NORTHERN IRELAND ASSEMBLY Monday 3 December 2007 Ministerial Statement Executive Committee Business Committee Business Private Member’s Business Oral Answers to Questions Private Members’ Business Adjournment The Assembly met at 12.00 noon (Mr Deputy Speaker [Mr McClarty] in the Chair). Members observed two minutes’ silence. North/South Ministerial Council — Special EU Programmes Sectoral Format Mr Deputy Speaker: I have received notice from the Minister of Finance and Personnel that he wishes to make a statement on the eighth meeting of the North-South Ministerial Council (NSMC) in special EU programmes sectoral format. The Minister of Finance and Personnel (Mr P Robinson): The North/South Ministerial Council met in special EU programmes sectoral format in Dublin on 7 November 2007. It was the first NSMC meeting in that sectoral format since the Northern Ireland Assembly and Executive were restored in May of this year. The Irish Government were represented by their Minister for Finance, Brian Cowen, who chaired the meeting. I represented the Northern Ireland Administration, and I was accompanied by my colleague the Minister for Social Development, Margaret Ritchie. The meeting began with a report from Pat Colgan, who is the chief executive of the Special EU Programmes Body (SEUPB). He updated us on developments since the Council last met in that sectoral format, which was on 9 October 2002. Mr Colgan outlined a number of achievements that there had been in those five years. Those included the completion of work to close the first EU Peace programme and the performance of the Peace II and INTERREG IIIa programmes. The Council commended Mr Colgan on his successful management of those two programmes. Both Peace II and INTERREG IIIa have, to date, achieved the annual spending targets that the European Commission set SEUPB. Mr Colgan informed the Council that SEUPB’s annual report and accounts are fully up to date and have been published with clean audit reports from the Comptroller and Auditor General for Northern Ireland and his counterpart in the Republic. The SEUPB has also delivered its corporate and business plans within the time frame that the two finance Departments agreed. Mr Colgan also reviewed progress on the development of the Peace III and INTERREG IVa programmes. The Council was informed that the work on programme development had been undertaken in both an evidence-based and participative manner. The final draft programmes were approved and subsequently sent to the European Commission for negotiation. The Commission formally approved the two programmes on 6 November. I am therefore pleased to be able to announce that both programmes will shortly be formally launched and opened for funding applications. The Council emphasised to Mr Colgan the need to address the observation that the Protestant community has failed to benefit fully from the opportunities available under the Peace programmes and, indeed, some wider Government initiatives. The Social Development Minister and I stressed the importance of that matter, and the importance of the full participation of all communities in the new programme. Mr Colgan assured us that SEUPB will continue its efforts to promote Peace funding throughout Northern Ireland and the border counties, and will encourage all communities to participate. Projects to build community capacity will again be funded, and all appropriate steps will be taken to encourage applications from both communities. The Council noted that the new Peace III programme has a total budget of €333 million. That comprises the €225 million provided from the EU budget, and match funding from Northern Ireland and the Republic. The programme will carry forward the work of its two predecessors, with a continued focus on the promotion of reconciliation and a shared society. The Council welcomed the fact that victims and survivors of the conflict in Northern Ireland have been listed in the programme document as a key beneficiary group for programme funding. Mr Colgan agreed that the Special EU Programmes Body would work closely with the Commissioner for Victims and Survivors in order to ensure that Peace III complements that organisation’s programme of work. The INTERREG IVa programme will have a budget of €256 million — some 40% more than its predecessor, INTERREG IIIa. That funding will be used to assist cross-border economic development activities in areas such as tourism and business support. The new programme will cover a wider geographical area than its predecessor because areas in western Scotland are, for the first time, eligible to participate. The Council welcomed the inclusion of the west of Scotland in the new programme as a development that can both benefit from and enhance the long-established social, cultural and economic links that exist between Northern Ireland and Scotland. I and Minister Cowen look forward to working with our Scottish colleagues on the ambitious new programme. The Council noted that Peace III and INTERREG IVa will have a more strategic focus than their predecessors. As in the rest of the EU, the emphasis will be on supporting larger, multi-annual projects that target identified needs in a structured and systematic way. Furthermore, there will be an attempt to lessen the work of programme administration, which some stakeholders have found unnecessarily burdensome. To that end, SEUPB will take on more of the work of programme delivery so that the number of intermediary bodies can be correspondingly reduced. The Council approved SEUPB’s corporate plan for 2008-10, and its 2008 business plan. We also approved a modest increase in SEUPB staffing to enable it to deliver the new programmes. That increase reflects the greater involvement of SEUPB in future programme delivery, and the corresponding reduction in the number of intermediary funding bodies. Finally, the Council noted SEUPB’s annual report and accounts, which were presented in advance of their submission to the Assembly and to the Republic’s Parliament. The Council agreed its intention to meet again in special EU programmes sectoral format in April 2008. The Chairperson of the Committee for Finance and Personnel (Mr McLaughlin): Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement. The Committee for Finance and Personnel has already made an initial examination of the work of the Special EU Programmes Body, and held an evidence session with its chief executive, Mr Pat Colgan, and other officials on 26 September 2007. Last May, President Barroso announced the creation of a special task force with the stated purpose of assisting us to maximise the benefits of European programmes and to make maximum use of experience from across the EU to further our economic aims and promote growth, innovation and opportunity. Will the Minister update the Assembly on the progress of the task force and state what role SEUPB will play in that regard? Will he also indicate, following the introduction of the 2007-13 programmes, what steps the Department of Finance and Personnel (DFP) and the SEUPB will take to promote long-term sustainability of projects and prepare for the period post-2013? Mr P Robinson: I welcome the involvement of President Barrosa, and I welcomed his visit to Northern Ireland when, along with the First Minister and deputy First Minister, I had the opportunity to meet him. I was impressed by his interest in Northern Ireland and with willingness to assist, particularly in tooling-up Northern Ireland to deal with the new set of circumstances in which it would have to compete for funds. As funds will be allocated on a transnational basis, and will involve other regions or members of the European Community, it will be likely that our partner, in particular, would be the Republic of Ireland. In those circumstances, SEUPB might have an important role in brokering arrangements and assisting us. Sustainability is part of the selection criteria for the 2007-13 programmes, and SEUPB will be promoting more strategic projects than before. As such, that will help sustainability. The hope is that Peace funding will be reduced in line with the facts, and I think we are very fortunate. Most people were delighted when the initial Peace project and funding came forward. A lot of work was carried out by our MEPs at the time in securing the second tranche of Peace funding, and we have been very fortunate to have achieved Peace III funding. Most people recognise that, with the additional burden on the EU budget due, in particular, to enlargement, it is unlikely that there will be a Peace IV allocation. Therefore, it is important that we get real strategic value from Peace III. The Deputy Chairperson of the Committee for Finance and Personnel (Mr Storey): I declare an interest as a member of Ballymoney local strategic partnership and as a member of the monitoring committee for Peace II. I thank the Minister for his statement. During the Committee for Finance and Personnel’s initial scrutiny of SEUPB, an issue arose regarding the distribution of EU funding. Will the Minister comment on what new measures will be put in place to ensure that there is equitable distribution of new funds across Northern Ireland? Will he also comment on the increased role for SEUPB in programme delivery, which has resulted in a reduction in the number of intermediary funding bodies? Will the more centralised approach to implementation run the risk of losing the involvement by communities from the bottom up? Mr P Robinson: The Member has considerable knowledge of the subject. He did not quite say whether equitable distribution was to be on the basis of location or communities: I suspect that he means the latter. It has been recognised that there has been a perceived under-representation of the Protestant community. I raised that issue at the meeting, and I was strongly supported by the Minister for Social Development. Around 44% of funding under Peace I went to the Protestant community. That was increased to 47% in Peace II, in no small part because it was possible in Peace II to draw down money for capacity building. 12.15 pm Therefore, over time, the figures have improved. Peace III is likely to have a more strategic focus, so I trust that that trend will continue. However, I am reminded of the joke about the lottery: in order to win the lottery, it is necessary to buy a ticket. In this case, in order to receive funding, it is necessary to submit an application. All Members must encourage people in the Protestant community to submit applications to ensure equity. Under Peace III, a smaller amount of money is available than under Peace II. The amount of that money that can be used for administrative purposes is also restricted; that figure had been 10%, and it is now 6%, which means that there is only one quarter of the amount of funding available for administration than previously. We must examine methods of delivery and take steps to reduce levels of bureaucracy, although that will reduce the useful bottom-up approach. However, the local community will be involved as much as possible. Mr Beggs: Historically, INTERREG funding has been perceived in many quarters as assisting border areas in particular. Can the Minister tell the House how INTERREG IVa, which will include Scotland, might benefit communities and bodies in the north-east and in my constituency of East Antrim, which have natural linkages with Scotland? Mr P Robinson: The inclusion of the west of Scotland in INTERREG IVa is a new development, which I welcome. My colleague the Member for East Londonderry clearly welcomes this move, as he indicated during my statement. Changes in INTERREG IVa mean that maritime borders will now be included. That border, of course, exists between parts of Scotland and the Republic of Ireland, because there is no border between Northern Ireland and Scotland. However, any scheme must involve the three regions — Northern Ireland, the Republic of Ireland and Scotland — and not simply Northern Ireland and Scotland, which would not meet the criteria. However, the scheme would allow us to encourage tourism and cultural links among the three regions. The Scots have never been hesitant about availing of funding, and I am sure that we will learn from them during the process. Mr O’Loan: I note the Minister’s earlier answer. Does the Minister agree that the “perception” that the Protestant community receives fewer benefits from Peace funding is, indeed, a mere perception and that the funding proportions in Peace II were close to actual community proportions? Does he also agree that any shortfall in funding for Protestant communities has been objectively and independently assessed as being related to relative disadvantage in Catholic areas and that SEUPB has worked constructively, and continues to do so, to tackle any under-capacity to avail of funding in Protestant communities? Mr P Robinson: I am not sure that I accept the Member’s statistical review. I indicated that the uptake in Peace I was 44%, whereas the community division is around the 54% mark, which probably indicates that the Catholic community received in the region of 56%. That means that it received funding above its weight. There are two issues: first, because the criteria included the TSN factor, that clearly would have been one of the issues at play; and secondly, as I said to colleagues, no small part of it is the fact that there were more applications from the Roman Catholic community than from the Protestant community. However, I was happy to see that between Peace I and Peace II, the statistics indicate that there was a move to a more equitable division. I hope that that continues. If all of us encourage those applications to come in, I believe that we can improve on those statistics. The Minister for Social Development accepted the statistics and the perceptions and indicated that this is not unique to European funding and that she has encountered it in other areas. She is doing particular work on capacity building to ensure that there is more of an uptake from the Protestant community. Dr Farry: I welcome the community-relations focus of Peace III. However, will the Minister recognise that there should perhaps be a stronger emphasis on cross-border work under the reconciling communities priority rather than under the shared society headline, which should be more Northern Ireland focused? Will he also recognise that the issue in the Protestant side of the community is that of capacity building, and will he agree that allocations should be on the basis of quality of project and need rather than rigorous communal allocation? Finally, with reference to INTERREG and the strong economic focus of this stage of the scheme, does the Minister foresee any dangers — when the Peace money dries up and we have to rely purely on structural funds — of INTERREG being broadened to deal with the social as well as the economic aspects? Mr P Robinson: In relation to the first part of the Member’s question, projects can, of course, be put forward for any form of reconciliation, and they will be scored on their merits. I agree with his second point: there is an open and transparent system that judges the merits of each of the applications and it is on that basis that the scoring takes place and the determination of appropriate projects is assessed. At the same time, unless there were significant discrimination, one would not intervene to make any changes. It is moving in the right way; it is about capacity building, as the Member suggests. The Minister for Social Development has recognised the need in that area and is building up programmes to improve capacity in Protestant areas. However, I return to my original principle: there is still a job for elected representatives to encourage that community and, where they see a deficit in capacity, to attempt to consider ways of filling that. There is one other factor to consider. There is a cultural reticence, to some extent, that prevents some in the Protestant community from making applications. There are a number of factors that must be overcome, but chief among them is capacity building. Mr Weir: I welcome the Minister’s statement and also declare an interest as a member of North Down local strategic partnership. Will the Minister comment on the share of the Peace III resources that will be available for administrative activity and how that compares with Peace II? Mr P Robinson: As I indicated earlier, the amount of funding available under Peace III is reduced, and therefore the amount available for administration is reduced. It had been 10% under Peace II; with a larger overall figure, it is now 6%. That means that we really need to tighten down on administration. I am one of those who believes that that is no bad thing. The purpose of those funds is to get them where they can be most used in the community rather than building up the bureaucracy. I welcome the fact that we are forced by necessity to allocate less to administration. Mr Hamilton: I welcome the Minister’s comments and proposed actions to encourage a fairer distribution of funding across both communities. Another group of people who have been under-represented in the past are the innocent victims of terrorist violence. What steps are being taken to encourage uptake and to increase awareness among victims’ groups? Mr P Robinson: Again, this is an issue that both the Minister for Social Development and I raised at the meeting with Mr Cowen. It has been agreed that SEUPB will make contact as soon as we have a Victims’ Commissioner. SEUPB will look at the programme that the Victims’ Commissioner is developing and attempt to work along with that office in delivering projects to benefit both victims and survivors. Mr Savage: The Minister advised us that the programmes were approved by the European Commission on 6 November. When will we know which applications have been approved? Mr P Robinson: The next stage is for the Executive, at our meeting on 18 December, to look at the criteria and, if those are agreed, to roll out the programmes very quickly thereafter. Mr Attwood: I welcome the meeting that has taken place and the tone of the report and of the Minister’s comments. I want to ask three very quick questions. I very much welcome the decision to provide funding for victims and survivors. What is the likely budget line for that? Given that the opportunity for funding is to be launched soon, is the Minister aware that the Victims’ Commissioner will be appointed during December? The commitment of SEUPB to work with the Victims’ Commissioner can thus be achieved. Secondly, can the Minister confirm how border partnership groups will continue to be involved in the INTERREG programme? They have been essential in building up capacity and understanding around the border. Thirdly, I acknowledge that there has been under-application by the Protestant community heretofore to the various Peace programmes. The much more balanced application rate is welcome. However, will the Minister reassure me that there is no intention that any European funding be targeted exclusively at any one community, be it Catholic or Protestant? It is very important that no EU programme — or any Government initiative, for that matter — should be targeted exclusively at one community. Mr P Robinson: I understand that the indicative allocation for victims and survivors is €25 million. As far as the Victims’ Commissioner is concerned, the Member has asked me something that is beyond my pay grade. However, as I understand it, every effort is being made to resolve that issue. The First Minister and deputy First Minister have given a date by which they intend to make an announcement. The Member points out rightly that there is no requirement to have any ring-fencing for any section of the community. The basis on which allocations are made is the merit of the applications. We do need to point out that, even though Protestants are statistically under-represented, at 47%, there is still a very significant uptake. Some 7,000 projects have been funded under Peace II thus far, and all sections of the community have benefited from that. There is still that statistical imbalance, but it is becoming more slender. 12.30 pm Mr McQuillan: I welcome the potential that Scotland’s involvement in the INTERREG IVa programme will bring. Will the Minister tell the House what contact the SEUPB has had with the Scottish Executive about that involvement? Mr P Robinson: Brian Cowen, the relevant Minister from the Republic, and I will want to make contact with our Scottish counterparts. At official level, contact will, of course, have already been made, and in the European Community, considerable discussion will have begun and will be ongoing. I believe that Northern Ireland will benefit from the inclusion of Scotland in the project, and I look forward to seeing the programmes that will be implemented as a result. I know that some links exist between the north coast and Scotland, and the project might be a suitable vehicle, if that is not a pun, through which those can benefit. Mr Ross: I welcome the Minister’s statement. Will he confirm that, unlike in previous rounds, all EU structural funds are fully additional to Northern Ireland? Will he perhaps explain the implications of that? Mr P Robinson: With the exception of the Peace funding, which I believe had to be fought for, there had not been true additionality. When making allocations to Northern Ireland, the Treasury took into account other structural funds such as INTERREG — those funds are now truly additional. That clearly means that Northern Ireland benefits, given the extent of the funds that come to it through those programmes. Mr A Maginness: I welcome the Minister’s statement, especially the constructive tone that he lent to it. John Hume said that the European Union was one of the finest models of conflict resolution in human history. I note that the Minister said that the programme will: “carry forward the work of its two predecessors with a continued focus on promoting reconciliation and a shared society.” I know that it may be above the Minister’s pay grade to speak for the Office of the First Minister and deputy First Minister, but there does not seem to be much evidence of that office’s embracing the concept of a shared society. Will the Minister reassure the Assembly that in so far as he can, he will encourage the programme to continue with its good work on reconciliation and the development of a shared society? Mr P Robinson: I have no reluctance — and I am pretty sure that neither the First Minister nor the deputy First Minister has any reluctance — in encouraging reconciliation in Northern Ireland where it is needed, including, indeed, reconciliation beyond our borders. I do not think that it would be proper to characterise either the First Minister or the deputy First Minister as being reluctant to act on that matter or of dragging their feet on it. Ms J McCann: Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement. Given that he has already said that a smaller amount of money will be available under Peace III compared to what was available under Peace II, is there a plan to ensure that funding will be available in the future for those projects that are currently funded by Peace II and whose funding will end in June 2008? I am referring specifically to those projects that are delivered in the community and voluntary sectors. Mr P Robinson: We need to be clear that Peace funding was never intended to be a long-term arrangement; by its nature, it was special and temporary. Therefore, a growing emphasis was placed on the sustainability of projects that were given life by funding. I hope that that, to a large extent, will be the case. There is still some life left in Peace II, and I trust that all of the projects that were started under it can be sustained. However, as the emphasis of Peace III moves to a more strategic level, and funding is for reconciliation, it is unlikely that there will be continued funding for projects that were born under Peace II. Road Transport Licensing (Fees) (Amendment) Regulations (NI) 2007 The Minister of the Environment (Mrs Foster): I beg to move That the Road Transport Licensing (Fees) (Amendment) Regulations (Northern Ireland) 2007 (S.R. 2007/461) be approved. The purpose of the motion is to increase current road freight and passenger licensing fees to recoup fully the cost of processing applications for road transport licences. Specifically, the fee for a road service licence will increase from £3·25 to £6·50 a month, or part of a month, and the fee for a road freight operator’s licence will increase from £7 to £30 a complete year. A road freight vehicle licence will increase from £4 to £5 a month, or part thereof. The fees for road-freight and passenger-operator licensing have remained unchanged since 1997, and a sizeable increase is necessary to keep the accounts in financial balance. The current fees do not recover all associated costs, and significant deficits have begun to accrue since 2004. Fee increases were not put in place earlier for several reasons, including the intention to undertake a fundamental review of freight licensing and anticipated new charges for criminal-record checks. When it became clear that neither issue would be resolved in the short term, it was decided that the fee increases could be delayed no longer. However, Members will be aware that the Executive Committee has approved the drafting of new legislation which, when passed, will introduce reforms to the licensing of the freight industry. Those reforms will not only improve road safety and enforcement, they will enable the cost of licensing to be spread more fairly across the whole industry. Until then, however, the Department still needs to recover the costs; hence the proposed fee increase. Using a partial regulatory impact assessment, the Department consulted on the fee increases, and that consultation ran from November 2006 to January 2007. There were over 2,500 consultees, but fewer than 20 responses were received. Following the consultation, the fee increases were discussed in detail at meetings with the main trade representatives, and there was general acceptance that the full costs must be recovered. In conclusion, the loss on freight and passenger licensing has been met in recent years by the Department of the Environment and, ultimately, the taxpayer. That cannot be sustained, as Government accounting rules require that the Department recover annually the cost of freight and passenger licensing. That is why I propose that, today, this statutory rule be affirmed. Question, put and agreed to. Resolved: That the Road Transport Licensing (Fees) (Amendment) Regulations (Northern Ireland) 2007 (S.R. 2007/461) be approved. Criminal Justice and Immigration Bill: Legislative Consent Motion Mr Deputy Speaker: Although no time limit is set for the debate, the Business Committee has agreed that Members’ contributions — other than the Minister’s — should be limited to 5 minutes. The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I beg to move That this Assembly endorses the principle of the extension to Northern Ireland of the provisions of the Criminal Justice and Immigration Bill dealing with nuisance or disturbance on Health and Social Services premises which are contained in clause 107 of, and schedule 18 to, that Bill as introduced in the House of Commons. The Criminal Justice and Immigration Bill was introduced in Westminster on 26 June 2007. One section of the Bill deals with nuisance and disturbance in hospitals in Northern Ireland. Although, with the Secretary of State’s consent, I could have introduced legislation in the form of an Assembly Bill, I did not wish to miss the opportunity presented by the Westminster Bill to make legislation available at the earliest possible date to assist healthcare workers. Health and social services bodies in Northern Ireland frequently experience low-level nuisance or disturbances that cause annoyance to staff and patients alike. For example, some visitors make undue levels of noise in hospital wards and waiting rooms and persistently demand the attention of staff for no medical or other legitimate reason. Such incidents can cause significant problems, such as low staff morale, absenteeism and low level of staff retention. Health and social services staff currently have no power to remove persons who create a nuisance from hospital premises without the assistance of the police. The new legislation will change that. It provides for the creation of a new offence of refusing to leave hospital premises having caused “a nuisance or disturbance” to staff. Secondly, it empowers certain authorised staff, or the police, to remove from the premises those who create a nuisance or disturbance. The removal should be undertaken with as little confrontation as possible, and reasonable force should be used only as a last resort. The new offence will not apply to patients or to any other person on the premises: “for the purpose of obtaining medical advice, treatment or care”. Neither will it apply to anyone who has a “reasonable excuse” for causing nuisance or disturbance or refusing to leave the premises. For example, the news of a bereavement, or behaviour caused by concern for a relative, may constitute a reasonable excuse. Authorised staff will not be permitted to remove a person who requires “medical advice, treatment or care”, and that will preserve the rights of individuals to receive medical treatment. The Department will issue guidance on the exercise of the power of removal. In particular, it will stipulate the type of behaviours that may be caught by the new offence and the procedures to be observed before a person is removed. The legislation is restricted to hospital premises only. To widen the scope of the offence to include a broad range of health and social services service-provider settings would have proved impractical at this stage. If a person is prosecuted and found guilty of an offence, he or she could receive: “a fine not exceeding level 3 on the standard scale.” That figure currently stands at £1,000. I am fully aware of the unacceptable number of verbal and physical attacks that are carried out each year on healthcare staff in hospitals and in wider community settings. The new provisions, however, are not intended to deal with such attacks. My Department is working on proposals to introduce new robust legislation that will make it a specific offence to carry out such attacks on staff. I will bring those new proposals to the Health Committee and to the Executive in due course. The provisions of the Criminal Justice and Immigration Bill are intended to deal with low-level nuisance and behaviour that causes disturbance in hospitals in Northern Ireland. Their introduction will empower health and social services staff to take immediate action to remove those who create a nuisance or disturbance on the premises. They will act as a deterrent to those who engage in such behaviour. I ask Members to support the motion. 12.45 pm The Chairperson of the Committee for Health, Social Services and Public Safety (Mrs I Robinson): Over recent years, attacks and assaults on staff working for the emergency services have increased. They range across all the emergency services, from assaults on doctors, nurses and other front-line hospital staff, particularly in accident and emergency departments, to attacks on health and social care staff in primary care settings and in the community, to the emergency services, particularly Ambulance Service and Fire and Rescue Service staff going about their work, often in trying and difficult circumstances. All sides of the Assembly agree that such appalling attacks must end. A comprehensive range of measures will be required to tackle the problem. Legislation is only one of those measures; nonetheless, it is very important. Today’s motion, which endorses the extension of certain provisions in the Criminal Justice and Immigration Bill to Northern Ireland, is a welcome move in the right direction, and the Committee for Health, Social Services and Public Safety fully endorses it. On 22 May, during a debate on assaults on emergency workers, the Minister gave a commitment that this Bill would be extended to Northern Ireland. In September, departmental officials came before the Committee to explain the provisions in the Bill. They explained that the Bill will not deal with violent incidents; those must continue to be dealt with by ordinary criminal law. However, it will deal with low-level offences, such as where individuals create a nuisance or disturbance in a hospital setting. If that type of behaviour is not stopped, it can often lead to more serious disorder or violence. Unfortunately, the Bill will only apply to health and social care premises. It will not cover doctors on call, for example, or health and social care staff working in the community. The Committee wholeheartedly welcomes the provisions as a small but significant step in the right direction. However, we have one concern. The Bill will give power to certain health and social care employees to remove from premises any person creating a nuisance or disturbance. The Committee fully recognises the need for such action to protect staff and patients, but it wants an assurance that those who are given that power will receive rigorous and appropriate training. They must be able not only to handle people who are abusive and aggressive, but to distinguish between someone who is being threatening or abusive and someone who is agitated or behaving strangely due to a medical or mental-health condition and who perhaps needs urgent medical or other attention. During the debate on 22 May, the Minister acknowledged that Northern Ireland needed a single comprehensive piece of legislation: “to protect all emergency workers and promote a culture of zero tolerance towards violence and abuse directed at staff.” — [Official Report, Vol 22, p182, col 1]. He also referred to the Emergency Workers (Scotland) Act 2005. I ask the Minister what progress has been made over the past six months on developing the proposed consolidated legislation for Northern Ireland, similar to that which was introduced in Scotland. When will it be brought before the Assembly? I support the motion. Ms Ní Chuilín: Go raibh maith agat. The provisions in the Criminal Justice and Immigration Bill relate to nuisance and disturbance. Although this is a reserved matter, it is a welcome development for staff to be given the authority to remove people who are creating low-level nuisance. As the Minister said, this relates to visitors making undue noise and persistent demands on people’s attention without any clear medical reason. The Bill is a clear demonstration of the Department’s and the Assembly’s commitment to hospital staff. My only regret is that, as the Chairperson of the Health Committee said, it has not been extended to doctors and other on-call healthcare professionals. Perhaps we can look at that in the future, because our support is about recognising the value that we place on all healthcare workers. The Criminal Justice and Immigration Bill, as outlined, will not affect anyone who has what the Minister described as a “reasonable excuse” — for instance, anyone who has just received news of a bereavement or anyone with certain medical or mental-health difficulties. That is to be welcomed. Currently, security staff do not have the power to remove anyone who is abusive or who is causing serious nuisance and disturbance, and they are often left feeling helpless when such situations arise. Although I support the motion, I have a couple of caveats. I am concerned about any potential there might be for the person who is being removed to suffer any shock or harm. The Minister mentioned “reasonable force”, and I would like him to define that for the House. Will the staff who are using reasonable force be made more vulnerable? I suppose that that is a catch-22 question. Ultimately, staff will have to be properly trained, and the training must be constantly monitored and evaluated. I assume that the Bill has been screened, but I must ask whether it has the potential to affect anyone’s civil or human rights. I hope that the legislation will lessen the abuse and attacks that staff, regrettably, have to endure. It will have the potential to act as a good deterrent; I have no doubt about that. Furthermore, it will demonstrate that the Assembly places value on all staff and healthcare workers, as well as on patients and their visitors. As the Chairperson of the Health Committee said, the Committee supported the zero tolerance policy towards violence in May, and I am encouraged to see these additional measures afoot. With those caveats, I support the Bill. Go raibh maith agat. Rev Dr Robert Coulter: I support the motion, and I am glad that the Health Minister has brought it before the House. This issue has occupied my attention for some time, and I have campaigned long and hard. It is completely unsustainable for any democratic society to allow attacks on health workers, especially in the accident and emergency departments. I am glad that there are specific definitive statements set aside to pinpoint the areas in which a criminal charge can be brought against someone who indulges himself or herself — under the influence of alcohol or drugs, or for whatever reason — on those who are trying to assist them to regain their health. However, we have to look beyond the hospitals and the accident and emergency departments. In these days when the health system is developing and evolving and many health workers are out in the community, we constantly hear stories of those who have gone to homes to help people and who have been abused verbally and physically by those whom they have gone to help, or by members of their family. The Bill should reflect all these things and cover all emergencies in that way. We are also appalled when we read of attacks on ambulance workers or on any aspect of the emergency services. The powers must be there to deal with those who think that it is entertainment to attack ambulance workers or their vehicles. I trust that the Bill will not be delayed, and that it will go forward quickly so that healthcare workers can be encouraged and motivated in the knowledge that this House supports them in the defence of their principles and their safety. Dr Farry: The Alliance Party supports the Bill, just as other Members and parties have done. However, it is important that Members see the motion in its proper context and recognise that it is a limited element in addressing the broader problem: the threats to health workers across the spectrum and in a range of locations. Obviously, the Minister is restricted today by the terms of the Bill that was drafted in Westminster and is up for discussion there. As an Assembly we have a much broader agenda, and it is important that we recognise that the terms of this piece of legislation are relatively restricted. First of all, it deals effectively with non-criminal behaviour. While causing a disturbance or nuisance in hospital will not be a criminal offence, refusal to leave under direction will be. In that sense the Bill parallels a lot of the antisocial behaviour legislation that has been passed in the United Kingdom in recent years. Like other Members I have concerns over gaps in the legislation. There are major problems with attacks on healthcare workers outside formal health-sector buildings, notably ambulance staff, paramedics, and doctors on call. There is also a parallel with other public-sector workers — for example, those who work for the Fire and Rescue Service. When criminal offences are committed against those who are doing an important job for the public good of society, it is important that those offences be treated as aggravated offences, subject to stiffer sentences when the culprits are caught and brought to justice through the courts. That type of approach would recognise the serious nature of those offences, in that they are not just offences against the individuals who carry out the work, but a threat to the public safety and all of society. Healthcare workers, like Fire and Rescue Service workers, must feel confident going into situations where they are required to give assistance to people who are suffering and in need of urgent medical, or other, assistance. That needs to be addressed through legislation in this Assembly, because the UK legislation is not sufficiently broad. I am puzzled as to why that type of legislation is not being put forward on a UK-wide basis, but, as it is not, it is incumbent upon this Assembly to take action, because the community at large feels very strongly about this issue. Another gap in the legislation is the issue of potential patients themselves causing problems. The Minister has referred to that. There is a need to ensure that people who are in need of medical assistance receive it, but we must be equally conscious that a lot of the problems of nuisance and disturbance come from patients, or potential patients. I have in mind the situation on a Friday or Saturday night when a lot of accident and emergency facilities are attended by people who are under the influence of drink and drugs. That has sometimes caused major difficulties. We must take that kind of scenario into account and provide the necessary protection for the staff, who are doing an important job. Other people using the facilities are also under threat, and it is important that we consider all of society in the legislation. Recognising that we can only do what is contained within the UK Bill at this stage, the Alliance Party is happy to go along with the motion today, while urging the Minister to take broader action to address the wider range of concerns. (Mr Speaker in the Chair). Mr A Maginness: On behalf of the SDLP, I welcome the Minister’s proposal. It is both balanced and reasonable, and should have the support of all Members of the Assembly. As Dr Farry pointed out, we are dealing with non-criminal behaviour that manifests itself in low-level nuisance and misbehaviour. This provision is very limited, but nonetheless to be welcomed by nursing staff and anyone engaged with working in a hospital setting. I note that the Bill is confined to hospital buildings, which is perfectly reasonable in the circumstances that the Minister has highlighted. In a professional, legal capacity I have come across many instances of misbehaviour by patients — and non-patients — in hospital buildings. It is a disturbing trend in the Health Service, and it must be addressed at a broader level by the House. 1.00 pm In a sense, the Minister is using a mechanism to deal with this type of mischief, to remedy it and to give the power of removal to hospital authorities. However, it falls short of what is necessary in a broad range of misbehaviours that affect Health Service staff across many disciplines. Justice and policing powers have not been devolved to the Assembly and, if nothing else, this provision highlights that gap. The sooner policing and justice powers are devolved to the Assembly, the sooner we can address the wide range of outstanding issues that affect our constituents, whether they are workers or people using hospital services. People in our society are very concerned about nuisance or disturbances in Health Services premises. I am sure that the Minister feels frustrated about not being able to address those issues today. The sooner policing and justice powers are devolved, the sooner we can address them. I appeal to all Members of the House to work constructively towards an early return of policing and justice powers to the House. My party supports the Minister’s proposition. Mr McGimpsey: I thank the Members who have contributed to the debate. It should be seen as part of an ongoing strategy for zero tolerance in dealing with verbal and physical attacks and assaults on health and social services staff, not only in hospitals but wider afield. Several measures have already been implemented, including the setting up of a zero-tolerance strategic group and a publicity campaign. Every trust is required to have policies in place to deal with violence against staff. We have used advertising posters and have carried out a leafleting campaign. Over 10,000 personal alarms have been issued, a pilot scheme in the accident and emergency department of the Belfast City Hospital is operating in conjunction with the police, and a senior director in each trust has explicit responsibility for staff safety. We can take those steps thanks to the opportunity afforded by the Criminal Justice and Immigration Bill. The next stage is proposals for new legislation that will make it a specific offence to assault any member of the healthcare profession while he or she is on duty, and we are working on those. Those measures will be specific to individuals and employees, but not to premises. I take Mrs Robinson’s point about low-level nuisance leading to higher levels of nuisance activity. However, specific guidance will be issued next year as part of the process, so that it will be clear whom hospital authorities are entitled to evict from Health Service premises and whom they are not. Anyone attending hospital for medical treatment — patients or others on the premises to obtain medical advice or treatment of care — will be exempt from eviction, because of the point made by Mrs Robinson, and the point made by Ms Ní Chuilín about the right to healthcare treatment. That is part of the thinking behind the measures. Those rights will not be impeded because of a particular medical condition, which may cause an individual to appear to act as a nuisance, but whose behavior is indicative of a deeper medical complaint that requires treatment. That is part of a process and strategy that we will continue to pursue because the number of assaults is rising. In 2006-07, there were just over 6,000 assaults, and that is completely unacceptable. Sadly, it is necessary to bring forward such legislation to deal with something that should be a given in society: that we look after those who care for us. However, we must do so. It is not a minimal response, but, it is, as Mr Maginness described it, a reasonable one, and it is part of a general strategy to deal with the unacceptable level of violence that is directed towards staff. Therefore, I ask all Members to support the motion. Question put and agreed to. Resolved: That this Assembly endorses the principle of the extension to Northern Ireland of the provisions of the Criminal Justice and Immigration Bill dealing with nuisance or disturbance on Health and Social Services premises which are contained in clause 107 of, and schedule 18 to, that Bill as introduced in the House of Commons. Ad Hoc Committee: draft Sexual Offences (Northern Ireland) Order 2007 Motion made: That, as provided for in Standing Order 48(7), this Assembly appoints an Ad Hoc Committee to consider the proposal for a draft Sexual Offences (Northern Ireland) Order 2007, referred by the Secretary of State for Northern Ireland, and to submit a report to the Assembly by 4 February 2008. Composition: DUP 3, Sinn Féin 3, UUP 2, SDLP 2, Alliance 1 Quorum: The quorum shall be five members. Procedure: The procedures of the Committee shall be such as the Committee shall determine. [Mr McNarry] [Mr Burns] Health Service Reform Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. All other Members who speak will have five minutes. Mrs I Robinson: I beg to move That this Assembly calls on the Minister of Health, Social Services and Public Safety to bring forward a health and social services reform Bill, as a matter of urgency, for consideration by the Assembly. I am delighted to propose the motion. The DUP cares passionately about the Health Service, as, I hope, do the other parties in the House. There was consultation on the draft Health and Social Services (Reform) (Northern Ireland) Order 2007 from January to April 2007, and, until 8 May, its proposals were widely supported. In recent times, there has been much discussion about the Budget allocation for health and whether, in respect of its share of overall resources, half the cake is sufficient. I am somewhat alarmed by the impression created by the Minister of Health, Social Services and Public Safety’s commitment to reaching his Department’s efficiency targets. I hope and trust that those targets will be reached and that the efficiency savings, which are important, will result in an improved Health Service. In the Democratic Unionist Party, we mean much more when we speak of efficiencies. Merely meeting efficiency targets may get us through the next couple of years; however, the position of the Health Service will be no better in three years’ time, come the next comprehensive spending review, when the massive proportion of the block grant sought by the Department of Health, Social Services and Public Safety will have rocketed even further. That is why fundamental change to the operation of the Province’s Health Service is essential. This is not about point scoring; it is about getting the best Health Service for the moneys that are put in. We cannot afford to keep plugging away with the same old methods, content that health will receive double-digit increases in Budget after Budget. We cannot have half the cake now, Minister McGimpsey, and two thirds of it in the future. Overhauling the way in which we commission services is vital. Key to the reforms is the replacement of the four existing health boards with a single authority, and the establishment of locally based commissioning groups comprising general practitioners and other local health professionals. The formation of the single health authority is much more than a simple matter of rationalisation. The most important consequences of that will concern performance management and the financial management of health services across the Province. Until the authority is in place, we will underachieve; we will not realise the maximum outcomes for the resources that we invest. The Minister says that he does not want to rush; he wants to consult with stakeholders. Perhaps he should consult his own party and Assembly group. The Minster’s party was most vociferous in support of reforms — it was certainly supportive of such reforms until 8 May 2007, when the Minister took office. In 2005, when the further consultation document on the review of public administration (RPA) suggested backtracking from a single authority, the Minister’s party leader, Reg Empey, in that party’s submission, was quite adamant in stating: “We view the current proposals as a recipe to continue the existence of the current health boards without an improvement in service. The Ulster Unionist Party has proposed the formation of a single Hospital Authority at the regional level with the creation of primary health care groups…we cannot agree to the current proposals as we view them as a retrograde step which, if implemented, would stymie the development of a… health service for the 21st century.” Less than one year ago, his party’s health spokesperson, Robert Coulter, said: “The failure to create a single Northern Ireland hospitals’ authority is one of many glaring missed opportunities in the RPA model.” — [Official Report, Bound Volume 21, p63, col 1]. However, on 15 November, on ‘Hearts and Minds’, UUP Health Committee member John McCallister described his party spokesman’s cherished single health authority as the “mother of all quangos”. Why the sudden change in opinion since the Minster came into office? Where do other members of the Ulster Unionist Party stand? Are they with their party leader and their party spokesman, or are they with Michael McGimpsey? No doubt, the Minister will continue to prevaricate, and claim that he needs more time. However, few people in Northern Ireland buy his excuses. The reforms have already been the subject of consultation twice. Too much time has already been lost. The current health structures have been in place for 35 years, yet, bizarrely, the Minister has argued that that is all the more reason to take his time. Undoubtedly, some people are resistant to change. The House can only hope that the Minister is not one of them. Northern Ireland cannot afford a Health Service that operates in that way and is still in the mindset of the early 1970s. We must increase productivity, because it is 11% worse than that in England. Doctors, nurses and all the other front line staff work tirelessly. There is little more scope to increase the work that they do. They are not working 11% less hard than their colleagues in England. I have no doubt that even to suggest that would make them fairly angry. Therefore, the problem must be the way in which the system works. A new system of commissioning is needed, with incentives to increase performance. Health professionals view the Minister’s delay as a blow to the completion of the reform that has been ongoing for more than five years. There are now only five trusts. I welcome that reduction, with the proviso that commissioning structures should be put in place to reflect the needs of patients in a bottom-up — rather than a top-down — manner. The Belfast Health and Social Care Trust is the largest such body in the United Kingdom, and one of the largest in Europe, with 22,000 staff. It spends £3 million every day. An organisation that large makes the establishment of a regional authority a necessity. 1.15 pm One of the targets in the draft Programme for Government is to reduce by 50% the number of unplanned hospital admissions by 2011. That can be achieved only by investing in better care in the community, primary-care intervention and self-care. Commissioning bodies should be facilitators in this, comprising GPs, dentists, pharmacists, optometrists, lay people, allied health professionals and nurses, all working together to commission services for patients in their areas of expertise. The single health authority was to be the commissioning organiser, maintaining the local care groups and commissioning regional services — a single bureaucracy that would support local groups and reduce duplication. Its performance-management role would be the key to holding local commissioning groups and trusts to account — something previously sadly lacking in the National Health Service in Northern Ireland. Doctors and nurses are constantly being quality-assessed for their competence to practice. However, nothing ever seemed to be in place to sufficiently assess management structures. Many staff nearing retirement saw the overhaul of structures as a chance to plan for early retirement, allowing flexibility in the service in order to keep the number of compulsory redundancies to a minimum. Some have already gone, but others are now being told that the change has been delayed for at least one year. That is not the greatest morale-booster. People in the boards are working in stressful conditions, and vacancies are not being filled. That could be forgiven with the April 2008 deadline fast approaching and a target to work towards. What impact will the delay until at least 2009 have on the vacancy controls? What reforms will be implemented to ensure that there are few compulsory redundancies? There was a lot of scepticism in the medical profession about these reforms, and it took a long time to bring them on board, particularly the doctors. The delay is a major let-down; one needs only to read this morning’s newspapers to see that. The legislative process must commence. Members do not necessarily have to agree on everything at this stage — it is unlikely that we will — but let us get the process moving by introducing the Bill and having the debates. The Minister wants to talk to stakeholders — let us use the time now to do that. The Minister should not waste valuable months, and maybe even years, consulting before finally introducing a Bill, only for Members to have to go away and consult again. The UUP tabled a motion criticising the legislation that is passing before this House. There is no reason not to have a health reform Bill. The excuses for delay from the half-the-cake Minister are, unfortunately, only half-baked. Mrs O’Neill: Go raibh maith agat, a Cheann Comhairle. I speak in favour of the motion, and I agree with most of the comments made by Mrs Robinson regarding fundamental change in the Health Service’s being essential. It is important to get the best service with the resources that we have. The review of public administration has been ongoing since 2002, when the Office of the First Minister and deputy First Minister (OFMDFM) launched the initial consultation on its terms of reference. The premise of the review was to reduce bureaucracy, create savings and restructure the public sector. Regarding the changes to the Health Service, five new health trusts have already been created, which is a welcome reduction from the overburdened 18 health trusts. However, in order to complement those changes, we need the introduction of the health and social care authority, the establishment of local commissioning groups, and the one-patient client council. The main driver for change in what was to be the new healthcare environment was to be a revolution in commissioning. The introduction of those structures is vital to counterbalance the powers of the newly established trusts. We now find ourselves in limbo in that regard. The Minister has stated that he wants to take his time to fully consider the impact of pushing forward with those changes, and that he wants to get the changes right. I agree with him in that respect — they must be right; we do not want to see change for the sake of change, with no benefit to the Health Service. However, a prioritisation of those issues by the Minister is required. The failure to push on with change is leaving the Health Service in disarray. Morale in the Health Service is low, and many rumours are circulating regarding what is happening to people’s jobs, to commissioning powers, and regarding the retention and recruitment of staff. That is all detrimental to good working environments. It would be remiss of Members, as elected representatives, to ignore the comments of health professionals who are directly involved and who are concerned at the decision being deferred for at least a year. I have been lobbied by GPs who have been appointed to local commissioning groups. One GP described the current situation as a hiatus in the development of those groups. GPs say that the groups sit monthly and are wasting public money: they are starting to become disheartened and feel like withdrawing from the groups, as they do not want to support a sham. Apparently, the local commissioning groups nominally share responsibilities for decisions on commissioning that are actually made by the boards. From those comments, it is clear that the support gained from doctors and other health professionals over the past 18 months, and the impetus in taking forward the proposed RPA changes, are in danger of being lost. Further delay in RPA reforms will impact negatively on the savings that they are designed to achieve. It has been suggested that some services are already being removed or withheld; for example, according to one trust area, cognitive behavioural therapy has been suspended due to the present uncertainty. I am sure that the Minister will agree that that is not in keeping with his commitment to make mental-health services a priority. The current situation is frustrating and confusing for all involved. I know that the Minister must take difficult decisions, but I urge him to take them as a priority. We want a Health Service that caters for the needs of all and that is efficient and accountable for the benefit of all the people of the North. I support the motion. Rev Dr Robert Coulter: I am glad that the motion has been tabled. Anyone looking at the monolith of the Health Service will agree that reform is necessary. I am glad that the Chairperson of the Committee for Health, Social Services and Public Safety, who tabled the motion, has noticed that the Ulster Unionist Party has called for this kind of reform for quite some time. My question is: what kind of single health authority do we want? The proposal is for a health and social services authority that will replace the four health boards. Such an organisation has been asked for, through legislation, for some time. It would have an annual budget of £140 million and 1,800 staff. Members should look at that proposal and see it for what it is: a glorified quango. I am sure that those who propose the motion do not wish to advance “quangoland” in Northern Ireland any further. We have far too many quangos, and we do not want a super-quango that will drain £140 million from the health budget every year and carry a burden of 1,800 staff. The Royal College of Nursing has supported the Minister’s stance and believes that the direct rule proposals now being adopted by the DUP are flawed because they fail to provide for accountability. The health and social services super-quango is to have 11 senior executives on salaries that will be well in excess of £100,000. The monstrous and unaccountable health and social services authority was the creature of direct rule Ministers. Why is the DUP adopting this further drain on the Health Service budget? The recent draft Programme for Government made us all sit up and ask where we had heard it all before. An Ulster Unionist Minister is crying for more money for the Health Service; but what was presented as new was an amalgam of Bills generated by the Civil Service machine under direct rule Ministers and rehashed and represented to us. In other spheres, a sensible solution would be called for. The one thing that I am afraid of is that, under political pressure, and because he belongs to one particular party, the Health Minister would bring forward something not carefully thought through. I think back many years, to the time when we looked for a new hospital in Ballymena. Under political pressure, the location of the new hospital was changed from Ballymena and it was built in Antrim. We were told that that was the right hospital in the right place. Looking back over the past few years, some may have commented that it would have been better had time been taken to think the project through properly, in which case the hospital would not have been located in Antrim, but in or near Ballymena, where it would have better served the area to the north-east of our Province. The trade union UNISON has said that that model, which some are attempting to rush through the Assembly, was in direct contradiction to the structures-and-reform model that was developed locally in the Hayes Report, and the RPA process. UNISON went further, and stated that the draft Order was established without specific consultation or an equality assessment, and replicated the dysfunctional elements of English Health Service delivery, including the purchaser/provider split, and the retention of the trust model. Unionists correctly said that they believed that legislation should be drafted in response to the consultation and introduced as an Act of the Assembly for consideration in the Chamber, and by the Committee for Health, Social Services and Public Safety, as per the normal legislative process. The Health Service is not a toy to be played with among political parties; it is for the patients, whom we should put first, rather than our political ideals. Mrs Hanna: I had tabled an amendment to the motion, and I am sorry that it was not accepted. I am not sure why that was, because a much more constructive debate is necessary. I do not believe that there is any Member — not the Minister, the Chairperson, or any members of the Committee for Health, Social Services and Public Safety — who does not subscribe to the idea of radical reform of health and personal social services. First, I shall deal with the proposal for a single health authority. In common with other Members, I have some reservations and concerns about delays, the detrimental impact on staff morale, and the potential loss of savings. The new health and social care authority must commission services on a regional basis. Unfortunately, five minutes does not give me time to go into the other recommendations, but they are equally important. Thanks to the findings of the Appleby Report and the Wanless Report, it has been well established that the Northern Ireland health spend is higher than in GB, although the differential is eroding. Professor Appleby also makes it clear that the differential for Northern Ireland’s needs — on indicators agreed in the Department of Finance and Personnel — has increased from 7% to 14%, and that the funding gap based on need rather than raw population is thought to be around £300 million. By 2011, that gap will increase to £600 million. Those realities must be recognised by the Assembly. That funding shortfall will not go away. Despite bickering among Members and parties, the shortfall remains, and if we are serious about looking after the health of the people of Northern Ireland, we must decide how we will address that. There are things that we can do: we can encourage people to take responsibility for their own health; we can examine the issue of repeat prescriptions; and we can educate doctors to save money by prescribing generic drugs and reducing prescriptions. Members will know that 70% of the health spend goes on staff pay, and through the RPA, we are considering a reduction in staff, partly through wastage, and through the reduction of bureaucracy and administrative duplication. The Bamford Review has made a strong economic case based on early intervention and increased action to promote good mental and physical health, particularly through early intervention, parenting and early-years support. 1.30 pm The National Health Service celebrates its sixtieth anniversary in July 2008. Its founder, Aneurin Bevan, described it as “pure socialism”. I prefer to say that the most socialist initiative that a democratic Government ever took is also the most politically popular. It is the hallmark of a decent society that it has an excellent and equitable healthcare system. The founding principle of the National Health Service was that it must be free at the point of need, even though healthcare demands are unimaginably different and complex compared with anything that was envisaged 60 years ago. There must be greater efficiency, effectiveness, innovation and value for money in the deployment of healthcare, and the SDLP fully backs those demands. My party accepts that the growth of a dynamic and innovative economy is a priority. However, it must also be accepted that to have a physically and mentally healthy population is the best investment than can be made in any society. People are society’s biggest asset. The 10% productivity gap between Northern Ireland and GB in the delivery of health services can and must be closed. Dr Farry: Like other parties, the Alliance Party supports the motion. However, Members must recognise that the motion has been tabled in the wider context of a row between the DUP and the Ulster Unionists over the health budget. Members must also be conscious that Health Service reform is not, by any means, the only area in which the Executive have been dragging their feet with the review of public administration. The feet-dragging that has occurred over the health and social care authority runs parallel to that which the Minister of Education and her Department have been doing over the education and skills authority. Therefore, rather than focus on the failure of one particular Minster, Members must recognise that there has been broader failure in the Executive to deal with the difficult choices that must be made in governing Northern Ireland. Members must also be conscious that there is now a democratically elected Assembly for Northern Ireland. With it, the context changes radically. It leads much more easily to the creation of Northern Ireland-wide single authorities to deliver the outcomes of policy decisions that are taken by Ministers and MLAs. There is a strong case for having a single health and social care authority for Northern Ireland, which has a population of 1·8 million people. A health authority for that size of population is not unusual in many other regions on these islands. Many Members are conscious of inconsistencies in the health and social care that is offered across Northern Ireland. Although that is a matter for the trusts, boards, or whoever their successors are, a single health authority for Northern Ireland can only assist in the process to establish consistency in the service across Northern Ireland. Budgetary considerations for a single health authority are also relevant to the debate. Members must be conscious of the fact that the health sector is under tremendous funding pressures. For example, Northern Ireland has enhanced need per capita compared with elsewhere on these islands; a greater number of the population is in worse health; drugs are becoming more expensive; the cost of healthcare technology is rising; and people are living longer, which, although that is to be welcomed, creates its own financial pressures. Northern Ireland also has growing demand for measures such as free personal care for the elderly — a matter that is close to the heart of my colleague from Strangford, Mr McCarthy. It is important that such issues are put on the agenda. At present, Northern Ireland suffers from the opportunity costs of not dealing with fundamental reform in the health system. My party has considerable sympathy with the Minister’s call for more funds. Despite the fact that the health sector gets the lion’s share of funds, enhanced need in Northern Ireland means that it is falling behind the rate of growth in the rest of the UK. The Assembly must reflect on and tackle those statistics. Mr Easton: Does the Member accept that the health sector gets 51% of all new moneys? Dr Farry: I fully accept that point. Equally, that amount of money is not sufficient to meet the gap between health funding in Northern Ireland and that in the rest of the UK. Mrs I Robinson: Will the Member accept that it is immoral to do the same thing, over and over again? Moreover, if there are efficiency savings to be made — and increased productivity — that allow moneys to be released, that should be done. We should not continue to do the same old thing, time and time again. The Appleby Report highlighted the fact that there are efficiencies to be made. Surely major efficiencies can be made, even by simply establishing a single authority? Mr Speaker: The Member has an additional minute for taking two interventions. Dr Farry: I do not agree with the honourable lady that it is immoral. Nevertheless, I agree with the remainder of her point. We cannot stick with the status quo; we must have change in Northern Ireland. By the same token, there are areas of the health sector that require urgent investment. The Minister of Health, Social Services and Public Safety, to his credit, set out a comprehensive list of bids under the comprehensive spending review. Virtually none of those bids was met. There are matters that the Assembly has endorsed — for example: free personal care for the elderly; free prescriptions; increased funding for mental health; and the recommendations of the Bamford Review. We are losing out on those issues, because we have not addressed the reforms. However, we still need an uplift in the health budget to meet those additional costs, something that we cannot even remotely consider at present. Although the honourable lady is correct in saying that we must have greater reforms in the Health Service and greater efficiencies, the Minister is equally right in saying that we are losing out on money and that the funding gap with the rest of the UK is getting wider and wider. It is important that we do not polarise the debate and that we recognise that we need to move forward on both those strands in order to provide a Health Service that is fit for purpose. Mrs I Robinson: Will the Member accept that £2 billion was provided for the health budget in 2000-01? In 2007-08, £4 billion will be provided for the health budget. Will he agree that we have seen double the benefits to the Health Service because of the doubling of that budget? Dr Farry: The Member is correct about the figures. Health budgets across the UK have risen at the same rate. Northern Ireland is no different to any other part of the UK. We need to find greater efficiencies and to release that money to reinvest in other facilities. Mr Speaker: Will the Member bring his comments to a close? Dr Farry: Thank you, Mr Speaker. Mr Easton: The people of Northern Ireland had every reason to expect that the establishment of devolved Government at Stormont would deliver a more efficient and better Health Service for Northern Ireland. We have had 40 years of terrorism and civil upheaval that has left us with an infrastructure that needs to be renewed. We are left with an economy that has suffered greatly as our traditional industries have declined. We have had years of direct rule by Ministers who have not faced up to their responsibilities as they might have done. We have had four decades of wasted opportunity, economic inertia and instability. We have seen many plans, investigations and reviews set in motion. However, the truth is that we have seen a great deal of prevarication, with important and critical decisions being deferred to another day in the hope that the problems would go away or be dealt with by someone else. It is now time to deal with the problems and to stop waiting for other people to solve them. It is time to get to work to build the better Northern Ireland that we promised our constituents when we sought election to the Assembly. When it comes to dividing and apportioning financial resources to the Departments, we know that those resources are limited. The cake that is to be divided out is a certain size, and no amount of discussion will avoid the necessity of taking hard decisions. The only way in which to increase the size of the cake is to grow a dynamic, innovative economy. In that endeavour, we need to examine every aspect of the way in which we do things to ensure that, in every area of public life, we are making the best of our resources. We need to ensure that, in every division of our economy, we have highly efficient and effective public services that deliver value for every pound that is spent and that make the best use of the revenue provided, and of our existing assets. We must all accept that collective decisions will be made that challenge individual Ministers and Departments. It is vital to ensure that pressures are placed equally on all Departments and that they all accept that they have a responsibility to work for the common good. There is a responsibility on all Ministers to ensure that their Departments are challenged and stretched to make their part of the overall organisation more streamlined, more effective and less expensive. The fact that something is better does not always mean that it has to cost more money. We must examine every aspect of our endeavours to ensure that they are the best that they can be. The health budget of £3·8 billion represents 48% of the entire block grant for the Province. Indications are that, in the next three years, health and social services will receive 51% of all new moneys. We spend more per capita of the population on health than the rest of the United Kingdom, yet our output is much poorer. I have worked most of my adult life in the Health Service, and my experience has given me a belief that as much money as possible should be spent on the people who need help and on those who are in the front line in providing that help. We must do away with expensive quangos. We need centres of excellence and increased productivity. We need to make massive efficiencies in the cost of drugs. We must look particularly at the level of staff in administrative areas of the Department of Health, Social Services and Public Safety (DHSSPS), and there must be joined-up practice across the various trusts. The levels of sickness and the cause of low morale among staff must be examined. Outpatient waiting lists must be reduced, and there should be charges for those who miss appointments without offering a reason or any notice of their intentions. Salaries and wages must be considered, and an equitable system developed in which nurses, in particular, receive a fair wage. We must also consider closely those who earn large salaries, including doctors, to ensure that there is fair distribution all round. We desperately need to reduce waste and bureaucracy. Those who work in DHSSPS know that those changes are necessary. Above all, the four health boards must be replaced by one streamlined cost-effective authority that could establish locally based commissioning and enhanced responses to local needs. The UUP’s response to the RPA consultation in February 2004 said that Northern Ireland has the most over-administered Health Service in the United Kingdom. In 2005, when it seemed as though Professor Appleby was less than enthusiastic, Sir Reg Empey reminded us that: “The Ulster Unionist Party has proposed the formation of a single authority at the regional level with the creation of primary health care groups.” The Ulster Unionist Party’s 2005 manifesto said that: “…there’s too much bureaucracy and too little flexibility.” “To reduce bureaucracy We would replace Northern Ireland’s 4 health boards with 1 health authority.” That reflected the 2001 manifesto, in which it was said that co-operatives, with control of their own budgets, should be formed to deliver primary care locally, and that acute care should be managed through a single Northern Ireland authority. Why then has the Minister refused to act on the advice and intentions of his own party and its manifesto? It is time for the Minister to get on with his job and stop his whinging — Mr Speaker: The Member’s time is almost up. Mr Easton: — and provide a better Health Service for the people of Northern Ireland. Ms Ní Chuilín: Go raibh maith agat, a Cheann Comhairle. On 9 October of this year, the Minister of Health, Social Services and Public Safety announced that the structures for health and social care trusts and the Ambulance Service would not change until April 2009. The reasons given were the need to ensure that we get it right, and, in particular, to ensure that any new structures and changes will deliver the best outcome for people — and, above all else, meet local needs. I doubt that any Member would argue against that. We all want to ensure that any change will result in better outcomes for staff, patients and carers. We are all committed to reforming and improving services for people who seek health, some of whom are among the most vulnerable in our society. Improving services for staff, patients and carers is a priority for everyone, and the need to augment the outdated structures and services that should be germane to achieving effectiveness and raising public confidence in our health and social care system is now a matter of concern. That having been said, the rationale behind the motion is about having the drive and the ability to see those changes through and to end the uncertainty that has become prevalent throughout the health and social care system. Most, if not all, of us have been recipients of health and social care to some degree or another. We all expect that care to be effective, and we expect delivery. However, the delay in establishing a single healthcare authority has unsettled many in our health and social care system. Let us reflect on some of the main themes of the proposed restructuring. The first is a new health and social care authority to replace the existing four health and social services boards. The second is to establish seven primary-care-led commissioning groups in the local authority, which will involve local health and social care professionals. It will also involve lay representatives in planning services at community level and in partnership with communities. The third is the abolition of certain agencies and the transfer of their functions, staff, assets and liabilities to other health and social care bodies. 1.45 pm The Committee for Health, Social Services and Public Safety has met, and will continue to meet, staff-side representatives from the unions and some of the colleges. There are concerns about the length of time in which reforms were to occur. People in the system are fatigued, and burnt-out by reviews and the prospect of more of the same. That has had an impact on Health Service staff. Despite that, they have continued to provide services and care with compassion and professionalism of the highest standard. The motion calls for the Minister of Health, Social Services and Public Safety to introduce a health and social services reform Bill as a matter of urgency. He should also try to ensure that reform takes place. We must make sure that the issue is not ducked. Local communities must be able to play a meaningful role, such as taking part in local commissioning groups. Some of those groups have argued that they have been considered as add-ons, rather than being integral to the health agenda. We must all acknowledge and embrace the challenges that reform will bring. The review of public administration, the Executive’s Agenda for Change strategy and the need for better investment in mental-health services must be time-bound, and our approach must be based on the realisation that our Health Service is 35 years old and is becoming archaic. The Assembly must see movement; otherwise, the anticipated savings that can be accrued from reform will begin to dwindle. We will also lose experienced and highly-trained staff, which will have a long-term impact on the health system. I support the motion on the basis that if a health and social services reform Bill is introduced, we can scrutinise it line-by-line, and end the wait for overdue reform, restructuring and implementation. As elected representatives mandated by the people, we all agree that the lack of investment under direct rule has had an impact. We have a responsibility to bring about changes that ensure equality for all citizens, regardless of postcode. Go raibh maith agat. Mr Hamilton: I welcome the opportunity to participate in this debate, and I congratulate my colleagues on securing the debate on such an important issue. We have clearly shown how we all support the guiding principles of the National Health Service, how each and every one of us wants to see a better Health Service for all of the people of Northern Ireland, and how we all admire the dedication to duty of our health professionals. Earlier, we heard about some of the physical dangers that they have to face in the line of their duty. Yet, all of their efforts are being hampered by systemic problems that stifle the NHS in Northern Ireland. We have already heard from the Chairperson of the Health Committee how spending on health and social care in Northern Ireland will more than double from £2 billion in 2001 to over £4 billion in the current Budget period. However, nobody could say that productivity in the Health Service in Northern Ireland has doubled over that period, proving the point made in the Appleby Report that it is the use of resources rather than the amount of those resources that is important. It is worth reminding the House of some of the grave inefficiencies in the Health Service in Northern Ireland that were highlighted by Professor John Appleby during the course of his work. He found that the unit cost of hospital procedures, hospital throughput, consultant productivity, the average length of stay in hospital and spending per head on prescriptions were all significantly worse in Northern Ireland than in England. Even if we were as efficient as England — hardly a model of efficiency in health provision itself — immense differences could be achieved. More patients could be seen in less time, and massive savings could be made for front-line services. Reform that targets those inefficiencies and improves the way in which the Health Service does its business is long overdue. That is why we all supported the consultation on the draft health and social services (reform) (Northern Ireland) Order 2007. One would have thought that this issue would have been at the top of the new Minister’s agenda. During a debate last week, the Member for North Down Brian Wilson compared the Health Service in Northern Ireland to an oil tanker. However, if we are to change direction we must start turning the wheel. Since assuming office, the Minister of Health, Social Services and Public Safety has shown no desire to address seriously the radical reform of Northern Ireland’s Health Service that is required. If anything, he has shown himself to be a roadblock to reform. Instead of tackling the issue head-on, he is heading in the opposite direction. Instead of doing what would receive widespread support in the House and further afield, he has illustrated a desire to head in the opposite direction, exemplified by his freeze on the RPA reforms in health. The creation of a single health authority and local commissioning boards has been widely recognised as being an essential element in a more efficient and effective health service. I only wish that the Minister would show as much passion about tackling inefficiencies in the Health Service as he does about whingeing and crying for more money. As other Members have said, the Ulster Unionist Party was in favour and supportive of the reforms. Around a year ago, the UUP’s health spokesman, Rev Coulter, said that the failure to create a single authority was one of the many glaring missed opportunities in the restructuring model. One might ask what has happened to the UUP’s 2005 election manifesto pledge: “To reduce bureaucracy We would replace Northern Ireland’s 4 health boards with 1 health authority.” It seems that ditching election manifestos is now at epidemic proportions in the UUP. There is a consequence for not carrying forward those reforms. Dr Brian Patterson, chairman of the BMA (British Medical Association) Northern Ireland Council, recently said: “The health boards are required to soldier on for at least another 18 months, but are they fit for purpose? They have lost many core staff to the new trusts or left the Health Service entirely. Those who are left are demoralised and paralysed to an extent by uncertainty.” The BMA’s criticism was shown to be spot on when that sense of paralysis and poor morale resulted in the resignation of David Sissling as chief executive designate of the HSSA (Health and Social Services Authority). A man whose capture was a coup for Northern Ireland has been lost to our Health Service, and our patients and health professionals will prove to be losers for that. As if demoralisation and paralysis were not bad enough, the state of stasis comes at a cost. Key management staff that have been appointed to the HSSA at an estimated cost of £500,000 are still in post. Rather than costing money to create the HSSA, it is costing much more not to go ahead with it. Foot-dragging is costing us a fortune. I urge the Minister to listen to what has been said in the Chamber today and to listen to people in the Health Service, and health professionals in bodies such as the BMA, who are urging him to move forward and get on with his job and do what he knows he has to do. Mr McCallister: Some strange and bizarre claims have been made today. Since Mr Hamilton is so good with election manifestos, will he consider reading his own party’s manifesto, as well as ours? The DUP’s 2005 manifesto states: “Northern Ireland has suffered from relative underfunding for decades. More than 20% extra spending per capita on health care is required to achieve the same level of service as England.” It is strange that the DUP has made such a turnaround. The DUP’s 2007 manifesto states that: “the Health Service in Northern Ireland has suffered from long-term under-funding relative to the rest of the UK.” The problem with the DUP’s finance and personnel spokesman, Mr Hamilton, contributing to the debate on health is that he is fixated with the money; that aspect is all that he knows. It is strange that in the House of Commons on 5 April 2005, a month before the general election, Mrs Robinson criticised the direct rule health budget increase of 9% as insufficient. Why is a 1·2% increase sufficient now? Mr Hamilton: Does the Member accept that the allocation in the draft Budget to health includes not only that increase, but much, much more for health? Mr McCallister: The increase will give the Minister of Health £16 million to develop new activities in the Health Service this year. Mrs Robinson quoted some figures on how much the Health Service spends each day and mentioned the Belfast trust; £16 million would not run the Health Service for two days. Mr Easton keeps bringing up the old chestnut that 48% of the draft Budget is to go on health provision. However, the Department’s portfolio covers health, social services and public safety — everything from doctors and nurses to the Fire and Rescue Service. Mrs I Robinson:It was £2 billion before that. Mr McCallister: You are on record as saying that that is not enough. Mrs I Robinson: And it is £4 billion now. Mr Speaker: Order. The Member has the Floor. Mr McCallister: The DUP has clearly distinguished between direct rule Ministers’ policies, which it criticised, and those of the proposed strategic health and social services authority. Its proposals differ little from those advocated under direct rule. However, the DUP suddenly wants to run with the direct rule Ministers’ proposals. Even Mr Hamilton said in his contribution that England was not a great model of financial efficiency to follow, so why does he wish to impose the same system here? The Labour Government in Britain have increased bureaucracy in the NHS enormously. In England, the average number of managers grew from 21,400 in 1997 to 30,900 in 2002. Central-function staff numbers there have increased from just under 61,000 to more than 72,000 in the same period. Most of the extra money that the Government have pumped into the NHS — money that is in no way matched in Northern Ireland — has gone on bureaucracy, consultants and administration. Experts consider — Mrs I Robinson: Will the Member give way? Mr McCallister: I will, if the Member is quick. Mrs I Robinson: I may have misunderstood the Member, but does he suggest that to pump more money into additional staff and management is the right direction in which to go? Mr Speaker: The Member, because he has taken two interventions, may speak for an extra minute. Mr McCallister: Thank you, Mr Speaker. I propose that we get the model right, because there is no point in our jumping headlong into something. As Dr Coulter has pointed out, it has already cost £140 million to create the strategic health and social services authority. Mrs I Robinson: You supported the Mr McCallister: Your party supported a 20% rise in its 2005 election manifesto, but it does not — [Interruption.] Mr Speaker: Order. The Member has the Floor. Mr McCallister: The Member’s party supported a 20% rise in its 2005 election manifesto, but it does not seem to trouble her much to go back on that promise. The way in which to handle the situation is to establish a plan for where our Health Service is headed. Everyone agrees that it needs to be reformed, and everyone agrees that that reform project is huge. I have every confidence that the Minister will deliver on a reform agenda. I know that the Chairperson of the Committee for Health, Social Services and Public Safety likes to engage in party political point scoring, but there is too big a job at hand for her to be doing that. The Committee should be working with — Mrs I Robinson: Will the Member give way? Mr McCallister: I have already given way to Mrs Robinson once, Mr Speaker. She is not as generous with her time when she is speaking. Mrs I Robinson: Nobody asked me to give way. Mr McCallister: Basil McCrea asked you to give way, and you refused. We must get Health Service reform right. The Minister is right to take his time and consult with people so that we might get the model that we want. Our view of healthcare is very different from that of the DUP. Mrs Robinson may think that the best way in which to deliver healthcare is to have one hospital in Belfast and have everyone drive to it — Mr Speaker: The Member’s time is almost up. Mr McCallister: Thank you, Mr Speaker. Mr Gallagher: I welcome this important debate on the reform of the Health Service. We must not allow political point scoring to distract us from that debate, because, as elected representatives, we are all aware of the demands that are placed on the Health Service, day and daily. We are also aware of the support that the Health Service needs in order for it to deliver. I wish to state an important fact about need. The Appleby Report pointed out that, although a differential did exist between here and GB, based on need, of 7%, that differential has now risen to 14%. That is an inescapable fact whether it occurs in the Department of Health, Social Services and Public Safety, the Department for Social Development, the Department of Finance and Personnel, or wherever. We all know that health professionals, carers and the service users have highlighted how they find the uncertainty that surrounds proposed Health Service structures confusing and worrying. We know that some of those problems have been inherited from the period of direct rule, but we know also that, as an Assembly, we must move on and deal with those issues, and establish plans and timetables as quickly as possible. 2.00 pm Important issues must be tackled, including the future of primary care and mental-health plans, the care of the elderly, and, not least, the morale of health workers. Morale is very low due to growing pressures, and because of delays in implementing the Agenda for Change programme. I draw Members’ attention to the situation in the Western Health and Social Care Trust area, where 99% of workers have gone through the job-matching process, yet 32% of them have still not received their pay award. In the Northern Health and Social Care Trust area, 20% of workers have still to receive their pay award, which is backdated to 2003. It is a disgrace that, at Christmas 2007, key workers still have not received their payments. I share the view that the Health Service is failing to satisfy the public because of some inefficiencies and the seemingly endless bureaucracy that many users encounter. Those matters must be addressed. As the motion states, reform of the Health Service must be “a matter of urgency” for the Assembly. I wish to turn to PFIs because, as we know, 10 new hospitals are in the pipeline under that process, and some of the tenders are at an advanced stage. The Enniskillen hospital is the pathfinder PFI project, and that is moving forward. We cannot afford to make mistakes, because we have seen them made elsewhere with PFI projects. Currently, there is not a Department-led, coherent approach to the handling of PFI initiatives. Mr Elliott: Will the Member agree that it would be most unfortunate if members of the Health Committee were to initiate a process in an attempt to stop progress on the hospital for the south-west, which is to be built at Enniskillen? Mr Gallagher: It would be most unfortunate were anyone to try to delay progress on that hospital. However, in reality, it is too late for delays. Progress is being made, but an inconsistent approach to such big undertakings has been adopted by the Department. That could prove very costly. For example, in the Western Health and Social Care Trust area, people and services are included in PFI tenders, and that has led to concerns about jobs and working conditions. In the Belfast Health and Social Care Trust area, there is an entirely different approach whereby people and services are not included in the tenders. There are important issues in respect of jobs and conditions, and people know what has happened in England, where some PFI projects have been disastrous and where private operators have been able to make savings by cutting design standards and by reducing bed numbers. All 10 of the new hospitals that are planned under PFI arrangements are crucial. The Department of Health must ensure that all the trusts adopt a common approach in order to avoid the mistakes that have been made elsewhere. Mr G Robinson: I pay tribute to Health Service staff, who carry out their duties in a professional and diligent way — sometimes at personal risk, as we have heard. Everyone in Northern Ireland should be grateful that such dedicated people work in the NHS. In the DUP’s 2007 manifesto, we committed ourselves to improving the Health Service in the Province. We knew that that would involve tackling the problems of understaffing, trolley waits, health promotion, illness prevention, addressing the needs of our longer-living population, services for the disabled, and, most of all, effective use of the available resources. The Health Minister seems to be unwilling to accept those aims, despite having almost half of the entire Northern Ireland Budget to spend. If more money were to be made available to the Minister, which Department does he suggest should take a cut in budget? Every Department faces financial challenges, and all Ministers are addressing problems in prioritising resources. All of them accept that there has to be a greater return for every £1 spent. For health, that will involve looking at innovative ways of carrying out treatments; greatly reducing the number of readmissions; tackling hospital-acquired infections such as MRSA; and adopting a more community-based approach to care. The best way to start the improvements that we all want in the NHS is by ensuring that there are enough well-trained, highly motivated staff with high morale to carry out patient care. As someone who, from personal experience, understands the need for a motivated workforce, I believe that we must address the current low morale of NHS staff. I am frequently told about that by NHS staff and it must be the starting point for all reforms of health provision. We acknowledge that all areas of public-sector funding in Northern Ireland have suffered; the Appleby Report confirmed that. Therefore it is essential that every £1 spent on the NHS produces the greatest possible benefit for the population. One way of achieving that is to move towards a Health Service delivery system that focuses on prevention rather than cure. The Minister should not be afraid of examining models in countries that have preventative rather than curative health service provision models for ideas on how our healthcare model can be reformed and adapted. I could give the Minister a long list of suggestions, but he may not want to hear them, and I have only a few minutes to speak. I ask him to examine the area of neurology urgently. Northern Ireland has a chronic shortage of neurologists, which needs to be addressed urgently because it affects those with long-term — and lifelong — health requirements who therefore have greater need of medical support and expertise. I am sure that the Assembly understands that any reforms proposed will be implemented in the mid- to long term. However, it is important that the Assembly hear the Minister’s vision for reform urgently. I support the motion. Mr Shannon: I congratulate my colleagues on tabling the motion. The issue is close to the hearts of many inside and outside the Chamber who want to hear what will happen to the Department of Health, Social Services and Public Safety. I contacted the Minister recently about a constituent of mine who suffered what could only be described as a nightmare hospital visit that lasted three days when it should have lasted one. She was left alone and frightened as she awaited treatment. The Minister, in his reply to me, agreed that that was unacceptable. Many cases have been publicised that detail, in precise and awful terms, the horrible experiences suffered by people due to glaring failures in our Health Service. In my constituency, patients bring blankets with them to keep warm while awaiting their appointments and tests in the outpatients’ department of the Ulster Hospital. That cannot be tolerated. I could tell many such stories; perhaps others could top them. However, no one here is under any illusion about the state of the healthcare system. Our system, despite having a talented workforce, doctors and surgeons, does not, sadly, provide what people need. Northern Ireland has the largest spend per head on healthcare, yet there are no real dividends from it. No one in the Chamber would argue against the case for reform; however, some will try to distract us from the fact that they are not pulling their weight or doing their job. The issue is not complex: there must be urgent reform. The Minister has been given half the money in the draft Budget, and it is the job of the Assembly to hold him accountable for spending it. The 51·5% represents £454 million of new money. A Member earlier mentioned the figure of £16 million: the actual figure is £454 million. The motion calls for actions instead of mere words, and it reminds the Minister that it is his job to introduce a reform Bill urgently and that it is the job of those elected to the Assembly to consider it. I was brought up on the simple phrase: if you are going to do something, do it right. I understand the Department’s desire to introduce a Bill that will change the system and have a positive effect on people’s lives. However, this reform was planned long before devolution day. My colleague Simon Hamilton has already mentioned the fact that the consultation and the start of this planned reform was in place as far back as 2005. At that time, the then, and current, leader of the Ulster Unionist Party stated that he wanted to see change. If he wants to see change, I suggest that now is the time to implement change. Initially, the Ulster Unionist Party fully supported change, yet as soon as a UUP Minister is in place, it is backtracking and saying that more time is needed. If anything, the need for change is even more urgent. Why is the Bamford Report at number 17 in the Health Service’s list of priorities? Mental health is important, and additional moneys have been allocated, but why is the Bamford Report not receiving — Mr McCallister: Will the Member detail some of the earlier health bids, or will he accept that those earlier bids concerned inescapables, which is why mental-health provision is priority number 17? Mr Shannon: I am not sure whether I thank the Member for his intervention, but I will respond to his comment. Mental-health provision is not an inescapable. We as a party put in an additional £450 million, and the bids must be addressed by that extra money. Why is that money not being used? I live in the real world, not in a world of rainbows and pots of gold. I would like to visit a world where time has slowed down and where excessive research is conducted that has no effect on people. There should be no delay; we want Health Service reform straight away. The British Medical Association has issued warnings and pleas to help the Department of Health, Social Services and Public Safety to realise that this situation cannot continue indefinitely. Mr Easton: Does the Member agree that, if the Minister restructured his budget bid more sensibly, he might be able to manage his resources? Mr Speaker: The Member is allowed an additional minute for taking two interventions. Mr Shannon: I thank the Member for his constructive comment; he is correct. Medical professionals are crying out for a change in the system that will enable them to utilise their skills and to do what they long to do — help people. Members also want to help people. It is the Minister’s responsibility to implement change and urgently issue a health and social services reform Bill before the system implodes and all the people of the Province suffer. I urge the Minister to tidy up his house and to put things in order. He must do this in a real-world timescale and not in the twilight zone in which some people seem to live. Not so long ago, the Ulster Unionist Party was complaining about a lack of legislative movement, only to discover that its own Minister is holding back what could possibly be one of the Province’s most important reforms. The situation would be laughable if it did not impact so seriously on the lives of our most vulnerable people. The Minister must introduce a motion for change, because we need reform, not empty words. He has the money — £450 million in additional money — and we ask him to do his job and allow Members to examine the Bill and so do our jobs. This is not a mere matter of numbers and data. Mr Speaker: The Member’s time is up. Mr Shannon: It is a matter of real life and death for some people. The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I shall do my best to respond to the points that Members have made. I am very clear about what I want from our health and social care system. It is what everyone wants: the best standard of treatment and care for all, delivered by motivated and highly skilled staff. Since I took up post in May 2007, I have been struck by two things: the dedication and commitment of our healthcare staff; and the vital need to transform the system within which they work. Five years ago, the review of public administration was hailed as one of the most radical reforms to public services in Northern Ireland in 30 years. The key aim of the RPA was to create a modern, accountable and effective system of public administration that would deliver high-quality public services to our citizens. Local government, education and, of course, healthcare structures were all set to be transformed for the better under the RPA. Five years later, Members are entitled to ask what has changed. The education system has four education and library boards, with plans to replace them and establish one education authority. Local government still comprises 26 councils, with as yet no apparent agreement on the final number of councils, which is a key feature of the work in which I am engaged. What about health? The RPA’s main proposals for health included: the establishment of a single health authority to replace the four boards and take on some Department and agency functions; a reduction in the number of health trusts; the establishment of one patient and client council to replace the five health and social care councils, and the creation of seven local commissioning groups tied to the proposed seven local councils, in line with the coterminosity that was regarded as important. 2.15 pm To date, and in sharp contrast to the lack of progress in other areas, the Department has been pushing ahead with the RPA reforms. In April this year, the number of trusts was reduced from 19 to six: five health and social care trusts and the Ambulance Service. Most staff are now working in the new organisations, and the trusts employ more than 50,000 of the 70,000 people who are employed in the health sector. I have informed staff of my decision that the current trust structures should remain largely as they are. However, the proposals for the establishment of a huge regional health authority caused me the greatest concern. The authority was to have 1,800 staff, a budget of well over £100 million and was set to become another large quango. As Minister, I want to examine further whether another administrative body, on top of the Department, trusts, and so forth, is required. In addition to the obvious question of the affordability of such a huge organisation, I want to be satisfied that any new structures will deliver my objectives and are robust enough to deal with current demands and future challenges. To do otherwise would be to fail the people of Northern Ireland. The authority, as proposed under direct rule, would be similar to the Health Service Executive in the Republic of Ireland, which has been the subject of much controversy and criticism due to its lack of accountability. One of the main objectives that the RPA was expected to deliver is democratic accountability, but where is the democratic accountability in an organisation that has no local representation? The direct rule proposal stipulated that the new authority would not have local representation. Other characteristics of the RPA include community responsiveness, equality, human rights and quality of services. Under the proposals, the current four health boards and four health and social care councils would be replaced by one patient and client council. Where is the accountability? Can one large organisation speak for patients from all over Northern Ireland? Surely it would be better to reinforce and strengthen the existing health boards and councils. I remain to be convinced that the excellent work being carried out on behalf of patients by the existing health councils would be improved |