“A lot of people measure it purely through waiting lists,” he says. “And we have done a lot on waiting lists. We were given a challenge in the Programme for Government to do 70,000 new procedures or appointments, and we’ve done 56,000 and we’ve still got many, many months left in the financial year.”

That progress, he explains, isn’t enough on its own. “The problem with putting money, devoting money to waiting lists and nothing else, is that when you’re spending the money, the waiting list comes down. When the money’s finished, the waiting list goes straight back up.”

His solution is to move care upstream, away from expensive hospital settings and into communities. “I’m looking to reform how we deliver health and social care,” he says. “It’s that famous shift left. Getting the emphasis away from the acute hospitals where all the really expensive procedures happen, and shifting left into primary care, into community pharmacies, into dental care.

“In an ideal world, if you need healthcare, you get it at home. But if not at home, as close to home as possible. So we’re trying to shift to as close to your front door as we can get, with prevention to keep healthy people healthy and with early intervention when people start getting sick rather than have them on a waiting list for 3,4,5 years, because when you do that, your condition will deteriorate, you’ll develop other conditions, and therefore when you finally get into the system, which tends to be at the acute hospital, it becomes a much more expensive process to get you right.”

The Health Minister believes reform is now unavoidable. “A few years ago, say when Bengoa was here, health was taking 46 per cent of the overall Executive budget. It’s now just over 50 per cent. That is a direction of travel which is unsustainable,” he says. “So we have to reform how we do health.”

That, he concedes, won’t be easy in an ageing society. “We’re swimming against the tide because the population is growing and people are living longer, not least because we are getting new medicines and new procedures that keep people who have got very severe illnesses alive when five, ten years ago they would pass. But it’s the only way to go, and I am determined to set in motion that direction of travel, towards a neighbourhood model of healthcare.”

For the Health Minister, reform isn’t just about hospitals, it’s about tackling the inequalities that define people’s lives long before they reach a ward. “Two girls born in the same maternity unit, maybe the Royal or the Ulster, might grow up in this city one mile apart,” he says. “One in the area of least deprivation and one in the area of most. Their healthy life expectancy will vary by 14 years. 14 years.”

That gap, he says, can’t be closed by any one department. “It’s not just health, it’s about socioeconomic factors, it’s about environmental factors, it’s also about behaviours like smoking and substance use. But it needs a whole-government approach if we’re going to shrink that gap.”

The same principle applies to the economy and education. “Twenty-seven per cent of the working-age population are either in work or seeking work, that’s what we call economic inactivity. The biggest single reason for that is poor mental and physical health. So it’s not just the Economy Minister’s problem, it’s mine as well. And if we look at the persistent problem of children who underachieve in schools, once again, healthier children are going to do better.”

Despite the political friction that often defines Stormont, Mike Nesbitt insists there’s a growing sense of shared purpose among ministers. “I have got a growing sense around that Executive table of people realising we have to help each other,” he says. “So the arrival of an election is never helpful, and the fact that it’s so far away, it’s regrettable that we seem to be already starting to gear up.”

It may be more than a year until the next scheduled election, but Mike Nesbitt said what we are witnessing with rhetoric in the Assembly chamber and within the media is parties getting into election mode. “I think what we do like is a very long run into an election,” he says. “And although it’s not to May 2027, I do sense in this building that parties are already, retreating into their bunkers and gearing up for an election and I wish it was not thus because I think everybody now realizes that if you look at any of the big ticket, difficult, sticky issues, it can’t be solved by a single minister or a single department.”

He’s also optimistic about cooperation beyond Northern Ireland. “The General Election was on Thursday, 4th July last year. By Saturday, right after the first Cabinet meeting, I was on a virtual call with Wes Streeting, the Secretary of State,” he says. “There is a new sense of the importance of adopting a four-nation approach wherever possible. Actually, what I’m trying to do tends to mirror what Wes Streeting is trying to do. Moving out of hospitals into the community, moving from waiting to cure people when they’re sick to trying to keep people healthy.”

For all the latest news, visit the Belfast Live homepage here and sign up to our politics newsletter here.