northern ireland assembly Tuesday 15 April 2008 Ministerial Statements: Private Members’ Business: Adjournment: The Assembly met at 10.30 am (Mr Speaker in the Chair). Members observed two minutes’ silence. British-Irish Council Demography Sectoral Meeting Mr Speaker: I have received notice from the Minister for Employment and Learning that he wishes to make a statement on the outcome of the British-Irish Council demography sectoral meeting. The Minister for Employment and Learning (Sir Reg Empey): The first ministerial demographic sectoral meeting of the British-Irish Council (BIC) was held in Edinburgh on 31 March 2008. My statement will provide an outline of the meeting that has been agreed with junior Minister Kelly, who also attended. As Minister for Employment and Learning, with lead responsibility for migrant workers, I was delighted to attend the successful sectoral meeting, which provided an opportunity for useful discussion on a wide range of issues across Administrations. I am grateful to junior Minister Kelly for agreeing to be the accompanying Minister. As the Scottish Government are the lead Administration on demography in the Council, the Deputy First Minister and Cabinet Secretary for Health and Wellbeing for Scotland, Nicola Sturgeon MSP, hosted and chaired the meeting. The British Government were represented by the Secretary of State for Wales, the Rt Hon Paul Murphy MP. The Irish Government were represented by the Minister of State, Tom Kitt TD. The Welsh Assembly Government were represented by the First Minister, the Rt Hon Rhodri Morgan AM. The Northern Ireland Executive were represented by junior Minister Kelly and me. The Government of Guernsey were represented by the Deputy Minister for Commerce and Employment, Carla McNulty Bauer. The Isle of Man Government were represented by the Minister for Trade and Industry, D C Cretney MHK, and the Jersey Government by the Minister for Economic Development, Senator Philip Francis Cyril Ozouf. A series of four papers was considered: an update paper that outlined the demography work stream’s current progress; a paper that compared demographic trends and measures across the Administrations that participate in the British-Irish Council; a paper that compared migration trends and policies across those Administrations; and a paper that outlined possible projects to be included in the work stream in future. The Scottish Government presented the four papers. The first paper summarised the five meetings held so far. Topics covered at those meetings were urgent policies and research in the different Administrations and migration reform in the United Kingdom. Ministers approved the demography work stream’s progress, which includes the sharing of the different Administrations’ current policy and research information, as well as information on migration reform in the United Kingdom. The second paper specifically covered recent population-growth trends; population projections over the next 25 years; the current and projected age structures of the populations; life expectancy; fertility rates; and migration trends. All those were acknowledged by Ministers, who also discussed policy implications of those different demographic trends and measures. They agreed that the British-Irish Council demography sectoral group should develop further work plans on migration issues. The third paper set out the different migration trends experienced by the Administrations, their existing migration policies, and any planned changes to those policies. Ministers discussed the successes and lessons that have been learnt from the different policies in encouraging or constraining migration. A key point that was highlighted was the need for integration of migrant communities. The fourth paper outlined the group’s future plans, which include investigating healthy independent ageing, and its implications for the provision of care for the elderly; examining the effectiveness of policy interventions on demographic trends; investigating fertility trends and their implications; understanding the impacts of migration; and the implications of wider student flows among BIC member Administrations. Ministers also recognised the need for more reliable information on current and future trends to be made available, and they expressed a common aim of producing flexible migration policy to match job shortages. They proposed to progress work on the impact of opening the EU labour markets on flows of migrants to BIC member Administrations. Ministers supported in principle the plans set out in the paper and proposed the following work plans: understanding migration and its impact; healthy independent ageing; implications of wider student flows among BIC member administrations; investigating fertility trends; and examining the effectiveness of policy interventions on demographic trends. Ministers also suggested that comparisons with other countries be made. The Chairperson of the Committee for Employment and Learning (Ms S Ramsey): Go raibh maith agat. I thank the Minister for his statement. It is important that Members hear about the work of the British-Irish Council, especially its work on population trends. Migration, and its impact on the labour market, is a critical issue, and, as the Minister highlighted, that research must continue to inform policy. It is also extremely important that information be shared among participating Administrations. We can learn lessons from one other. The Minister mentioned a number of research work streams to which the participating Administrations have an input. Has anything unique to our experiences in the North emerged from the population research? Go raibh maith agat. Sir Reg Empey: I thank the Committee Chairperson for her questions. She asked whether there is anything unique in our experiences. Each Administration has different statistics, and one issue that was discussed at length — and Paul Murphy, who represented the United Kingdom Government, was a key player in this matter — is the need for accurate information. That is part of the difficulty. Given that people are entitled to benefits after living here for a year, at present, someone who comes to Northern Ireland from, for example, one of the A8 accession countries will probably register voluntarily in order to prove the length of time that they have been here. However, if that person were to leave before that year were out, there would be no record of their stay. The problem is that we do not know how many people we have. Therefore, we must first compile accurate statistics. Work has been done to try to establish how many people we have, because that has huge implications for future policy making. According to the statistics that we have for each Administration, our unique profile shows a population that is slightly younger than those of GB and some of the islands. As far as we can assess, we have greater inflows of migrants than some Administrations, but smaller inflows than others. Basically, the papers that were provided at the meeting contain tables that rank the different Administrations according to the inflows and outflows of population that they are believed to have. Moreover, an age profile of each population was tabulated, and that was used to anticipate, as I mentioned, a healthy ageing population and any care facilities that we will need in the future. Northern Ireland has a unique population footprint. However, that is accompanied by a health warning, because the statistics are anything but reliable. That is why we must make an effort to get better information. Mr Ross: First, immigration will have a huge impact on the student population in Northern Ireland. Will the Minister enlighten the Assembly on the ways in which further-education colleges and universities in other jurisdictions have coped with immigration? What guidance has he given to our further education colleges and universities to ensure that immigrant students have all the facilities that they require? Secondly, given reports — not least those from my constituency of East Antrim — that some migrant workers have been exploited, will the Minister outline what steps have been taken in other jurisdictions to ensure that such exploitation does not happen? What guidance has his Department given to employers in Northern Ireland to ensure that it does not happen here? Sir Reg Empey: The Member will have heard me refer to student flows within the Administrations. That is a matter of particular interest and concern in Northern Ireland. Members will be aware that the Department for Employment and Learning is proactive in trying to bring back some of the students that we lose. Between 25% and 30% of our students in full-time higher education attend institutions outside Northern Ireland, so it is a big issue for us. It is also a big issue for some of the other smaller Administrations whose choice of further and higher education is limited by their size. I assure the Member that I am particularly keen on further and higher education, because there is absolutely no doubt that we are haemorrhaging those who have the skills that we need. If, as a result of efforts that are made at the economic conference next month, the chief executive officers of companies seek to invest here, one concern will be whether we have people with the skills to do the work, or whether we can train them. Such a skills base will be one of the key elements in sustaining our economy in the future. Members have expressed their concerns in the Chamber on several occasions about employers exploiting migrant workers. They will know that we are introducing and strengthening measures to protect people’s rights. However, we must go back to basics first and establish who is here, the long term trends, and the implications for housing, health and shared resources. We must adopt a back-to-basics approach to ensure that the statistics are correct in the first place. 10.45 am Mr McClarty: I thank the Minister for his statement. Will he outline the areas considered by the working group on demography? Sir Reg Empey: Junior Minister Kelly and I returned from the meeting with a proposed work stream. Some issues are cross-cutting and, therefore, I have sent papers to Executive colleagues seeking their agreement. During the meeting, we made a commitment in principle only and made it clear that we wanted the approval of the Executive. If they agree, there will be four main areas under consideration. We must determine accurate numbers of those involved in each jurisdiction. It is important to anticipate the inflow and the outflow; it is a circulating process that will have huge implications for the labour market. We are relying on anecdotal evidence. Trends can change rapidly, and the biggest example of change in recent months has been the exchange rate. The euro has strengthened against the pound and, therefore, the financial advantage of working in Northern Ireland has decreased. I am sure that the Minister of Finance and Personnel will know that figure to three decimal points, but I think that it is approximately 17% or 18%. That has had a huge impact on earnings. Also, other economies are improving, and the Polish Government, among others, are trying to recover people. Incidentally, I notice that the Minister for Finance and Personnel did not outline the exact figure. We must examine healthy-ageing issues. In many of the jurisdictions, the number of older people is increasing, and, in some areas, the population is not replenishing itself. That has implications for future resources. What will happen to health and care services if people live longer? Scotland has suffered significant emigration in recent years, and the Scottish Administration have a policy to increase the population. Student flow is another area under consideration that has significant implications here. We must examine fertility trends because, if the population is not being replenished, that might have a major social and economic impact. How would business and industry survive without immigrant labour? All of those factors have a social implication downstream, and, to some extent, it is the elephant in the room, which Members are reluctant to discuss. However, there is no profit in not addressing these issues. If tensions were to develop because people were following the same scarce resources — be it housing or health services — then we could run into difficulties. An advantage of this work is that we can anticipate problems and plan to avoid them. Mr Attwood: I welcome the report of the first demography sectoral meeting of the BIC. As the Minister has outlined, the progress of this work will be important for the health of the population in all member states. My question, however, relates to the communiqué issued after the meeting. Under the heading “Demography Workstream Future Work Plan”, it states that Ministers: “proposed that work be progressed on the impact of opening of EU labour markets on flows of migrants to the BIC Member Administrations.” That is a healthy proposal. However, does the Minister acknowledge the tension between all member Administrations progressing that work and an individual Administration independently advancing proposals to deal with the flow of migrants into its state? For example, the Irish Government have introduced proposals — considered by some to be draconian in certain areas —on migrants entering the Republic of Ireland. Their proposals could adversely affect the operation of the border on this island. Does the Minister acknowledge that tension and the fact that the Republic of Ireland’s introduction of such proposals could have an impact on the work stream? Has the Minister had any conversations with the Irish Government about their proposals? Sir Reg Empey: I thank the Member for his question. He used the term “draconian” to describe the Irish Government’s proposals. The genesis of those proposals was the meeting of the BIC in this Building in July 2007. During a general discussion, the Scottish Administration and the Irish Government raised the issue of demography and migration trends. At that stage, it was clear, particularly from what the Irish Government representative Minister Micheál Martin said, that the Irish Government were greatly concerned about the implications of a future economic downturn. We must bear in mind that approximately 10% or 11% of the workforce in the Irish Republic is of non-Irish origin, and, therefore, migration is a huge issue. Members will know that when I met my counterparts at the beginning of the school term in September 2007, a significant case was highlighted: in a school that opened outside Dublin, every pupil was black. That had never happened before, and it was causing great concern. Since the summer of 2007, it has been clear that the Irish Government have major concerns. I take the Member’s point that the unilateral action of an Administration makes the work of the group more difficult. The Administrations agree to undertake the work together but, at the end of the day, each Administration is master of its own house. Thus, there is no binding requirement on Administrations to conform or to constrain their policies. However, the Member will be aware that in the first three months of 2008, some 28,000 jobs were lost in the Republic — the most rapid loss of jobs there in the past 30 years. That is having an impact and, reading between the lines, the Irish Government anticipated such a loss in the summer of 2007. They are greatly concerned about migrant labour because of the potential social tensions that it may create. I am acutely aware of the issues that the Member raised, and I briefly discussed the situation with Tom Kitt on the margins of the meeting. He gave a presentation, and, during the free-flowing discussion that followed, some of those issues emerged as matters of major concern. In Northern Ireland, approximately 5% of the workforce could be deemed to come from non-local backgrounds. Migrant workers make up more than twice that percentage of the workforce in the Republic. Members will appreciate, therefore, why it is such an important issue for the Irish Government. Ms Lo: I thank the Minister for his statement. I particularly welcome the work plan on understanding migration and its impact. It is important to get the facts and figures right, because there have been a number of conflicting research reports on the merits of migration. It is important that public-sector bodies are informed of those facts and figures so that migrant workers and their families are not made scapegoats for coming here. I remind the Minister that a very good report was produced in Northern Ireland through the Racial Equality Forum and its migrant workers thematic subgroup. I understand from the Minister’s previous statement that that report, which would contribute to the overall work plan, is with the Executive. Sir Reg Empey: I thank the Member for her contribution. I am aware of the forum’s work. One of the reasons why the demography group exists and why the Scottish Government — whose First Minister proposed it at the British-Irish Council last July — were so keen to lead it, is that all of the Administrations involved are concerned that migrant workers should not be made scapegoats. That is exactly what we do not want to happen. I take comfort from the fact that all the Administrations are discussing the issues, because there is no point in waiting until problems occur. The Member is correct in saying that that is why the information is needed. I want to outline some of the research and data-gathering issues that we are looking at, because it is important that that is done. Questions about public attitudes to, and perceptions of, migrant workers were included in the Northern Ireland omnibus survey and the Northern Ireland life and times survey, which have been published on my Department’s website. A contract has been awarded for a survey of migrant workers in Northern Ireland, to discover their experiences of employment, of settling in Northern Ireland and any indication of their intentions. In addition, the Department for Employment and Learning (DEL) plans to commission research on the impact of migrant workers on the economy and labour market in Northern Ireland. That is obviously a highly contentious issue, and recent reports will have drawn Members’ attention to that. The Northern Ireland Statistics and Research Agency, which is involved with the Office for National Statistics and is represented on various national committees, is represented on the migrant workers thematic subgroup, and so provides that subgroup with up-to-date information on national policy and processes regarding statistics and data sources. The Member can be assured that we are taking steps — independently and with others — to try and obtain that information. We are also trying to assess the experience of migrant workers and their families and analyse that experience from their point of view, to understand how they view their circumstances, and from that of others. We can make a sound judgement only when we have that information. Mr Newton: I thank the Minister for his statement. On learning that he was due to make the statement, I was sad enough to spend my time looking up the report from the ministerial meeting of the British-Irish Council on demography. I imagine that, given the content of the various reports, there will be a great clamour from members of the Committee for Employment and Learning to be represented at the next meeting of that group, when it is announced. Does the Minister share my concern and that of others that the figures in the statistical study of the population are out-of-date and inaccurate? The known extent of illegal entry into the UK is clouded by a great number of issues. Will the Minister comment on the implications that that will have for his Department’s ability to plan for further education and for solutions to skills shortages? 11.00 am Sir Reg Empey: I do not think that it is sad of a Member to look up details of the meeting of the ministerial demography group. Indeed, it is perfectly natural — what else would one do on a Sunday? I share the Member’s concerns. He has correctly identified the issue: we do not know for certain how many non-nationals there are in Northern Ireland. The rules of the European Union mean that non-nationals register only on a voluntary basis, to prove that they have been here for a year and are therefore entitled to claim benefits and so on if required. The Secretary of State for Wales, who was representing the British Government, was questioned for some time on the issue of illegal entry into the UK. It was clear that there is huge anxiety in Whitehall about that issue. Indeed, I detected a hardening of attitudes towards immigration, particularly from non-EU sources, and I believe that policies on that matter will become progressively more aggressive. To some extent, I perhaps missed a point that Mr Ross made earlier about the implications of immigration for further education and so on. My Department is being forced to spend substantially larger sums of money on, for example, teaching English as a second language. That is something that we cannot accurately budget for, because statistics do not exist. We simply rely on people turning up for such courses. That creates difficulties. In the past three years the amount of money that has been spent on such courses has increased from £300,000 to £1·5 million. We have had to spend that without the ability to accurately budget for it. The Minister of Finance tells us that we have to make plans and so on, but my Department is unable to do that because we simply do not know how many people are going to show up for those courses, which means that we have to basically pay in arrears. That is one of the weaknesses in the figures. I accept that the figures are out of date. The issue of illegal entry into Northern Ireland is of great concern — we simply do not know how many people have entered the country illegally. All of the evidence that has been produced nationally has consistently underestimated the number of illegal entrants. Governments are simply fooling themselves if they continue with such practices. We are going to make a genuine effort to improve the statistical information, for the obvious reasons that the Member identified. Ms Anderson: Go raibh maith agat, a Cheann Comhairle. I welcome the work of the BIC, and I am glad to hear that junior Minister Gerry Kelly attended the meeting and that he is establishing good relations with our Celtic cousins. Does the Minister agree that sharing our experiences and research with our Celtic neighbours on issues such as migrant workers benefits us all, particularly in ensuring that migrant workers are not exploited and paid less than the going rate? Furthermore, does he agree that the work of the Scottish Parliament, which is reflected in how it is performing, and about which we have all received positive information and reports, shows us what an Assembly can do when it has more control over its destiny and more powers? Sir Reg Empey: I thought that the Member was going to say that she was supporting Celtic Football Club, but she did not go that far. It is important to remember that the experience of the Scottish population in recent years has been different from ours. Scotland’s population has been falling for a number of years, and there has been a large outflow of people. The Scottish Government are attempting to reverse that trend. Unless the situation changes, the long-term economic implications are that Scotland’s economic productivity will decrease. The Scottish people sought devolution for a long time, and it is only natural that they want their Parliament to produce results. The Assembly should be mindful of that. All of us will need to raise our game and try to produce more results for our community. The issue of the exploitation of workers has been debated in the Chamber several times recently. Ms Anderson and other Members expressed concerns about that matter. The legal powers of the Department are being strengthened in order to deal with any employment agency or business that might try to exploit people. The Department for Employment and Learning now has the power to inspect the books of any employment agency or business. An inspector has been employed and is currently out in the field, visiting agencies or businesses at random, or following up complaints. The legal position is also changing — people can be taken to court and fined very heavily, or could have their licences suspended. I assure the Member that my Department will continue to take the issue of exploitation extremely seriously. He is not currently in the Chamber, but the Member for East Antrim Mr Sammy Wilson raised the issue of a migrant worker who was being exploited in rented accommodation. The Department now has the power to deal with cases in which employers require people who are seeking work to occupy certain accommodation. Workers can now withdraw from such contracts, and they must be informed in writing by employers that they have the right to do so. If Mr Wilson or any other Member has examples of — or concerns about — the maltreatment of workers, I would appreciate those being brought to my attention. Mr B McCrea: I thank the Minister for his statement, which was comprehensive and detailed. On behalf of the Northern Ireland Executive, does the Minister intend to follow the lead that has been set by the Scottish Executive with respect to encouraging immigration by highly skilled people — particularly graduates and people with specialist skills — who might boost the regional entrepreneurship of Northern Ireland? Sir Reg Empey: I thank the Member for his question. I have received a number of requests from employers for assistance in approaching the Home Office with regard to obtaining appropriate licences for certain workers to come to Northern Ireland. Requests were recently made to the Home Office on behalf of a meat plant to allow a number of Brazilian workers to work here. Some businesses tell us that they do not have enough graduates in certain disciplines or do not have enough people with certain skills at graduate or postgraduate level. As part of a departmental initiative, DEL representatives will attend a number of job fairs this year, initially in Great Britain. We will probably eventually attend job fairs in Dublin. That initiative is designed to encourage the private sector to co-operate with us. The Department will attend two job fairs in Scotland next month, together with representative of companies that are experiencing staff shortages. Those companies will be offering real jobs, and we will be attending student fairs in an effort to attract to Northern Ireland people whom employers are seeking. The Department will be supported in those efforts by a number of employment and recruitment agencies. The programme will be ongoing over the next year or two to see whether the problem can be fixed. However, I stress that it is coming at different ends of the labour market; there is no single pattern. It can arise owing to shortages in a meat plant or shortages of highly qualified researchers. It covers a broad range. In relation to entrepreneurship, several companies tell me that they would not be able to sustain and develop their businesses without the assistances of persons outwith our current labour force. Performance and Efficiency Delivery Unit (PEDU) Mr Speaker: I have received notice from the Minister of Finance and Personnel that he wishes to make a statement on details of the performance and efficiency delivery unit. The Minister of Finance and Personnel (Mr P Robinson): With permission, I wish to make a statement on the performance and efficiency delivery unit (PEDU). In particular, I want to take this opportunity to provide a little more detail on what PEDU will and will not do, but, first, let me reflect a little on the recent Programme for Government and Budget. (Mr Deputy Speaker [Mr Molloy] in the Chair) When I presented the new Executive’s first Budget to the Assembly in January 2008, I stressed two key themes. The first of those is efficiency. Instead of simply increasing the tax burden on households and businesses, we decided to help fund new priorities by becoming much more efficient. That gave householders welcome relief from snowballing rates bills, and it also offered the prospect of additional investment for new and improved public services. The second theme is delivery. The people of Northern Ireland pay their taxes in the expectation that their locally elected representatives will deliver a return on their investment in the form of visibly improved services. On many occasions in the past, people here had their taxes raised with promises of new or improved services. However, too frequently when the time came to see delivery, the public often failed to see an outcome that lived up to those earlier pledges. Ministers in this Executive must, and can, do better than that. The Programme for Government set out what the Executive have committed to achieve, and the Budget has put in place record levels of investment to support those targets. The challenge now for every Minister is to ensure delivery against our collective commitments. Our two themes of efficiency and delivery are central to the Budget and the Programme for Government and, as a result, they are also central to the work of PEDU. In effect, the Budget and the Programme for Government set out the mission statement for PEDU, asking it to have a twin focus of examining the scope for greater efficiencies, while also working with Departments to ensure that the funds allocated by the Executive deliver the improvements promised. That is no different to the current remit of my Department. However, by creating a single unit with a clear and undiluted focus, and by developing a new way of working with Departments, we can bring about transformational change in the delivery of public services and a totally new culture built upon a shared and relentless focus on delivering better-quality services for the people of Northern Ireland. The core approach of PEDU will be collaborative in nature, working with Departments and, through them, with the wider public sector to get the best public-service outcomes for our community. The approach will not be one of hindsight and negative criticism, but of working alongside Departments and agencies, in real time, to enhance public-service provision. That is not to say, however, that the journey will always be easy. Such an approach requires honest and open acknowledgement of problems, and no doubt robust discussions about the best way forward, but that will be in the clear context of a shared desire to improve performance, and not one of protecting established working practices and fiefdoms. In relation to detail at an operational level, the work of PEDU will, by and large, fall into two broad categories: work focusing on identifying and tackling poor performance and delivery; and reviews focused on tackling inefficiency and releasing resources. I will give a flavour of what that will involve. 11.15 am Concerning the unit’s work on delivery, there will be a link into the Programme for Government’s monitoring arrangements. Therefore, for example, if that monitoring system were to indicate that a particular public service was not on track to meet the Executive’s targets in the Programme for Government, PEDU could investigate the matter by working with the relevant Department, or Departments. In such a case, PEDU’s approach would involve consideration of quantitative and qualitative information to detect the source of performance shortcomings. In collaboration with the relevant Departments, the unit would then seek to identify actions to address the problem and bring delivery back on track. Incidentally, it is worth recognising that, in many cases, as a by-product of improved delivery, efficiency and productivity will also improve. Ultimately, therefore, as funding is better and more quickly translated into additional and better outputs, resources will be used more efficiently. On the other hand, a review that focuses exclusively on efficiency is likely to have a somewhat different objective. In that case, the review’s intention should be to identify operational efficiencies in processes and organisations by using data analysis or by benchmarking with comparable service providers. Such a review might be employed, for example, in circumstances in which a merger of organisations failed to yield the anticipated benefits, or, perhaps, if a spend-to-save initiative had spent the money but not delivered the savings. Some people might consider a PEDU review as a threat. Let me be clear; the only threat will be to inefficiency and poor performance. Those who care about public services — and I am sure that all my Executive colleagues are in that group — will welcome PEDU’s involvement. No matter what circumstances lead to PEDU’s involvement, the unit will work in co-operation with those responsible for service delivery in the Department or agency in question. That spirit of partnership will be vital in the quest to identify and overcome barriers to delivering improved public services. In essence the Executive, the Assembly and the public simply want good-quality, well-run public services. Ultimately, PEDU will be there to help Departments get services working in the desired manner, deliver what was promised and, in doing so, provide taxpayers with value for money. It would be unwise to expect instant success on delivery forged as a result of an overnight switch throughout public services to a performance culture. In reality, such a change will not be plain sailing, and will demand much effort and persistence. However, in addition to hard work and dedication, such change will undoubtedly require Members, as public representatives, to contemplate radical options to make tough decisions and to take positive action to deliver public services in the manner promised in the Programme for Government. I have established a ministerial advisory panel to assist in our mission of reaching a point at which all Government’s tools are focused on maximising performance and delivering better services. The small group of individuals on that panel will offer the benefit of their insight and experience in delivering significant improvements in large organisations, overseeing organisational change and driving improvements in performance and efficiency. Authoritative, independent perspectives are always beneficial — particularly if problems are persistent, radical change is required and vested interests are rife. In respect of the panel’s composition, I shall avoid being dogmatic about the number of members, the panel’s duration etc. Undoubtedly, as we seek to create a new performance culture, the panel will be most beneficial in the short-to-medium term. Furthermore, I wish to avoid a situation arising in which I might have to forgo an outstanding individual’s services just because the set number of positions are already filled. Bearing those points in mind, I have already secured the involvement of Sir Michael Barber, Frank Cushnahan and Dennis Licence as members of the ministerial advisory panel. They are outstanding individuals, with significant experience and credibility in driving step changes in performance in a variety of organisations at local, national and international levels. Sir Michael Barber, now with McKinsey and Company, is a leading expert on public-service delivery, and is probably best known for establishing and leading Tony Blair’s Prime Minister’s delivery unit between 2001 and 2005. That unit had much success in getting the Government machine in Whitehall to focus on delivery. Sir Michael will provide his support as part of a small McKinsey and Co team. Frank Cushnahan, a corporate banker by profession, is known to many Members. He is a former chairman of the Belfast Harbour Commissioners, and he spent eight years overseeing a period of change and strong growth in our largest seaport. In addition, Frank brings significant financial and commercial experience, gained in the banking sector. Moreover, he has led a number of public assignments to restructure a range of organisations and industries. I have asked Frank to chair the advisory panel. Dennis Licence is the chairman of a local accountancy practice. He retired as managing director of the First Trust Bank in 2005 after a long career in banking, during which he held several senior positions. Dennis understands consultancy work and specialises in business restructuring and development, human resource management and strategic development. He has served in a range of other positions, including being a fellow of the Chartered Institute of Marketing, chairman of Business in the Community and president of the Employers’ Forum on Disability. PEDU is located in the Department of Finance and Personnel (DFP), and it will be led by Richard Pengelly, one of my senior departmental officials. Thus, it will combine public finance skills and expertise with significant knowledge of the outputs promised by Departments when they bid for resources during the recent Budget process. He will lead a small team of PEDU staff, some of whom are already in place. That core team will be supplemented by additional staff on short-term assignments, who bring with them expertise on the particular area under review at the time, or who have specific skills in areas such as organisational audit and review. In some cases, that will include front-line professional staff, whose experiences and insights are particularly valuable, as well as individuals from beyond the public sector. The head of the unit will report directly to me and through me, as Minister of Finance and Personnel, to the Executive. It is right that PEDU should report to the Executive, because delivery of the Executive’s Programme for Government is at stake. If a key target is in danger of being missed, the Executive not only need to know about it but they require the tools to take direct action to deal with the problems and get delivery back on track. As a result, PEDU will focus particularly on the Executive’s priorities and, where funding is not translating into the desired outcomes, the Executive can use PEDU as a means to take direct action to identify problems and implement solutions. Where will the early focus of PEDU be directed? The unit will be keen to determine whether the key initiatives set out in the Programme for Government have robust delivery plans that are designed to convert funding into results. That should help to establish whether any of our key initiatives are in need of assistance at this early stage. We already know that the economy is the Executive’s top priority — and rightly so — which often leads me to ask what actions we could take quickly to facilitate economic growth. Planning is a key enabler of such growth, and although that often leads to debates over planning policy, we should not forget that a good-quality planning process is also beneficial. Long-drawn-out processes can increase holding costs and uncertainty and, ultimately, only delay compliant projects. The Minister of the Environment and I believe that we can, and should, improve on performance in that area. That is only one area of concern: undoubtedly, there will be others. In my Department, I am aware of the concerns expressed by the Committee for Finance and Personnel and other public representatives about the increase in the level of rates arrears and the uptake of housing benefit, particularly among owner-occupiers. In response, I could highlight the challenges faced by the new Land and Property Services agency over the past 18 months in the introduction of the new domestic rating system. However, rather than review the past, I have required the agency to put in place a clear recovery plan, designed to ensure measurable improvements over the next 18 months, and I seek reassurance that the LPS is getting the support it needs to deliver from other parts of my Department. Therefore, I have asked PEDU to work with the Land and Property Services in DFP to ensure that there is an action plan and timetable in place to deal with those problems. In other Departments and public bodies we should not expect everything in the Programme for Government to be delivered with ease. If that were the case, I could only conclude that we had failed to set the bar high enough at the beginning. In progressing, some areas will struggle. With PEDU in place, the Executive should be better placed to identify who is struggling and be better positioned to do something about it. When the Executive’s agreed Budget was announced in January, I paid tribute to the constructive approach taken by my ministerial colleagues, which had allowed agreement to be reached on financial allocations to Departments for the next three years. Agreeing and announcing plans, programmes and budgets was relatively easy. The Executive now face the challenge of delivering on their commitments and on their shared ambition to make Northern Ireland a better place for all citizens. We must not fool ourselves, or attempt to fool others, that delivering the changes needed to make public services more efficient and more focused on the needs of our community will be easy. There will be resistance to change and to making change quickly. I believe firmly that the Executive can deliver on their commitments in the Programme for Government if they can create and maintain a clear and urgent focus on delivering on our shared commitments to the people of Northern Ireland. The creation of the performance and efficiency delivery unit provides a clear signal that this is our priority and our ambition for the future. Some Members: Hear, hear. 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 Finance Committee has had periodic updates on the progress of the proposition, which has been well signalled. The Committee appreciates the additional information presented by the Minister. Members will be interested in how PEDU’s success will be measured and the targets that will be set for it. PEDU’s accountability and reporting arrangements will also be of interest — how will the Assembly’s scrutiny role be factored into those arrangements? Will the Minister indicate what protocols have been established to ensure positive relationships between PEDU and Departments, and whether those include potential incentives for Departments to co-operate? How will he ensure that PEDU will not contradict or encroach upon the work of the Audit Office or DFP supply? Go raibh maith agat. Mr P Robinson: I thank the Chairperson for his questions. The answer to the first question is difficult in that the only measure of PEDU’s success will be the delivery of the Programme for Government. I envisage that from this moment on, PEDU will fade into the background in a public sense. Its role is to collaborate with Departments. It is not there to say “PEDU has arrived”. PEDU is not the story. The story will be the delivery of the Programme for Government and the achievements of various targets set by Ministers. Success will probably best be determined by Ministers at an Executive level, because they will have seen the assistance that has been given behind the scenes. Regarding the reporting role, I have indicated that PEDU will report directly to me. It will be based at my departmental headquarters; it will report to the Executive through me, and because this concerns the delivery of the Executive’s Programme for Government, I expect to be updating the Executive on the work of PEDU on a fairly regular basis. The Committee’s role will be important. It will have the opportunity at any stage to raise issues about the work of PEDU, and perhaps the Committee for the Office of the First Minister and deputy First Minister may also be taking an interest as this is about the delivery of the Programme for Government. Committees as a whole may want to have a role in drawing the attention of PEDU to issues within their Departments where they think that it can be of assistance. 11.30 am It is an incentive for everyone to have better performance, efficiency and delivery; that is the ultimate goal. We are here to serve the community, to deliver its aspirations and to deliver on the programme to which we have committed ourselves. The incentive, therefore, is the delivery of that programme, and it is hoped that an aspiration to raise their game will be at the forefront of every Department’s mind. It is for that reason that I have volunteered an area of activity from my Department that I want PEDU to examine. I believe that PEDU can do a useful task, and, to that end, I will give colleagues a lead. I remember that the Member for East Londonderry Mr Dallat put down a question for oral answer about how the Audit Office might become more involved in the running of schemes and programmes, and he followed up that question on several occasions. In response, I said that it was not appropriate, because the Audit Office’s role comprised being able to stand back and look at outcomes impartially and independently. If the Audit Office were to be involved at the early stage of a scheme, it would be part of the end problem. PEDU, however, will be involved throughout the process in real time, as I said in my statement. That is the distinction between the two roles. The Audit Office role will not be affected, but since PEDU will intervene in the early stage of a scheme or programme, it is hoped that there will be less for the Audit Office to be critical about. Mr Storey: I thank the Minister for his statement. What budget has been allocated to PEDU? Has that money been allocated from the DFP budget, or have other Departments contributed? The Department must ensure that PEDU does not add to the structures of bureaucracy that exist in a system that is, already, bureaucratic. Has the Minister set a time limit, after which the effectiveness of PEDU will be reviewed? Given that there has been a delay, when does the Minister envisage that PEDU will commence meaningful work from which the Assembly will see results? Mr P Robinson: PEDU has a budget of approximately £0·5 million, which comes from DFP’s resources. We are not, therefore, seeking additional funding for its operation; its budget came about as a reallocation within the Department. I will be pleased if other Departments want to make contributions, but I am sure that it will be difficult to prise resources from them. I assure the Member that increasing bureaucracy is the last thing that PEDU will do. The function of PEDU already exists in my Department; DFP is not merely taking on some new role and authority. We have the power to do all those things, but it is important that we have a more focused and dedicated unit to deal with the issues. Therefore, I do not believe that we have increased bureaucracy. We are going through the three-year cycle for the Programme for Government, and at the end of that period, I am sure that the Assembly will want to examine how effective PEDU has been and take decisions at that stage. That would seem to be an appropriate time in which to see the unit’s worth within the overall structure. Mr Storey mentioned delays; I do not recognise delays. As I said previously, the unit has been set up, and it has started work. It is working with OFMDFM on the monitoring arrangements so that we can fit in properly to whatever role is there. I have mentioned some of the early areas that we are going to look at — planning and the Land and Property Services — so we are in business. Mr Beggs: I concur with the Minister who, in his statement today, indicated that a spirit of partnership will be vital for PEDU to achieve a successful outcome. PEDU has been developed from the Prime Minister’s delivery unit (PMDU), and successful aspects of that unit included working with delivery bodies to seek to improve efficiency and delivery, rather than holding Departments and other bodies to account. Given the non-voluntary aspects of the model that have been outlined by the Minister, how can he be certain that PEDU and the Departments will work in partnership successfully? Mr P Robinson: To some extent the Member is right; PEDU is a development of Tony Blair’s PMDU and, indeed, we have been fortunate to have had the head of Tony Blair’s delivery unit, Sir Michael Barbour, involved in our unit. One of the values of Sir Michael’s involvement will be that he will bring the protocols that operated in the delivery unit in the UK as a whole to our system here in Northern Ireland. If anyone wants to read more about that issue, Sir Michael has written a book on his experiences as head of PMDU, which is worth reading, and I am sure that the Library either has a copy or will get one very quickly. Sir Michael Barbour adopted a collaborative partnership approach; going into the Departments not to expose them or show them up but on the basis that whatever credit came from better performance by a Department would remain in that Department. Again, the story was not about the delivery unit itself, and there is a need to understand that. In the early stages, I know there will be — in fact there already has been — concern among officials about PEDU coming into their Departments like storm troopers, causing havoc all around as they lift every stone to see what is underneath it. That is not the role that PEDU will have, and the more that PEDU works in the system, the more collaborative partnerships and working relationships will be created. I hope that Departments will not see PEDU as something that they should fear, but rather as something that they will want to work with in their desire to have better performance, efficiency and delivery. Mr O’Loan: I thank the Minister for his substantial statement and I assure him of my full support for the initiative. I note and support the initial steps and areas of inquiry, including the planning system and rate arrears that he referred to in his statement. I encourage Ministers to join in this collaborative effort. The Minister referred to the role of political representatives, and I take this opportunity to congratulate him on his election as leader designate of the Democratic Unionist Party, an important role within our political system that, among other things, will give him an opportunity to further the ends referred to in his statement. As regards the Minister’s comments on radical options, tough decisions, and the role of political representatives therein, does he agree that there is not enough awareness of opportunity costs in our political system? There is an assumption that if resources are put to a good end, that is necessarily a good thing. However, every pound spent in one way forgoes the opportunity to spend it in another. The task is to spend that pound in the most efficient and effective manner. Will the Minister comment on whether he thinks that that would call for a significant change in our political culture? Mr P Robinson: First, I thank the Member for his good wishes — I think. I also thank him for his support for the work of PEDU. I emphasise that when I chose planning and the Land and Property Services as areas that PEDU might want to look at, there was no implication or criticism contained in that choice. However, it is recognised that they have an important role to play in meeting the targets that the Executive have set. If we were to ask PEDU to work on various areas, we would not want the people who work in those areas to think that that is being done because they are doing a bad job. PEDU will do that work because those people have a major role to play in ensuring that the targets that the Executive have set are reached. Mr O’Loan a Member for North Antrim mentioned tough decisions. Such decisions may have to be made if the targets that the Executive have set in the Programme for Government are not being met. One of those decisions might be that more funds are required, which may mean that a reallocation of resources around the Executive is necessary to achieve those targets. We will have to make those types of tough decisions, including those on the opportunity costs to which the Member referred. The reality of public-funding allocation is that when money is allocated to one source of activity, it is denied to another. That is why I get a little impatient when Departments do not spend the funds that they have been allocated. That leads to underspend and to people in other areas of activity being frustrated. Those people ask what they could have done with the millions of pounds that a Department has not spent. Opportunity costs are important, and one critical area to consider is whether best value is being achieved for all the money that is spent in the public sector. That is the imperative that the business cases that are required for significant projects must take into consideration. Dr Farry: I also congratulate the Minister on receiving the endorsement of his party colleagues yesterday. I wish him well in whatever challenges the future may hold. On behalf of the opposition, I welcome the creation of PEDU. [Laughter.] Hopefully, that means that the unit has unanimous support in the House as being a good and welcome initiative. Before Easter, my party colleagues and I had a constructive meeting with the Minister on the Deloitte report on the cost of division and the wider challenges that are involved with that issue. Recently, the issue was highlighted further by the BBC ‘Panorama’ programme, which brought it to the attention of a UK national audience. How does the Minister envisage that the cost of division will be addressed through the good offices of PEDU? Does he envisage any particular challenges or targets being thrown down to Departments during the 2008-11 Budget period? Mr P Robinson: I thank the Member for his kind remarks and for his support for the delivery unit. I said that one of the two key roles of PEDU is ensuring efficiency. If funds are being wasted and squandered because of the cost of division, PEDU will want to deal with that. It is too early for PEDU to identify the areas that it will deal with, but it is within the unit’s remit to consider what savings can be made. Efficiency is one of the key areas of activity for the performance and efficiency delivery unit. Mr Weir: I thank the Minister for his statement. I welcome the appointment of what he referred to as outstanding individuals with a high level of experience and talent. However, I wonder whether he would been better off hiring Mr Farry, who clearly feels that he could do the entire job on his own. That would have been much more cost-effective. Several Members mentioned the attitudes of other Departments. Does the Minister have any concerns about the level of co-operation or resistance that PEDU will receive from other Departments? What role, if any, does he see for the statutory Departments in contributing to the process of PEDU? 11.45 am Mr P Robinson: Does the Member mean statutory Committees? Mr Weir: Yes. Mr P Robinson: First, I am not going to get in to the North Down thing. [Laughter.] We already have Mr Farry’s services; he will have a role as a member of the Finance Committee, and, therefore, we will benefit from his wisdom at no additional cost. If I were a departmental official, I would be reluctant to resist PEDU’s involvement because, to some extent, it would expose me as someone who was opposed to improved performance, efficiency and delivery. If I were Minister of a Department where officials were unhappy about PEDU’s being involved, I would be asking what they were trying to hide, and I would be all the more enthusiastic to get PEDU involved. I do not think that departmental officials will show that kind of resistance. If officials have to meet targets for their Ministers, and they feel that there is a major task involved, they will want the assistance of PEDU — particularly if they think that they will need some additional resources. That will be a test, and that will be the message that we will get back. Obviously, the Finance Committee will play a key role in continuing to monitor PEDU’s work. However, Committees will be intimately involved in the operation of their own Departments, closely examining where their strengths and weaknesses lie. Committees will see those before many others will. Therefore, if a Committee feels that its Department is underperforming in a particular area, it can call on PEDU for intervention and support. I, along with my Department and PEDU, will take that very seriously. Ms J McCann: Go raibh maith, a LeasCheann Comhairle. Does the Minister share the concern that because PEDU’s main focus will be on efficiency-savings targets, Departments will be forced to cut front-line services for the community? Whenever Departments are told to introduce efficiency savings, services are cut, and that can impact on the local community. How will the Minister seek to alleviate that? Mr P Robinson: As the name implies, the purpose of PEDU is to improve performance and efficiency and to deliver better services on the ground. Therefore, my focus is on ensuring that the end consumer gets a better deal and a better service. The purpose of PEDU is not to reduce services but to get better services for the community. No part of today’s presentation has been about reducing front-line services. In fact, it has been quite the opposite — we want to ensure that money is not wasted on bureaucracy but rather that it goes to improving front-line services for the people who need them most. Mr Hamilton: Like others, I welcome the creation of PEDU. I particularly welcome the securing of Sir Michael Barber’s services. I am sure that PEDU will benefit from his expertise, as he pioneered the Prime Minister’s delivery unit. It is likely that some Ministers may be concerned that PEDU will take over various functions and, almost, start running Departments. The Minister has admitted that there is likely to be some resistance in the system. How will PEDU affect, or not affect, departmental responsibility? Mr P Robinson: I join my colleague in welcoming the fact that PEDU has secured Sir Michael Barber’s services. He has a high profile and possesses a proven track record, which gives people confidence and adds credibility to the unit. However, the other two individuals whom I have asked to be part of the advisory panel, Frank Cushnahan and Dennis Licence, also come with considerable reputations. They will bring a great deal of experience to the advisory panel, and that experience will ultimately benefit the unit. Assuming the responsibility for running a Department is the last thing that PEDU will want to do. Let me be clear: there is to be no change in departmental authority. Ministers have the same responsibility for their Departments today that they had yesterday — PEDU does not interfere with ministerial authority at all. Rather, it will be an instrument that Ministers can use in order to improve departmental performance. Ministers, more than anyone else, will look to PEDU to assist them in the long term, particularly if improvements are required in their Departments. Ministerial control is to be as it always has been; neither PEDU nor the Department of Finance and Personnel has assumed additional functions. DFP already has the authority to do everything that it asks PEDU to do. Mr Cree: I thank the Minister for dealing with this important issue. Will he tell the House how the Strategic Investment Board’s work, as well as the unique role that it plays in Departments, will be monitored? What use will be made of modern management techniques, such as total quality management or continuous improvement? Mr P Robinson: Were OFMFDM to ask PEDU to do so, Strategic Investment Board’s (SIB) activities would be something that it could also consider. No strand of Government has a fence built around it to indicate that PEDU should stay away. PEDU’s role is to examine the performance and efficiency of any area of Government — SIB is not exempt. Moreover, PEDU will use all available management techniques. As I said earlier, Richard Pengelly will lead the unit. Anyone who knows Richard will be aware that he is a most competent official, who has the added advantage of having been intimately involved at every stage of the Budget process. He knows what Ministers and officials promised they would deliver when they sought moneys. Therefore, he is ideally placed to ensure that they deliver on those promises. Mr McQuillan: I join others in welcoming the Minister’s statement, and I thank him for making it. How will PEDU determine areas of activity for examination? Mr P Robinson: Several different mechanisms will probably be employed to determine the subjects that PEDU will explore, some of which we have discussed already. One that will be used is OFMDFM’s target-tracking mechanism. If one of the Executive’s Programme for Government priorities is not being met, PEDU will be involved in getting it back on track. If a Minister, believing that it will be beneficial, requests PEDU’s assistance, the Department of Finance and Personnel may be able to identify, using DFP Supply processes, where PEDU involvement might help. I have already spoken about the role that the Committees could play. However, if problems are identified and if help is sought, PEDU will be available to give support. Mrs I Robinson: I also welcome the Minister’s statement. One issue to consider is that old habits die hard in the Civil Service and in Departments. That is particularly the case in the Department of Health, Social Services and Public Safety where, as I am sure the Minister knows, several efficiency savings regarding Health Service staff must be made. There is a mentality of empire building in the way in which Departments are managed. What can PEDU do to help break that mindset — if that terminology is appropriate — to allow for appropriate staffing in the Health Service and to ensure that it is staffed by front-line professionals rather than by management? Mr P Robinson: I am truly glad that I have the support of the Member on this issue. [Laughter.] Through the creation of PEDU, we are attempting to create a new culture of performance and delivery in public services. Speaking from my own experience in local government, so that I do not appear to be pointing the finger at any Department, I know that local government was seen simply as a service whereby money was given to every job in order to ensure that it got done. There were no real criteria to measure whether the public was getting best value for money. Only more recently has the concept of value for money come to the fore in the delivery of local government services. We are the custodians of the public purse. It is not our money that is being spent; we are spending hard-earned taxes and rates. We, therefore, have a massive responsibility to ensure that when we are spending that money, we are spending it wisely. We must also ensure that we are getting the best value for that money and that when people give us their money, we deliver the services that they expect. Given that people have invested in our public services, we must ensure that we deliver the best services for that. PEDU will attempt to change the culture in Departments so that they perform better and so that we have an efficient, timely delivery of public services. Cancelled Clinics Mr Deputy Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. All other Members who are called to speak will have five minutes. One amendment has been selected and published on the Marshalled List. The proposer of the amendment will have 10 minutes to propose and five minutes to make a winding-up speech. Mr Easton: I beg to move That this Assembly calls on the Minister of Health, Social Service and Public Safety to introduce measures to reduce the cancellation level of outpatient clinics. It should be clear by now to all of us who are charged with political responsibility in Northern Ireland that we face difficult times. The looming financial crisis will require us to be effective and industrious in the way in which we do our business in future. The failure of the Prime Minister, Mr Brown, to address the wrongs of the past through his delivery of an inadequate package to finance infrastructural support will create problems for the delivery of central services to the public. The havoc that was wreaked on our community by terrorists and terrorism during the past 40 years resulted — to the detriment of our physical infrastructure — in a large proportion of available finances being spent on security. Money that should have been spent on hospitals, schools and the physical infrastructure was siphoned away to pay for the security bill. We are now left to pick up the pieces, and we are required to respond to many public demands while being burdened with a significant infrastructural deficit and finite resources. It is, therefore, incumbent on all Members to ensure that every penny is spent wisely. We must look at every budget and item of expenditure to ensure that we are getting value for money without a penny having been wasted. The budget for the Department of Health, Social Services and Public Safety is a significant proportion of the total Northern Ireland Budget, and we need to be sure that there will be no waste or inefficiencies. In an attempt to make the best use of our available resources, we also need to ensure that no area of expenditure is being left unvisited. In that context, Members will know that the level of cancelled clinics requires urgent and radical appraisal. Across the trusts in 2003-04, there were 13,065 cancelled clinics; in 2004-05, there were 13,995; in 2005-06, 14,771; and almost 14,000 in 2006-07. The did-not-attend rate for patients in Northern Ireland in 2006-07 was 11·4%. In England the rate for the same period was 10·8%. 12.00 noon I draw the attention of Members to the amount of money that is spent on using independent-sector providers to reduce outpatient waiting times. In 2005-06, the figure was over £400,000, which jumped to over £6 million in 2006-07. In 2006-07, 43,319 people were seen by the independent sector, and a further 22,417 people were seen in the 2007-08 period. Those people should, and would, have been seen in the Health Service if it were not for the level of cancelled outpatient clinics. Independent-sector providers were used to achieve a welcome and substantial reduction in waiting times, and the Minister and his Department should be congratulated for that — there is nothing worse than waiting for treatment in the knowledge that a date for an appointment cannot be found in the near future. However, such use of the private sector is similar to robbing Peter to pay Paul or applying a sticking plaster when surgery is required. Subsidising the private sector in that way is an admission that an important aspect of our clinical arrangements requires an immediate and comprehensive overhaul. The crisis in the outpatient waiting times would not have arisen if the problem of cancelled clinics had been properly addressed. The money that is spent on reducing waiting lists through the outsourcing of work to the private sector could be more effectively employed in other areas. In each of the past four years, approximately 48,000 new referrals did not attend their outpatient appointments as scheduled. A new referral is the first — in some cases the only — attendance at a consultant’s outpatient clinic in a hospital. In the same four years, approximately three times that number of consultant-initiated appointments were missed by patients who did not give any notice to the hospital. On average, there were 200,000 appointments each year in which the patient did not turn up, and the real figure could be as high as 390,000. A 4% reduction over a four-year period cannot be considered encouraging. All of that represents an enormous failure in the system and is totally unacceptable. The potential efficiency savings are considerable, and expensive temporary solutions will disguise the problem without dealing with the root cause. There is also the cost in human terms for nursing and medical-records staff when people fail to turn up without warning, the consequent increase in waiting lists when operations or procedures are postponed. There are some obvious changes that consultants and other medical staff could make. They should be required to find cover if they go on leave, and no leave should be granted if cover is not found. Clinics should be able to proceed in the absence of a consultant if a senior registrar or another consultant is present to cover. More efficient management of time is required, with flexibility built into the system, perhaps through more evening and weekend clinics that afford more choice for patients. That happens already, but more flexibility is required. Medical professionals should be discouraged from taking study leave during clinical time, and it should happen only when consultants have no outpatient clinics. Consultants have an important role to play, and they must be forced to deliver. Ultimately, however, responsibility must be placed on those who abuse the system, and we should consider the penalties that can be applied to discourage irresponsible behaviour by those seeking treatment. Sanctions on those who fail to attend a second appointment could be applied — two strikes and they are out. In any event, a root-and-branch review of every aspect of the appointment system is required until the problem is brought under control. I call on the Minister of Health, Social Services and Public Safety to introduce measures that reduce the level of cancellations in outpatient-clinic appointments, which would create efficiency savings with no reliance on the private sector. Ms S Ramsey: I beg to move the following amendment: At end insert “; and further calls for a holistic, patient-centred approach from the Minister and his department to tackle waiting lists.” Go raibh maith agat, a LeasCheann Comhairle. I thank the Members who brought the motion to the House for debate. The Assembly, the Health Committee, the Minister and his Department must get involved in this important issue in order to tackle waiting lists and the level of cancelled clinics. Waiting lists are a concern for everyone in one way or another. As community activists, elected representatives and family members, we can all highlight cases of cancelled clinics or long waiting times for appointments. Whether clinics are cancelled or patients fail to show up, waiting lists are, and will continue to be, a problem for the Health Service. More importantly, unless we get serious and try to sort out the situation, they will continue to cost millions of pounds a year. Some figures have been mentioned, and I do not propose to go over them again. I want to thank the Minister for attending the debate. I hope that he tells Members, in simple terms, how he and the Department propose to tackle the issue of cancelled clinics. In fairness — and I know that Alex Easton has mentioned it — we know that the Minister is doing some positive work. However, I suspect that he has many more pressing Health Service issues to deal with than identifying and using money and resources wasted because of cancelled clinics or non-attending patients. I accept that there are a number of reasons for this, which I will come back to later. I have looked at some of the information relating to cancelled clinics and read the excellent report published by the Public Accounts Committee (PAC), which highlighted a number of reasons for cancellation. However, while we support the motion’s call for the Minister to introduce measures to reduce the number of cancelled clinics, we felt that a patient-centred approach was needed. The PAC report states that in 2005-06, £259 million was spent on outpatient services in the North. The PAC blames inefficiencies on non-attendance and the trusts’ cancellation of clinics, both of which waste resources and lead to increased waiting times for other patients. That is why I propose the amendment. A holistic, patient-centred approach to the issue is key. Scotland’s new approach to its waiting lists and non-attendance is a patient-focused system of booking appointments that puts users at the heart of a dialogue process. At the outset, patients are sent a letter acknowledging their referral. As the patient nears the top of the waiting list they receive a further letter, inviting them to telephone to arrange an appointment. The process is complemented by a policy preventing the clinic from being cancelled with less than six weeks’ notice. The patient is then offered a choice of dates and times from which they choose the most convenient. Failure to telephone leads to a further letter being sent to the patient and their GP, explaining that they have been removed from the list. Patient-focused booking enables the patient to choose an appointment that is more suited to their lifestyle. Information shows that patients are, therefore, much more likely to attend and that less administrative staff time is spent on cancelling or rearranging appointments. A survey of 700 people on this approach found that 98% of patients were happy to telephone and arrange their appointments, while 97% were happy with the appointment that they received. Those figures show that there is an onus on patients to be centrally involved in the process. The PAC reported that there was a problem with the perception that private-practice commitments of consultants may have some impact on whether clinics actually take place. The PAC stated that, while there is no doubt that the majority of consultants operate to the highest professional standards, it must also be recognised that there can be a potential conflict between the private and NHS elements of consultants’ work. The Minister should comment on that, and on the PAC report in general. I support the motion but also propose the amendment. The Chairperson of the Committee for Health, Social Services and Public Safety (Mrs I Robinson): I wish to emphasise how important it is that of all the people of Northern Ireland work in close co-operation with their elected representatives to build a better future for us all. The process of creating a peaceful, democratic society is still in its infancy. There is much work to be done in the years ahead to build relationships that were severely damaged by the past four decades of community strife and terrorism. We must also rebuild our economy and infrastructure to meet the challenges of living in the global economy of the twenty-first century. Our future will depend entirely on our ability and determination to make our devolved Government work and to drive our economy forward. Success in making the necessary improvements in education, the environment, regional development and health will depend on how successfully we can develop every aspect of the economy. Those improvements will include reviewing every aspect of the Health Service to ensure that there is no waste, that inefficiencies are reduced, and that every penny spent is spent wisely and accountably. We owe an enormous debt to those who work at all levels in our hospitals and clinics. Every day, we see the dedication of medical staff, who can be assured of our gratitude. However, it is devastating for health professionals and those in the community who are urgently seeking an appointment to learn that, in 11·4% of cases, people fail to turn up for a scheduled examination, procedure or operation, without indicating their intention in advance. That is a clear and unacceptable abuse of the appointment system. That is demoralising for medical staff and represents a hugely expensive waste of resources, time and money. Such abuse also has the potential to lead to unnecessary suffering for other patients who are awaiting treatment. In the past four years, approximately 50,000 new referrals failed to turn up as scheduled. Approximately 1,500 consultant-initiated appointments were cancelled because patients failed to attend and gave no warning or notification to the hospital. Some people are quick to criticise health workers and politicians, but this is a clear example of an issue on which we can all pull together to put things right. The culture of tolerance of those who behave inappropriately must change. We must review the process of cancelled appointments and consider what steps can be taken to reduce the number of cancellations. However, ultimately, people must be held responsible for their failure to provide adequate notice that they are unable to attend a scheduled appointment. Cancelled appointments lead directly to lengthening waiting lists. Perhaps it is time for the Health Service to consider imposing a charge on people who fail to turn up for an appointment without giving notice. Some mechanism must be put in place to ensure that expanding waiting lists do not contribute to longer-term health problems for patients who are careful in keeping their appointments, particularly in the mental-health sector, where cancelled appointments seem to be most prevalent. I call on the Minister and his officials to urgently address that issue, because many millions of pounds are being wasted. We need an immediate response from the Minister. I support the motion and the amendment. Mr McCallister: I welcome the debate, which I hope will go some way towards tackling the problem. The Department of Health, Social Services and Public Safety states that around 345,000 clinics are held each year, with almost 2·7 million attendances. Those are sizeable numbers. Departmental figures show that, over the course of a typical year, around 300,000 outpatients are not seen. Those figures represent a combination of patients who had their appointments cancelled by trusts, who cancelled their own appointments — which were not subsequently filled — or who failed to attend their appointments. It is a matter of great concern that people with mental-health issues are the most likely to fail to attend appointments, and specific improvements must be made in that area. 12.15 pm Those overall figures make up 10·2% of the total number of outpatients. Although I appreciate that, due to recording anomalies, there are often discrepancies between recorded statistics and actual attendances, the figures are still significant. Cancellations have consequences. First, those that have not been seen either will not receive their treatment, or will have to wait to do so, and that can have clinical and health implications. Secondly, the potential cost to the Department of Health — and, ultimately, the taxpayer — of non-attendances and cancellations is estimated at £11·6 million annually. In a period of fiscal tightness, that is a substantial amount of money that could be used for front-line services. I understand that the Minister has inherited a difficult situation. For a long time, Northern Ireland has lagged behind its regional counterparts in the rest of the United Kingdom. However, I appreciate that the Department has introduced measures to tackle the problem, and a major programme of service reform to improve outpatient waiting times has seen substantial success. A significant component of that is the introduction of partial booking of outpatient appointments, whereby, shortly after their referral, patients are advised of the probable wait for an appointment. Six weeks before the end of that wait, they are asked to contact the hospital to agree a convenient date. Such an approach has been successful in Wales, and I hope it will bring further reductions in cancellations and non-attendance in Northern Ireland. Given that a reduction of 1% in non-attendance or cancellations could save up to £1million, the need for further success becomes apparent. The Minister has had success in reducing outpatient waiting times: today no one will wait more than six months for a first outpatient appointment. I appreciate, however, that more can be done. Although the Ulster Unionist Party will support the Sinn Féin amendment, I was initially worried that it would take some of the focus from the issue of cancelled clinics. However, party members are happy to accept both the motion and the amendment. I understand that achieving goals in non-attendance and cancellations will take time; however, policies that tackle both the cancellations by trusts and the non-attendance of patients are required. Patients must be made aware that they have responsibilities to hospitals, health professionals, other patients, and — above all — to themselves. An environment of respect must be fostered between patients and the Health Service, so that the best care can be provided for those most in need. We are taking meaningful steps. Cancellations and non-attendance figures are heading in the right direction, but more can be done, and I am confident that more will be done. I shall listen with interest to what the Minister has to say, and I welcome any update that he can give regarding the current situation and any actions that he is taking. I support the motion and the amendment. Mrs Hanna: I support the motion and the amendment and thank those Members who tabled them. Unfortunately, the consequences of missed appointments, which are a common occurrence in outpatient clinics, are not particularly well known. They include the cost to the Health Service, and to other patients, who are bumped back each time. When I examined the Comptroller and Auditor General for Northern Ireland’s report on missed appointments, several points became apparent. Patients sometimes cancel appointments at the last minute, and some just do not show up. Others persistently do not show up, and sometimes the trusts cancel appointments. Patients who miss appointments tend to cite such factors as forgetfulness as the main reason. They must bear their share of the responsibility; it really must be brought home to patients that missed appointments have monetary consequences for the Health Service. It must be explained to patients that they must cancel their appointments if they decide not to attend because they are feeling better. They must appreciate the importance of doing so. The auditors also pointed out that it is time to improve on current arrangements and to create a more comprehensive service that meets users’ expectations of the appointments process as regards booking, changing and cancelling appointments, and more flexible opening hours. When walking down the Lisburn Road and the Malone Road, I have observed that the private clinics are open at all hours, including weekends and evenings. We could consider changing the opening times of clinics to suit people’s lifestyles. Some patients are concerned that private-practice obligations may impact on the times at which clinics are held. The merging of private healthcare with the National Health Service always raises anxieties, and those anxieties cannot be dismissed. Some consultants spend a large proportion of their time in private practice, and it is valid to argue that that may have a detrimental effect on the National Health Service. We know that consultants also cancel clinics, sometimes at very short notice. Patients must be told in advance whether they will be able to see their consultant. Some patients may be particularly worried about a health concern and turn up religiously for appointments, yet never get to see their own consultant. Patients often do not get to see the named consultant. If we are to restore confidence in the National Health Service, we must reduce waiting times to an acceptable level. People should not have to scrimp and save for private treatment because they are worried about a condition or are in pain. Although the targets have led to improved waiting times, I still believe that the waiting times are not acceptable — if somebody is worried or in pain, they might still have to wait up to six months for an appointment. Although it is possible that improved technology could result in better booking systems, it is unlikely that one solution will work right across the National Health Service. Although the non-attendance rates are higher in some areas than in others, we need a more patient-centred approach, as Sue Ramsey said. Many patients fail to attend their appointments without phoning ahead to cancel them. As I said, it is vital that patients take responsibility for their appointments. As someone who has attended outpatient clinics, I know that it is not always clear whether one will be given a new appointment. Sometimes the process is hit or miss. A patient could have a serious illness, but unless they remember to stop at the reception desk to ask for a follow-up appointment, they will not get one. We know that people sometimes have good reasons for not taking up their appointments, and that the Department has set targets and met them. Although that is welcome news, we must further reduce the number of missed appointments. The majority of people are responsible and notify clinics, but there are particular issues in relation to attendance at mental-health clinics, and there is a special onus on personnel to ensure that the patients are well aware that they are expected to attend appointments. I look forward to hearing the Minister’s proposals for reducing the cancellation level of all outpatient appointments. Mr McCarthy: I support this important motion and thank the Members who tabled it for bringing it to the House. The Health Service should be our number one priority at all times. As the Alliance Party’s health spokesman, I acknowledge the high standard of work that is carried out by so many people right across the Health Service: consultants, surgeons, doctors, nurses, cleaners, the Ambulance Service and every single person who is involved in the delivery of a first-class Health Service to all our population. Unfortunately, there are times when, for whatever reason, the Health Service does not deliver in the way in which we want it to. In those cases, lessons are learned and improvements made, and so we all strive for better results. The motion raises real concerns for both health administrators and patients. Regardless of who cancels the appointments, the end result is a drain on scarce resources. That is the problem that we are trying to overcome. Information to which I am privy states that some 13,500 clinics were cancelled in 2006 at a cost to the Health Service of £11·5 million — a staggering figure, and one that must be reduced. Many reasons exist for clinics being cancelled, but it is in everyone’s interest to ensure that some form of procedure be put in place sharply in order to reduce that anomaly. It is not only in patients’ best interests but health officials’ that that happen. I welcome the fact that the Minister of Health, Social Services and Public Safety is present. I have no doubt that he will take on board the genuine concerns that have been expressed and make every effort to get on top of this serious problem. Genuine reasons exist for many cancellations. However, pressure must be applied, encouragement must be given or whatever is required must be done to ensure that patients understand the importance of attending appointments. Surely common courtesy tells patients that, if they cannot attend appointments, they should at least telephone the hospital or clinic as early as possible to advise of their non-attendance and to give their reasons. If that were to be done, and done early, new appointments could be issued and another patient seen without wasting the precious time of consultants and others. As Sue Ramsey mentioned, patient-focused booking has been introduced in Scotland to some good effect. If patient-focused booking is considered a success in Scotland, Northern Ireland may be able to repeat that success. Anything that greatly reduces the number of cancelled clinics and saves Health Service costs is to be welcomed. I support the motion and the amendment. Mr Shannon: I support the motion. I also support amendment, which enhances the motion. Most people dislike nothing more than the thought of having to go into hospital, having to share a ward, and being able to see their family and eat only at certain times. That being the case, many patients, in an attempt to get home, will play down how ill they feel. For those patients, outpatient care is essential. It is of the utmost importance that aftercare be properly administered and that checks on progress be made in order to ensure a patient’s health and safety. For those reasons, the outpatient clinic is a vital part of the healthcare system. Any problems that arise there directly affect constituents’ health. The NHS has some of the most intelligent and progressive doctors in the world, and our patient care should be second to none. As it stands, however, patients are waiting too long for care, because of inefficiencies in the system. No one factor is entirely to blame. The cancellation of clinics can be caused by numerous factors, such as staff illness, and unavoidable problems may arise that result in an outpatient clinic’s not being held. However, cancellations that are down to, for example, staff holidays cannot be accepted, and changes must be made to ensure that that does not happen. People are entitled to their holidays, and no one is suggesting otherwise. However, holiday leave should be noted down in advance so that administrators then can get adequate cover in place to ensure that patients do not lose out on healthcare. One reason why one in 10 people is not seen at an outpatient clinic as soon as they should be seen is because patients themselves sometimes forget about an appointment or cannot get time off work to attend it. The Minister’s strategy must include a publicity campaign to ensure that people are made aware that missing an appointment could be detrimental to their health. Such a campaign would also make people aware that others who could have made use of that appointment are missing out, too. I shall give one example from the doctor’s clinic in Kirkcubbin — not that I attend the doctor, because I am very fortunate in not having to. However, just after Christmas, I was at the clinic and saw a sign on the wall that highlighted the number of missed appointments. That sign focused the minds of those sitting there that appointments are important and not to be overlooked. Therefore, innovative ways exist to draw people’s attention to the issue of cancelled outpatient appointments. The public must be made aware that they have to play their role. However, with respect, the onus is on the Minister to clarify and improve the current situation. I fear that, sometimes, we examine figures and statistics and forget that it is not simply a matter of crunching numbers and ticking boxes, but of having the right number of clinics and staff. Those clinics are instrumental in saving lives. Staff can spot the early signs that illness is returning or worsening, and can ensure that treatment is dispensed. Although a two-week cancellation may not seem much of a setback in some people’s diaries, for others it can mean the difference between life and death, such as when a developing heart problem is discovered early and treated. I want to make it clear that my remarks are not an attack on staff in any way, shape or form. They are the people who are most aware of patients’ needs. I simply wish to remind the Minister that he cannot allow the system to fail staff and patients. Therefore, I join my colleagues in urging the Minister to ensure that problems that are evident in the system are rectified urgently. I read the Comptroller and Auditor General’s report ‘Outpatients: Missed Appointments and Cancelled Clinics’ and discovered that there has been some improvement among trusts, which must be commended for their work and efforts. The problem is that, although the number of cancelled clinics throughout the entire Province dropped from around 14,700 to 13,800 — a drop of approximately 900 — during 2006-07, it is clear that more must be done. That could be achieved through a co-ordinated effort by the Minister and his Department. I urge the Assembly to join me in calling on the Minister to deal with this issue through a proactive strategy that begins at the top level, works its way down, and takes into account not only the successes that have occurred in Northern Ireland, but the systems that are in place on the mainland. Rather than see a total of 924 cancelled clinics by April 2009, the Minister must aim to reduce the number of cancellations to 5%, which is a more acceptable level. We ask the Minister to take action immediately in order to make a difference to patients who are waiting for appointments and who will benefit from a more efficient system. I support the motion and the amendment. Mr Deputy Speaker: The Business Committee has arranged to meet immediately upon the lunchtime suspension of the sitting. I propose, therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm, when the next Member to speak will be Dominic Bradley. The sitting was suspended at 12.32 pm. On resuming (Mr Deputy Speaker [Mr Molloy] in the Chair) — 2.00 pm Mr D Bradley: Go raibh míle maith agat, a LeasCheann Comhairle. Some worrying changes are taking place at my local hospital in Newry. Staff at Daisy Hill Hospital who arrange appointments for ear, nose and throat (ENT), antenatal, surgical, and other outpatient clinics have been told that — under the review of public administration (RPA) — their work will be centralised to a call centre at Craigavon Area Hospital. Many people believe that that move has the potential to impact adversely on the care of patients as, under those proposals, GP referral letters would initially go to Craigavon Area Hospital before being returned to Daisy Hill Hospital. There is no guarantee that those letters would arrive back in Daisy Hill Hospital in time for consultant clinics and, indeed, that has been the experience in other areas. Consultants, therefore, could end up being faced with patients for whom they have no GP referral notes. Such a situation would play havoc with outpatient appointments, and could lead to urgent treatment being delayed. Ironically, therefore, the system itself could produce missed appointments. The intention behind RPA is to give patients better care and better services. I doubt whether this change will guarantee that. The relevant professionals are also worried about the potential impact of the change. Consultants at Daisy Hill Hospital were not made aware of the changes, and they have written to the Southern Health and Social Care Trust to communicate their anxiety. The staff at the hospital also had little warning. The proposal was sprung on them on 20 March, with only two weeks of consultation time, including the Easter holiday period. Such undue haste does not allow sufficient time for the effects of the change to be properly assessed. Furthermore, medical staff — consultants and GPs — are far from convinced that the proposals are for the benefit of patients. Trade unions at the hospitals involved have told me that they were not consulted about the changes and that equality impact studies of the proposals have not been carried out. The further a service is moved away from the local area the less personal it becomes. The excellent local knowledge built up by staff over many years will not be used to its best effect in a call centre at some distance from the residence of the patients. I am very concerned about the impact that the changes will have on patients’ health and care and on the smooth running of outpatient clinics and appointments. I am glad that the Minister is here today. I ask him to investigate the situation and to examine the ramifications of the changes, especially considering the deep reservations expressed by the consultants and GPs involved. I welcome a response from the Minister on that issue in due course. A LeasCheann Comhairle, sin deireadh a bhfuil le rá agam. Go raibh maith agat. Mr G Robinson: I welcome and support the motion proposed by my colleague Mr Easton. In doing so, I hope to help achieve what every politician wants — to save the Health Service money that is currently wasted, so that it can further develop the programmes that benefit all in society. It was shocking to read in the Public Accounts Committee report that £12 million of an already stretched health budget is wasted each year due to the cancellation of clinics, or non-attendance of patients. All Members would agree that that money could be put to much more beneficial use. To achieve systematic change, we must examine the way in which hospitals cancel clinics and why patients fail to attend appointments. Although I accept that the exact reasons behind patient non-attendance might be difficult to establish, I ask the Minister to consider using modern communication methods, such as emailing or text-messaging patients — only with their written permission — in an effort to ensure that the number of missed appointments is reduced. As for hospital-cancelled clinics, I appreciate that staff sickness or bereavement cannot be easily taken into account when making plans, but annual leave can be programmed in effectively. I urge the Minister to ensure that procedures are in place to deal with that issue effectively. Although it may inconvenience staff, I am sure that they will appreciate that it is frustrating for patients to have appointments cancelled by the hospitals, sometimes at very short notice. It should also be remembered that many patients work and might have to arrange leave in order to attend appointments. Despite those and other problems, improvement can be achieved in that area. The question is how we should go about it. The model adopted by NHS Scotland appears to be a valuable example of the way in which improvement can be achieved. Patient-focused booking has reduced the number of hospital-cancelled clinics or missed appointments by about 2%. If the Health Service in Northern Ireland were to reduce its figures to that level, it would save approximately £10 million. It is worth remembering that the patient is at the centre of the process and should be the priority consideration in developing any new appointments system. I am sure that the Minister could find good use for the money saved, such as keeping acceptable levels of out-of-hours services in Limavady, in my constituency. However, achieving change will require commitment from National Health Service staff and patients and, no doubt, foresight on the part of the Minister. I encourage him to have the foresight to implement workable, adaptable changes that will benefit patients, Health Service staff and the Department’s budget. In conclusion, I take this opportunity to commend all the healthcare workers, who do a magnificent job. I support the motion. The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I welcome the opportunity to discuss the steps that my Department is taking to reduce the cancellation of outpatient clinics and the number of missed appointments, ensuring that patients have timely access to high-quality, safe services. That is a priority that we all share. As recently as two years ago, 110,000 people in Northern Ireland waited more than 13 weeks for a first outpatient appointment — some people waited for up to 10 years. Today, apart from a handful of patients, no one waits for more than 13 weeks. I am committed to reducing that waiting time further, to nine weeks, by next March. Similar progress has been made in relation to the time patients wait for a diagnostic test, such as a computerised tomography (CT) or magnetic resonance imaging (MRI) scan, and for inpatient or day-case treatment. Today, no patient waits more than 13 weeks for a diagnostic test, and only about fifty patients have waited more than 21 weeks for treatment. Furthermore, I will seek further significant reductions in waiting times in those areas, over the next year, to nine weeks for diagnostic tests and 13 weeks for treatment. To illustrate that point, the current waiting-time targets are 13 weeks for initial appointments, 13 weeks for diagnostics and 21 weeks for treatment — 47 weeks in total. I plan to set the target for the end of this year to reduce waiting times from 47 weeks to 31 weeks in total. That will allow up to nine weeks for initial appointments, nine weeks for diagnostic tests and 13 weeks for treatment. That bears significant comparison with previous figures. For example, in March 2005, the target was 18 months for treatment, and that was routinely missed. In March 2006, the treatment target was one year, and that was often missed. We can demonstrate significant improvement in performance as far as treating patients is concerned. I assure Members that I am by no means complacent about our current position. A transformation in waiting-time performance was achieved through the introduction of a comprehensive reform programme, the key elements of which ensure that patients of the same clinical priority are attended to in strict chronological order. Consultants must determine the clinical priority of patients, and urgent patients will always be seen as a matter of priority. Patients who have been assessed as a routine clinical priority will be seen in a fair and clinically appropriate manner, with the earliest appointee being attended to first. The Department asked specialist consultants to pool their lists to ascertain how waiting times could be equalised. In the past, some specialist hospital consultants may have had lengthy waiting times, while others — perhaps the more recently appointed — had shorter waiting times. By equalising those times and by pooling lists, we have ensured the even distribution of patients across all consultants. That has had a major impact in reducing waiting times. Sue Ramsey, George Robinson and other Members mentioned the patient-friendly booking system that has been introduced, and there are new booking arrangements whereby patients can choose the date and time of their appointment. That provides a better-quality service to patients and recognises that people lead busy lives and need to be able to choose a time that suits them. It also reduces the number of patients who fail to attend outpatient appointments. The Department reviewed outpatient clinic schedules, and trusts are required to ensure that sufficient time is set aside for new patient referrals. In addition, we have introduced ICATS, which is a range of new integrated clinical assessment and treatment services. ICATS is a term that is used for a range of services that will be provided by integrated multi-disciplinary teams of Health Service professionals in a variety of primary- and secondary-care settings. It includes assessment, treatment, diagnostic and advisory services. Under traditional outpatient arrangements, GPs have no alternative other than to refer to hospital consultants those patients who they are unable to manage in the primary-care sector. That led to a significant number of patients who are waiting to see a hospital consultant. In such cases where the patient does not see the consultant, that consultant will often be able to do little for the patient as surgery is not required. Indeed, not all patients require a consultant’s level of expertise. ICATS ensures that patients are referred to the most appropriate next step of the care pathway as quickly as possible and that those patients who need to see a hospital consultant will do so after the completion of all necessary diagnostic tests. If a primary-case referral is assessed as not being clinically urgent, it will be directed by ICATS to the next appropriate step. Again, that reduces the patient’s journey time. There are five possible next steps. First, a referral to diagnostics — including the various modalities of imaging — all forms of scoping, as well as pathology and other physiological measurement services may be considered. Secondly, a patient may be referred for direct treatment to an inpatient or day-case schedule. Certain indications imply that direct treatment, rather than further specialist opinion, is necessary. Thirdly, a patient may return to primary care for discharge with advice or a request for further information. Fourthly, a patient may be referred to tier 2 outpatient services, which is the name that is given to the new clinical services that should typically form the core of the ICATS. Those services will take referrals that are not initially indicated for consultant-led clinics and will carry out face-to-face assessments and examinations and commence treatment where appropriate. Finally, some patients may be referred to a hospital outpatients clinic, because even with the introduction of those new services, there will be a significant remaining stream of non-urgent patients for whom a traditional outpatient appointment will be the appropriate next step — in other words, they will need to see a consultant. The ICATS model offers considerable benefits to patients by ensuring that they are seen by the most appropriate healthcare professionals as quickly as possible and that limited consultant resources are reserved for those patients who have been assessed as requiring that level of expertise. New ICATS services have already been introduced for orthopaedic referrals across Northern Ireland, and they are now being introduced in urology and ophthalmology. There are also plans to introduce ICATS for ear, nose and throat; dermatology; and cardiology. In relevant specialties, ICATS are expected to resolve at least 50% of all referrals from GPs, without the patient having to see a hospital consultant. In 2008-09, it is expected that ICATS will manage some 30,000 orthopaedic referrals, which will significantly reduce the pressures on hospital services. 2.15 pm As many Members pointed out, the cost of cancelled clinics is significant. The Northern Ireland Audit Office estimates the cost to the taxpayer of cancelled clinics and missed appointments at £11·6 million. That significant sum could be used to benefit patients by allowing them to be assessed and treated more quickly. However, it will never be possible to eliminate waste totally. A small number of clinics will always be cancelled because of unavoidable circumstances, and, similarly, some patients will fail to attend appointments. Mr McCarthy: Mention was made of the possible introduction of financial penalties — similar to those imposed by dentists — on patients who fail to turn up for their appointments. Although I do not agree with the idea, will the Minister consider any such penalties to encourage patients to turn up or give clinics early warning when they cannot attend? Mr McGimpsey: Financial penalties could be administered only at a disproportionate cost, and, in any case, I do not want to go down that road. The cancellation of clinics at short notice is wasteful, and it is disruptive to patients. Typically, a clinic lasts for half a day, and, depending on the specialty, involves up to 20 patients a session. Therefore, when a hospital cancels a clinic, a considerable number of patients who may be anxious, or in pain, are affected, and they must wait for another appointment. Outpatient clinics must, therefore, be cancelled only in exceptional circumstances. In Northern Ireland, a relatively low proportion of outpatient clinics is cancelled, and that must be viewed in the context of the large number of patients who are seen each year. In hospitals and other healthcare settings, over 1·5 million outpatients are seen. The vast majority of them are seen quickly and experience no difficulty with cancellations. A detailed census was undertaken after discussions with the Northern Ireland Audit Office. It found that, in September 2006, only one in 35 consultant-led clinics was cancelled — less than 3% of the total. In the week of the census, 3,680 of the planned 3,791 clinics took place, and the remaining 111 cancelled clinics equates to only 2·9% of the total. Most cancellations result from staff being on sick leave. There will always be occasions on which doctors fall ill and are absent from work at short notice. Therefore, it is inevitable that some clinics will be cancelled. The impact of such cancellations is more problematic for smaller hospitals. When a consultant in a larger hospital falls ill, a colleague routinely takes over his or her duties, whereas smaller hospitals, in which a greater proportion of single-handed clinics take place, may have no one available to take over at short notice. My Department has placed a requirement on trusts to ensure that clinical staff, including doctors and nurses, give at least six weeks’ notice of their planned annual or study leave. George Robinson made a point about the planning of clinics; that requirement is designed to minimise clinic cancellations, facilitate the proper planning of clinics and guarantee as far as possible that when a patient is given an appointment, the clinic takes place. As employees, the trusts must enforce that requirement and intervene should any pattern of short-notice cancellations emerge. Trusts have confirmed that staff compliance is closely monitored and that the cancellation of any clinic with less than six weeks’ notice is investigated. Although we do not compare unfavourably with England, Scotland and Wales, it is normal for those countries to measure cancelled appointments rather than cancelled clinics. To illustrate the point: in Northern Ireland, if Doctor Brown is booked to do a clinic in a particular hospital at 9.00 am on Monday morning, and Doctor Green does the clinic instead, that would be recorded as a cancelled clinic because Doctor Brown’s clinic has been cancelled, even though the same patients are seen by Doctor Green. Therefore, as our counting has a degree of correctness that results in slightly skewed figures, cancelled appointments will be recorded instead. That is more relevant because each cancelled appointment involves a patient not being seen. As I have noted already, cancelled clinics are only part of the problem. Another part involves patients cancelling, or failing to attend, their appointments. If patients give adequate notice when cancelling appointments, their slots can be allocated to others. However, when patients cancel their appointments at short notice — or worse — fail to attend without giving any notice, their slot is wasted and they deprive someone else of being seen. In 2006-07, 11·4% of patients failed to turn up for their appointment and did not give any notice. In the first three quarters of 2007-08 the percentage of patients failing to attend their appointments, although it had fallen, was still 10·6%. There is a cost of £54 for every patient who does not turn up for an appointment. Per annum, 1·5 million patients are being seen, so 11% of that is approximately 160,000 patients. Therefore, of the £11·6 million that is being lost, approximately £8·5 million of that is the cost of patients not turning up for appointments. The number of patients not turning up for their appointments is still too high. The introduction of more effective and responsive systems for booking outpatient appointments is a key reform that will help to address that problem. In the past, patients received a letter months in advance with a fixed time and date for their appointment. Under that system, hospitals could not be sure that a clinic would take place, and there was no consideration of convenience for patients. As a result, patients often needed to cancel their appointment because it was unsuitable, or else they simply forgot about it. In addition, hospitals occasionally needed to cancel the clinic because key members of staff were not available. My Department now requires all trusts to implement new partial booking processes to deal with that issue. Mr Deputy Speaker: The Member’s time is up. Mr McGimpsey: I have gone somewhat over my time, Mr Deputy Speaker. Much good work has been done — long waiting times are now a thing of the past and that is welcome, as we continue to improve our performance. Ms Ní Chuilín: Go raibh maith agat, a LeasCheann Comhairle. Ba mhaith liom tacaíocht a thabhairt don rún. First, I add my support to the motion. I apologise for my colleague Sue Ramsey, who has to leave, and for Michelle O’Neill, who is elsewhere. It is very encouraging to hear about the reduction in waiting times for patients from 26 weeks to 13 weeks, with a view to that time being reduced further. That is a success story, as it is an example of locally-elected representatives being held to account and taking a patient-centred approach. I also acknowledge the work that has been done by Assembly Research and Library |