Northern Ireland Assembly Monday 2 July 2007 Executive Committee Business Committee Business Private Members’ Business Oral Answers to Questions Adjournment The Assembly met at 12.00 noon (Mr Speaker in the Chair). Members observed two minutes’ silence. Royal Assent Budget Bill Mr Speaker: I wish to inform Members that the Budget Bill has received Royal Assent. The Budget Act (Northern Ireland) 2007 became law on 29 June 2007. Welfare Reform Bill Mr Speaker: I wish to inform Members that the Welfare Reform Bill has received Royal Assent. The Welfare Reform Act (Northern Ireland) 2007 became law on 29 June 2007. Committee Membership Mr Speaker: The next item on the Order Paper is a motion to change the membership of the Business Committee. As with other similar motions, it will be treated as a business motion. Therefore there will be no debate. Resolved: That Mr Patsy McGlone replace Dr Alasdair McDonnell as a member of the Business Committee. — [Dr A McDonnell.] NHS Dental Treatment Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes for the winding-up speech. All other Members who wish to speak will have five minutes. Mr Gallagher: I beg to move That this Assembly expresses concern about the lack of availability of NHS dental treatment and calls upon the Minister of Health, Social Services and Public Safety to act immediately to ensure that NHS treatment is available to all those who are entitled to it, in conjunction with a dental health strategy. The motion’s purpose is to highlight the present shortage of dentists carrying out NHS work and to draw attention to the urgent need for the implementation of a better dental-health strategy for everyone in Northern Ireland, especially for children and older people, as well as economically disadvantaged people and people with disabilities. The failure of previous Governments to agree terms with dentists to carry out NHS work has meant that dentists here, in increasing numbers, are taking on more private patients. In turn, that has led to the present situation in which people, when they seek dental treatment, find it very difficult to make appointments for NHS services. Some have to travel significant distances to access NHS treatment. A report on the Southern Health and Social Services Board area showed that, in October 2006, only 43% of dentists were providing NHS treatment; by May 2007, a few months later, the number had dropped to 21%. Although those figures are particular to one area, the picture is similar across the west. Many constituents in Fermanagh and South Tyrone have expressed their concerns about the growing problem and the difficulties that they face when trying to access out-of-hours services for emergency treatment. General dental practitioners, who are independent contractors, provide the majority of services. There is no obligation on them to treat patients under the Health Service, and the current contractual arrangements do not permit health and social services boards to require dentists to provide NHS dental services. Finding a solution to this situation must be a priority. Ensuring that patients have access to dental care is the first step, after which the problems with dental contracts must be resolved. Funding for hospital-based services that deliver specialist treatment must be secured, and the number of training places for dental hygienists and dental nurses must be increased. The primary dental-care strategy for Northern Ireland proposes fundamental changes to the way in which dentistry is provided, including the introduction of local commissioning and new contracts for high-street dentists. That offers an opportunity to make radical changes and to transform poor oral health. Mr S Wilson: Does the Member agree that there are only two routes open to the Minister to ensure widespread dental care: either dentists being compelled to carry out some NHS work or offering dentists incentives to do so? The incentive route would allow dentists to hold the Department of Health, Social Services and Public Safety to ransom for the price contracts that they demand. Mr Gallagher: I want to make it clear that I am not an advocate of compulsion. I notice that the Minister is in the Chamber; I await his comments on that area. The poor state of oral health among the people of Northern Ireland is well documented. It is much worse than anywhere else on these islands. By the time children here reach 12 years of age, they have more than double the level of tooth decay that their counterparts in England have. The greatest single reason for children having to go under general anaesthetic is to have teeth extracted. The Department must make tackling our poor record on dental health a key issue. The lack of availability of NHS dental treatment inevitably increases the risk of poor oral health, with the attendant negative impact on general health. Most at risk are vulnerable people in the community, those who experience social deprivation, elderly people, and, as I said earlier, young children. The lack of availability of NHS dental treatment also has a severe impact on people in rural areas, who have to travel greater distances to be treated. Very often, they do not have access to public transport. Approximately 53% of the population is registered with a dentist. Registration, however, lapses if individuals do not attend their dentists within a 15-month period. An awareness campaign is needed to inform the public about that issue, since many people, when they require urgent treatment, discover that they are no longer registered. The availability of NHS dentists, and equality of access for all sections of the population, need to be addressed urgently. That will require the Department and the health and social services boards to take immediate steps to employ additional dentists to provide treatment for NHS patients. The underfunding of dentistry has been carried over from previous Governments, and it has fallen behind other areas of the Health Service. Since 1997, UK-wide general spending on the Health Service has increased by 64%. However, spending on general dental services has increased only by 22%. As a result, the salaries of dentists who have concentrated on NHS work have markedly reduced. Since costs for premises and equipment are the dentists’ responsibility, it is not surprising that more and more of them face falling incomes and put a greater emphasis on the treatment of private patients. The new strategy must ensure that dental-health promotion, information and advice for patients are key elements of new contracts, because dentists have a significant role to play. That work is time-consuming, and it should be part of a wider care package in dentists’ contracts. Two out of three dentists in Northern Ireland believe that they are unable to spend sufficient time with their patients. Patient surveys indicate that patients want more time with their dentists to discuss preventive measures. Patients want their dentists to spend more time advising them about good dental health. The Health (Miscellaneous Provisions) Bill is at Committee Stage; it provides an opportunity to begin to address some of those issues. The proposed policy change that allows dental services to be commissioned locally by health and social services boards is a first step in tackling the difficulty of access to Health Service dental care. I ask the Department, in conjunction with the health and social services boards, to take steps for the immediate employment of NHS dentists. Local commissioning will allow resources to be targeted at areas of greatest need. Priority must be given to the safeguarding and development of community dental services in order to protect that role in providing care to the most vulnerable patients, such as older people and those with special needs. The Chairperson of the Committee for Health, Social Services and Public Safety (Mrs I Robinson): I welcome any opportunity to speak on health issues. However, I am at a loss to understand why the motion has been tabled. As Mr Gallagher said, the Committee for Health, Social Services and Public Safety is already dealing with the issue of NHS dental treatment. The Committee Stage of the Health (Miscellaneous Provisions) Bill gives Committee members the opportunity to scrutinise the Bill line by line, and to add to it or take away from it. However, I have to concede that, although there have been improvements in oral health over the past few years, children and adults in Northern Ireland continue to have higher levels of dental disease than their counterparts in Great Britain and the Republic of Ireland. All Members accept that fact. Figures from the 2003 child dental-health survey show that 60% of Northern Ireland’s five-year-olds already have tooth decay. Some 50% of that decay presents in the most deprived 10% of the population, and 75% is in the most deprived 20% of the population. That equates to approximately 8,000 children in the Province having teeth extracted annually under general anaesthetic. Alarmingly, a high percentage of children attending for dental general anaesthetic are under five years of age. 12.15 pm There is also a problem with taxpayers funding the training of dentists who, shortly after qualifying, concentrate on private work outside the National Health Service. We must urgently ensure that sufficient NHS dentists are available throughout Northern Ireland. Much good work is being done at community level, and I want to refer to one example. The area community dental service and health-visiting teams throughout the Southern Health and Social Services Board area work in collaboration to improve the health of all and reduce inequalities in healthcare. They are particularly concerned with improving tiny tots’ teeth — I think that that is rather sweet. I should not have said that — sugar is bad for teeth. With additional Investing for Health funding, they have been able to extend the programme by providing free toothbrushes and toothpaste for children in the most deprived areas. All children who attend health-visiting assessments receive oral health advice from a health visitor. Toothbrushes, fluoride toothpaste and leaflets on oral health are also provided. Feeding cups are distributed by health visitors to encourage children from six months of age to use a feeding cup, and inappropriate feeding practices are discouraged. If health visitors identify families in need, resources are provided for other family members; therefore, inequalities in healthcare are also being addressed. Health visitors have been trained to run the programme, and resources are distributed by the area community dental service. The provision and distribution of feeding cups by health visitors during children’s assessment visits reinforce the Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommendations that children should be introduced to drinking from a cup at six months of age and that bottle-feeding should be discouraged from age one. Inappropriate and prolonged use of a bottle can result in long-term health problems. Examples are poor feeding technique; food refusal; speech problems; and tooth decay. Health visitors also raise parents’ awareness of the dangers of sugar-sweetened drinks, which can cause tooth decay early in childhood. There is substantial evidence to show that the provision of toothbrushes, and toothpaste containing 1,000 parts per million of fluoride, produces a significant improvement in the levels of decay in young children’s teeth. Health visitors encourage parents to assist with twice-daily tooth brushing until children can do it effectively themselves, usually by the age of seven. Early childhood is a vital time for good nutrition and healthy tooth development, which can reduce the risk of health problems in later life. The tiny tots’ teeth initiative shows that increased collaboration and partnership working is a starting block towards the achievement of the shared goal of better health and well-being for all. Working together can make a difference and encourage parents and carers to adopt healthy lifestyles for themselves and their families. This is important work and an indication of what can be achieved through collaboration. However, it is essential that we ensure that sufficient dentists are available for patients throughout Northern Ireland. Mrs O’Neill: Go raibh maith agat, a Cheann Comhairle. I am glad of the opportunity to speak to the motion, and I share Tommy Gallagher’s concern about the lack of NHS dental treatment. I am contacted by constituents who regularly experience such difficulties. They cannot find a dentist who can take them on as NHS patients in an area close to them. As a result, they are forced to go to clinics in other areas and pay the additional travelling costs. Given that those who live in the most deprived areas live with high levels of social deprivation, they are more likely to have poor oral health. Children who live in the top 20% of most deprived wards are twice as likely to have dental decay as those who live in the top 20% of most affluent wards. Those in the former category pay more to access treatment, which is a disincentive for getting the required treatment. The oral health of the North has consistently been worse than that in the South of Ireland or in England. The average five-year-old child in Belfast has approximately 2·5 teeth affected by tooth decay, and a similar child in London has about 1·5 teeth affected. A similar child in Dublin has only one affected tooth; there is a great disparity there. The Health (Miscellaneous Provisions) Bill contains proposals to allow the Department to commission dental services and to employ dentists directly. I hope that that will go some way towards achieving better results. The Department must target resources at the areas of greatest need and encourage dentists to register and provide care for patients with greatest need. That must be a priority. I support the motion. Rev Dr Robert Coulter: I am sure that every Member agrees with the sentiment of the motion; however, I have difficulty with it. In the Health (Miscellaneous Provisions) Bill, there is a substantial section on dental care and contracts for dentists. Members discussed the Bill, and it was sent to the Committee for Health, Social Services and Public Safety for scrutiny. The Committee has taken evidence from dentists and others. Discussing on the Floor of the House a Bill that is with the Committee makes us nothing more than a talking shop. Instead, we should follow the procedures that have been laid down in Standing Orders for the handling of a Bill, and for all of the work of the House. The Bill should be discussed in Committee and any amendments should be brought before the House. Although we agree with its sentiment, it amazes me that the motion could be brought before the House when the Bill is with the Committee. We must regulate our business better. I will not, therefore, speak to the motion. I agree with its sentiment; however, we should follow the procedures that are right and proper. Mr McCarthy: The want of dental facilities in Northern Ireland is nothing short of a scandal. In fact, it is a shame on those who are supposed to deliver a basic health service to the people of Northern Ireland. Dentistry and the prevention of tooth decay are a vital part of our Health Service and should be available on the NHS to everyone from the cradle to the grave; however, that is not the case. Dentistry — like every other facility in the Health Service — is grossly underfunded, and that must be put right without delay. I sincerely hope that the Minister of Finance and Personnel does not classify the need for sufficient funding for a decent Health Service as a crowd-pleaser. Visiting the dentist when necessary is a basic human right. The prevention of tooth decay should be an important part of that health facility. The money paid by Government to dentists for basic work falls far short of the actual work and materials used. Therefore, dentists perform work privately and, thus, many constituents cannot get an appointment. Mr S Wilson: Will the Member give way? Mr McCarthy: No, I will not give way. I have only five minutes. The result is that newly qualified dentists leave Northern Ireland for more lucrative posts elsewhere. The fundamental problem of funding resources and support for primary-care dentistry must be a priority for the Assembly. The number one priority must be the health of our people, and sufficient funding must be forthcoming. We hear much talk of a new multi-sports stadium costing millions of pounds, but no one seems to agree that we really need such a facility. It is certain that no one can agree on where it should be sited. Furthermore, a new Irish language Act will cost us millions of pounds. I am sure that those are noble causes, but we cannot afford such luxuries if ordinary folk cannot even get a dentist. Surely common sense would tell us to get our priorities right. Luxuries can come later. If the motion is passed, I will expect the Health Minister to get the necessary funding through the Executive to allow all dentists to provide a first-class service to everyone in Northern Ireland. Dr Coulter’s comments amazed me. All private Members’ motions that come to the Floor of the Assembly have been approved by the Business Committee. The UUP has two Members who sit on that Committee, as do most other parties. They must believe that today’s motion is important. I expect the parties that make up the Executive to listen to the voice and the will of the Assembly through their elected Members who sit on the Business Committee. I am glad to see that the Health Minister is present — he has attended every debate on health matters and has perhaps been one of the busiest Ministers. Some Members: Hear, hear. Mr McCarthy: I expect Mr McGimspey to attend tomorrow’s debate on the shortage of respite care. I sympathise with the Minister to some extent because, since 8 May 2007, his Department has been asked to find resources for several important health issues: free personal care for older people; equality in prescription charges; dentistry facilities for everyone in Northern Ireland; and increased provision of respite care for all who need it. With the support of the Health Minister’s Executive colleagues, dentistry facilities for everyone can be provided. That is exactly the type of thing that the Assembly was set up to do. Shortly, it will be proved whether the Minister and his Executive colleagues can deliver on what elected Members have stated as priorities. The entire Business Committee deemed the provision of dentistry facilities for everyone to be a sufficiently important subject to debate, and I support the motion. Mr Buchanan: I welcome the motion. However, I am at a loss, as was the Chairperson of the Committee for Health, Social Services and Public Safety, as to why the motion is before the House today, given that that Committee is still considering the Health (Miscellaneous Provisions) Bill. Notwithstanding that, the access to and availability of NHS dentists in Northern Ireland has been an ongoing problem for far too long, resulting in ever more people missing out on vital oral healthcare. As a consequence of the increasing numbers of dentists who are moving to private clinics, fewer dentists now work for the NHS. The cost of oral healthcare that private clinics provide further isolates many in the community, who are forced to join waiting lists or travel great distances to visit their dentists. Healthcare, oral or otherwise, is the right of everyone, and Northern Ireland lags behind the mainland in the number of people who are registered with dentists. The Department of Health, Social Services and Public Safety and the health boards must examine what is being done to ensure that newly qualified dentists enter and remain in the NHS, and how to improve the system so that dentists are not lured into private practice. The cost and restrictions that face dentists serve only to frustrate the current systems, and certain limitations mean that many dentists feel forced to go into private practice. Therefore, the Department must consider how to improve the lot of the NHS dentists who struggle to keep costs down while providing a high standard of service to their patients. The Assembly should not tolerate the major knock-on effects of ignoring dental hygiene. More children suffer from tooth decay in Northern Ireland than anywhere else in the UK. It is a deeply rooted problem. [Laughter.] Mrs Foster: He delivered that line with a straight face. Mr Buchanan: Yes, I did. Members must support any programme to educate children about oral health and to encourage them to visit the dentist. Tooth decay, particularly in children, is a result of an unhealthy diet. That problem is made worse when the teeth are not regularly checked. If the encouragement of children to attend regular check-ups at locally based NHS dentists can be made to coincide with education on healthcare, that should reduce the numbers suffering from tooth decay. Preventive measures can be embedded in the mindsets of children before major dental work is required. Ideally, there should be no differentiation between the services that are provided by the NHS and by private clinics. Unfortunately, however, that is not always the case. More pressure will be added to the already pressurised NHS dental service because more of the ageing population are retaining their own teeth. 12.30 pm The NHS needs the resources to meet demand to a high standard, and that should be made clear in the overall dental-health strategy. The Department must examine the frameworks that are currently in place to eradicate any future escalation of that problem. What is being done in those areas that most suffer from dental problems and where people cannot readily access a local NHS dentist? According to the British Dental Association (BDA), the uptake of dental services is low in clearly identified areas of Northern Ireland. Those areas must be targeted with literature and resources that detail what people can expect from their local NHS dentist. The Health Minister cannot afford to stall on this matter. There is a great need to alleviate this fundamental problem, which can be easily rectified with the right strategy in place, and easy access to an NHS dentist. Ms S Ramsey: Go raibh maith agat, a Cheann Comhairle. The Minister must be happy that there is a five-minute time limit on each contributor to the debate because Kieran McCarthy was getting through the health budget rightly, and spending it on a number of measures. Others, including the Chairperson of the Health Committee, have mentioned that the Committee has begun to examine dental-care provision and have said that the current system must be changed through the Health (Miscellaneous Provisions) Bill. I have no doubt that the comments of Members and the response of the Minister will be taken on board by the Committee when it considers the Committee Stage of the Bill, as Bob Coulter said. I look forward to the debate that we will have on the Bill in the House in the coming months, and to making progress on the issue of lack of provision of NHS dentists and dental care. Reports and strategies that have been commissioned over the years have shown that the North has the worst oral health in Britain and throughout the island of Ireland. The primary care strategy of September 2006 outlined that the reasons for that related to lifestyles and deprivation — as mentioned by Mr Buchanan. It has been widely accepted that people who live in areas that are affected by multiple deprivation suffer the worst levels of oral health. The location of dental practices has been largely due to market forces, rather than attempts to meet the needs of people who live in a particular area. Equity and equality should be at the heart of our attempts to improve oral health care for all. Dental practices should be located beside shops and community and health centres. Dental practices must provide a flexible and mobile service for people who live in rural constituencies, and particularly for those with special needs. Those services must be beside — and brought to — people in order to improve oral healthcare. I am sure that the Minister will take that point on board. Schools, particularly preschools and primary schools, are currently promoting healthy-eating schemes for our young people. Children are becoming more aware that sugary foods and drinks harm their teeth and gums. However, despite that, the primary care strategy of 2006 outlined that: “approximately 10% of 5 year-olds possess half of all the decayed teeth for this age group”. That problem is strongly related to deprivation. The link between poverty and health inequality cannot be ignored. Moreover, the oral healthcare needs of the homeless, Travellers, ethnic minorities and others must be improved, in conjunction with dental services for the elderly. Services for people living in isolated rural communities and for people with learning difficulties must also be improved. Those are some of the most vulnerable and socially excluded groups in our society. Investing for Health dental targets, following the review of the oral health strategy, were surpassed. The current targets that are included in the Department’s priorities for action outlined that, by March 2008, boards and trusts must reduce tooth-decay levels in five-year-olds in the top five most deprived wards in each of the trust areas. I would appreciate it if the Minister could tell Members how those efforts are going, if he has any such information. The Assembly must identify the links between poverty, deprivation and ill health, including poor oral healthcare. Better oral health will have an impact on self-esteem and self-confidence; it will create greater awareness of health promotion, and lead to a greater uptake in the number of people who register with their local dentist. Suggested changes to the way in which dental services are organised are cited in the Health (Miscellaneous Provisions) Bill. More local dentists, provision for dentists through the NHS, better registration and a greater uptake of services are all welcome. I look forward to debating this subject in the autumn, and I also look forward to discussing it with the Committee. I thank Tommy Gallagher and Carmel Hanna for tabling the motion. I note Members’ comments about debating dental treatment in the Committee. The House should not be stopped from debating a motion just because it is being discussed in a Committee. I support the motion. Mr Shannon: I support the motion, ever mindful of the fact that it is already doing the rounds of the Committee for Health, Social Services and Public Safety. There are few things that can stop a man in his tracks, and a sore tooth is one such thing. The sad fact is that Northern Ireland has the worst oral hygiene and tooth decay in the UK. Recent statistics from the British Dental Association show that the average number of bad teeth in a 12-year-old child in England is one, in Wales it is one and a half, in Scotland it is one and three quarters, and here in the Province it is two and a half. Why is that? Some of the problems may stem from sugary drinks and sweets. Northern Ireland — indeed, the UK as a whole — has a serious lack of dedicated NHS dentists. Some 2,000 left the NHS last April alone. Previously, NHS dentists were paid on the amount of work done, rather than paid in general, as happens with doctors. There was a “drill-and-fill” mentality, which sometimes resulted in fillings that were not strictly necessary, and no time was spent on preventive care. As a result, we have a generation that was not taught good oral hygiene and is suffering the result. We are passing the fear of dentists, and an unhealthy attitude, on to our children. We have the highest number of people with no natural teeth left than any other part of the UK or the Republic of Ireland. Many would say that it is small wonder. A constituent of mine went to Belfast City Hospital recently one Sunday and found the waiting room chock-full of people in agony with dental problems, unable to see their dentists — if they were registered with one in the first place. They were praying that the hospital dentists would be able to stop the pain. As often happens, the dentists are reluctant to work on the teeth of the patient of another dentist, preferring to prescribe something for the pain and referring the patient to his dentist, which puts the patient back to square one. That is what happened to a 31-year-old lady with a tooth broken at the root. She suffered in agony for nearly a week before giving in and going to hospital. Her dentist had been struck off for misconduct, and other surgeries were reluctant to take on a young woman with a husband, and five children under the age of nine on the NHS. They preferred to tell her about a prepay plan that would have cost her a fortune, so she suffered the pain, praying that it would let up, until she could take it no longer. Mrs Foster: I am glad that the Member is now talking about female tooth decay. I was worried that he was implying earlier that there was only male tooth decay. Does the Member agree that one of the difficulties, especially in rural areas, is that not only are dental practitioners going to the private sector, they are also moving to other jurisdictions such as, for those living in border areas, the Republic of Ireland? The Member who moved the motion will probably agree with that. Mr Shannon: I agree with the Member wholeheartedly. Dentists are taking their practices elsewhere, and that is part of the problem. Some Members can remember when dental nurses came to schools and gave each child a tablet. It turned the mouth blue, which showed whether a child had bad teeth, and that was the whole idea. It has been found that middle-class professional families are more likely to have 20% less decay than those from working-class families, and that also underlines the issue. A dentist in Ards came to me for help with getting planning approval for her surgery. She has promised to undertake NHS treatment. However, the difficulty we faced in trying to get the surgery through the planning process almost — I was almost going to say that it almost drove me to drink, but that would be wrong — drove me up the walls. Mr S Wilson: Sweets. Mrs Foster: Fizzy drinks. Mr Shannon: It would make you eat more chocolate. Maintaining good oral health must be encouraged in schools and carried through to dental surgeries, where dentists have time to demonstrate good oral hygiene. It is important to be able to see a dentist without paying absurd amounts of money and to get emergency appointments when in agony. It is also important to be able to have teeth professionally cleaned once a year in order to stop decay and for parents to access advice on how to teach their children good oral hygiene. All those issues are important, and that is why I shall support the motion. Of the 75% increase in spending on the NHS, only 9% went to dentistry. The dental system must be brought up to date. There is a fear that, by 2011, the current shortage of NHS dentists will have doubled. Something must be done now to ensure that that statistic is never realised in the Province. Mr S Wilson: This debate is important, although it has been alleged that it is premature as the Bill is in Committee Stage. Nevertheless, it is worthwhile for Committee members and the Minister to hear some views from the Floor of the House on how the issue might be best addressed in the Bill. We have listened to the usual round of Members suggesting that more money should be spent on employing more dentists, that more surgeries are needed, that surgeries should be located closer to populated areas, and that surgeries should perform a wider range of work. However, the most important thing, from the Assembly’s point of view, is to focus on the fact that available resources are finite. From that standpoint, we can try to advise the Minister on how those resources might be best spent. I am not an expert but, having looked at some of the statistics, I am struck by the fact that, in comparison with other parts of the United Kingdom, Northern Ireland does not have a big shortage in the number of dentists per head of population. The problem is therefore not a case of people being unable to find a dentist simply because not enough dentists are employed. That is an important point to make, because at least three Members who have spoken so far in the debate have urged the Minister to employ more dentists. If the Minister decides to use the resources available to him to employ more dentists, it might not actually address the issue that really needs to be tackled. If other parts of the United Kingdom, with similar population distribution, similar levels of deprivation, and a similar geographical spread etc, can provide a better service with the same number of dentists, that is clearly not the direction in which we ought to be pointing the Minister. Another striking aspect of the debate is that many Members have said that the problem stems from the fact that dentists are migrating from National Health Service work to private work. I assume that that happens because dentists have a degree of independence, and they use that independence to follow the market and to make the most money. If that is the source of the problem, there are only two options. One option is to employ more dedicated National Health Service dentists, as Mr Gallagher seemed to suggest. Enough Members are of a certain age to remember when a dual system was in operation. I am not so sure that that is the way to go. Because of the way in which pay would be structured under a two-tier system, and the fact that dentists can make more money through private work, it would be inevitable that the best dentists would not be attracted to dedicated National Health Service work. If they were directly employed, the best dentists would go into private practice, with the remainder going to the National Health Service. I do not think that we want a two-tier system. The other option would be to accept that dentists can operate independently. We can either direct them to do a certain percentage of NHS work — an option that appears to have been rejected by the proposer of the motion — or we can find a way to give dentists an incentive to do NHS work. Furthermore, an incentive to do a wider range of work avoids Jim Shannon’s contention that dentists simply get paid for the number of teeth that they drill and the number of fillings that they stick in — although I think that my dentist may have worked on that basis in the past. 12.45 pm We must be careful. If it is decided that a contract should be negotiated that pays dentists for any work that they do, that pays them to do preventive work, and, perhaps, even allows them to send out dental nurses to give advice to patients, we must ensure that — in light of what happened in England when GPs negotiated their new contracts — the contract does not give dentists a bye ball that allows them to make piles of money from the system without actually delivering a better service. If that is the route that we decide to go down — and I notice that another Member, whether inadvertently or not, used that term also — and we decide to allow dentists to pick and choose between private practice and NHS work, we must ensure that the new contract is sufficiently foolproof to guarantee as wide a range of services as possible without hitting the public purse. The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I thank the proposer of the motion. I am grateful for the opportunity to address the issues. I believe in a Health Service that is high quality and easily accessible. I know that access to Health Service dentists is a problem for people in many parts of Northern Ireland. My Department is addressing that problem. Northern Ireland has the worst oral health in the UK. When compared to their counterparts in the rest of the UK, our 12-year-olds have almost three times the level of dental decay. That level of decay is related to lifestyle and to deprivation. On average, we spend more money each week on cigarettes, confectionery and sugared soft drinks than any other part of the UK. For the information of Members, those three things are extremely bad for teeth and oral hygiene. We also eat less fruit and vegetables and brush our teeth less frequently. People in disadvantaged areas are doubly affected. Health inequalities affect all areas of the population’s health, including dentistry and oral health. There are two ways to address the matter. First, I will consider the experience of the Republic of Ireland. At one time, children’s dental health in the Republic of Ireland was considerably worse than that in Northern Ireland. Now, the Republic of Ireland boasts one of the lowest rates of dental decay in Europe. Five-year-olds in Dublin have less than half the dental decay of five-year-olds in Belfast. A recent cross-border study showed that 16-year-olds living in the Republic of Ireland have significantly better dental health than their counterparts in Northern Ireland. The same study showed that oral health inequalities in the Republic of Ireland have virtually disappeared. How did the Republic of Ireland achieve those improvements? Water fluoridation was used to address the problem. In the 1960s, fluoride was added to the water in the Republic of Ireland. Improved dental health is the result. Mr Campbell: The Minister is entering quite a contentious area: forcible fluoridation. He referred to children and young people and the considerably worse ratios in Northern Ireland. Will he tell the House whether, over the past years, the poor dental records of younger people in Northern Ireland have been statically bad or have they been improving from an even worse position, for example, 10 years ago? Mr McGimpsey: I would have addressed that point if I had had the opportunity to finish speaking. I said that fluoridation is one instrument that has been used. Another instrument is available to us. In the south-east of England, fluoridation is virtually superfluous because of better support from dental services and a better understanding of prevention through improved oral health and oral hygiene. We have to choose one option or the other. Mr Campbell stated that fluoridation is a contentious issue. However, providing that the support were to exist for it, the south-east of England example could offer an alternative method for addressing the problem of poor oral health. The delivery of dental services is the responsibility of each health and personal social services board. Dental services in Northern Ireland are delivered in two ways. The general dental service, which provides the bulk of Health Service dentistry in the Province, is delivered by high street dental practices. Dentists are paid fees for each registered patient and for each item of treatment given. Non-exempt patients pay 80% of the fees, up to a maximum amount. Dentists have a financial incentive to provide treatment, as greater volume equals greater income. The second way is through the community dental service, which is a trust-based salaried service, dealing with individuals who are unable to use the high street dentists, such as children with learning disabilities. That service also provides oral health promotion and school screening. Private practice is also available to patients willing to pay. General dental practitioners in the Health Service have a contractual obligation to provide out-of-hours treatment and ensure that any patient who is registered with them has access to urgent treatment. Currently, dentists are paid for each item of service and claim for those items through the Central Services Agency (CSA). There are problems with those arrangements, however; dentists have no financial incentive to improve the quality of their services or provide wider oral health promotion advice and education, as they do not get paid for that. Since the early 1990s many dentists have reduced their commitment to the Health Service and have developed better-paid private practice work. That has resulted in a shortage of dentists providing treatment under the Health Service. Although many dentists continue to provide Health Service treatment for children and exempt adults, a growing number will only see fee-paying adults under private contract, which creates access problems. Sue Ramsey, Jim Shannon and other Members mentioned a lack of dentists. There are significantly more dentists per head of the population in Northern Ireland than in any other part of the UK. The issue is not the number of dentists; it is about putting a proper contract in place for their services, and that it what I intend to do. Ms S Ramsey: I thank the Minister for his comments. My point was not about the number of dentists, but about the people who cannot get dental services, especially in rural constituencies — it is about bringing the service to them. Mr McGimpsey: I agree that access is the key; however, as Sammy Wilson said, the problem lies in getting more dentists into the system rather than merely producing more dentists; the number of dentists that we already have should be adequate. Although access to Health Service dentistry in Northern Ireland is better than it is in England, I acknowledge that the situation here is deteriorating. Seven hundred and eight thousand people are now in receipt of Health Service dental treatment in Northern Ireland — almost 32,000 fewer than in the figures published five years ago. High street dentists in Northern Ireland are independent contractors. Currently, they can choose to provide general dental services or private dentistry, or a mixture of both. Dentists are not obliged to accept a patient for Health Service treatment, and they can deregister patients if they so choose. Under current contractual arrangements, health and personal social services boards cannot compel dentists to provide Health Service dentistry. The boards cannot ensure that independent local practitioners provide enough Health Service dentistry to meet all needs, nor can they prevent gap areas in which Health Service dentistry is unavailable. The Member who moved the motion, Tommy Gallagher, represents a constituency that is a gap area. The health and social services boards will try to fill that gap by employing salaried dentists. My Department’s primary dental-care strategy, which was published last November, sets out a 10-year plan for Health Service primary dental-care services. The strategy was developed around the local commissioning of services. Under the proposed arrangements, commissioners will be responsible for securing primary care dental services. Those services will be obtained from general dental practitioners, the community dental service, salaried staff, or a mixture of all three. It is important to note that the commissioners will be able to contract for the delivery of dental services, which will give the health and social services boards more flexibility than they have in meeting the needs of their areas, and will help the commissioners to ensure that dental services are available to everyone in their locality. It will also access problems where general dental services are not available by giving the boards the control to establish contracts with a variety of providers. The reforms in the strategy include local commissioning of services; access to appropriate Health Service dental care for those who need it; greater emphasis on disease prevention; guaranteed out-of-hours services; and a revised payment system that rewards dentists. Negotiations have already started between my Department and the general dental practice committee of the BDA to secure a bespoke contract for Northern Ireland, thus enabling the recommendations of the primary dental care strategy to be implemented. Mr McCarthy: Is there a time frame for implementing the strategy? Mr McGimpsey: The strategy was published in November 2006 and is governed by the Health (Miscellaneous Provisions) Bill. It is a work in progress. During a debate on free personal care, which I believe was proposed by Mrs Hanna, I explained to the House that, taking into account the stages involved, the strategy’s implementation would be completed by 2010 at the earliest. An amendment was proposed for implementation to be completed by 2008. However, it is just not physically possible to do so in that time frame. As I said to the House on that day, if the strategy could be implemented faster, I would ensure that it was implemented faster. However, the Health (Miscellaneous Provisions) Bill governs the roll out of such matters. The new commissioning powers to be given to the health boards will improve access to Health Service dentistry, allow a greater focus on prevention and enable the development of a regional contract with local flexibilities. A question was asked concerning what could be done to address the drift of dentists from the NHS to private practice. Following representations from the BDA, an additional recurring investment of £2 million from 2007-08 was agreed. That will slow the drift from Health Service dentistry. The additional £2 million will assist dentists who continue to provide care for Health Service patients with the costs of running their practices. This investment forms part of the proposed new contract arrangements. Mr Donaldson: Is the Minister aware that there have been some cases in which dentists have told their patients that they can no longer remain in their practices because they are moving to private practices, and, in some of those cases, the dentists have refused to pass on those patients’ dental records to colleagues who could provide NHS care? Will the Department issue a direction to dentists in Northern Ireland stating that, at the very least, dental records should transfer with patients? Mr McGimpsey: I thank Mr Donaldson for that point. I am aware that dentists can deregister patients. I understood that records did follow patients, but I will make enquiries about the matter. It is a very important point. Health and social services boards are seeking to commission salaried dentists in areas where there are problems with access to dental services. Mr Gallagher’s constituency of Fermanagh and South Tyrone is one such area. The Northern Health and Social Services Board supplied a business case to the Department and secured funds to employ a salaried dentist. The Western Health and Social Services Board identified the need to recruit dentists to address access problems in its area. The other two boards have also been asked how they intend to address shortfalls in Health Service dentistry in their areas. I assure Members that all possible steps will be taken to ensure that dental treatment is available under the Health Service to those who are entitled to it and who wish to avail of it. Mrs Hanna: I am pleased to make the winding-up speech on the motion, which was brought to the House by my colleague Tommy Gallagher and myself. The motion highlights a very important health issue. Indeed, it will strengthen our resolve to ensure that the legislation does the business. Northern Ireland has the worst level of oral health when compared with the UK and the Republic of Ireland. Years of underinvestment have left Northern Ireland with an unacceptable National Health dental service. Like the National Health Service, dental treatment must be free at the point of need and provide a competent service to everyone who needs it. As has been mentioned by other Members, the solution does not lie with merely increasing the number of dentists but with increasing the number of dentists who work in the National Health Service and ensuring that patients have adequate access to dentists. 1.00 pm The Health (Miscellaneous Provisions) Bill is introducing changes to the way in which dental services are organised in an attempt to address the difficulties that people face in getting access to Health Service dental care. It is also introducing changes in the targeting of resources in areas of greatest needs. Provisions contained in the Bill will also enable a health and social services board to enter into a contract, under which primary dental services are provided. Furthermore, the Bill contains provisions to govern the terms and content of the new general dental services. I welcome that as an enabling amendment, and I want to talk it up. I want to ensure that it widens access to those who need it. Who would have thought that National Health dental services would be at an all-time low? Given a fair wind, the legislation will enable progress but it is also an act of faith that must be monitored to ensure that it does the job for which it is intended. I am disappointed that some Members do not feel that this is worth further debate. As Kieran McCarthy said, the Business Committee decided that it was a priority, and it has been in the system for some time. Iris Robinson referred to fluoride in toothpaste making a difference. In the Republic of Ireland, fluoride is put in the water supply, and teeth have strengthened. That has not been debated here, but perhaps fluoride could be put in milk so that people could choose whether to take it or not. I have no doubt that there will be a debate in the future. I am disappointed that my colleague Robert Coulter does not consider NHS dental treatment worth further debate. Michelle O’Neill and Sue Ramsey made some good points on the impact that a lack of access to NHS dental treatment has, particularly to disadvantaged people. The fact that such people cannot get dental treatment compounds their disadvantage. Jim Shannon graphically illustrated what it is like to have bad toothache and be unable to get a dentist. Toothache has been compared to some of the worst pain. Some people have said that it is worse than the pain of childbirth, but I do not know about that. Sammy Wilson commented on the choice of dentists. I have made the point that it is not the number of dentists that is relevant, but the number who work in the National Health Service. I agree that we cannot afford to develop a two-tier system. That trend has started in health generally, but it must be stopped and reversed. Poor oral health has a negative impact on people’s general well-being. It is acknowledged that the most vulnerable in society have the poorest dental health, often because of their diet. Young children are particularly vulnerable, especially those who are not registered with a National Health Service dentist. Those children do not learn how to look after their teeth, and that leads to major health problems in later life. It has been well documented that decay in someone’s mouth can spread to other parts of the body. The elderly population is rising, and, because a larger number of them are keeping their teeth than in the past, they also need access to dental health. The 2006 primary dental-care strategy for Northern Ireland proposes fundamental changes to the provision of dentistry. Its primary aims are to reduce dental health inequalities, to improve the oral health of all of the Northern Ireland population with a high-quality service and to ensure a rewarding career for dental professionals, the lack of which is part of the problem. Patients are entitled to, and must have, access to a quality dental service. For emergency treatment, it is important that there is easy access to dentists; the dental hospital cannot do it all. Patients who are required to pay for dental treatment, especially those whose income is just above the threshold for benefits, are often the hardest hit. The dental-charging system must be simplified so that patients know what they are paying for. All Members know of people who have required expensive treatments, such as root canal work, but could not afford it. Why are dentists dissatisfied and disillusioned with the National Health Service? Dentists wish to deliver high-quality treatment and care, and the focus for the future, as in other parts of the review of public administration, must be to ensure that entire practices have the right skills and good infrastructure in place. Dentists must be encouraged, motivated and supported to work in the National Health Service, and the ethos of “drill and fill”, which demotivates those dentists who wish to stay in the NHS, must be left behind. As has already been said, there cannot be a two-tier system; wider access must be maintained. In addition to a better working environment, more dental hygienists and nurses are required as part of an integrated approach by all dental-health professionals. The BDA has brought many issues relating to the running of dental practices to my attention and to that of the Committee for Health, Social Services and Public Safety. In particular, it highlighted the rising cost to dentists of meeting legislative, regulatory and good practice requirements. One must consider the bigger picture when attempting to improve the dental health of the people of Northern Ireland. Dental-health promotion and preventive treatments are key to the improvement of general oral health, and there must be a long-term focus on such work. Proposals on the new contractual arrangements for dentists have been outlined. Any such new measures must be piloted before they are generally implemented. In England and Wales, there are still grave problems. Members must monitor that situation and ensure that any potential legislation does what it sets out to achieve, which is why I wished to debate this matter. It has been suggested that the new contractual arrangements are too driven by results and targets and not by oral health and patient access to NHS dentists or orthodontists. The failure to increase patient registrations has also been recognised. To reiterate the focus of the motion, it is important that those who require dental-health treatment have access to it. The Assembly must also recognise the problems that face dentistry and identify how to attract people back to the National Health Service. Members have discussed why dentists are attracted to private practice — it is more lucrative — but we could be more creative. When dentists come out of training, which has cost the public purse so much, perhaps they could be contracted to the National Health Service for a certain length of time. That would also give them an opportunity to repay their student loans. Other areas of the Health Service and allied professions could also consider that idea. For services delivered through contract, there are many issues to be considered. However, it is important that this matter was debated today, and I welcome the fact that the Minister of Health, Social Services and Public Safety has been in the Chamber for this and every other debate on health issues and that he has taken the arguments on board. Members will closely watch the progress of legislation and, more importantly, the outcomes to ensure that it does the business. Question put and agreed to. Resolved: That this Assembly expresses concern about the lack of availability of NHS dental treatment and calls upon the Minister of Health, Social Services and Public Safety to act immediately to ensure that NHS treatment is available to all those who are entitled to it, in conjunction with a dental health strategy. Accidents in the Construction Industry Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes for the winding-up speech. All other Members who wish to speak will have five minutes. Mr Cree: I beg to move That this Assembly calls on the Minister of Enterprise, Trade and Investment to ensure continued progress in addressing accident rates in the construction industry through the Buildsafe Northern Ireland initiative. Many Members will have read reports that construction sites across Northern Ireland faced a sweep of inspections earlier this month. The Health and Safety Executive for Northern Ireland (HSENI) stated that it was conducting inspections as part of a drive to improve the safety record. That inspection blitz was also part of a Europe-wide campaign to reduce the number of serious and fatal accidents. The safety drive was necessary because construction workers in Northern Ireland are three times more likely to be killed in a site accident than workers in the rest of the United Kingdom. The fatal-accident rate for the construction industry is also worse here than in the Republic of Ireland, according to the HSENI. That is an alarming statement and presents a major challenge to us in moving the economy forward. The cost to the Northern Ireland economy due to work-related fatalities, injuries and illnesses is estimated at 1·3% of the country’s gross value added (GVA) or, in monetary terms, £300 million a year. In human terms, it means over 20 deaths each year, a further 60 deaths due to the legacy of past asbestos exposure, 800 major injuries and 35,000 employees absent from work at any one time due to work-related illnesses. That is 5% of the total workforce. Let us compare the Northern Ireland fatal and non-fatal injury rates per 100,000 employees for 2005-06 with those of our near neighbours. In Great Britain, there were 281 non-fatal accidents, and 0·6 fatal accidents, per 100,000 employees. In the Republic of Ireland, the figures were 350 non-fatal accidents and 3·2 fatal accidents. In Northern Ireland, there were 273 non-fatal accidents and 1·3 fatal accidents per 100,000 employees. Among the major causes of injury and illnesses are poor manual handling; work-related distress; falls from heights; unsafe vehicle movements; exposure to asbestos fibres; and, not unexpectedly, slips and trips. The agriculture, quarrying and construction sectors accounted for 76% of all work-related fatalities in the five-year period from 2001-02 to 2005-06. The Health Service and the education sector have contributed significantly to the 35,000 employees — 5% of the total workforce — absent due to illness caused, or made worse, by work. Last year, two thirds of fatal accidents in Northern Ireland were the result of falls. The Buildsafe-NI initiative was introduced in 2004 for public sector contracts only. It is a partnership between the Construction Employers Federation, public sector clients, the unions and the HSENI. The initiative has a target to reduce the 2002 accident level in the industry by 50% by 2008. I was concerned to learn that participants in the Buildsafe-NI steering group have doubts that the original objective of the initiative may be achieved within the timescale. The Minister of Enterprise, Trade and Investment has said in this House, with regard to accidents and fatalities, that employment in the construction industry in Northern Ireland is one of the most dangerous occupations. I agree with him, and it is crucial that the matter be addressed urgently. I also agree that legislation alone cannot resolve the problem. We must educate and enforce at the same time. 1.15 pm Positive partnership between employers and other stakeholders must be promoted to improve radically the industry’s safety record. We do not want to trivialise health-and-safety challenges or engage in non-productive, class-war rhetoric against employers. The purpose of the motion is to emphasise the need for significant improvement in the industry’s health-and-safety record and to draw attention to the positive moves that the industry has already taken. Employers must work in partnership with unions and the Health and Safety Executive, which is more likely to promote a health-and-safety culture rather than just enforce an aggressive regulation. I was interested in a recent paper from the Quarry Products Association, in which it advocated fiscal incentives as a reward for good performance. It highlighted the aggregates levy credit scheme, which has successfully promoted best practice in the industry. Perhaps a similar scheme could be developed to encourage good safety performance. The Health and Safety Executive does a good job with the resources that it has. The public procurement element of Buildsafe-NI must be extended to local government, housing associations and other bodies. The health-and-safety culture that I referred to must start at boardroom level. More must be done for young people who enter the workforce. I hope that Members of the House will support the motion. Mr Hamilton: I commend the Members who moved the motion. Safety in the building industry is of increasing importance given the growing centrality of construction to economic growth in Northern Ireland. The recently published ‘Northern Ireland Business Monitor 2006/2007’ indicates favourable trends for the construction industry in turnover, profitability and optimism for the future. The Department of Enterprise, Trade and Investment’s ‘Northern Ireland Economic Bulletin 2007’ shows a massive growth in employment in the sector, with an increase of over 75% during the last decade. The most up-to-date quarterly employment survey shows a further increase of 500 construction jobs. Members must always be mindful that although the rate of accidents and fatalities is unacceptable and must be improved, the increase in the number of people who are employed in the construction industry is a significant factor in that. In April 2007, an Ulster Bank study concluded that construction is now the driving force behind our economy. Through the investment strategy for Northern Ireland and the work that is being carried out by the Strategic Investment Board (SIB), public-sector capital expenditure here continues to grow. We hope that it will continue to grow at an unprecedented level. I am sure that I speak for many in the House when I say that a major capital expenditure project that Members do not want the Government to be engaged in is new premises for the Assembly, a proposal for which has been reported in today’s news. One only has to walk outside the Chamber and see the Belfast skyline to see the construction boom that the city and the wider country is experiencing. I do not refer to the cherry picker that seems to have taken up permanent residence outside the Building. The Belfast skyline and those of other parts of Northern Ireland are changing. That shows centrality of construction to the growing economy. If Northern Ireland is to be transformed into the vibrant, high-tech, high-value-added economy that Members want, that must be built upon high-quality infrastructure, such as new roads, factories and office blocks. Construction is at the heart of the new economy. It goes without saying that an industry that expects to grow in the future must be a safe industry. It is nothing short of scandalous that a construction worker in Northern Ireland is three times more likely to be killed at work than in any other part of the United Kingdom. The 44 deaths and more than 500 severe injuries that occurred during the decade prior to 2003 are tantamount to carnage in the construction industry. For those reasons, I wholeheartedly support the Buildsafe NI initiative — not least, because it appears to have had a positive impact. Since its introduction, the number of accidents on public-sector projects, on which it has been concentrated, has fallen even though expenditure on such projects has risen dramatically. The number of accidents in which workers have sustained major injuries has dropped from a high of 27 in 2003-04 to 17 to date this year. Sadly, however, deaths in public-sector construction projects sadly remain, with two in each of the past two years. The Buildsafe initiative is one of those rare examples of where Government action and regulation can have — and has had — a positive outcome. The imposition of a premium upon health-and-safety standards in public procurement policy has sent a clear message to construction companies about their responsibilities to their employees. However, I agree with Mr Cree who said that compliance is needed, rather than the introduction of further new laws. For many years, construction workers have felt as if they are treated like second-class citizens when matters concerning their safety are being considered. Day in and day out, they are involved in building a better economy for Northern Ireland, and in so far as Government can provide it, they deserve proper protection. I am in no doubt that the Minister will continue to give the initiative his full support. Mr P Maskey: Go raibh maith agat, a Cheann Comhairle. I support the motion, and I commend Mr Cree and Mr McFarland for tabling it. It is especially welcome given the fact that construction workers are six times more likely to be killed at work than any other employee. Despite the reduction in the number of construction employees suffering death or serious injury over the past decade or so, the overall rates are still too high. In 2005, seven workers lost their lives in the North of Ireland, and in 2006, six people died from injuries sustained when working on construction sites. In the 10 years prior to that, 44 construction workers were killed and over 500 were seriously injured. Those incidents also have a detrimental effect on families, friends and work associates. The figures are too high, and they must be reduced immediately. As well as the high accident rates, construction workers are more likely to suffer from ill health as a result of their work in the industry and due to their exposure to hazardous substances and harsh working conditions. That must be borne in mind when Members are discussing the motion. It is important that the motion is being debated at a time when the construction industry is experiencing a major growth. As Simon Hamilton said, the amount of construction going on and the many cranes that are visible in our cities show the growth in that sector, and, consequently, the number of employees in that industry is also increasing. At this time of growth, we must ensure that the health and well-being of everyone involved is safeguarded. We must bring to an end the deaths and injuries sustained on building sites by making them a safer environment for all employees to work, and employers must be responsible for ensuring the health and safety of their employees. We must also remember that construction hazards are not restricted to those working on sites: children and other members of the public have been killed or injured because construction activities have not been adequately controlled. The Buildsafe initiative is an excellent idea because it brings together the public sector, the construction industry, trade unions and the Health and Safety Executive. The initiative’s commendable target is, by 2008, to reduce the number of major accidents to construction workers by 50% of the 2002 level. However, the Buildsafe initiative does not have much legal status or legislative basis; therefore, sanctions are not imposed on employers who fail to meet its key aims. That must be reviewed. Unfortunately, our most up-to-date official industrial accident statistics cover only the period until 2004, so we are unable to assess the success of the Buildsafe initiative to date. However, in recent years, the number of fatalities on building sites is on a par with the years prior to the introduction of the Buildsafe initiative. More, therefore, needs to be done. Considering that the initiative’s target date is 2008, it is imperative that we reassess the initiative next year and evaluate its success, and, at the same time, consider any possible recommendations that might make the initiative more effective and, ultimately, further reduce accidents in the construction industry. Key to reducing accidents in the construction industry is providing appropriate training for any individual before they enter a construction site. We must ensure that apprenticeships are not only effective in providing individuals with the skills of the trade through recognised bodies such as City and Guilds, but in providing rigorous health and safety training. The implementation of those measures, in conjunction with the appropriate inductions for young starts on building sites, would immensely decrease the number of accidents on construction sites, especially considering that young workers are more likely to have an accident or injure themselves due to inexperience. We must ensure that all that can be done is done with regard to employee safety on construction sites. The construction industry must implement the Buildsafe initiative, and more legislation must be introduced to ensure workers’ protection at all times. I will be supporting the motion, and I urge the Minister of Enterprise, Trade and Investment to raise the profile of the Buildsafe initiative. I hope that lives can be saved as a result. Go raibh maith agat, a Cheann Comhairle. Mr O’Loan: I agree with other Members that this is a hugely important issue. There is an unacceptable and unnecessary level of death and injury in the construction industry. I have examined statistics from the Health and Safety Executive Northern Ireland, and it appears that there is no sign that the situation will improve over the five-year target period. As far as 2006 is concerned, the figures for all types of accident appear to be up. The statistics for major accidents have increased, and although the figures for fatal accidents are a bit uncertain, on my reading of the situation, they are not convincingly down. I will listen with considerable interest to the Minister to see how he reads the situation. The Buildsafe-NI initiative is welcome in as far as it goes, but its scope is limited. It only affects firms that are bidding for public-sector contracts. The information at my disposal tells me that the major problem exists in the private sector, and, in particular, in small firms. My main point relates to the Quarry Products Association Northern Ireland (QPANI), which is an organisation whose firms overlap the construction industry. I commend its chairman, Mr Seamus McKeague of Creagh Concrete Products Ltd, and its regional director, Gordon Best, for adopting a highly proactive approach to health and safety. QPANI is a substantial body, with 265 member companies. It spans the quarrying, ready-mix concrete, concrete products and asphalt-plants sectors. QPANI’s regional director writes in ‘The Quarry Products Industry Journal 2007’: “Health and safety was again the main priority across all the sectors that QPANI represents.” I commend QPANI for saying that among the economic and many other issues that it must deal with it considers health and safety to be its main priority. QPANI works closely with the HSENI and runs repeated safety-awareness days for its members. One such event featured 75 participants from 35 companies. It runs a safety conference and holds an awards ceremony, both of which have a large involvement. It runs county-based hard-target clubs, which bring businesses together to learn from one another, and it sets challenging targets in accident reduction. It seems to me that the process is working, from which a good lesson can be learned. In a survey of its members, the regional director reports substantial improvements from 2004 to 2005. Those gains were made in a range of indictors, from frequency and severity of accidents to days lost to accidents. I herald the fact that QPANI has taken a superb bottom-up approach, which makes good use of expert assistance. It looks as if it could be a model for the entire industry. The attitude of owners and managers is right, and that is an absolutely vital ingredient in order for there to be progress. The quarrying industry is progressing towards what it calls its hard target of 50% reduction, and, from there, it intends to pursue a zero-accident goal. That is an excellent example of good practice, which is worth bringing to the attention of everyone concerned. I make two other important points. First, resourcing for the HSENI is not adequate. As a consequence, the HSENI is largely reactive, not proactive. In particular, the HSENI is not reaching small businesses that are often not members of any bodies and are therefore difficult to target. Secondly, QPANI is keen to see financial incentives being attached to accident prevention, to which Mr Cree has referred. Those incentives would be similar to the aggregates levy credit scheme (ALCS), by which credit is given for environmental protections. In this case, credit could be awarded for having good health-and-safety systems in place. Although there would be up-front costs, the public purse would be saved money, because, as other Members have said, accidents cost large sums. Credits of £20 million could, arguably, save £100 million. I know that QPANI is to meet with the Minister of Finance and Personnel, and I will also raise the matter in the Committee for Finance and Personnel. I welcome the motion. This debate will give an impetus to there being real progress. Mr G Robinson: Accident rates in the construction industry must be kept on their present downward trend in order to ensure that those who work in what is an extremely hazardous job are kept as safe as is possible. If that occurs, despite the dangers of the working environment, that will result in fewer injuries and in fewer sites being closed in order for health-and-safety investigations to take place. 1.30 pm More importantly, it will result in fewer workers and their families suffering hospital stays, recovery time, reduced income and, in the worst cases, loss of a family member. Progress in reducing accident numbers is always welcome, but there is no room for complacency. It is vital that the Buildsafe-NI initiative continues to minimise risk to workers. It has already helped to stop injury to highly skilled workers whose skills are in great demand. It has kept them economically active and independent of state benefits, and their skills are vital to the Northern Ireland economy. At all costs, we must protect them. The Buildsafe-NI initiative helps to achieve that. I am pleased to support this worthwhile motion. Mr Brolly: Go raibh míle maith agat, a Cheann Comhairle. Beidh mé ag labhairt anseo agus ansiúd go pearsanta ar an ábhar seo. On a previous occasion in the House, I described how I received the news that my father had been killed at work — buried alive in a 15-feet deep, unshored, trench. To think of the devastation that that caused to my mother and the rest of us — my youngest brother was only 11 years of age at the time — is still very difficult. When I speak on this subject therefore, I am not interested in statistics, percentages or measures, but in the important human question of the safety of people at work — human beings at work, not workers. It was difficult when news reports said simply that a worker had been killed at work. It reminds me of the song sung by The Dubliners: ‘McAlpine’s Fusiliers’. In the song, a man is lost in a concrete stair, but the employer’s only retort is: “I’m a navvy short”. Get me another navvy. This stuff has to come from the heart. We are dealing with vulnerable people who are, as another Member rightly said, the bedrock of our economy, and will be for some time to come. We must consider how families are looked after in the wake of such an event. When my father died, it seemed — as I have already described — as if no one was interested. The company was good enough, and the employers were sorry that it had happened. The authorities were good enough, and our friends visited and all that. However, in 1970, my mother was compensated to the tune of £7,000 — a very poor price for a man of my father’s status in the community. He was much more than a worker on a construction site. Gradually, people get over these things. However, as a result of my father’s death, I am very concerned about how building sites are conducted. When I last spoke about this, I made a point about corporate guilt; a similar point could be made about corporate debt. As a corporation, a company can be held responsible for a death; however, no one person has ever served a day in jail for negligence, because that guilt is spread among the directors of the company. They pay compensation, which they can well afford. Their insurance premium may rise a bit, but that is all. The Assembly should advocate an all-Ireland Buildsafe initiative. At present, construction workers from all over Ireland are employed all over Ireland. They come from the North to work in the South and from the South to work in the North. A firm, all-Ireland, Buildsafe policy should be established so that workers are looked after properly. As I said, nobody has ever spent a day in jail or ever really been punished for negligence towards workers. It is heartening to see that construction companies are now spending much more money on safety. It is good that local scaffolding firms now have proper scaffolding and shoring, and so on, but we must be tough on this issue, down to the last detail. I do not like the concept of corporate guilt. The person who is immediately responsible for the negligence that causes a death or serious injury should be brought to court and be made to carry the can. He gets paid to do his job, so he should pay the price. There is talk of post-traumatic stress syndrome at the moment; can Members imagine how traumatic it is for fellow workers — Mr Speaker: The Member’s time is almost up. Mr Brolly: Mr Speaker, could you let me finish this point? Thank you. When workers go to the hut for 10.00 am teatime, they chat about their families, and so on. They work in a situation in which the expectancy of death or serious injury is not high. Imagine what it is like for those workers not to talk of the family of a man who has been killed on site. Mr Gardiner: I support the motion proposed by my hon Friend the Member for North Down. For some time, I have been concerned about the level of death and injury in the construction industry. The Buildsafe-NI initiative is one way to develop a culture of safety on our building and construction sites, which will avoid the unnecessary level of human suffering and tragedy that has prevailed up to now. In the Transitional Assembly, I tabled a motion that specifically referred to death and injury in the construction industry. I mentioned the need for a comprehensive corporate manslaughter Bill to be introduced in Northern Ireland, once justice powers had been devolved to the Assembly. Such a Bill is the necessary legislative underpinning of any dramatic improvement in the levels of safety in the construction industry. My interest in the subject was kindled in 2005 when one of my constituents, a young man from the Lurgan area who was just starting out in life, tragically lost his life on a construction site on the M1 motorway. That needless death, and all the human suffering that came with it, was a watershed for me. From that day on, I was determined not to rest until I had effective corporate manslaughter legislation in place in the Province. After my demands in 2005 for corporate manslaughter legislation, in January 2006, I also called for the introduction of a new offence of secondary liability for corporate manslaughter, where it could be shown that a company’s failings were provably caused by the culpable negligence of one or more individuals in the firm. Only individual responsibility for the death of a worker because of the company’s negligence will make management take this matter seriously and give worker safety sufficient priority. Many building firms are big corporations, and they have broad backs. They may simply have to pay financial penalties, but that is not enough to change attitudes in the construction industry. For people to take seriously the death of workers on site, they will have to feel that they will actually and individually face a manslaughter charge, if they are proven to be negligent. Juries should be asked to consider whether management failure had caused or contributed to the death. On the basis of that finding, the Public Prosecution Service should determine whether individuals in a company should also be prosecuted for manslaughter. The average number of work-related deaths in Northern Ireland stands at 20 a year. We must keep that figure in mind when dealing with this matter. Once justice powers are devolved, the Assembly will have a duty of care to our people. In relation to the construction industry especially, that duty must be anchored in corporate manslaughter legislation with teeth. While I wholeheartedly support this motion we must move on corporate manslaughter as soon as possible. The Chairperson of the Committee for Enterprise, Trade and Investment (Mr Durkan): Thank you, Mr Speaker, and apologies to other Members that I have not been in the Chamber for the whole debate — I was at an interview. I have nevertheless been following the debate. As Chairperson of the Committee for Enterprise, Trade and Investment, I want to congratulate Leslie Cree and Alan McFarland for moving this motion. The Committee recently received a very competent, compelling and cogent presentation from the Health and Safety Executive, and the Buildsafe-NI initiative was touched upon then. I appreciate the fact that Members feel the need to underline the importance of that very good work. Members have mentioned the real economic costs that arise from accidents and fatalities at work and in the construction industry in particular. Members have also talked about the human cost. Francie Brolly in particular articulated that cost in a very poignant and sensitive way. That adds, I hope, to the sense of urgency and determination about making sure that we continue to press for progress. I do not intend to rehearse the statistics comparing the rate of injuries and deaths here with those in other places, but they clearly show that there is a serious problem. When I was Minister of Finance and Personnel in a previous period of devolution, the Department had responsibility for sponsoring the construction industry. At that time we established the construction industry forum and took early steps to set up the Government construction clients group. Both projects were aimed at trying to make sure that there was higher priority for safety issues. The Construction Employers Federation members, who work in the industry, were very alert to safety— this was not just coming from the Government or the politicians, but from the industry itself. The developments we have seen since, and the development of Buildsafe-NI in particular, prove that. Of course, Buildsafe-NI is about work contracted by the public sector. The logic behind it is nevertheless to create a standard that will radiate out to all building work. The Committee welcomes the opportunity to confirm support for the continued good work of Buildsafe. We must do all we can to educate young people entering the workforce and support the Health and Safety Executive’s plans to launch Safe Start Northern Ireland, which aims to do just that. When the Committee was looking at early indication bids for the comprehensive spending review (CSR) recently, it learnt that HSENI’s Safe Start Northern Ireland bid is being regarded as a discretionary, lower-priority bid by the Department — it seems to be in the bottom five of the Departments CSR bids. If we want to put safety rather than savings first, that must be given higher priority. Now, speaking in a personal capacity rather than as Chairperson of the Committee, I would like to see safety issues given a much higher priority right across the Government. When the Departments were created several years ago, the logic behind having “public safety” put into the name of a Department was to make sure that it would act as a safety auditor, examining the safety performance of all Departments. The Department of Health, Social Services and Public Safety has not been doing that job. 1.45 pm There is a valid role still to be applied, because safety issues must be addressed, whether they concern school buses, health and safety in the workplace, road safety or farm safety. Those issues are the responsibilities of different Departments. However, there should be one authority to set stronger standards and to ensure the development of a stronger safety culture. I agree with the Members who mentioned the all-Ireland dimension to this issue. The issue could also be addressed at a British-Irish level in order to ensure a much higher standard of safety throughout these islands. The Government’s motto should be “safety first”, not “savings first”. Mr O’Dowd: Go raibh maith agat, a Cheann Comhairle. I want to start where my colleague Francie Brolly finished, because he made some valid points. Families who lose loved ones in accidents in the construction, manufacturing or food-processing industries not only suffer that loss, but they often do not know what their rights are. They do not know how to move forward, because they are suddenly thrown into an unexpected and tragic situation. The Health and Safety Executive has an awesome responsibility. However, we must define who should look after the next of kin. A properly funded service should be set up to inform family members how the investigation into the accident is developing, to assist them in establishing their legal rights and direct to them to, or provide, counselling services. Without going into too much detail, I know of one family that lost a loved one in a factory accident. The family only found out that there would be no prosecution six months after the decision was taken. They had to phone and ask what was happening with their loved one’s case, which added to the trauma of the experience. As I have said, the HSENI has an awesome responsibility. First, it must ensure that health and safety procedures are in place across all factories and construction sites. Secondly, it must investigate in the terrible event of a death at work, ensuring that the investigation is carried out thoroughly and properly and that no stone is left unturned. I will communicate privately with the Minister about one case that has recently come to my attention where there have been failings. Health and safety inspectors do a traumatic job; investigating the details of any death is traumatic. However, inspectors not only investigate a death but try to ensure that that sort of incident never happens again. If employers are found to be liable for an accident, they must be brought to book. That raises the need to introduce corporate manslaughter legislation. Sinn Féin supports the call for such legislation, which has been the subject of previous debates in the House. I hope that the Minister will inform us of a timescale for, or at least his views on, corporate manslaughter legislation. I want to touch on another matter that concerns workers in the construction industry and other sectors. There is now a large migrant worker population, and the Assembly must ensure that all information is available in the languages of those workers. Too often, migrant workers do the lowest paid, most dangerous and dirtiest jobs, and they are therefore at the highest risk. There is an onus on us, as politicians, and on the Health and Safety Executive to ensure that all publications are available in the languages of those people. Mr Neeson: I welcome the debate, although the Minister addressed the issue at Question Time only two weeks ago. All Members must acknowledge the growth in the construction industry in recent years. We must also recognise that the industry is employing a growing number of migrant workers who may not be aware of the law or who may be used to different working practices. I welcome the Construction Industry Forum initiative, but I believe that it is important that we should also involve the trades unions and public sector bodies that have an interest in the industry. There have been many accidents on construction sites over the years, but today there is a greater awareness throughout Northern Ireland of the need for health and safety on building sites. I very much appreciate the work of the Health and Safety Executive, which oversees the safety of workers on such sites, and I also appreciate the good work that is done by buildings services departments at local government level. However, the workforce on site is not the only group of people who are affected by this issue. I believe strongly that sites must be made secure, given the many accidents over the years in which children, sadly, have sometimes been killed after straying on to building sites. The building boom is now bringing a different type of construction to Northern Ireland. Under the proposed plans for the Titanic Quarter in Belfast, the whole skyscape of the city will change in the coming years. With taller buildings, much more intricate problems will arise so training in health and safety will be vital for employer and employee alike. Finally, I wish to make the point that the promotion of health and safety in the workplace is in everybody’s interests. The Minister of Enterprise, Trade and Investment (Mr Dodds): I thank Mr Cree and Mr McFarland for proposing the motion, which calls on the Executive to ensure continued progress in addressing accident rates in the construction industry through the Buildsafe-NI initiative. This has been a short but useful and constructive debate, and I thank all Members who have made their views known during it. As the Minister responsible for health and safety at work, let me confirm my commitment and that of the Health and Safety Executive to reducing the number of needless incidents on building sites that result in death and injury. I am pleased to hear the comments, which Members from all sides of the House have made, about the excellent work that the Health and Safety Executive carries out. As Members will know, Buildsafe-NI was set up four years ago to reduce the unacceptable number of deaths and major injuries that occur in the construction industry. To give some background to the initiative, let me explain that it brings together a range of key stakeholders including Government — in the shape of the Department of Finance and Personnel and the Department of Health, Social Services and Public Safety, both of which are major clients of the construction industry — as well as contractors, subcontractors, suppliers, construction professionals such as architects and engineers, the Construction Employers Federation, the trade unions and the Health and Safety Executive. Although its focus is on health and safety, Buildsafe is not just a departmental initiative; rather, it has broader cross-departmental ownership and is run under the auspices of the Construction Industry Forum, which, as Mr Durkan mentioned, is sponsored by the Department of Finance and Personnel. Buildsafe aims to get things done and make change happen. The representative working bodies that make up the Buildsafe working group each have an action plan through which they make their contribution to the initiative’s overall aim of reducing the number of major injury accidents among construction workers to 50% of the 2002 level by 2008. Several Members raised the issue of statistics. In 2002-03, 60 major injuries were reported. It is unfortunate — although unsurprising — that that figure climbed to 98 in 2004, before falling to 88 in 2006-07. I say that the increase is unsurprising because, as several Members pointed out, the number of people who are employed in construction rose by almost 30% during the same period. To that can be added the greater statutory reporting of accidents, and that is due to an increase in HSENI inspections. Although those figures are a stark reminder of the high-risk nature of construction work, they should not be allowed to mask the progress that has been made. For instance, in public-sector contracts — the sector in which Buildsafe-NI has had the greatest uptake — accidents have decreased by 40%, with fatal accidents also showing a downward trend. Buildsafe-NI exploits the power of public-sector procurement to demand higher health and safety standards on publicly funded construction projects. That has led to the situation in which all contractors seeking to tender for public sector construction projects must provide evidence of fulfilling several conditions. First, they must show that their health-and-safety management systems have achieved third-party accreditation, and secondly, they must show that their site workers, and those of their subcontractors, have completed appropriate health and safety training. The numbers of construction workers who are being trained in practical site safety — some for the first time — is truly remarkable. Of the 80,000 or so who are currently employed in construction, over 90% have been trained and hold a construction skills register card, which is effectively their passport to working in the industry. Efforts are being made to spread the public-sector procurement model, which has been deployed successfully under Buildsafe-NI, to large private-sector developers. Early indications are that many such developers are minded to move in that direction. Although we should be encouraged by that, we cannot be complacent. Buildsafe-NI does not have all the answers, and it does not reach the many small and micro-building businesses that we know exist. It is vital to ensure that everyone involved in construction fully understands their roles and responsibilities for workplace health and safety if improvement is to be made across the board. Several Members referred to compliance, education and enforcement. In his opening remarks, Mr Cree talked about the need for enforcement and education. In previous contributions, I have indicated that it is critical to have both of those working in tandem and to use education to create a culture of increasing awareness. Mr O’Loan picked up on that point when he referred to the excellent work of QPANI and about the right attitude being instilled in that sector. Mr Hamilton also mentioned the work of QPANI — I know that he is not in his place, but he asked me to convey his apologies for not being present to hear the winding-up speeches. People should not have any illusions about the fact that existing legislation requires employers and those who work in the construction industry to fulfil certain conditions. It is a matter of ensuring that the education process works alongside the industry and that everything is done to ensure that everyone involved in the industry takes the right attitude. We can have all the inspections that we like — and we need to carry out more inspections — but non-compliance should not be left to inspection alone: the industry must assume responsibility in that area. Members will want to know that the Government intend to introduce further measures. The Construction (Design and Management) Regulations (Northern Ireland) 2007, which come into operation on 9 July, will go a long way to ensure that everyone who is involved in construction understand their roles and responsibilities. The regulations will replace outdated and over-bureaucratic legislation that was introduced in the 1990s, and they will reduce bureaucracy and paperwork; simplify the regulations and improve clarity; encourage more co-ordination and co-operation; and be more flexible in their application. They offer an opportunity for a step change in health-and-safety performance. The new regulatory package will be used to re-emphasise the broader business benefits of a well-managed and co-ordinated approach to the management of health and safety in construction. An approved code of practice supports the regulations. In addition, the industry has developed clear and simple guidance for small and medium-sized enterprises and clients. The guidance will be crucial in helping smaller clients to address misconceptions and alleviate concerns. 2.00 pm The Buildsafe-NI initiative has developed other ways to improve standards in the industry. These include the development of a communications plan to raise awareness of the main risks and the measures that can be taken to address them; the formation of six regional groups to communicate information and share best practice; and the provision of a mobile training unit to deliver specific training to individual sites. In the public sector, the Department of Finance and Personnel recently held a seminar for housing associations and district councils in an effort to spread the benefits of the procurement aspects of the Buildsafe-NI initiative. A number of Members, including Mr Cree in his opening remarks, mentioned involving housing associations and local authorities. Currently, those bodies are encouraged, but not obliged, to adopt the system. More needs to be done to ensure that all district councils abide by the Buildsafe-NI initiative’s tendering rules. There are enough Members who are also members of local councils to ensure that that message is heard. There has been a good response from housing associations, which is encouraging. The House will know that the initial phase of the Buildsafe-NI initiative is due to end in April 2008. Work is under way to evaluate and review progress and to develop plans that build on successes and address the weaknesses that are identified. Options for improving standards with smaller clients, subcontractors and the self-employed are already being discussed. In talking about statistics and the available initiatives, we must not lose sight, as Mr Brolly stated, of the human dimension of accidents in the construction industry. We are talking about people who work to support their families, and are injured, sometimes fatally, at their places of work. In his powerful and important contribution, Mr Brolly brought home the human dimension of the issue and the human cost that he and his family have suffered. It was important for that message to be brought to the House, as it ensured that the importance of the issue was re-emphasised, particularly to the Department and me. To those Members who mentioned the scale of the problem, none of us is complacent or thinks that enough has been done so far. The number of fatal accidents in the construction industry in Northern Ireland has remained fairly constant over the past six years. However, the number of incidents across public-sector contracts and private-sector contracts has risen. It is important to point out that, in the past five years, the Health and Safety Executive’s level of enforcement has increased by over 100%. Members also raised the issue of resources for the Health and Safety Executive. The Health and Safety Executive gives priority to construction — a specific construction compliance team was recently established with 10 field staff, representing over 25% of its entire inspector and compliance officer cadre. The Health and Safety Executive has also freed up more of that team’s time for preventive work by allocating all major construction incident investigations to a specialised team. The issue of migrant workers, which Mr O’Dowd raised, has become increasingly important in light of the level of immigrant workers arriving in Northern Ireland. The Health and Safety Executive has published a universal safety booklet that relays key health and safety messages to construction workers without the need for words. That has been widely distributed by the Construction Employers Federation and voluntary organisations that work with migrant workers. Inspectors can also access interpretation services via their mobile phones when they encounter migrant workers on building sites. With that backup, during on-site inspections, they can ensure that migrant workers are adequately supervised and trained. Translators are now available to enable Polish and Latvian workers to undertake the safety training that allows them to be included on the construction skills register. That is an important issue and I hope that what I have said reassures Members that it is being tackled. A number of Members mentioned the all-Ireland dimension of this matter. The Health and Safety Executive has already set up a working group with its counterparts in the Irish Republic. That group shares the expertise of those bodies, which are working on a number of initiatives together. I cannot stress too strongly that Buildsafe-NI represents but one part of a much wider approach to improving health and safety standards in the construction industry. It is widely recognised that a key aspect of improving health and safety standards rests with ensuring that the directors of businesses take ownership of the matter, and personally take the lead in health-and-safety issues for their companies. Mr Gardiner, Mr Brolly and a number of other Members raised the issue of corporate manslaughter. That issue is, as I pointed out in a previous contribution to the House, a matter for another place — it is not a devolved matter. It is a very important issue, and consideration is currently being given to it in Parliament. However, Members should be concentrating on what we can do as a devolved Assembly. I hope that this debate will ensure, as Mr Cree said, that attention is brought to that matter, and that it will reinforce to employers, and everyone involved in the industry, the need to actively and proactively do their bit as far as the health and safety of employees is concerned. Although the focus of the motion is on accidents, a bigger issue, which is often ignored or overlooked, is the illness and health problems suffered by those who work in the construction industry. That issue was touched on, to some extent, by a number of Members. I can assure Members that that is also an issue that my Department will take seriously. I thank everyone who took part in the debate. I am sorry that I have not had more time to respond to all of the points that have been raised. I look forward to hearing from Members if there are individual cases that they wish to draw to my attention. They can be assured that I, the Health and Safety Executive and the Department view this matter with the utmost seriousness. Mr McFarland: This has been a useful debate. My colleague Leslie Cree set out the safety problems that are faced by employees of the construction industry in Northern Ireland. Statistics show that six people were killed in the construction industry last year. As the Minister said, some 88 people suffered major injuries during that period. Furthermore, approximately 211 people were off work for more than three days due to injuries in the last year. Therefore, this is a serious issue. The three major causes of deaths and injuries over a number of years have been falls, people being crushed as trenches have collapsed, and — strangely — electrocutions as building machinery has touched overhead wires. Simon Hamilton highlighted increased construction in Belfast, which is much welcomed, and the need to protect workers — a group that he said had been left behind in the past and treated as a low priority. Paul Maskey pointed out that there are more people involved in the construction industry. He also highlighted the issue of children and others having accidents on poorly supervised construction sites. Furthermore, he referred to the increased risks that are faced by young and inexperienced workers. Declan O’Loan referred to the need to expand the Buildsafe-NI initiative into the private sector of the building industry and into smaller firms. He mentioned the good work in the area of safety introduced by the Quarry Products Association and its suggestion that an incentive scheme be introduced to encourage people to improve safety. George Robinson gave strong support to the Buildsafe-NI initiative. Francie Brolly gave a moving account of the effect that his father’s death — from a construction accident — had on his family. That brought a stark reality to the debate. He mentioned the issue of corporate manslaughter. He also raised with the Minister a matter that my colleague Sam Gardiner had raised during Question Time on 18 June 2007 and during the Transitional Assembly — the issue of whether a firm that does not look after its workers can be taken to court. Mr Brolly also raised the issue of cross-border Buildsafe and the effect of post-traumatic stress disorder on workers who were present when their co-workers were killed or injured. My colleague Sam Gardiner spoke movingly about a young man in his constituency who had been killed on a building site, and he outlined the campaign for corporate manslaughter legislation that he has waged over several years. Mark Durkan reiterated the human cost of construction accidents. He reminded the House of his role in developing the construction industry forum. He also spoke of Buildsafe and the proposed Safe Start initiative, and called for a higher priority and proper financial support for safety issues. John O’Dowd spoke of the need for further clarity on workers’ rights and greater support for the families of those killed or injured so that the trauma of their experience is not exacerbated. He highlighted the need for a lesson to be learned after accidents so that they do not happen again, and for sanctions against errant employers. He also spoke of the need for translation for migrant workers, and the Minister has very kindly just covered that in his speech. Sean Neeson also talked of support for migrant workers, and he pointed out that building sites must be secure so that children do not have access. I am encouraged by the Minister’s contribution that he was committed to the safety of workers on construction sites. I am pleased to see that new regulations are to be introduced in July, and I also welcome his information on increased training and other co-ordination measures. In conclusion, we have heard that Northern Ireland lags behind other parts of the United Kingdom in keeping its construction workers safe. It could be argued that because we have a construction boom here — one only has to look at the number of cranes on the Belfast skyline to see that — a greater number of employees are involved and thus the risk may be greater. It could be argued that the increase in number of migrant workers, whose first language is not English and who therefore may not fully understand instructions given to them, might be raising the risk level. However, none of these should be a factor if employers are fully training their on-site workers and if those in charge have carried out a comprehensive risk assessment. Good work has been done since the introduction of Buildsafe in 2004. I urge the Minister to discuss with employers, unions and the Health and Safety Executive how Buildsafe-type measures can be rolled out across the construction industry, and in particular into the private sector. It is in the interests of all involved to avoid loss of life or injury to workers; trauma to the families; and the loss to companies in fines, in downtime of workers on the site, and in PR embarrassment if they are found guilty of not protecting and caring for their workers properly. Improvements have been made to safety in the construction industry, but more needs to be done. I support the motion and urge the House to do likewise. (Mr Deputy Speaker [Mr Molloy] in the Chair) Question put and agreed to. Resolved: That this Assembly calls on the Minister of Enterprise, Trade and Investment to ensure continued progress in addressing accident rates in the construction industry through the Buildsafe Northern Ireland initiative. Mr Deputy Speaker: Question Time will start at 2.30 pm. The sitting was suspended at 2.14 pm. On resuming (Mr Deputy Speaker [Mr Molloy] in the Chair) — 2.30 pm Department of Health, Social Services and Public Safety Free Personal Care for Older People 1. Mr Lunn asked the Minister of Health, Social Services and Public Safety to set out the timescale for the introduction of free personal care for older people in Northern Ireland. (AQO 248/07) The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I have asked my officials to review, by the end of October, the work carried out by a group from the previous Executive that examined the potential impact of free personal care. When that review is complete, I will consider to its findings and prepare a proposal for my Executive colleagues. If the Executive are content with the proposal, and if it has the support of the Assembly, it is estimated that the earliest possible date for the introduction of free personal care for all client groups in Northern Ireland will be April 2010. Mr Lunn: I thank the Minister for his answer. Given the clear will expressed by the Assembly in a debate a few weeks ago to introduce free personal care in 2008, can he give any hope that that timescale can be advanced? Mr McGimpsey: I have covered the timescale issue on more than one occasion. I am bound by process, as much as by anything else, in progressing the legislation. Organising finances will be a major part of introducing free personal care. Guidance for officials at the end of the process will also have to be produced. Given that, April 2010 is a realistic date. Mr Shannon: The Minister will be aware of the difficulties in introducing free personal care in Scotland. With that in mind, has he had any consultation with his colleagues in the Scottish Executive on how some of those difficulties could be avoided? That would improve the situation for us. Mr McGimpsey: Mr Shannon makes a good point. Experiences in Scotland and Wales will form an important part of the review. Rev Dr Robert Coulter: I welcome the Minister’s comment that he will examine the issue of free personal care. He said that the earliest possible date for the introduction of free personal care in Northern Ireland will be April 2010. Given that that date is some three years away, what steps can the Minister take in the interim to help address the problem? Mr McGimpsey: As I said during the debate in the House on the issue, there are certain measures that can be considered in the interim. One important step would be to make provision for disregarding the value of the family home as part of a resident’s financial assessment. Another step that has been taken in other parts of the United Kingdom is to increase the capital thresholds at which a resident becomes liable to pay the full cost of personal care. My Department will look at that issue in the interim. Increasing the personal expenses allowance to allow residents a higher level of income to spend on personal items will also be considered. The allowance is aimed at those people at the lowest end of the scale of income who rely entirely on their old-age pension. Most of their old-age pension is taken up with paying for their costs. On average, those at the lowest end of the income scale are left with £5 a week for personal expenses. That is hopelessly inadequate. We will look at how we can increase that amount of that allowance. Hospital Car-Parking Fees 2. Mr Moutray asked the Minister of Health, Social Services and Public Safety how much money was raised in car-parking fees at each hospital in Northern Ireland that charges for this service, in each of the last two years. (AQO 233/07) Mr McGimpsey: The following amounts were raised to the nearest £1,000 in 2005-06 and 2006-07 respectively: Belfast City Hospital, £627,000 and £726,000; Ulster Hospital, £508,000 and £538,000; and Mater Hospital, £108,000 and £117,000. The amount raised at Altnagelvin Area Hospital was £85,000 in 2006-07, when charges for car parking were introduced there. Mr Moutray: I thank the Minister for his answer. Given that it is often elderly people, the infirm, those suffering from acute conditions, or their families, who are most frequently within hospital precincts, what steps will he take to ensure that charges are kept to a minimum? Furthermore, what steps will he take to maximum relief for people in those categories? Mr McGimpsey: As regards frequent visitors and those who are ill, concessions are already offered to patients who attend hospital regularly. The |