Philip McGuigan
North Antrim · Sinn Féin · Northern Ireland
“I concur with the Minister that patient safety is ultimately the top priority, but patient safety is also important, as the Member said, in terms of assessments. If you cannot get assessments, your safety is compromised.”
“On a point of order, Mr Speaker. Further to my party colleague's point of order about the DUP's internal investigation, what is the point of doing an investigation if you are telling us that you have nothing to answer for? You were the leader of the DUP at a time when accusations were levelled against Jeffrey Donaldson.”
“Minister, in your previous answers you talked about the pressures and the difficulties. You said that you were looking for a fair funding model, and you spoke of the need for taxpayers here to be treated equitably.”
“Minister, the inquiry found systematic abuse, neglect and serious governance failure at Muckamore Abbey Hospital over many years — failures that were not isolated incidents but reflected systematic issues across leadership, staffing, safeguarding and oversight that resulted in decades of physical and psychological abuse.”
“When I engage with health service sectors as my party's health spokesperson, there is not one that does not talk about workforce pressures and problems with staff recruitment and retention. That is clearly the case with doctors.”
“First Minister, you have spoken previously about the opportunities created as a result of our unique economic and trading position and about the increased potential that comes with all-island cooperation.”
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“Idir an dá linn, áfach, thiocfadh lenár nAire Sláinte focal a chur ar na seirbhísí atá in úsáid sa Deisceart le gurbh fhéidir le bunadh an Tuaiscirt iad a úsáid fosta. Rinneadh neamart i ngalar na handúile ar feadh i bhfad ró-fhada. Caithfimid mórán níos mó a dhéanamh.”
“That means that those suffering from addition are less likely to pay for treatment. <BR /> <BR />Others have mentioned voluntary organisations that do great work on addiction and in supporting those with addictions and their loved ones. I particularly want to put on record the great work of Alcoholics Anonymous, Narcotics Anonymous and Gamblers Anonymous. On any given day, they host numerous meetings across the island and help people to recover through shared experience and a 12-step programme. Some of the most impressive people whom I been fortunate to meet in my life I have met in the rooms of Alcoholics Anonymous and Gamblers Anonymous. <BR /> <BR />Tacaím leis an rún, nó ba chóir ionad cóireála saintógtha a bheith ann san iarthuaisceart.”
“White Oaks has saved many lives and set many individuals stricken by addiction on the path to recovery. Ar an drochuair, caithfidh saoránaigh ón Tuaisceart táille a dhíol as a chuid seirbhísí.”
“I also welcome the call in the motion for the issues of mental health and addiction to be addressed on an all-Ireland basis. That just makes obvious sense. <BR /> <BR />Tá ionad cóireála den scoth ann san iarthuaisceart: White Oaks i gContae Dhún na nGall.”
“Cuirim fáilte roimh an díospóireacht, agus gabhaim buíochas leis na Comhaltaí sin a mhol an rún seo. Ar dtús, ba mhaith liom a rá go bhfuil ár saoránaigh atá ar slabhra ag an andúil — andúil sna drugaí, san alcól nó sa chearrbhachas — agus a bhfuil cónaí orthu áit ar bith sa Tuaisceart, chan amháin san iarthuaisceart, go bhfuil faillí á déanamh iontu cionn is nach bhfuil go leor ionad cóireála ann. I Sasana, mar shampla, tá deich n-ionad cóireála cearrbhachais de chuid NHS ann a fhaigheann lánmhaoiniú. Sa Tuaisceart, níl oiread is ceann amháin ann.”
“I thank the Minister for that response. Further to that, will she outline what DFI's legislative responsibility is in the adoption of developments?”
“Minister, among the public, there is enthusiasm about and knowledge of the transformative impact that Casement Park could have. There is also knowledge that that enthusiasm is not shared by the Minister, who should be knocking down the door of the British Government to get that meeting. <BR /> <BR />Moving on, Minister, last week, the president of the GAA said that he feels that the GAA is operating in a hostile environment with regard to the failure of unionist politicians to condemn the erecting of anti-GAA signs in Randalstown. What will the Minister do to address those genuine concerns?”
“It is the route map to truly addressing the issues with all our public services and to delivering better outcomes for all the people whom we represent.”
“<BR /> <BR />The only way in which to truly address the challenges that we face in health, and across all our other public services, is through constitutional change. That is a discussion that is gathering pace, and one that can no longer be easily dismissed. In the meantime, the Programme for Government is undoubtedly a positive step. The achievements of our previous and current Finance Ministers in securing additional funding from the British Government represent a step forward and are significant, as is the argument for maximum devolution of fiscal powers to the North. That argument must be pursued, but our ambition for our people has to be greater and based on our having the maximum ability to shape our own decisions. That is why the conversation on constitutional change is so important and must continue at pace.”
“<BR /> <BR />As with any Programme for Government, there is always more that could be included and always more that needs to be done, even within the identified priorities. There is, however, a growing acknowledgement that the Executive simply do not have the Budget or the fiscal levers to generate finances at the level required. We all know that the North has been chronically underfunded in the past and the impact that that has had on our public services. Indeed, we continue to be underfunded. As a devolved institution, our ability to deliver for our population will always be constrained by decisions made in Westminster, where the interests of the people here will never be a top priority.”
“It is clear that tackling that priority in the Programme for Government will require long-term planning, as well as multi-year Budgets to support the health service to deliver a consistent, high-quality and sustainable level of care and to provide better health outcomes for our population, regardless of where they live. I therefore welcome the commitment to the target to invest up to £135 million a year to reduce waiting lists by treating an additional 70,000 patients, as well as to invest a further £80 million a year to increase elective care capacity through the expansion of elective care centres and mega-clinics, which will reduce the demand on capacity that causes our waiting lists to grow.”
“Despite the difficulties and pressures, we must do all within our power to reduce the unacceptable waiting lists. As I said, over 500,000 people — a quarter of our population in the North — are on a waiting list to have their first consultation with a specialist. That figure is unacceptable, and we need to see action taken in the year ahead so that we can start to turn the corner and reduce that number. That is especially the case for cancer waiting lists and services, where urgency is key to treatment, key to outcomes and, indeed, key to saving lives.”
“That in itself is by no means a silver bullet. The current challenges in the health service are great and have been discussed at length many times in the Chamber, most recently during the Budget Bill debate. We are still dealing with the impact of the COVID pandemic on our waiting lists. Our health service has growing demand and need, coupled with workforce and capacity challenges, and we have an ageing population with co-occurring and complex needs.”
“With over 500,000 people currently on a waiting list to have their first consultation with a specialist, I welcome the fact that cutting waiting times is an Executive priority and that addressing health inequalities is recognised as being part of that solution. <BR /> <BR />The Executive's commitment is evidenced by the significant proportion of the block grant, over 50%, that has been allocated to the Department of Health.”
“I welcome the publication of the Executive's Programme for Government. It is a positive step, and it demonstrates collective commitment to delivering better public services for all citizens right across the North. Better public services will mean better outcomes for people, which is why there was such a good response to the consultation. I thank the individuals, groups and sectors that responded to it. <BR /> <BR />I speak as my party's health spokesperson. From that perspective, I welcome the narrative in the Programme for Government that key to achieving better health outcomes is a focus on preventative measures to keep people well for longer in the first instance, combined with early detection and timely intervention when required.”
“— policies and strategies to ensure that our public services are fit for purpose in order to meet the needs of our older population. That should be a priority.”
“<BR /> <BR />As I said, we need to focus much more on preventative measures to keep people well for longer. I attended a very informative event in the Long Gallery yesterday that had been organised by the allied health professional sector. There were quite a number of demonstrations given at that event that, if implemented, could improve the quality of outcomes for elderly citizens. I therefore encourage the Minister of Health to take a look at yesterday's event to see what he can learn from it. <BR /> <BR />Our Executive will face many challenges in the time ahead. As my party's health spokesperson, I am aware that there are many challenges in the health sector alone. It is crucial that we adopt —”
“<BR /> <BR />For older individuals with dementia, Sinn Féin advocates community and home-based care rather than hospital admission. We emphasise the need for adequate training for health and social care staff who deal with patients with dementia, as well as increased investment in home care supports and housing adaptations. We also acknowledge initiatives that are currently under way and that deserve our praise. The frailty pathway and the acute frailty audit programme aim to improve the journey and outcomes for older people who become acute inpatients. The ageing well public health planning team that the Public Health Agency (PHA) has established aims to enhance the health and well-being of older individuals and to reduce health disparities.”
“We therefore need to find ways around those workforce shortages, and we need to ensure that our healthcare workers are paid appropriately for the work that they do. <BR /> <BR />Moreover, we can, and should, deliver more local and community initiatives. The IMPACTAgewell project, which is delivered by the Mid and East Antrim Agewell Partnership in my constituency, is an excellent example of a community-based approach to improving the health and well-being of older people. It states that, since its inception, it has saved the health service approximately £6·1 million through avoiding unscheduled care costs. There are many other examples across North Antrim, and across the North, of groups and communities coming together to help and support our ageing population. They should receive our support.”
“We know that prolonged hospitalisation can negatively affect older people's health and life expectancy, yet we, as constituency MLAs, are also acutely aware of the problems that lots of families currently face in accessing quick and appropriate domiciliary care packages. We need to enhance home-based care so that we can reduce unnecessary hospital admissions and free up hospital beds. Older individuals generally prefer to receive care in their own home, which can lead to better health outcomes and also respects their wishes. Providing that care requires staff, and we know that the healthcare sector faces significant workforce shortages, particularly, but not exclusively, as a result of Brexit.”
“As an MLA for North Antrim, I represent, as does the proposer of the motion, part of the north coast, which has the North's highest percentage of the older population, so I am clearly in favour of the motion. We need to look at the strategic approach being taken and the policy being developed right across government in order to meet the demands. <BR /> <BR />Our health service currently faces significant challenges, including extensive waiting times, an escalating mental health crisis and severe workforce shortages. Those pressures are not solely because of a lack of funding. They are also as a result of the ongoing need to implement meaningful reform.”
“Those 11,000 days could be my potential lifespan. That is what people used to be concerned with — how long they live for — and it is, obviously, still very important. However, there is, rightly, a growing shift towards focusing on people's healthspan. As individuals and as a society, we should work towards and focus not just on the years that we live but on the quality of our life and the years in which we can live in good health and independently, free from chronic diseases, disability or significant physical or mental decline. <BR /> <BR />The Executive therefore need to focus on the reality that, by 2027, the number of people living in the North who will be aged over 65 will exceed the number of children in our population.”
“I welcome the motion. It clearly covers much more than health, as the proposer outlined, but that is what I, as my party's health spokesperson, will focus on. <BR /> <BR />The good news is that, because of science, modern medicine and better knowledge of fitness and nutrition, we are living longer, and our life expectancy is predicted to continue to increase. According to NISRA, the life expectancy of females is expected to increase from 82·3 years in 2022 to 85·4 years by 2047, and, for males here in the North, it is expected to increase from 78·4 years in 2022 to 81·9 years in 2047. For someone my age, that means that I have roughly 11,000 more days left, if I am lucky enough to reach the average male life expectancy. That sounds like a lot, but, as I get older, I use the phrase "time flies" much more often.”
“I appreciate the Minister's answer. In a four-to-five-year period to 2023, there were 50,000 reported incidents of violence against healthcare staff. It would be interesting to know what the figures have been since. You will be aware, Minister, that, in 2023, your Department launched a new regional framework to address the issue. It would be useful to get your assessment as to whether that framework has been implemented and your assessment of it, going beyond what you have said about body-worn video.”
“I take on board the Minister's caution, given that negotiations are ongoing. He mentioned opening up access in the final part of his answer to Mr Tennyson. Does the Minister agree that resolving the indemnity issue would have a very positive impact on opening up and providing greater access to GP services?”
“That has all impacted negatively on what Ministers here can do, which, ultimately, impacts on the citizens whom we represent. It is important that we continue to speak on the matter with one voice and support the Finance Minister as he continues to negotiate for additional funding and seeks to achieve greater fiscal sustainability in the long term to help improve all of our public services.”
“I am conscious, as you have outlined, that this is the Budget debate and not a debate on our health service, and that it is not the Health Minister but the Finance Minister in the Chamber. However, improving health goes beyond the responsibility of just the Health Minister and requires proper funding. As I said yesterday, the Executive have made health a priority, correctly so, and the Finance Minister has made over 50% of his available Budget to the Department of Health. <BR /> <BR />Yesterday, I also said that it was obvious that the Budget available to the Finance Minister and the Executive from Westminster was clearly not enough. Our public services have been decimated by years of underfunding in successive Westminster Budgets.”
“Likewise, the All-Island Congenital Heart Disease Network is an excellent joint initiative that has provided comprehensive high-quality support for children with congenital heart defects. Initiatives such as the €10 million provided in 2023 to fund 250 undergraduate nursing and midwifery places at Ulster University and Queen's University and the additional €9·5 million committed from 2024 to 2028 to support 161 extra places in various health and social care professions should be continued and strengthened. An improved all-island approach to healthcare would not only improve the quality of life for people on our island but make our health system more sustainable. <BR /> <BR />A Phríomh-LeasCheann Comhairle,”
“<BR /> <BR />With regard to the pay deal, Sinn Féin has consistently called for fair pay and conditions for all healthcare workers, and we welcome the fact that progress has been made on the issue. We recognise that some pay negotiations are still ongoing, and we will continue to stand in solidarity with workers to ensure that their contribution is acknowledged and valued. I urge the Minister to bring those talks to a speedy resolution. <BR /> <BR />As with every public service, we should look at how we can do better and work better on the island to improve outcomes for our citizens. That is just common sense. The North West Cancer Centre at Altnagelvin has provided patients in County Donegal with a vital resource and become an example of all-Ireland cooperation in healthcare having a tangible impact on people's lives.”
“Ambulance waiting times have increased, and the demand for emergency ambulance care, coupled with ongoing pressures on ambulance handover times, show an extremely worrying trend. Paramedics and ambulance staff work in some of the most difficult circumstances and are the first response to medical emergencies. Unfortunately, staff shortages and pressures on A&E departments are causing delays, with paramedics waiting with patients for hours. Urgent action to address the ongoing crisis needs to be taken by the Minister and his Department to improve patient safety. <BR /> <BR />The Minister has prioritised tackling health inequalities, and I welcome that focus and the Live Better pilot that he has introduced. Key to all of that, however, is developing and expanding on that and other initiatives.”
“Over the last number of days, it has been further perplexing to receive emails from groups such as the Samaritans and others expressing their disappointment at missing out on funding for projects to tackle mental health. My colleague Órlaithí Flynn has written to the Minister on that, and I look forward to his explanation. <BR /> <BR />We must see action to reduce the pressures on our emergency departments. That means action in our hospitals but also action beyond the hospitals. We need investment in domiciliary care services and staff so that we can not only release the valve on hospital pressures and give the most appropriate care to our vulnerable citizens in the setting that is most suitable to their needs.”
“That is especially needed for cancer waiting lists and services, where urgency is key to treatment, outcome and, indeed, saving lives. The Minister needs to utilise the budget that he has for the cancer strategy more efficiently to ensure that all available money is spent on screening, diagnosing and treating cancer patients. I welcome the comments that the Minister made at last week's Committee meeting about putting plans in place for a lung-screening programme and to expand bowel screening. I look forward to hearing more detail on that in the time ahead. <BR /> <BR />On numerous occasions in the Chamber we have debated what we can do about the growing mental health crisis in our society, so, again, it was disappointing to see that the Department had not spent all the available resources that it had in its 2024-25 budget.”
“<BR /> <BR />As part of that briefing, the Minister outlined the anticipated funding gap in Health. A significant proportion — over 50% — of the overall Executive Budget is allocated to Health. I know from the comments made yesterday throughout the Chamber and in previous debates that there is a clear recognition that we must use that substantial Health budget to do better. We must produce and implement plans and strategies that deliver better health outcomes for patients and create a better and safer working environment for staff. <BR /> <BR />Over 500,000 people — a quarter of the population of the North — are on a waiting list to have their first consultation with a specialist. That figure is unacceptable, and we need to see action in the year ahead to start turning the corner and reducing that number.”
“I appreciate that that will require additional resources, and, as Committee Chairperson, I am keen to work with the Minister and the Department to make the argument for additional funding for our health service and provision of the necessary support for our Health and Social Care workers. <BR /> <BR />I will now speak for a few minutes to make a number of additional points in my capacity as an MLA and Sinn Féin's health spokesperson. As was mentioned, the Health Minister and the permanent secretary attended the Health Committee last week to brief us on the Budget, and I thank them both for doing so. I also record my appreciation for the current permanent secretary, Peter May, as he steps down from the role and to thank him for his many years of public service. I wish Peter well in whatever the future holds for him.”
“<BR /> <BR />I also want to mention the Department's capital budget. Over the past number of years, we have seen significant capital projects in the health estate. As with other projects, however, they tend to run over time and budget. Indeed, last week, the Committee went to see the new maternity hospital at the Royal, which is a magnificent sight. There is no doubt that it will provide high-quality, safe care for many mothers and babies. However, there are significant delays in opening the hospital, and I encourage the Department and the trust to work together to get that hospital safely opened as soon as possible. I also encourage the trust and the Department to learn from that process and apply that learning to the build of the new children's hospital, which is to be commenced soon.”
“That highlights the real need for long-term planning in the Department of Health. <BR /> <BR />The Committee looks forward to further work being undertaken by the Executive to bring forward multi-year Budgets that will allow the Department of Health to plan for the long term and put in place planned interventions to address the waiting lists and the increasing health inequalities that we all see. The Committee is also keen to see how the Department and the Executive will link the Budget to the Programme for Government. The PFG outlines key priorities for Health in relation to reducing waiting lists and the reform and transformation of public services. It is important that we and the public see the links between the Programme for Government and the Budget, with clear and achievable targets that allow progress to be monitored and measured.”
“When the Committee was briefed on the statutory rule in November, we were advised that the cost would be between £1 million and £1·5 million. However, in the equality impact assessment (EQIA) produced by the Department, the cost was put down as £5·7 million. That is significant change in the figures provided to the Committee. We have requested further information on that. <BR /> <BR />The Committee has also requested a detailed breakdown of the expenditure for 2025-26, but, so far, has been sent information only on how the Department has used the percentage split from the 2024-25 opening allocations to allocate the additional funding across the programmes of care for 2025-26. The Department will not be able to provide detailed information until many months into the new financial year.”
“On the mental health strategy, only £5·9 million was spent against the target of £42 million. That is extremely disappointing. It illustrates the significant pressure that there is on the system. We need to see action plans detailing how money will be allocated in the future. <BR /> <BR />We are aware from briefings from the trusts and representative bodies that the significant bottleneck in the system relates to the provision of domiciliary care and the need for significant investment to provide sufficient service to allow the flow of patients through hospitals. We need to see plans for how the Department will address that important issue. <BR /> <BR />A member also raised the issue of, and cost to provide, free period products in our Health and Social Care buildings.”
“The Committee has requested further information on the plans that are in place for the incoming financial year to ensure that families get the respite that they need and that that important service is utilised fully. <BR /> <BR />On access to GP services, members raised the issue of funding for indemnity for GPs and, generally, the pressure that there is on access to primary care. It has been disappointing to see over the past number of years GP practices being taken over by trusts and a number of GP surgeries in financial rescue plans. That clearly shows the need for significant investment in our primary services to improve access. <BR /> <BR />On the cancer strategy, the Committee heard that only £10·6 million was spent in the past financial year against a planned spend of £34·2 million.”
“Members highlighted the significant impact that it will have on the health and social care sector, including GP surgeries, pharmacies and social care. Committee members were advised that the Minister has been in contact with the British Government Minister on that matter. <BR /> <BR />With regard to respite care for families, members raised the announcement of £2 million to be spent in the current financial year and £13 million in the following financial years on short-term respite care. The Committee welcomed that announcement at the time and is disappointed that only £1·377 million will be spent in the current financial year.”
“<BR /> <BR />The Health budget makes up over 50% of the block grant and has significant implications for the health and well-being of the people whom we in the Chamber represent. It is therefore crucial that we understand its impact and significance. Over the past year, the Committee has engaged with the Minister and departmental officials on the budget. Just last week, the Minister briefed the Committee on the budget for next year. The Minister explained that, with this year's budget allocation of £8·4 billion, there is still a shortfall of £400 million in the next financial year. During the briefing, members covered a number of areas with the Minister, including the National Insurance contributions increase.”
“I welcome the opportunity to contribute to the debate on behalf of the Committee for Health. <BR /> <BR />As I mentioned in yesterday's debate, the financial landscape that we find ourselves in has presented significant challenges to all Departments. That has had a considerable impact on the provision of services in our communities. Those financial challenges are having a pronounced effect on those in our communities who require treatment in our health system and on the staff who work in the Health and Social Care (HSC) system. At the outset, I pay tribute to our Health and Social Care workers, some 70,000-odd staff, who go above and beyond to provide care and support to our sick and most vulnerable citizens, while battling against long waiting lists, longer waits in emergency departments and services that are stretched to breaking point.”
“I am certain that it will be a priority for the current Finance Minister, as, I am certain, it is for all Ministers. Despite the fact that we have nine Departments, the Finance Minister has allocated over 50% of the available 2024-25 Budget to Health. We must see that substantial investment being used to transform our health service, ensuring better care and outcomes for all citizens.”
“We are all aware of the pressures that that brings to the day-to-day functioning of Departments and the impact that they have on our ability, as a collective, to transform public services and improve the lives of the people whom we are here to represent in a real and meaningful way. As I said, nowhere is that felt more than in the health service. <BR /> <BR />That said, I recognise the significant achievement of the previous Finance Minister, Caoimhe Archibald, in securing the interim fiscal framework, which not only recognises that the North is funded below need but includes the commitment to address that going forward. I also know that, within the constrained budget available, funding for the Department of Health was a priority for the previous Finance Minister.”
“However, there are, of course, many others, including access to GP services and the impacts on our community pharmacies, dental services, cancer screening and treatment, mental health services, domiciliary care services and much, much more. All of that has a detrimental impact on the quality of life and health of our citizens. I will talk in more detail on that in tomorrow's Budget debate. <BR /> <BR />I recognise the importance of the three motions before us, which seek to provide legal certainty on the funding of services up to this point and for the remainder of the financial year. We have all heard and spoken about the challenges presented by the constrained short-term Budgets that are a feature here and by our limited fiscal levers.”
“We must understand that there is little scope for the transfer of funding from other Departments, and we must make the case to the British Government to support our health service and health service workers before it is too late. <BR /> <BR />I will make a few brief comments in my capacity as an MLA and the Sinn Féin health spokesperson. Nowhere is the decimation of our public services by successive British Governments starker and more visible than in our health service. In the remarks that I have just made as Chair of the Health Committee, I referenced a number of pressure points within the Department of Health, such as waiting lists, emergency departments and staff morale and retention.”
“<BR /> <BR />It is concerning that we are in a position in which the Department has to rely on in-year allocations just to maintain service delivery. The Committee has been frustrated that we have not seen any money invested in waiting lists and other much-needed services. The Fiscal Council has highlighted that the level of in-year transfers to Departments underscores the underfunding that the North faces from Westminster, reinforcing the need for the fiscal floor to be further adjusted. <BR /> <BR />The Committee remains committed to working with the Minister and the Department to ensure that additional funding is provided to the Department of Health. As Chairperson, I am happy to support the Minister and the Executive in discussions with the British Government on additional funding for our health service.”
“In that letter, he advised of the possible consequences of the Budget, including a halt to waiting list initiatives; no pay settlements; restrictions on the use of new drugs; the suspension of some vaccination programmes; a reduction in domiciliary care of 1·1 million hours; a reduction of 500 independent sector care home beds; and a reduction of 140 acute hospital beds. Thankfully, I am glad to say, the Minister did not have to resort to those consequences, due to the in-year allocations received from the Executive. Throughout the monitoring rounds, the Department was provided with the bulk of the additional funding available, getting £122 million in June, £350 million in October monitoring and an additional £7 million in January monitoring. In addition to those allocations, the trusts made significant savings over that period.”
“That is why it is important that we, as a Committee, undertake detailed scrutiny of the departmental spending plans and priorities. <BR /> <BR />When the Budget allocations were announced last April, the Department was provided with a resource allocation of £7·759 billion and a capital allocation of £416 million. At that point, the Committee was advised that the Department's estimate of the shortfall in its allocation was approximately £500 million. The Committee received a letter from the previous Minister outlining his disappointment at the allocation that his Department had received.”
“More than one fifth of patients now face 12-hour waits to be treated in, admitted to, discharged from or transferred from emergency departments. At the start of January, we saw reports of patients having to be treated in unused tea rooms, with corridor care becoming normalised. <BR /> <BR />The inability to offer competitive pay has led to low staff morale and challenges in retaining healthcare professionals. Many are considering opportunities elsewhere, exacerbating the existing workforce shortages. In the past year, the Committee has heard from many organisations and representative bodies, including GPs, surgeons and nurses, about how the current system is close to collapse. If there is not significant transformation in our services and structures, the consequences are not something that we will want to dwell on.”