Official Report Tuesday 15 May 2007
Private Members’ Business
Child and Adolescent Mental Health Services
The Assembly met at 10.30 am (Mr Deputy Speaker [Mr Molloy] in the Chair).
Members observed two minutes’ silence.
Private Members’ Business
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 for the winding-up speech. All other Members who wish to speak will have five minutes.
Two amendments have been received and published on the Marshalled List. The proposer of each amendment will have 10 minutes in which to do so and five minutes for the winding-up speech.
Mr B Wilson: I beg to move
That this Assembly notes the introduction of unfair changes to the rating system, and calls upon the Department of Finance and Personnel to conduct a full review of the new system, including in particular, consideration of further income-related reliefs and a full income-based system.
I congratulate you on your appointment, Mr Deputy Speaker.
Since the recent rates revaluation, I have been approached by a number of my constituents whose rates have increased dramatically, in some cases by more than £1,000. For some, their rates would have doubled had it not been for transitional rate relief. Most of those constituents live in an old family home and exist on a modest pension. The rates increase will cause extreme hardship in most cases, and in extreme cases it will result in people having to sell the family home. It is unacceptable that elderly people who have worked all their lives and have saved for their retirement are now being hammered by those excessive rate demands.
The Executive must revisit the options for funding local government services. The present system, which is based on the regional rate, increasingly puts the burden on the elderly and those on a fixed income. It also hits low-income families. That cannot be acceptable in a civilised society. Rates are a regressive tax, and they bear little relation to a person’s ability to pay. They not only create hardship for those on fixed incomes but have a disproportionate impact on the low-paid. The Department of Finance and Personnel’s own figures, which are based on the 1999-2000 household survey, show that a house with a weekly income of £100 would pay 11·6% of that in rates, yet one with a weekly income of more than £400 would pay only 2·5% of that figure.
The new valuations, which are based on capital values, that were introduced in April 2007 highlight the rating system’s unfairness. Any system, however, that is based on property values is inherently unfair, as it totally disregards a person’s ability to pay. The problems raised by that revaluation are not new, but they are fundamental to any system that is based on property values.
For years, I have highlighted the plight of many elderly constituents who live on small pensions and who must pay more than 10% of their income on rates. The current proposals have emphasised and exacerbated their hardship. It is time for something to be done to reduce their burden.
Rates are a regressive tax, and they bear no relationship to one’s ability to pay. How can one justify an old-age pensioner’s having to pay the same as a family of three wage earners, simply because they live in a similar house? Moreover, payment of rates does not relate to the use of facilities. Can it be argued that a pensioner makes more use of an ice rink or squash courts, creates more rubbish, or uses more water than a family of four? Is it right that a person who lives on a pension should pay full rates while a young person who earns a substantial wage and lives in the family home should contribute nothing to the cost of local services?
Rates should be replaced by a tax that is based on ability to pay. The recent change from a rates system that is based on rental values to one that is based on capital values is merely tinkering with an unacceptable system that needs fundamental reform.
I have long argued that rates are inherently unfair because they take no account of ability to pay. In 1982, I raised that issue with the then Secretary of State, Jim Prior, when we met him to propose the abolition of the regional rate. The problem has worsened significantly in recent years as successive Finance Ministers — both Executive and direct rule — have raised the regional rate disproportionately to pay for the upgrading of our economic infrastructure. Few people would dispute that we must raise additional revenue to upgrade that infrastructure, but that should not be done through an unfair rating system that places the burden heavily on the most vulnerable sections of our community. I therefore call on the Minister to carry out a full review of the means of funding local services.
I recognise that, in 2000, the Executive set up a review of rating policy and began an extensive consultation process. However, the terms of reference for that review were extremely restrictive and the consultation was unable to consider options other than those that were based on property values. My submission, which proposed a local income tax, was dismissed as going beyond the terms of reference.
Much has happened since then. The regional rate has almost doubled, and both the Lyons Inquiry and the Burt Review of local government, in England and Scotland respectively, have suggested changes to local government finance.
There were more than 100 responses to the consultation in Northern Ireland, but the input from some political parties was limited by the terms of reference and, in other cases, was non-existent. I was the only elected representative to oppose the principle of the charges and to call for the replacement of rates by a tax that is based on ability to pay, such as a local income tax.
Three of the political parties that were then represented in the Assembly did not submit any evidence, and the comments of the other four queried the details of the new system, rather than the principles behind it, which are fundamental to the achievement of a just system. Over the five-year consultation period, there was very little interest from most politicians until last year, when the new valuations were announced. Politicians then demanded that the proposals be withdrawn.
The motion calls for a review of all the options, particularly income-based alternatives such as a local income tax. That would clearly be fair, as it would be based on one’s ability to pay; it would tax non-householders who do not pay at present, and it would not act as a disincentive to improve property. Other options include a local sales tax; a services tax; green taxes, which would help the environment as well as raising revenue, based on the principle that the polluter pays; and a land-value tax.
The Green Party in the Scottish Parliament has proposed a land-value tax, which is being considered by the Scottish Parliament and Executive. The Assembly should examine that option, because such a tax would benefit people on low income and would encourage the development of derelict land. When land is derelict, no one pays tax on it, and no income comes from it. A land-value tax would stop speculators from building up land banks on which they pay no tax, but from which they benefit from almost daily rises in land prices. Many developers, particularly in the greater Belfast area, have land banks where affordable homes could be built.
The values of those land banks have increased dramatically in recent years. It is wrong that developers rather than the public should benefit from the appreciation in land prices. We should examine all those options, and the Assembly should seek to acquire tax-raising powers so that all increases in public expenditure are not met solely from the property tax paid by the ratepayer but from a basket of taxes.
I accept that such a review will take time; however, a great injustice could be resolved immediately. We should end the discrimination against single householders in Northern Ireland. Since 1993, single householders in the rest of the UK have benefited from a 25% rebate. That takes into account the fact that they make less use of public services than larger households. That rebate has helped millions of householders in Great Britain, the majority of whom are pensioners.
In 1992, I wrote to the then Finance Minister, Michael Mates, to ask that he introduce a similar discount in Northern Ireland. He rejected my request, pointing out that local-government finance is different in Northern Ireland. I wrote to all subsequent Finance Ministers and have a file of their replies, which were pretty awful. Those Ministers did not understand the issue — for example, Paul Murphy pointed out that the Exchequer funding for Northern Ireland is much higher than in the rest of the UK. Mark Durkan replied that the issue would be considered in the course of the review of rating policy. The matter has been put off, year after year, since 1992. Why should Mrs Jones from Bangor in north Wales get a 25% discount, while Mrs Jones from Bangor in County Down does not? Such discrimination cannot be justified, particularly as the regional-rate burden has increased significantly in recent years. In North Down alone, 5,600 single pensioners would benefit from such a rebate. We call on the Minister of Finance and Personnel to introduce the 25% rates discount for the single householder and to end this discrimination.
In conclusion, I ask the Minister to set up a review of the funding of local services and to consider moving from a property-based tax to a mainly income-based tax. That review should also examine all other options, such as a local sales tax, service tax, land-value tax and green taxes. If necessary, the legislation must be changed to give the Assembly tax-raising powers, which it should have anyway. It is essential that the burden of taxation be spread more evenly and does not continue to fall most heavily on the elderly and those on fixed incomes. In the meantime, I ask the Minister to introduce the 25% discount available in the rest of the UK, thereby reducing the hardship and concern experienced by tens of thousands of pensioners in Northern Ireland.
Mr Beggs: I beg to move amendment No 1: Leave out all after “notes” and insert
“the widespread public concern at the changes to the rating system and calls upon the Department of Finance and Personnel to conduct a full review of the new rating system, including consideration of a generous, non-means tested, rates relief scheme for pensioner households.”
I tabled the amendment in the interests of avoiding the complex, highly expensive and bureaucratic system that would emerge. For “income-related reliefs” in the text of the motion, we should read “means-tested reliefs”. With regard to take-up of means-tested relief, a 2006 report from the Office for National Statistics indicated that benefit take-up was in the range of 62% to 68% by caseload and 65% to 71% by expenditure for 2004-05. In other words, a third of people entitled to those reliefs did not claim them, so any such scheme will miss one third of the most vulnerable.
Pensioners’ groups have also examined the issue. Help the Aged found, similarly, that 37% of pensioners did not take up their benefit entitlement. We should not be surprised at that figure.
10.45 am
In a 2006 policy statement, Help the Aged indicated that means testing much of this help has created a complex and bureaucratic system, resulting in the failure of millions of the poorest pensioners to benefit from the changes. Pensioner interest groups have expressed concern; therefore, my amendment includes the words “non-means tested”. Any form of relief should be universal; everyone should be free to apply for it or to receive it automatically.
Help the Aged commented that:
“Universal benefits tend to have the best rates of take-up as they are simple to understand, usually have clear eligibility criteria, and are not associated with any kind of stigma.”
Many elderly people do not take up their entitlement because they believe that they must reveal all of their personal circumstances. It is an invasive process, and it is important that we realise that. Stigma, therefore, is a big issue to consider when determining how any new system should operate.
The motion mentioned income-based systems. That means income tax, and I am pleased that the proposer of the motion mentioned that in his speech. However, he did not mention it in the motion itself, because he wants additional income tax for Northern Ireland. Will that help the economy or detract from it? We must encourage as many people as possible to return to employment and assist them to contribute to the economy. The fear that an increase in income tax effectively means an additional tax, a poll tax, for working families contributes to the problems.
There is a choice. There can be a full income tax system for everything; for example, what was raised by property rates could be raised by income tax. However, that would remove any choice from local government. Each area would simply be handed a budget with central control over what could be done with it.
That is a complex system to administer. We must remember that, apart from income tax and the Inland Revenue, there may be issues concerning national insurance, child tax credit, pensioner tax credit and working families tax credit. How would all of those things work together in a system? There is no doubt that any effect on someone’s income will impinge on other benefits. It is therefore foolish to introduce an income tax unless it is introduced in the whole of the UK. Instead of a huge administrative burden, it could be done more efficiently and should be considered only at a national level.
To follow that route in replacing the rates system would create a complex system. I surmise that the 250 staff employed by Crystal Alliance to administer water charges is only a small number compared to the number of civil servants required to administer any new income tax system that is not fully integrated into the Inland Revenue. It is likely that we would have to pay many civil servants to run yet another bureaucratic system, thereby damaging the economy and without reaching the people we want to reach.
The proposer of the motion referred to another choice involving an income tax-based system, and that is to raise the regional rate element from income tax and the remainder from property tax. Two systems would, therefore, have to be administered. Money that we want to spend on services in the community would be wasted.
Those new Members who have yet to come into contact with issues involving the complex system will, I fear, do so before long. I refer in particular to the tax credit system. Some of the poorest families tried to take advantage of benefits to which they believed they were entitled, only to discover that, following an assessment by the Inland Revenue at the year end, and owing to administrative errors and miscommunication, they had to pay back several thousands of pounds.
That exacerbates the situation. Therefore a move towards income tax would be done at our peril; it will be worthy of our consideration only when it is co-ordinated at the national, UK level.
It is important that any new rates system should be universal so that everyone who is entitled to benefit from it will take it up. In particular, vulnerable pensioners should be able to make use of it without stigma. Incentives and entitlements should remain in such a system so that everyone can save and be prudent as they prepare for their later years. It is important not to create unreasonable administrative burdens.
The Member who moved the motion talked about other taxes that he wishes to employ. Let us be careful with our economy; we should avoid administrative burdens, complex systems and layers of tax that create difficulties for small businesses and discourage people from becoming workers or employers. We must allow the economy to grow. I am aware that the current system must be reviewed for fairness and so that it can deal with additional reliefs, but that must be done carefully. I suggest that the grief that Members get currently from constituents about property tax is minimal compared to the complaints that we would receive if we were to consider introducing further income tax burdens on the working community. Remember that for “income tax”, I read “working family taxes”. Let us encourage everyone back into employment and to save, and let us be cautious as we administer tax burdens on our community.
Some Members: Hear, hear.
Mr O’Loan: I beg to move amendment No 2: Leave out all after the second “system” and insert
“which fundamentally fails the essential test of ability to pay; and further calls for this review to give particular consideration to fair and transparent income-based protections, and suitable reliefs for pensioners and all disabled persons.”
The SDLP supports the need for a review of the new rates system. This amendment is necessary to emphasise that the central task that faces the Minister of Finance and Personnel is the understanding that the current system significantly generates rate demands that are not in line with ability to pay.
A property tax creates basic tensions about ability to pay. Houses do not pay the rates; occupants pay. Houses do not have incomes; occupants do. Houses do not have outgoings and varied circumstances; occupants do. Therefore the Minister faces quite a task in creating a property tax that truly reflects ability to pay. However, that should not be regarded as an argument for a local income tax; it is not that simple.
Let me be clear that the SDLP is not calling into review — and I doubt that any other party will, either — the central change in the new system, which was the replacement of a rental-based valuation of property by a capital-based one. All the evidence is that the old, rental-based approach was regressive and placed a disproportionate burden on those with lower incomes. A property tax is better based on capital, rather than rental, values.
It is proper that those who are in the political system recognise good administration, so, in passing, let me pay tribute to the staff in the Department of Finance and Personnel and the Rate Collection Agency who administered a complex changeover. Taken as a whole, they did it well.
A capital-based system, however, brings its own problems. There may be some broad correlation between the value of a house and the ability of the occupant to pay. However, there are many exceptions and anomalies that the Minister must address.
The SDLP wants income-based protection proposals for both water charges and rates, to include a guaranteed maximum payment as a percentage of a person’s income.
There are particular problems for pensioners. In some cases they have valuable homes but low incomes. That happens frequently after people have been widowed. There are places along the north coast, for example, where even modest homes have been priced astronomically for some time. Pensioners who live in such situations are carrying an unfair burden and need relief. The Government’s well-established concept of a minimum income guarantee under the social security system is significant in this debate. Failure to allow proper relief for pensioners under the present rating system undermines and contradicts that guarantee.
If Draft Planning Policy Statement 14 is not removed, many people will fear the next property revaluation exercise. Small cottages on rural sites are now worth fortunes, and would be rated accordingly.
The SDLP amendment mentions “disabled persons”. There is 25% rates relief for disabled people whose property has been modified; the SDLP wants that relief to be extended to every person with a disability. Why should a person with mobility difficulties who lives in a bungalow that does not need modification be treated differently from other people with disabilities?
The SDLP proposes that there should be a revenue regulator — an independent watchdog for all Government revenue proposals. The regulator would assess, comment on and have powers to regulate such proposals, including their cumulative effect. My party commends that proposal to other parties for consideration.
There must be more transparency in the rating system. Members have seen the people’s anger during the argument over the water element in the regional rate. People want to know what they are paying for.
Finally, the SDLP has no objection to a local income tax being studied, but there are many problems involved. The Assembly has no tax-raising powers; the Scottish Parliament has such powers but has never used them, and there must be good reasons for that. HM Revenue and Customs would have difficulty in building in such a scheme. If it were achieved, revenue would be collected across Northern Ireland uniformly, but local council revenue demands vary enormously, so there is no simple answer. There will be a property-based charge in Northern Ireland for the foreseeable future. The current system contains significant defects, which the Minister must rectify.
Mr McLaughlin: Go raibh maith agat, a LeasCheann Comhairle. Congratulations on your appointment, Mr Deputy Speaker. I missed the opportunity to congratulate you yesterday.
I support the motion, and I have no difficulties with the amendments, which extrapolate the issues that would have to be considered during a review. Sinn Féin’s preferred option is the removal of the rates and their replacement with a system of progressive direct taxation. However, that is work in progress, and a considerable amount of work needs to be done. Sinn Féin intends to pursue the matter with the Exchequer.
Sinn Féin believes that equality and ability to pay must be at the heart of any rating system, and that such a system must be transparent and fair. There should be a clear relationship between rates revenue, value for money and the quality of services provided. Mr O’Loan referred to a prime example, which is the widespread public view that people are being asked to pay twice for the same service when it comes to water charges.
Consequently, Sinn Féin believes that the rating system in the Six Counties is in urgent need of a radical overhaul, in the context of a review of the Barnett formula, and the negotiations, which we hope will be concluded successfully, on a meaningful peace dividend.
I call on the other parties in the Assembly to consider and support Sinn Féin’s call for tax-varying powers for the Assembly. That would be a key element in bringing forward policies and measures that reflect local issues, expertise and accountability.
11.00 am
The current rating system, which was introduced by a direct rule Minister, does not distribute the rates burden fairly and has achieved little or no buy-in from stakeholders in our community. Every party addressed the issue in the recent election. In particular, current rating policy does not address the fact that, in many cases, house values bear no relationship to income. Therefore, many people are in the unenviable position of being asset rich but income poor and are experiencing exceptional hardship because of this unfair system.
In the absence of a progressive tax-gathering power to replace the present system, Sinn Féin argues that rates should be assessed through an income-related system, which is based on the ability to pay, and with specific exemptions for economically vulnerable groups such as older people, those with disabilities and other low-income households. Sinn Féin continues to raise public finance issues including tax-varying powers, the Barnett formula, and the legacy costs of many years of neglect and underinvestment by successive direct rule Ministers. Sinn Féin is raising those issues to give the new team of Executive Ministers the tools and the opportunity to deliver on an agreed Programme for Government.
It is incumbent on MLAs, parties and party groupings to continue to provide support for that call and to continue to address those issues with the British and the Irish Governments. Sinn Féin supports the motion and the amendments.
Go raibh maith agat.
Mr Weir: The DUP has been consistent in its concerns about the proposed system. The party has highlighted its concerns from the start, and has raised them consistently with Ministers. Taking the capital value of houses on 1 January 2005 is not a reliable basis for determining rates. Therefore today’s debate is welcomed.
People who fall just outside the benefits system and whose net income does not reflect their level of wealth will suffer most as a result of the review of rating policy.
The DUP has pressed on a number of issues and it will continue to press for a financial package to alleviate the situation. Unlike other parties in the House, the DUP has not thrown in the towel on that issue. At St Andrews, the DUP stressed that any system that left Northern Ireland ratepayers without a cap on rates was inherently unfair. It was unacceptable to have a situation in which people in Northern Ireland were, potentially, paying a lot more than the Duke of Westminster. I am glad to say that the DUP achieved a cap on rates. However, the level of the rates cap is too high, and that needs to be taken into account in any review of rating policy.
There should be a greater focus on the need for more generous relief for pensioners, and I welcome references to that matter in both amendments. Pensioners are the most vulnerable group who may be suffering because of changes to the rating system.
A fundamental mistake was made during the reinvestment and reform initiative (RRI), when rates rises were linked to council tax in England and Wales. The result was that many of us who served in local government saw a massive increase of 19% in the regional rate, which meant that no matter how prudent local councils were, ratepayers were given an unacceptable burden. The DUP believes that the link between council tax levels in Great Britain and Northern Ireland should be broken.
The DUP is content with both amendments as they focus on the key issues; rates relief, and the protection of vulnerable groups. The DUP will support the amendments because they improve the motion. Having listened to the proposer of the motion, I have a number of concerns with the issues he has raised. His solutions seem to be twofold — first, he proposes some kind of agrarian revolution in this country in which landowners are taxed.
The landowners will not pick up the bill for that: when land is used for development it will simply become an additional tax passed on to property owners. We do not need further inflation of house prices in this country. However, the United Community group — and the Alliance Party, for whom I assume the proposer speaks also — has become the party that believes in taxation to the hilt, because that is what has been proposed.
The other imaginative solution put forward by the group is that of a local income tax. Again, the effect of that would be to tax people to the hilt. When we are given an opportunity to vary income tax, the Treasury will inevitably look at our expenditure — whatever the block grant is in Northern Ireland — and advise that if we are looking for more money we should simply increase our taxation to the maximum level possible before they can consider any additional finance.
The flawed thinking offered by Mr Wilson and others would not soak the rich, but rather drown the working man and women in a tidal wave of extra taxation.
The DUP welcomes the opportunity to debate the subject and believes that there must be a fundamental review and examination of the rating system. However, a review must focus on what will benefit people and must not be counterproductive to the people and the economy of Northern Ireland.
Mr Storey: Members would do well to ask why this debate is necessary. It is because of the failed political arrangements of the past, under both direct rule and the failed arrangements of the Belfast Agreement. However, we are in a new dispensation, and that dispensation has placed on us a responsibility to ensure that we get it right —
Mr McClarty: The Belfast Agreement mark II.
Mr Storey: — unlike the hon Members who are now reduced to a small number in the corner of the House, who cannot bring forward any proposals that command respect in the community, and whose election results were a clear indication of that.
There are few recently elected Members who have not come to realise the importance of the rating system in Northern Ireland. They will also have realised how important it is for the Assembly to take real action to ensure that the current situation imposed by direct rule administrators is reviewed and a new system implemented that does not unfairly penalise Northern Ireland homeowners. In that I include homeowners on Rathlin Island, the most remote part of my constituency, some of whom I am delighted to welcome as guests in the visitors Gallery this morning.
The DUP laid out its position clearly on the rating issue in the run-up to the election, and it does not believe that the capital value of someone’s home on 1 January 2005 is a sufficiently reliable indicator of a person’s ability to pay to be used as a sole basis for determining rates. It is therefore clear that a different system must be employed. The motion calls for consideration of a “full income-based system”. While I doubt strongly that an income-based system is the way forward, I welcome the call for a review to lay out all the different possibilities, so that the House —
Mr Campbell: I thank the hon Member for giving way. He is touching on an important point. The amendments, along with the motion, concentrate on exemptions, and that is right and proper for people on a low income. However, should we not also look at increasing disposable income across society so that the take is not reduced because of the exemptions that must be introduced?
Mr Storey: The hon Member for East Londonderry has made a good point. There is no doubt that we should look in detail at the level of relief given to vulnerable groups in our society. The DUP has already called for a 25% rate reduction for single pensioners living alone. Most often it is the older people, living in family homes for a long time, who find themselves in financial difficulty when faced with rate bills that continue to rise.
This issue should not be looked at in isolation, as my hon Friend and colleague has said. The ongoing negotiations with the Chancellor can make a significant impact. The reinvestment and reform initiative, a hallmark of devolution under the Belfast Agreement, shackled householders to huge rates hikes simply to allow the then Northern Ireland Executive to access borrowing. That situation cannot and should not be allowed to continue. It will be a significant step forward if we can break the link between local tax levels in England and the regional rate in Northern Ireland.
There is little point in claiming that there is going to be a simple solution to the problems of rating. However, it is an issue that this party has taken to the electorate, and we have clearly received an overwhelming mandate to take the issue seriously. That was demonstrated by our taking the Finance and Personnel portfolio as our first choice in Government. I have every confidence that the Minister who has been appointed to that position will ensure that delivery is a hallmark of the policies that we have set out. I look forward to working with the Minister and the Committee and hope that we will be able to bring to the House a review on terms that are acceptable and able to be implemented.
Northern Ireland does not have unlimited resources. It is vital that the best efforts be made to make sure that those resources are distributed to the benefit of all in our community. I hope that a review of rating will be combined with a cutting back of much of the waste that has been a hallmark of devolution in the past.
Mr Deputy Speaker: Time, please.
It has been some time since we have had full-blown debates in the Chamber, but the convention has been that Members do not refer to the Public Gallery. We have been getting back into the habit very quickly.
Mr F McCann: Go raibh maith agat, a LeasCheann Comhairle. I commend the two Members who have brought this motion. The introduction of the new rating system was universally criticised across the North of Ireland. The issue has been to the forefront of people’s concerns since the changes were announced last year against the wishes of the vast majority of the population, who see them as a way for the Government to force more money out of those who, in many cases, do not have the ability to pay.
(Mr Deputy Speaker [Mr Dallat] in the Chair)
We were told that the rates were being brought into line with payments in England and that we had had it easy for many years and were not paying our way. However, that does not take into consideration the facts that people here pay higher prices for fuel, both domestic and commercial, that food is more expensive in general, and that the cost of living is comparatively high here. Add in our low earnings and high unemployment and an altogether different picture is painted.
Those in power — and their advisers — chose to ignore those very relevant issues. Why did they not leave the old system in place so that an incoming Assembly could deal with it? They chose to do that with other matters, but they knew that while local politicians may not agree on every element of what would be required, once at the helm the Assembly would at least have looked at the matter sympathetically. In fact, the last Executive commissioned a review of the rating system, but were unable to complete the job before the Assembly collapsed.
Direct rule Ministers argued that the present system was fair and would benefit those most in need. Such nonsense! If it is that good, why did they not push to have it introduced in their own constituencies? Many of those responsible for its introduction here are the same people who came out strongly against the poll tax.
Sinn Féin has consistently called for a radical review of the rating system. We would prefer to scrap the rates altogether and introduce a system of progressive direct taxation. Consequently, we believe that the rating system in the Six Counties needs a radical overhaul, in the context of a complete review of the Barnett formula. We also need a meaningful peace dividend and the granting of tax-varying powers to the Assembly and the Executive.
In the meantime, equality and ability to pay must be at the heart of any continued rating system. Also, the system must be made transparent. It must be fair, with a clear relationship between rates, income, value for money and the quality of service provided.
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The current system does not distribute the rates burden fairly. In particular, the failure to address the correlation between house values and income means that many people will be in the unacceptable position of being asset rich but income poor, and will pay higher rates than they can afford.
Rates relief should be addressed through an income-related system, which is based on ability to pay and has specific exemptions for economically vulnerable groups such as older people, those with disabilities and other low-income householders.
Some people with disabilities are forced to adapt their homes to enable them to live with dignity — their circumstances should be taken into account in any rating system. The rating system must address disadvantaged and low-income groups in a meaningful way. The British Government’s scheme, in its present form, does not address those core issues, which are essential criteria and which must be at the heart of any review.
Go raibh maith agat.
Mr Hamilton: I take the opportunity to welcome you on your first occasion in the Chair, Mr Deputy Speaker.
There is no doubt that a review of rating policy is required. Many objections to the capital value system have been well aired this morning. I will dwell on the concerns about local income tax that were overlooked, perhaps understandably, by the proposer. Having listened to him, one might be forgiven for thinking that local income tax is a panacea for all of our taxation ills.
There is some popular support for an income-based system. Recently, the Lyons Inquiry, which examined local government finance in England, found that half of its respondents were in favour of some, or all, local taxation being raised through an income-based tax. However, four in ten people did not express a view, which suggests that there is a lack of knowledge about the implications of such a system.
A local income-based tax system would result in significant rebalancing — from retired householders to the working-age population — and this is where a judgement is required. Do Members want retired householders to pay less, on average, than younger, working householders?
It is often said during discussions about local income tax — and was repeated by the proposer — that any system should be based on ability to pay. However, Members must consider which definition of the phrase “ability to pay” should be applied. There are some attractions about a scheme that is purely based on income. However, should retired householders with modest incomes, but significant savings, or equity, pay less than a young family with a slightly larger income but no assets?
Income-based tax has been a hot topic in the recent Scottish election. Professor David Bell of Stirling University has illustrated the “classic case” of a household comprising a fireman, a nurse and their young family. He found that that household would be £73 worse off under a Liberal Democrat plan for a local income-based tax system — a plan that has had some support from the Alliance Party Members.
Are there implications for a local government that is financed through local income tax? Would resources rise and fall because income yields would create uncertainty for councils in bad times, with the risk, and temptation, of over-extension in good times?
The ease with which such a scheme would be implemented should also be examined. Any new tax inevitably creates complex and often unforeseen problems. I am sure that Members agree that we want a simpler and fairer tax system. Taking that tax at source would inevitably lead to more stress for businesses, which are already burdened by bureaucracy.
David Watt of the Scottish Institute of Directors has said that a local income-based tax would be an anti-business measure that could impact on competitiveness and add to the tax collection burden for businesses. My impression is that Members want to increase competitiveness in Northern Ireland, and that no one wants to see businesses burdened by more bureaucracy and red tape.
A local income-based tax system is attractive on paper, especially because of the general view that ability to pay translates into fairness, but it is easy to overlook that such a system has serious limitations.
There would be a substantial increase in tax for the working population, potentially less stable funding for local government than current streams, and an undoubted effect on business. Any change to any tax system will result in winners and losers, and a local income tax would simply create different winners and different losers.
Mr Gardiner: Mr Deputy Speaker, I wish you well in your appointment as Deputy Speaker of this House. I will speak today on the amendment proposed by my hon Friend Roy Beggs.
The changes introduced to the rating system by direct rule Ministers were one of the most distasteful aspects of the direct rule regime. They occasioned widespread public outcry and a deep sense of public unease at their unfairness. They became the cause of major public protest. It would be fair to say that outrage over the rates was a major factor in determining the public mood that ultimately led to the restoration of this Assembly. It was not just a matter of the substance of the rates proposals, but of the way the direct rule Ministers handled the public outcry — their attitude bordered on dismissiveness, if not actual contempt.
At the very heart of my concern about the rates issue is the disproportionate impact it will have on many senior-citizen households. The ability to pay a tax has to be a major factor in how publicly acceptable that tax is. That is why a review of the ability of many senior-citizen households to pay the tax must be undertaken and why rates bills must include a significant rebate for older people living on fixed incomes. Many elderly people live on fixed incomes and pensions and are in no position to meet massively increased rates demands. They cannot increase their incomes and cannot reasonably be expected to sell their homes, their major asset, to pay their rates bills.
Those homes are not just houses, but family homes. In many cases, older people have lived all their lives and brought up their families in those homes. There is something deeply personal about a home — especially as a person gets older. Those homes are filled with memories and have a real sense of place for their occupants.
The distress caused by this issue cannot be overstated. Older people could not have predicted the massive boom in house prices recently. Could any of us have predicted that 10 years ago? Therefore they were in no position to plan for such an eventuality throughout their lives. Thus, significant rebate must be built into the system for older ratepayers on fixed incomes and that issue must become a basic focus of any review of the rating system that Ministers set up.
The fact that older people’s homes are now worth a lot more makes no material difference to them. They will never see the value of their homes unless they sell them, which is unthinkable for many. They may be asset rich, but their income stream may be incapable of absorbing new rates bills and water charges.
Societies change and older people often get left behind. There are 200,000 more people living here than there were decades ago, and large numbers of people are returning to Northern Ireland now that civil strife has ended and the political landscape has changed. Furthermore, people are living longer.
It is small wonder, therefore, that house prices have risen with the pressure of demand. It is also true that they have risen because of planning restrictions. Both factors have impacted disproportionately on first-time buyers and older people.
In the light of these arguments, I ask the House to advocate a review of the rating system that will give special consideration to generous rebates for older people living on fixed incomes.
The eyes of the people are on us, and we must not fail them.
The Minister of Finance and Personnel (Mr P Robinson): Mr Deputy Speaker, I congratulate you on your appointment as one of the Assembly’s Deputy Speakers and join other Members in welcoming you to the first sitting over which you have presided.
Few issues are more important to householders in Northern Ireland than the level of local taxes that they have to pay. I congratulate the two Members from North Down on securing this debate at such an early opportunity and thank all the Members who have contributed. The return of devolution can make a real and meaningful difference on this issue. I welcome the opportunity to put my views on record and to set out how I intend to proceed.
Although it will not be for the Minister of Finance and Personnel alone to determine the future arrangements for rating in Northern Ireland, I will ensure that any proposals that are brought to the Assembly and the Executive represent a fair deal for householders.
As someone who fought for election on a manifesto commitment to review the present rating arrangements, I am glad that the motion and, indeed, the amendments are broadly consistent with that outlook. Today’s debate has helped to focus on many of the failings of the present arrangements. That is the easy bit; the real challenge is to devise arrangements that can command widespread support and be seen to be fair.
Let me make it clear that I am committed to reviewing the arrangements for domestic rates in Northern Ireland. I intend, in the next few weeks, to bring a paper before the Executive setting out the steps that I propose to take. I agree with the Chairperson of the Finance and Personnel Committee that it is important that rating reform be viewed in the context of how the Executive intend to address the funding of water in Northern Ireland.
In the past five years in Northern Ireland, extensive research and consultation has been conducted on the rating issue. In Great Britain, Sir Michael Lyons has recently conducted a lengthy review of local government finance. What is needed now in Northern Ireland is not a lengthy analysis but a short-term review that can deliver changes by next April and consider what further long-term steps should be taken.
We must not only achieve as fair a rating system as possible; we must also ensure that the system does not place too great an overall burden on householders as a whole. Recent years have seen some unprecedented increases in the level of the regional rate, with an increase of 19% in 2006-07. Such increases are neither sustainable nor acceptable.
In this financial year, the domestic regional rate is forecast to contribute £240 million to public spending in Northern Ireland. Put another way, that represents about 2·5% of planned departmental expenditure. Each 1% increase in the domestic regional rate provides a little over £2 million in additional spending power. Therefore, increases in the regional rate can have a big impact on householders but a limited impact on public spending.
Mr Weir: Will the Minister give way?
Mr P Robinson: I will give way on this occasion. However, if I am to respond to the remarks made by each Member who spoke, I cannot give way again.
Mr Weir: Will the Minister confirm that if, as a result of his review of the rating system, domestic rates are revalued, the process will be carried out on a revenue-neutral basis and will not lead to an increase in the regional rate?
Mr P Robinson: The mechanism for determining the regional rate is that the Executive determine what the Budget requires from the regional rate, which amount is then divided based on the valuation of all eligible properties. Therefore, the only distinction in a revaluation is the extent to which one person’s property is out of kilter with the other valuations. The overall intake is the same, and, therefore, the process is revenue neutral.
As I was saying, a 1% increase in the domestic regional rate provides a little over £2 million in additional spending power. By comparison, the proposed efficiency targets of 3% per annum for each Department over the comprehensive spending review (CSR) period will free up £790 million of additional spending power by 2010-11. A modest increase in the current efficiency target to 3·5% a year would raise an extra £120 million.
11.30 am
As well as mapping out the long-term options for raising revenue in the Province, it is essential that short-term measures be considered in any review. As I said, I intend to carry out an early review of the domestic rating system. As part of that review, the effectiveness of the new relief packages, which are already on offer, will be examined. There are better ways of delivering relief to those who are most deserving, and we need to examine the options for doing so.
We also need to look at ways of encouraging the most vulnerable, particularly elderly people, to take up the reliefs that they are entitled to. I will be urgently seeking ways of making improvements in this area. Enhanced assistance for pensioners has recently been put in place; it provides additional relief for pensioners on lower incomes. I want to ensure that all those entitled to this relief are aware of it and take advantage of it.
The motion includes a proposal that would require new legislation, which could not be completed in time for the next rate bills, even if the proposal were considered sound and approved by the Executive and Assembly. There are issues, then, that could only form part of a long-term review. Whatever the possibilities for change in the longer term, we must be able to make changes that can be in place for next April.
There is scope for change within the existing legislation to deliver alternative or supplementary income-based reliefs. Options such as circuit-breakers, which would ensure that no household paid more than a certain percentage of its income on rates, must be examined as part of any review. Although there are many administrative difficulties with this approach, it could offer significant benefits, providing we can deliver it easily, which means within the scope of the existing legislation.
Other changes that could be made quickly and without the need for new primary legislation include the introduction of a minimum payment or a change to the level of the cap. In addition, we have the power to introduce the rating of vacant homes or to bring in a deferment scheme for pensioners. Although I am uneasy about a number of these options, it is important that any review examine all of them.
There are no easy answers. Difficult choices will have to be made. Rating is distinct from other forms of taxation because the amount of money to be raised is decided first each year as part of the Budget process of the Assembly and the district councils, and the individual bills are worked out accordingly. Therefore, providing more reliefs will either add to everyone else’s bills or lead to money being foregone.
This will inevitably lead to difficult choices for the Executive to make, and, at a time when increases in public spending are at their lowest for a decade, there are significant spending pressures. People will not tolerate spiralling local taxes when they believe that there are significant inefficiencies in the public sector. That places a huge responsibility on the Executive to ensure that every pound of public expenditure is well spent.
A complete overhaul of the system is within the power and reach of the Assembly. However, more significant change, such as bringing in a purely income-based system, would take longer to achieve, if it were thought to be appropriate. As an incoming Executive, we have an obligation to ensure that a fairer system is in place for next year’s rate bills. In the coming months, I will look at the evidence carefully and bring back proposals to my ministerial colleagues, the Finance and Personnel Committee and the Assembly.
Members raised a number of points during the debate and, in the short time available, I want to respond to as many of them as possible. I have no doubt that, in the months ahead, we will return to this subject. Certainly we will do so before conclusions are reached.
The option of a local income tax has been suggested as an alternative to a property tax. Although this cannot represent a short-term solution, it should be considered, if only to be rejected, as part of any review. I agree with the Member for Strangford Mr Hamilton that this option is not a panacea to the problem, as many have suggested it is. It could only be done with the agreement of Parliament and would require an amendment to the Northern Ireland Act 1998. Evidence suggests that a local income tax system would be expensive to introduce, difficult to administer and open to fraud.
Research has demonstrated that people expect to benefit from a local income tax to a greater degree than would, in fact, be the case. It is estimated that to entirely replace the current regional rate in Northern Ireland, about 7p would have to be added to the basic rate of income tax. Despite that, I shall not rule out the option, but we must be realistic about the timescales and the likely costs, as well as other factors. All of those matters must be carefully considered. Nevertheless, without prejudice to the outcome of such an analysis, the existing system can be made more income sensitive.
The Member for North Down Mr Brian Wilson mentioned the position of single pensioners. I understand that the assistance available through the enhanced relief scheme goes further than that provided for single pensioners in Great Britain. As Members consider the amendment that was tabled by the Member for East Antrim Mr Beggs, it should be noted that enhanced assistance has been recently introduced, which provides additional relief for pensioners on lower incomes. I want to ensure that all those who are entitled take advantage of that scheme. One way of doing that is to examine the case for applying a non-means-tested relief for pensioners, which can be provided automatically.
I listened to those Members who spoke about non-means-tested reliefs; I will take their views seriously and consider them carefully as part of the early review. However, such an option would require new legislation, which could not be completed in time for the next set of rates bills, even if the proposal were approved.
Mr O’Loan mentioned the mammoth task that was carried out by the staff and officials of the Department of Finance and Personnel. I welcome Mr O’Loan’s acknowledgement of the difficulty of valuing more than 700,000 properties. If those who criticised the Department had put their complaints in the context of the task confronted by those officials and staff, they would have reached the same conclusion as Mr O’Loan, and I welcome his remarks on that matter.
The Chairman of the Committee for Finance and Personnel, Mr McLaughlin, said that the motion and all the amendments related to it were acceptable to him. Likewise, I do not have a problem with them. Although they laid a different emphasis on various aspects of any review, they all ask for a review. To that extent, the motion and the amendments are acceptable.
The Member for North Down Mr Weir mentioned the RRI and the link with tax levels in Great Britain. He knows — and gave me the opportunity to say — that we were successful in our discussions with the Chancellor of the Exchequer in breaking the link between the RRI and local taxation, which was one of the causes of the massive rate rise in 2006.
This debate has provided an early opportunity for the Assembly to consider this important matter. In the months to come, the way in which the Assembly addresses this issue will be regarded by many as a litmus test for the success of devolution. I am determined to ensure that we can make a difference in this crucial matter.
Mrs Hanna: I appreciate the openness of the Minister of Finance and Personnel’s response and the various expressions of genuine concern about achieving a fairer system — albeit from different angles — during the debate on the motion and the amendments.
Given our new situation, I hope that we can be reasonably confident that the Assembly will not be subject to suspension. We are now best placed to set up a review of the current unfair and unworkable rating system, which was introduced by direct rule Minister David Hanson MP. I support the introduction of further income-related reliefs, although I was somewhat puzzled by the phrase “a full income-based system”.
All parties requested, or demanded, a rates review. A short time later, the Assembly was suspended. Now that we are back, it makes sense that we take control of the issue. It is a telling fact that the Assembly voted to replace the former system of basing rates on rental values, which was acknowledged to be outdated, unfair and discriminatory against those on lower incomes.
Since 2002, the SDLP has been entirely consistent in calling for a system based on ability to pay. We opted for the capital valuation model, with caveats, purely because we considered it to be the least unfair of the options available. However, the effects of that model would still need to be mitigated by the introduction of a comprehensive relief package to take account of householders’ ability to pay: single householders; pensioners; those with disabilities; and, indeed, those just above the benefits threshold — the new poor. The criterion of ability to pay must be the cornerstone of rating policy.
Soaring house values have had a distorting effect on house prices. The fair rates campaign must be mentioned. Whether we like it or not, the fair rates campaign maintained focus on the rating issue through the election period. The campaign’s website contains many well reasoned arguments.
The fact is that Mr Hanson used Northern Ireland as a testing ground for rating policy, when the Government did not appear to have the courage to introduce the same system in Great Britain. Many people have felt that the rating issue was a north Down or south Belfast problem. However, the cold reality is that sharply increasing house prices throughout Northern Ireland, coupled with the introduction of Draft Planning Policy Statement 14, has led to rating policy becoming an issue in rural areas also.
Many people will be in for a nasty shock in coming years unless there is serious rates reform. It is a debate for another day, but the issue of more social and affordable housing and the release of public land to that end, which could help burst the bubble, will have to be addressed.
Many people who bought their houses for modest prices decades ago have seen the value of those houses go sky-high, often as a result of development and the building of apartments and town houses. Through no fault of their own, those people are now being penalised and face the threat of being forced from their homes by an inability to pay their rates bills. Those people do not want to move from their homes, but they cannot really take a few bricks out of the walls to pay their rates bills in Chichester Street.
Itemised rates bills are required, because there is no clarity at present. The issue of itemised billing has come up time and time again. People want, and need, to know exactly what they are paying for. As well as considering the many options that have been mentioned, whether it is a pre-determined percentage of income, non-means-tested reliefs or the introduction of an independent rates regulator, we must get to grips with the issue and emerge from the review with a fairer system.
I want to mention the full income-based system, which I now know to be a reference to a local Northern Ireland tax, and which is the preferred option of the Alliance Party. That is one option that is up for review but, as has been said, the fact that the Scottish Parliament has tax-raising powers —
Mr Deputy Speaker: Will the Member draw her remarks to a close?
Mrs Hanna: I shall finish now, Mr Deputy Speaker. I look forward to the review. Any rating system must be fair, equitable and based on ability to pay.
Mr Deputy Speaker: Order. The Member’s time is up. There can be no latitude.
11.45 am
Mr B McCrea: First, Mr Deputy Speaker, I offer you my congratulations. Only yesterday, when making my maiden speech, did I understand the importance of your role and the protection that you can offer Members who are making speeches. I offer my sincere congratulations on that.
It is my privilege to make the winding-up speech on the amendment tabled by my colleague from East Antrim Mr Roy Beggs. In doing so, I will try to pick up on points that have been made. I was pleased that Mr Peter Weir, a Member for North Down, has clarified that his party has not thrown in the towel. No doubt he will be making a press statement, because his comment will be news to some people. I was a little disappointed in the comments of the Member for North Antrim Mr Storey, who has suggested that people such as me do not have a contribution to make on subjects such as the rates.
Some people fundamentally misunderstand the relationship between capital and revenue, and the issue of being asset rich but cash poor lies at the heart of that. A very unfortunate situation can arise for pensioners, and it is no fault of their own. They can be living in a house with a high capital value but — as was pointed out earlier — they cannot remove bricks and take them down to the bank as payment. As an interim measure, we may have to find a way of giving such people substantial, non-means-tested support. I am grateful that the Minister of Finance and Personnel has stated that he will consider that issue.
The time when a person can realise a capital valuation is when he sells the house, and that is a perfectly valid option. However, we have to consider a disgraceful situation that can arise — when people have to sell their house to pay for their healthcare. A person might have lived all his life making extra mortgage payments, extra rates payments and so on, but might then — just when he needs it most — have to sell his big asset. We will have to consider that in a review.
It is especially important that we consider a rates cap. I can think of nothing more outrageous than the fact that some pensioners in south Belfast appear to have to pay more in rates than either David Beckham or the previous Prime Minister. It is fundamentally important that taxation should be fair, should be related to ability to pay and should offer value for money.
There is another issue that we have to consider in our discussion of my hon Friend’s amendment, and it is one on which I fundamentally disagree with the position of the Alliance Party. It has to do with the difference between rates and income tax. Rates are supposed to be tied to local consumption; they are not a tax on income, which is a fundamentally different matter. Rates are for services such as collecting waste from the bins, putting in flowerbeds and regenerating local areas. Those services should be locally based, and people should buy into them. The fundamental problem that can arise is one of fairness, transparency and ease of administration.
We talked earlier about whether we should be a low-tax or a high-tax environment. I believe that we should have a lower tax where possible and that that tax should be collected in a way that the people of this Province support. I support the first amendment to the motion.
Mr Deputy Speaker: I now call on Dr Stephen Farry to wind up the debate on the substantive motion.
Dr Farry: Thank you, Mr Deputy Speaker — and I too congratulate you on your new post.
In essence, the motion is a call for a review of the new rating system that was introduced on 1 April 2007, a process that was begun by the previous devolved Executive before it was suspended. Although its result may not have been precisely what that Executive had in mind, the review was far too limited in scope. That point has been reflected in the Chamber today. Specifically, the review did not include consideration of sufficient income-based reliefs or of a full income-based system — as was pointed out by the Alliance Party at the time.
It is notable that the Lyons Review into local government finance in England and Wales, and the Burt Review in Scotland, considered that option, as Brian Wilson pointed out.
The minor tweaking of the creation of a £500,000 cap on bills is not sufficient to address the range of concerns with the current system. If anything, it introduces further unfairness. Politicians from all parties in the Assembly have pointed to dissatisfaction with the new system. That dissatisfaction needs to be followed up by supporting a full review that considers all of the options. The motion does not ask Members to endorse any particular reform, but rather to ensure that all options remain on the table.
I am grateful to the Members who contributed to the debate, particularly the Minister. I am very pleased that he is prepared to launch a full review into the system, the terms of which we await with great interest. I am also pleased that he has, at least, accepted that the issue of a local income tax can be kept on the table. Although he may not feel that such a tax is appropriate, if it is on the agenda, we are prepared to argue the case. We shall await with interest the response from people of Northern Ireland.
The difficulty with the amendment tabled by Roy Beggs from the Ulster Unionist Party is that it focuses solely on pensioners. Mr Beggs called for a non-means-tested review, whereas Mr Gardiner suggested that it should be means tested. Addressing the needs of pensioners alone will pass more of a burden back onto families — whom Mr Beggs was so keen to protect in his initial remarks. The amendment from the Ulster Unionists essentially rules out a local system.
The SDLP has made great play of the issue of ability to pay, yet, once again, the idea of a local income tax or local income-based system was dismissed. The SDLP seems to think that we can edge towards such a system by introducing more reliefs. In effect, that would create more bureaucracy, whereas a full income-based system is much cleaner. If, in using the term “ability to pay”, the SDLP means taking into account someone’s assets, it is worth remembering that many pensioners deliberately put their savings aside to finance themselves for 20 or 30 years beyond retirement. In the absence of free personal care, paying for one’s old age is something that many people have to bear in mind.
The problems with the rates system have been well aired. A property-based system is inherently unfair; the value of property is a very blunt measure of ability to pay. The system struggles to adequately reflect personal or household circumstances, with those on fixed incomes, such as pensioners, most affected. Ultimately, those who are asset rich but income poor face the greatest problems. Many people find themselves in the situation where the family home, in which they have lived for many years, has shot up in value due to a booming housing market while their income has not kept pace.
Single people are also particularly affected in comparison to those in larger households who live in properties of similar value but inevitably place a greater strain on a range of services. Mr Basil McCrea made the point that rates are based on the services that people use. That is false: people living in the same street in similar-sized houses pay the same rates, irrespective of whether the council empties their bin or whether they use the entire range of council services, from leisure centres downwards.
The regional rate is the only means through which the Northern Ireland Administration can raise additional funds and balance the books. Previously, the purpose of the regional rate was to reflect the services charged by councils to ratepayers in Great Britain. In Northern Ireland, however, those services were provided by central Government. Since 1999, the regional rate has been used to fund general services, particularly the reinvestment and reform initiative, which the Minister mentioned. Therefore, Northern Ireland is the only part of the UK where a property tax is used to fund central Government services.
Over the past few years, the people of Northern Ireland have suffered considerable hikes in their rates; Mr Weir and Mr Robinson mentioned a figure of 19%. If the Executive continue to use that system, such unfairness will be magnified. The move from rental values to capital values essentially only tinkered with an already unfair system. Much more fundamental change is required.
Simply capping the rates is not the solution. The Alliance Party is wary of caps, which are blunt instruments, and the impact of which tends to be regressive. It is worth noting that the Lyons Report suggests that council-tax capping be removed in England and Wales. The current £500,000 cap may help some people who are experiencing difficulties, but it provides no comfort for others. That cap also allows millionaires to escape paying their fair share of moneys. The cost of lost revenue from a cap will have to be found elsewhere in the system; that entails spreading the cost around other ratepayers. Simply lowering the cap to £300,000 will increase the system’s unfairness rather than dealing with the problems. Members have mentioned other relief schemes, which the Alliance Party is happy to consider.
The idea of an income-based rating system has caused much controversy, but it could replace either the regional rate or both the regional and district rates. Both of those options are available. That may require legislation from Westminster. However, if the Assembly agrees that that is the way forward, it can approach Westminster for that measure.
The claim that an income-based system inevitably means tax increases is a huge red herring. An income-based system would simply replace the property-based system. It would be a different, and fairer, way of redistributing the same tax burden; it is revenue neutral. The point is made that some people could be paying hundreds of additional pounds in income tax each year. It must be borne in mind that an income-based system would replace the hundreds or thousands of pounds that people currently pay in their rates bills.
The decision on how much money to raise from the system would lie in politicians’ hands, and that is the case with the rates system today. The SDLP’s proposition for the appointment of a revenue regulator is interesting. That party would appear to suggest that the Assembly cannot be trusted to take decisions on taxation and expenditure, which is what Members were elected to do. It seems to be an admission that some parties in the Assembly are incapable of taking balanced decisions about money.
In any redistribution of the tax burden, there will inevitably be winners and losers. Some people claim that families will be particularly hard hit. However, the income-tax system already takes account of family situations and whether people have children.
An income-based system would pose new administrative challenges, but I doubt that a new system would be much more complex than the management of the current rates system. The introduction of an income-based system into Northern Ireland may even carry some opportunities. All citizens share the same BT postcode, and all taxpayers’ home addresses are available from Her Majesty’s Revenue and Customs. For Mr Beggs’s information, Her Majesty’s Revenue and Customs is the new name for the Inland Revenue; he was not aware of that fact in his earlier comments.
Mr Kennedy: Thank you for that.
Dr Farry: I am glad to keep Members up to date with developments. Tax codes can be modified geographically.
The Lyons Report holds open the door for the introduction of a local income-based system in England and Wales. If that can be done in England and Wales, consideration should be given to it being done in Northern Ireland. As Mr Hamilton mentioned, the report found that there was strong support for that option.
The Minister of Finance and Personnel said that the issue of how revenue is raised cannot be considered in isolation from public expenditure in Northern Ireland. I cannot stress how important those comments are. Northern Ireland depends hugely on the UK Treasury. That situation will not be allowed to be sustained in the long run, notwithstanding any financial package that the Assembly may receive in the short term.
If the Assembly is to avoid passing further unsustainable burdens on to the people of Northern Ireland, it must promote economic growth and expand the local tax base. It must also address the inefficiencies and costs in the system. The Minister referred to the 3% efficiencies in the 2007 comprehensive spending review.
The Alliance Party has also pointed to an annual cost of some £1 billion that is spent on trying to manage a divided society. That sum dwarfs the amount of money that is raised by the rates. The Office of the First Minister and the Deputy First Minister has commissioned a report from Deloitte, which will be published shortly. That report will set out the issues in detail.
The Alliance Party believes that our motion reflects the wide range of available options. Both amendments are unnecessary and, if anything, contradict each other. Our motion represents the best way forward and keeps all the options on the table. I urge the Assembly to support the motion.
Mr Deputy Speaker: I remind Members that if amendment No 1 is made, I will still put the Question on amendment No 2.
12.00 noon
Question put, That amendment No 1 be made.
The Assembly divided: Ayes 63; Noes 7.
Ayes
Martina Anderson, Billy Armstrong, Roy Beggs, Cathal Boylan, Mickey Brady, Allan Bresland, Francie Brolly, Lord Browne, Thomas Buchanan, Paul Butler, Gregory Campbell, Trevor Clarke, Willie Clarke, Fred Cobain, Rev Dr Robert Coulter, Jonathan Craig, Leslie Cree, Nigel Dodds, Jeffrey Donaldson, Alex Easton, Sir Reg Empey, Arlene Foster, Samuel Gardiner, Simon Hamilton, David Hilditch, William Irwin, Danny Kennedy, Fra McCann, Jennifer McCann, Raymond McCartney, David McClarty, Basil McCrea, Ian McCrea, Dr William McCrea, Alan McFarland, Claire McGill, Michael McGimpsey, Gerry McHugh, Michelle McIlveen, Daithí McKay, Mitchel McLaughlin, David McNarry, Adrian McQuillan, Stephen Moutray, Robin Newton, Carál Ní Chuilín, John O’Dowd, Michelle O’Neill, Rev Dr Ian Paisley, Ian Paisley Jnr, Edwin Poots, Sue Ramsey, George Robinson, Iris Robinson, Caitríona Ruane, George Savage, Jim Shannon, David Simpson, Jimmy Spratt, Mervyn Storey, Peter Weir, Jim Wells, Sammy Wilson.
Tellers for the Ayes: Leslie Cree and George Savage.
Noes
Dr Kieran Deeny, Dr Stephen Farry, Anna Lo, Naomi Long, Kieran McCarthy, Sean Neeson, Brian Wilson.
Tellers for the Noes: Naomi Long and Kieran McCarthy.
Question accordingly agreed to.
12.15 pm
Mr Deputy Speaker: The Question is that amendment No 2 standing on the Marshalled List be made. All those in favour say “Aye”.
Mr McNarry: On a point of order, Mr Deputy Speaker. If the second amendment —
Mr Deputy Speaker: You must wait until the vote is over, Mr McNarry.
Mr McNarry: I will address the issue then. Thank you.
Question, That amendment No 2 be made, put and agreed to.
Main Question, as amended, put and agreed to.
Resolved:
That this Assembly notes the widespread public concern at the changes to the rating system and calls upon the Department of Finance and Personnel to conduct a full review of the new rating system, which fundamentally fails the essential test of ability to pay; and further calls for this review to give particular consideration to fair and transparent income-based protections, and suitable reliefs for pensioners and all disabled persons.
Mr Deputy Speaker: As Members know, the Business Committee has arranged to meet at lunchtime today. I propose therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm.
The sitting was suspended at 12.17 pm.
On resuming (Mr Deputy Speaker [Mr Molloy] in the Chair) —
2.00 pm
Mr Deputy Speaker: The Business Committee has agreed to allow one and a half hours for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make the winding-up speech. Other Members will have five minutes each. One amendment has been received and has been published on the Marshalled List. The proposer of the amendment will have 10 minutes to propose and five minutes to make his winding-up speech.
Mr McCarthy: I beg to move
That this Assembly calls upon the Minister of Health, Social Services and Public Safety to establish a cost and benefit review for the purpose of abolishing health prescription charges as has been carried out in Wales.
As the Alliance Party’s spokesman on health, social services and public safety, I wish to see the best possible health provision for everyone living in Northern Ireland, and I am sure that all Members agree with me. To that end, I hope that the Assembly will support my call to the new Minister of Health, Social Services and Public Safety, Michael McGimpsey, who I am glad to see in the Chamber, to initiate a cost-and-benefit review for all current prescription charges.
In addition, I am happy to support the amendment.
The Alliance Party’s policy on health provision continues to be that the service should be free to patients at the point of delivery; funded through general taxation; available to all on the basis of need; and universally and equally accessible by everyone.
The National Health Service was introduced throughout the United Kingdom in 1946, and it was to be free from any charges. However, in 1949 a new Act was introduced to permit charges for prescriptions, and it came into force on 1 June 1952. Prescription charges were abolished in 1965, and prescriptions remained free until June 1968 when charges were reintroduced. Those charges remain throughout the UK to this day, with the exception of Wales where all prescription charges have been abolished from 1 April 2007.
I congratulate the National Assembly for Wales on the planned and gradual way it abolished prescription charges. The Welsh Assembly’s main reason for abolishing the charges was that it wanted to ensure that people would not be put off going for their medication due to cost, and that patients would get the medication they required to improve their health and, ultimately, their quality of life. The Welsh Assembly also reckoned that people who were on modest incomes and who had chronic illnesses might not have been eligible for free prescriptions under the previous exemption system, which could be complicated.
Research has shown that costs have prevented patients availing of healing drugs, and that the long-term costs to the NHS could end up being much greater through avoidable hospital treatment having to be carried out.
UK regions have different opinions on prescription charges. Scotland has promised to reform its system and introduce more exceptions for chronic conditions, students and people on low incomes. England retains prescription charges, but its health Minister has pledged that increases will not go above the rate of inflation and that all proceeds from these charges will go straight back into front-line services. At present, we in Northern Ireland have to pay for prescriptions, although it is now estimated that some 90% of people get prescriptions free of charge for one reason or another.
Our challenge today is to ensure equality of treatment for everyone in Northern Ireland. My information is that everyone in the Republic of Ireland is entitled to either free or subsidised approved prescription drugs and medicine and certain medical and surgical aids and appliances.
In asking the Minister to instigate a cost-and-benefit review on prescription charges, there are many factors to be considered. For instance, how much does it cost the Health Service to administer the prescription system? What is the revenue from prescriptions in the context of the wider health budget? How can we reduce prescription fraud, which was estimated in 2005-06 to amount to almost £7·6 million? Should free prescriptions for Northern Ireland be introduced on a single date, or should we gradually reduce the cost of prescriptions as happened in Wales? What has to be done to ensure that patients comply and take their prescribed medication? The review must answer these and many more questions, taking into account the voices of local GPs.
There is also a fear that if all prescriptions were free, patients would simply telephone surgeries and ask for medication that can be bought over the counter, thus giving our already hard-pressed GPs extra and unnecessary work. The review must consider, in addition, the overall benefit to the National Health Service and how to make a real and visible improvement in Health Service provision.
In conclusion, we acknowledge the efforts of one of our leading newspapers, the ‘Belfast Telegraph’, to establish a level playing field for all patients by seeking the total abolition of these charges. Indeed, I warmly welcome the Minister’s published views on this important subject and his eagerness to have a review of it. Now he has the opportunity to respond positively to my proposals today.
I ask Members to support the motion and the amendment.
Mr Buchanan: I beg to move the following amendment: After “Wales” insert
“; and to review the list of conditions that currently entitle patients to free prescriptions in order to reduce anomalies.”
Prescription charges were first introduced in 1952 and, except for a three-year period between 1965 and 1968, they have been levied ever since.
A person can qualify for exemption on three grounds: age, financial status or medical condition. It is estimated that around 50% of the population qualifies for free prescriptions under the current exemption arrangements.
However, because this group includes children, the elderly and people with chronic health conditions, all of whom are high users of medicine, it is estimated that over 90% of items dispensed could be supplied to patients free of charge.
Undoubtedly there are arguments in favour of prescription charging. It places a value on the medicine that patients require, helps reduce the level of less urgent demands on GPs’ time and provides a much needed source of revenue for the National Health Service.
There are indications that between a quarter and a fifth of people would be more likely to go to their doctors for prescriptions if prescriptions were free to all. Dropping prescription charges might lead to an increased demand on doctors’ time and for prescriptions.
As indicated in the amendment, current exemption arrangements contain certain anomalies that need to be addressed. Any changes to the present system should be straightforward and easy for patients to understand. Secondly, the impact of any changes should not increase the administrative burden on GPs and community pharmacists. Some chronic conditions are currently exempt while others are not.
The argument is made that it is one thing for diabetics, for instance, to receive free prescriptions for their condition, but quite another that they should receive free prescriptions for conditions unrelated to diabetes.
However, it may prove difficult to determine whether one medical condition is related to another. In addition, some conditions can cause secondary problems or can affect sufferers’ general health. For example, the symptoms that affect sufferers of multiple sclerosis are wide-ranging. They include fatigue, pain, spasms, depression, incontinence and other problems. Drawing a distinction between drugs that relate to multiple sclerosis may, therefore, be difficult.
Similarly, it has been recognised that treatment of the main condition may cause side effects for which a prescription is also required. Furthermore, a patient may suffer from an illness that is unrelated to the exempt condition, but which may, nonetheless, lead to a deterioration of that condition if left untreated.
Concern has also been expressed that limiting exemption to treatment for the main condition would require significant changes to be made to current administrative systems, which would be costly. From a processing perspective, it would be difficult to have some items on a prescription form that were exempt from charges and others that were not. It has even been suggested that such changes could cost more than the complete abolition of charges for people who have a chronic condition.
Another idea is to base exemptions on a list of drugs rather than on a list of conditions. However, there are several drawbacks to that suggestion. The extra bureaucracy required to maintain the list of drugs may prove costly. There would be a potential time lag between new drugs coming on to the market and their addition to the list of exempt drugs. The feasibility of developing a list of drugs that includes all of those medicines that are required to treat even common chronic conditions is questionable. As many drugs are used to treat more than one condition, drugs-based exemption from charges might be granted not just to those who have chronic conditions, but also to those who have minor ailments or short-term acute illnesses who may be less in need of assistance with charges. For example, antibiotics can be prescribed for anyone who has a cough. For a patient who has cystic fibrosis, however, the consequences of not taking antibiotics are severe. That is not the case for other patients.
Some people have suggested that there be a reduced flat fee for prescriptions. The main argument in favour of that is that all patients would contribute something to the cost of their medicine, which would provide much-needed revenue to the NHS. There is no doubt that some of those people who are already exempt from charges could afford to pay something towards their medication.
For patients who require many prescriptions, a more affordable option is to purchase a prescription prepayment certificate (PPC). Those can be cost-effective when a patient needs several items over many months. The PPC system could be improved by allowing patients to pay in instalments, issuing PPCs retrospectively and publicising the system better. For patients who are not exempt on the grounds of income, but who require many or frequent prescriptions, the prescription prepayment certificate presents a more affordable way of paying for their medication.
However, it is recognised that the PPC system has several shortcomings; in particular, the size of the upfront fee may present difficulties for some patients, particularly those who are on lower incomes. Options include abolition of the system of upfront payment and allowing patients to pay in instalments with the option of paying by direct debit, standing order or by a stamp-scheme system. Some people favour the retrospective issuing of PPCs to patients who incur significant but unanticipated charges during a set period.
There are many varied ideas on prescription charging. Representatives of the Royal College of General Practitioners have suggested replacing the current charging and exemption arrangements with a patient co-payment system, similar to those that exist in other countries, in which charges vary for different categories of drugs. They have also stated that it would be worth examining experiences elsewhere, such as the current French system in which patients receive a higher level of reimbursement for evidence-based treatment than for newer or more expensive medication, which is not necessarily more effective.
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In such a model, it is likely that the great majority of prescription medicines — perhaps 90% — would be free to the patient. That would require the categorisation of all medicines. However, as a first step toward addressing this important issue, Members should seek to review the list of exempt conditions.
Mr Deputy Speaker: I call Mrs Michelle O’Neill. She will be making her maiden speech, and it is the convention that it be heard uninterrupted.
Mrs O’Neill: Go raibh maith agat, a LeasCheann Comhairle. I am pleased to have the opportunity to make my maiden speech on an issue that has an impact on the lives of so many people.
Sinn Féin is determined to create a society in which inequalities in health provision are eradicated. To that end, we launched a campaign for free prescriptions over a year ago, which we took to most councils in the North. It received universal backing.
Sinn Féin notes that the graduated abolition of prescription charges over one electoral term was in the UUP manifesto, and we will support the Minister of Health, Social Services and Public Safety in achieving that worthy goal.
Prescription charges should be redundant in the Health Service, which is supposed to be free at the point of delivery. The current cost — almost £7 per prescription — has the detrimental effect of excluding many people from receiving the correct medical treatment. People on low incomes cannot access the medications that they need. That cannot be allowed to continue, and Members must end charging now.
Sinn Féin recognises that it may take some time to implement, as it did in Wales. In the interim, we urge the Minister of Health to go the extra mile and to adopt our recommendations from last year concerning the list of chronic conditions that qualify for exemption. As other Members have said, that list was compiled in 1968, is no longer fit for purpose and must be modernised. There have been tremendous advances in pharmacology in the 40 years since the exemption list was compiled. Sinn Féin urges the Minister to immediately widen it to include long-term conditions such as Alzheimer’s disease, arthritis, cancer, multiple sclerosis, HIV and schizophrenia, to name but a few. There must be a more consistent approach for patients who require repeat prescriptions for long-term medical conditions. The disparities associated with the outdated exemption list must be addressed as soon as possible.
In its report, ‘Unhealthy Charges’, the National Association of Citizens Advice Bureaux found that more than two thirds of those with long-term health problems had difficulty meeting prescription charges. That has an adverse impact on their health and raises costs elsewhere in the Health Service due to hospital admissions and appointments.
With that in mind, Sinn Féin calls on Members to support the motion.
Rev Dr Robert Coulter: Members have heard some lucid arguments in favour of the motion. A look back in time may help Members to take a long-term view.
In 1979, the prescription charge was 20p. Figures for the retail price index, on the 1974 basis, show an increase by a factor of 6·62 between 1979 and 2007. That implies that the prescription charge could reasonably be expected to have increased from 20p to £1·32 — yet in 2007 it had reached £6·85. That is more than five times what might have been expected due to normal inflationary pressures. That simple arithmetical exercise shows how inflated prescription charges have become.
That is not the whole story. If prescription charges played a significant part in recovering the cost of medicines, such an overblown increase might be understandable — even justifiable, if all moral and ethical issues were set aside to deal just in figures and recovery costs. However, the picture painted by the facts shows that prescription charges are negligible in terms of cost recovery.
In 2004, just 4% of the cost of prescription items was recovered through prescription charges. Some 95% of prescription items — 25·73 million prescriptions — were not paid for at the point of dispensing. That figure included the 90% receiving free prescriptions and the further 5% using prescription prepayment certificates.
In 2005-06 the 501 pharmacies in Northern Ireland dispensed 27·1 million prescription items at a cost of £340 million. Four million pounds was received in prescription prepayment certificates, and only £10 million was received in prescription charges. That is £10 million out of £340 million. The general pharmaceutical service cost some £381 million in 2005-06, and that cost was defrayed by only £14 million from prescription charges and prescription prepayment certificates.
The extent of the bureaucracy involved in administering the system simply cannot be justified in terms of the rate of recovery. A new prescription bar- code system, begun in 2006 and based on a £6·8 million contract with Hewlett Packard, will enable whatever data recovery is necessary on patterns of prescribing by drug, patient and doctor. That will render much of the bureaucracy obsolete.
Quite apart from this statistical approach, there is the ethical issue of taxing health. Make no mistake — that is what prescription charges actually are. Strip away all the arguments and you come back to this point. That is why the Welsh Assembly, which has fewer devolved powers than the Northern Ireland Assembly, has abolished prescription charges from 1 April 2007.
The purpose of levying prescription charges is now unclear. The income from them is negligible in overall terms. We must get away from continuing and perpetuating activities simply because we have always done them. Levying prescription charges is one of those survivals from past practice that no longer makes sound business sense for Government.
It may be argued that we need to get back to the founding principles of the National Health Service in this matter. The National Health Service introduced in 1947 was a comprehensive health service that was free of charge at the point of need. If patients are treated free of charge at the point of need, medicines should also be free.
The motion calls for a review of prescription costs and benefits. On that basis, I support the motion.
Mrs Hanna: The existing charging scheme in Northern Ireland is outdated and inconsistent. A review of the system is clearly needed. There are many inequities and anomalies in the system. Although around four out of five prescriptions are exempt, the price of a prescription — set at £6·85 from April — sometimes hits those who cannot afford these charges.
There are many people with chronic conditions who are still not exempt. With the continued rise in prescription charges there is concern that more patients will be discouraged from visiting the doctor when they are ill. Research in the UK and Canada shows that charges result in patients not taking the treatment that they require.
Therefore, prescription charges may constitute a financial barrier to receiving treatment for a portion of the population, which would obviously have a detrimental effect on the health of those individuals. That is probably accurate. There are many other groups of patients who are on long-term, or indeed lifelong, treatment, such as those with cancer, cystic fibrosis, Parkinson’s disease and other conditions. They are certainly disadvantaged.
Unfortunately, some terminally ill patients cannot afford the cost of medicines. It would be fairer, particularly for the most vulnerable, to extend the grounds for exemption from prescription charges to include chronic illness. Cancer charities have recently called for the abolition of charges for the chronically or terminally ill to be implemented as a matter of priority. Of course, a fair legal definition of the word “chronic”, on which to base the exemptions, would have to be established.
The Scottish Parliament is not convinced that an equitable charging scheme can be created by identifying exemption categories and may be in favour of abolishing prescription charges entirely. However, in Northern Ireland the abolition of charges should be costed to determine whether it could be budgeted for. It is estimated that, in Wales, free prescriptions will cost £25·5 million for the first year. I have no doubt that the Minister of Health, Social Services and Public Safety will initiate a cost-and-benefit review to measure the impact of abolishing prescription charges. Indeed, it might be more cost-effective to abolish charges; the vast majority of people already do not pay for prescriptions.
Another important question is whether abolition of prescription charges will impact positively on public health and benefit the people of Northern Ireland. There is an argument that free prescriptions will result in fewer hospital stays. Conversely, there is an argument that free prescriptions will encourage a rise in the number of prescriptions issued, which will put further pressure on the health budget and may not be good for public health.
Doctors should be encouraged to prescribe less expensive generic medicines. Pharmacists should inform patients when there is a cheaper, over-the-counter alternative to that prescribed. Pre-paid prescriptions should be availed of and made more flexible.
Society is very reliant upon medication, and that is not to detract from the benefits of powerful drugs. However, these are often seen as the only solution to health problems. Members interested in health issues will accept that we must create a Health Service that promotes good health and supports early intervention. People must be encouraged to take more responsibility for their health, so that they do not become too reliant upon medication. That is why the costing of free prescriptions is important. It will assist those who cannot afford essential medication. Should prescriptions become free, the prescribers — mainly general practitioners — will have an added responsibility and will have to be extra careful, especially with regard to repeat prescriptions. We are all aware of individuals who are dependent on medication. Last weekend, we heard about an eight-year-old boy who was selling his parent’s medication. That is becoming common. It is important to weigh the options, and remember that medicine is not a panacea.
Ms Ní Chuilín: Go raibh maith agat, a LeasCheann Comhairle.
I support both the motion and the amendment. As the Sinn Féin spokesperson on health, I look forward to working with the Minister and acknowledge that the Committee for Health, Social Services and Public Safety and he will have much work to do together.
The Investing for Health strategy should be at the centre of the Executive’s concerns. Health, like many other policy areas, cuts across the responsibilities of several Departments. Deprivation in north and west Belfast has been well publicised, as have the links between ill health and poverty. In this debate Members have consistently made the connection between those on low wages having restricted access to prescriptions and the fact that they also suffer the long-term effects of lack of access to primary care. Those people will be much more expensive to treat when accessing secondary care, which will put more pressure on an already stretched Health Service. Furthermore, it does not take into account the cost in human terms to the individuals.
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At this early stage of the Assembly, it is good that Members are seeking to help those in most need — by trying to give them access to services from which they are deprived due to the financial implications. Sinn Féin supports the motion and the amendment. Go raibh maith agat, a LeasCheann Comhairle.
Mr Deputy Speaker: I call Mr John McCallister to make his maiden speech, and I ask Members not to interrupt.
Mr McCallister: First, I congratulate the Members who tabled the motion for bringing the extremely important issue of prescription charges before the House. It is encouraging that they have read, and agree with, the Ulster Unionist Party manifesto. It is with personal satisfaction that I make my maiden speech on such a pressing matter.
If the Department of Health, Social Services and Public Safety establishes a cost-and-benefit review, such as the motion calls for, I hope that it would result in firm and sustainable proposals to abolish health prescription charges. I use the phrase “firm and sustainable” because there have been situations in which similar measures have been adopted and subsequently rescinded.
The National Health Service Act 1946 did not allow for health prescription charges — those were introduced in 1952. The founding fathers of the NHS wanted the service to be free at the point of need. It was my party that brought the National Health Service to Northern Ireland.
However, for many hard-working families today, the Health Service is not free at the point of need. Those people have already paid for their healthcare through their taxes; therefore, the present situation results in almost double taxation. Members must agree that it has to stop.
As Rev Coulter stated, prescription charges are a tax on health, or indeed on ill health. A recent citizens advice bureaux survey found that 37% of respondents who suffered from long-term conditions such as arthritis could not pay for all or part of their prescriptions because of cost. If those people cannot afford prescriptions, their health may deteriorate, they may be hospitalised and may cost the NHS and the taxpayer even more money.
There are serious flaws in the current exemption regulations for prescription charges. The exemption system does not necessarily include chronic conditions and terminal illnesses such as cancer, multiple sclerosis, cystic fibrosis, arthritis and asthma, which means that sufferers have to pay for what could be life-saving treatment.
The Ulster Unionist Party wants to introduce free prescriptions, and the cost would be around £14 million to the taxpayer — less than 0·5% of the current health budget. The new Minister of Health, Social Services and Public Safety, my friend and colleague Michael McGimpsey, has reiterated his commitment to free prescriptions. The Welsh Assembly has delivered free prescriptions from 1 April 2007, and the Scottish Parliament may follow soon. Why should Northern Ireland be the only devolved region in the UK to be different?
The proposal to abolish prescription charges serves as an excellent example of how devolution can benefit all of the people of Northern Ireland. It is a prime demonstration of how the Ulster Unionist Party plans to serve the people, and how we will strive to improve the quality of life for everyone.
Mr Armstrong: I welcome the debate and support the call for the Minister of Health, Social Services and Public Safety to examine the cost and benefits of abolishing prescription charges. Ending prescription charges is a step towards restoring a key principle of the National Health Service. The Ulster Unionist Party supported free prescriptions in its manifesto, and I am delighted to see that the measure has attracted support from all parties.
Prescription charges are effectively a tax on illness. It is an unfair system that gives free medication to various groups who can often afford to pay, while charging numerous other groups who may find it difficult to pay — for instance, those who have chronic illnesses or who are on a low, modest income but who do not qualify for income support.
The current exemption system is complicated and unbalanced. There is a range of chronic and terminal illnesses that are not included in the list of conditions that are exempt from prescription charges. These conditions include arthritis, asthma, cancer and multiple sclerosis. Sufferers of those illnesses must continually pay for medication that could effectively save their lives or at least improve their quality of life.
It is grossly unfair that 230,000 people in Northern Ireland who are affected by arthritis, many of whom have to take a wide range of medications over a long period of time, should not be awarded free prescriptions on the basis of their condition. Those costs are in addition to other financial restraints such as loss or limitation of employment and the cost of aids and adaptations that are necessary to easing their everyday lives.
Arthritis is the single largest cause of physical disability and lost working days in Northern Ireland, yet many people suffering from arthritis find it difficult to pay for the necessary medications to reduce their pain. That is unacceptable.
Similarly, all those suffering from cancer would benefit from free prescriptions. Macmillan Cancer Support research has shown that one in seven cancer patients under the age of 55, who must currently pay for prescriptions and whose financial situations have worsened, are unable to afford their cancer treatment. Poverty is a particular problem for people of working age who suffer from cancer. That is deplorable.
Macmillan Cancer Support research has established that, of those people who have been diagnosed with cancer at age 55 or younger, seven out of 10 households have suffered an average loss of income of 50%. Furthermore, increasing numbers of cancer patients receive their treatment as outpatients, which means that more and more people must now pay for medication such as treatment for side effects, long-term preventative medicines and even treatments such as oral chemotherapy when they get home.
Prescribing medicines is often complicated, with some medicines complementing another, and others requiring to be taken with another drug. Two substances can sometimes be combined into one tablet, but others cannot and must therefore be paid for separately. That creates further financial problems for many people who are already suffering a lot of distress.
The National Association of Citizens Advice Bureaux found that 37% of respondents with long-term conditions have failed to purchase all or part of their prescriptions because of cost. It would surely be more cost effective for the National Health Service for patients’ conditions to be adequately treated as prescribed rather than paying for avoidable hospital treatments in the long term. Rather than select only parts of medication that patients are prescribed, free prescriptions would enable them to comply fully with their prescription, bringing longer-term health benefits.
The inequalities of the current system must be eliminated. The British Medical Association calls for a:
“fundamental review of the whole system of prescription charges”,
describing prescription charges system as “outdated”.
The current system awards free prescriptions to 87% of the people, but many of the remaining 13% who pay regularly for prescriptions are suffering because of the outdated system. The National Health Service makes a real difference to our lives, contributing in vital ways to the quality of life of people in Northern Ireland.
Mr Deputy Speaker: The Member’s time is up. We need to keep within the time allotted for the debate.
The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I thank the two proposers for tabling the motion. The motion is entirely in keeping with the Ulster Unionist Party’s manifesto commitments and my already stated determination on the issue of prescription charges. Therefore, the support of Mr McCarthy and Dr Deeny is wholly welcome.
I also thank all the Members who have spoken on the subject. Many useful points have been made. It is not overstating the case to say that there is strong agreement in the Chamber. I look forward to further cross-party enthusiasm in support of my future requests for additional health funding.
Some Members: Hear, hear.
Mr McGimpsey: It is clear that prescription charges are an issue on which Members want to make progress and that the people of Northern Ireland wish to have addressed. That is why the Ulster Unionist Party is committed to the introduction of free prescriptions for all. Therefore, I welcome the opportunity to bring the issue forward for review. Indeed, I have already told my departmental officials that such a review is a priority.
My Department will also seek to restore the key principle of the National Health Service, which is that healthcare should be free at the point of use. After all, it was a Stormont Government that brought the National Health Service to Northern Ireland. Now, this Stormont Government have the opportunity to renew their commitment to the fundamental principles of the National Health Service.
Some Members: Hear, hear.
Mr McGimpsey: On prescription charges, it is worth considering a number of points. Currently, each prescription item costs £6·85, unless a patient is entitled to free prescriptions. Members will be aware that there are several grounds for exemption from paying for prescriptions. These include age, medical condition and income. However, the implementation of exemptions is complex and highly bureaucratic.
Until now, the direct rule Government’s view has been that if people can afford to pay for their medicines, they should do so. Annually, approximately 28 million prescriptions are dispensed here. The income from charge-paying patients is around £13 million. That must be set in relief against the £360 million that is spent on medicines prescribed by GPs. Of that £360 million, only a small proportion — around 3·5% — is recovered. Additionally, each year, hospital consultants prescribe approximately £100 million worth of drugs, all of which are free to patients. Therefore, only a small proportion of the costs is recovered as income through prescription charges.
People who are not exempt from prescription charges, and who need regular medication, can reduce their costs by using pre-payment certificates. These certificates cost £98·70 for 12 months. If a person buys a pre-payment certificate, it allows him or her access to a year’s worth of medicine for £100.
Approximately 90% of NHS prescription items are dispensed free of charge: not 90% of prescriptions, but 90% of prescription items. Although that appears to be a lot, it disguises the fact that it accounts for approximately 28 million items.
One prescription with, for example, four items on it will cost about £27. Therefore, prescription costs can be an onerous financial burden on families. I know only too well of large numbers of people — people with serious, often chronic conditions — who still have to pay for the very medication that is keeping them alive. That is not the kind of NHS that we envisage because it is not a free service. That principle apart, there are serious inequities and weaknesses in the current system that must be addressed. Irrespective of our views on charging for prescriptions, Members must ask whether the current system reflects the best way to deliver medicines to those people who need them.
We must consider the categories for exemption. Aside from age, pregnancy, a war disability and income, several medical conditions are listed as exemptions, with no apparent justification for their inclusion, while others are excluded. How does that stack up in equality terms? Do we have a rational and robust explanation for why one person is exempt and another is not? Why does one person’s suffering have a greater priority than that of another? Those are the questions that must be answered. The rationale must be defensible on the basis of evidence or health grounds. Why is a prescription issued by a hospital consultant free of charge, while the same prescription, written by a GP, for the same illness and the same patient, attracts a charge?
There is no good answer to that either. Why is a 50-year-old with a serious illness charged for prescriptions, yet a 60-year-old with a different illness, who may be better off, can get free prescriptions? I could go on, but the point is clear. The current system cannot be the best, and it should be changed.
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As Minister of Health, Social Services and Public Safety, however, I know that my Department’s budget is neither infinite nor a bottomless pit. I have a responsibility — and I am well aware that Members will hold me to that responsibility — to ensure that the budget is spent in the most prudent, far-seeing and intelligent way for the health, social care and well-being of the people of Northern Ireland. In short, I shall decide how and where the health budget is best used to maximise its impact.
It worries me to hear evidence from patients and their families that prescription charges deter some people from having their prescriptions dispensed, either in part or entirely. The long-term costs for the Health Service of avoidable hospital treatment would improve if patients were able to afford the medication needed to treat their condition.
I am aware that people who might be able to go back to work fear that, in doing so, they will not be able to afford the prescriptions to which they were entitled when unemployed.
There are many anomalies in the system. Not only is it complex and bureaucratic, and breaks the principles of the Health Service as laid down, it is, on several grounds, hard to justify. For example, hard-working families feel that they are being taxed twice; they pay their taxes for the National Health Service and, as patients, they pay prescription charges. Northern Ireland’s hard-working families deserve better. They deserve a National Health Service that is genuinely free at the point of use, and that must include prescriptions.
There are equality implications for the people of Northern Ireland in ensuring fairness and social justice. Scotland, England and Wales have recognised the fundamental flaws in the existing system. Scotland has concluded that the list of exemptions must be substantially extended and seeks a fairer alternative to the present charges. In England, a review of the list of conditions already exempt is being undertaken, and a report will be forthcoming later in the year. England also recognises that the existing system is flawed and not fit for its purpose. As Members know, the National Assembly for Wales abolished prescription charges — not all at once, but over five years.
I welcome the motion, which supports my expressed intention to establish a cost-and-benefit review for the purpose of abolishing prescription charges. The time is right for Northern Ireland to look at arrangements locally. My officials will establish a review that will inform how we move forward on this question. The review group will include representatives of the key stakeholders involved — pharmacists, doctors, and, most importantly, patient representatives through the health and social services councils.
I want the review to take full account of the needs and wishes of patients, as well as of the practical implications for the professionals who have to deal with the consequences. The review will involve wide research and public consultation, and an equality impact assessment will be undertaken. I shall ask the review group to report back to me before the end of the year with options and recommendations. I shall bring my decisions and proposals back to my colleagues in the Executive, the Health Committee and the Assembly for approval.
Mr Spratt: I am delighted that the hon Member for Strangford Kieran McCarthy supports the inclusion of the amendment proposed by my hon Friend Tom Buchanan. The issue of prescription charges is an important one for the Assembly to debate. Our counterparts in the Scottish Parliament and the National Assembly for Wales have also considered the matter. Wales has abolished prescription charges for everyone; Scotland has been more circumspect.
Although free prescriptions are a fine idea in principle, the prospect raises other significant issues that must be fully considered before a decision can be reached. From where would the extra funding be found? What other services might suffer as a result? Access to expensive but effective new drugs, which is already very limited, could be reduced further.
The current exemption list should be reviewed, as it disadvantages those with certain lifelong or terminal illnesses who depend on regular medication. For example, patients who receive free prescriptions for diabetes may also benefit from free prescriptions for other ailments. Some may ask whether that is necessarily fair. Those patients can avail themselves of an all-round free prescription service while others with life-limiting cystic fibrosis cannot access free prescriptions for anything. A review of the current list of exemptions should be carried out, and I am delighted that the Minister has announced one this afternoon.
Initiatives to control the number of prescriptions being issued should also be investigated, so that the service is not taken advantage of or misused in any way. We do not want to reach a position in which over-the-counter drugs that are already available are sidelined in favour of free prescriptions. The sale of over-the-counter medications must be monitored. GPs will also need to monitor whether patient demand for free prescriptions increases. How will GPs react if that occurs? Those patients and families who are living with terminal or lifelong illnesses should be considered.
Free prescriptions already benefit many groups of people, such as those on low incomes and women during and after pregnancy. There is clearly an argument that those who can afford medicines and are not dependent on prescriptions should not necessarily be exempt. We also need to calculate the likely amount of drugs that would be wasted if all prescriptions were to be free of charge, and, again, how that might be monitored. If people no longer value their medications, compliance will suffer and more money will be wasted.
It seems reasonable that patients who are subject to compulsory treatment orders should not be expected to pay for their medication. That should be a ground for exemption in any new list of conditions.
In considering the shape of a further list of conditions, it is widely felt that all patients who are terminally ill or have lifelong conditions should be exempt from paying prescription charges. It is felt that many other specific conditions should be included on any new list. Among those most commonly mentioned are cystic fibrosis, cancer, asthma and mental illnesses.
I am pleased to support the motion and the amendment.
Dr Deeny: I congratulate you on your appointment, Mr Deputy Speaker. A lot of people were congratulating you yesterday. I have worked out that if all 108 of us were to congratulate all the new Deputy Speakers, we would be here until Christmas. I sincerely wish you well, as I do the other Deputy Speakers and, in his absence, the Speaker himself.
The issue is very important to me as a GP. I do not have much to say, because it has all been said, and I do not want to be repetitive. I am in my twenty-seventh year as a doctor. Apart from one year in Australia — 1985-86 — I have spent all that time in the NHS. I am delighted to hear the representatives of all parties going right back to the fundamental principles of the NHS, which was set up just after the Second World War.
Like many GPs, I believe in the fundamentals, concepts and ethos of the NHS: equity for all patients; free at point of use; funded through general taxation; and available to all on the basis of need. That final point is important, because as recently as this morning there was a radio discussion about the possibility of people being refused healthcare, and operations, if they are too obese, or if they smoke. That is a dangerous and wrong road to go down. That, however, is an issue for another day.
Healthcare should be universal, and there should be equitable access for all. Most of my GP colleagues would agree that those are the tenets of the NHS. I absolutely support the motion. As I am also wearing my GP hat today, I am delighted to hear Members from all parties expressing concern for “poor” GPs.
Some Members: Poor? [Laughter.]
Dr Deeny: I do not mean poor in the financial sense, but certainly in the administrative sense. That point should be taken on board.
In the 26 years in which I have worked in the NHS, I have seen huge and dramatic changes, and the cost incurred is a big issue. The spiralling costs of operations have gone through the roof, and investigative procedures and drugs are now very expensive. A course of oral drugs for shingles can cost more than £100. That is one example of what drugs can cost in 2007.
Healthcare costs are increasing. I fully support my colleague and namesake’s motion, but constituents will want us to address other equally important, or more important, healthcare issues. The important word is “prioritisation”. Not enough operations are being done — waiting lists must be tackled. There are not enough front-line healthcare workers, or enough doctors or nurses, and the number of available hospital beds is a problem. I worked for five years at a hospital and I have now worked for 21 years as a GP, and I cannot accept trolley waits in modern-day healthcare. To have human beings on trolleys waiting in hospitals is an indictment of any Health Service in the developed world. That would not happen in a veterinary hospital, so resolving that situation should be a priority for us all in the Assembly, in particular for our new Minister of Health. I am delighted to see him in the Chamber, along with several members of the Committee for Health, Social Services and Public Safety.
Mental health has always been the poor sister in healthcare. It is necessary that the Assembly look at that issue, and I think that a will exists to do just that.
We have talked about 90% of prescription items being exempt. One benefit of the introduction of free prescriptions would be that it would do away with prescription-exemption fraud. Another issue that has been mentioned is what GPs call “poly-pharmacy” — where a patient who, although not in an exempted category, is not well off and has six or seven medical conditions, for which they pay six or seven different charges. That is wrong.
The review should look at certain simple medications that are currently free but that perhaps should not be available on prescription. The dangers of having free prescriptions across the board are that patients may not appreciate the medication and that there will be wastage. Regardless of the situation, GPs will always have the problem of poor compliance, which is something that will also be looked at during the review.
3.00 pm
Mr O’Dowd: Does the Member agree that the primary objective of any Executive or Government should be the promotion of the good health and well-being of all its citizens and that one of the most significant steps forward that the Executive could take would be to reintroduce the Investing for Health strategy at ministerial and Executive level? I did not want to interrupt the Minister during his announcement this afternoon.
Dr Deeny: Yes, I agree.
I welcome the amendment. I know the good Member from West Tyrone Mr Buchanan very well, and I know that he has a deep interest in health. I agree with his amendment, although I would prefer that the word “criteria” replaced the phrase “list of conditions”.
We must be careful when dealing with this matter. For example, rubs, sprays and lotions that people currently get on script should be taken off prescription. That issue should form part of the review. However, we must ensure that very important medications are kept on script, and those prescriptions should be free.
Mr Buchanan mentioned that it would be difficult to deal with a list of drugs as opposed to a list of conditions. I do not agree with that. Doctors would be much happier to deal with certain drugs. Indeed, doctors would know what drugs should be on script and what ones would be better given over the counter. For example, somebody could ring the doctor’s surgery to say that they have a serious back injury and ask for a spray, but that spray may only be needed for a sports bag. People could say that their child has a serious fever and needs Calpol, but it may well be used just for teething. Different scenarios must be considered.
I agree with my colleagues across all the Benches that it is wrong that less-well-off people who suffer from conditions such as cancer, multiple sclerosis, debilitating rheumatoid arthritis and chronic heart disease have to pay for prescriptions, while a 60-year-old millionaire may well get Calpol free on prescription. That is wrong, and it is an issue that we must consider.
People have asked how free prescriptions will be paid for. I do not know. Again, this is a subject for discussion in the review. However, we have been told that the reforms that will arise from the review of public administration will help front-line services and will focus on patients’ needs. If those reforms do what they say on the tin, money should be available for many more front-line health services and for patients. Thus, that is one area in which money could potentially be found. I was delighted to hear the Minister say that we as a group should push for a very substantial and decent healthcare budget. I hope that that will be the case.
We must deal with all the other front-line issues — hospital bed shortages, trolley waits, operations and mental health — and ensure that important medications are kept on prescription while very simple medications that really do not belong there are taken off prescription. If we can deal with all that, I believe that we can realistically look towards the introduction of free prescriptions for all in Northern Ireland.
I support the motion.
Question, That the amendment be made, put and agreed to.
Main Question, as amended, put and agreed to.
Resolved:
That this Assembly calls upon the Minister of Health, Social Services and Public Safety to establish a cost and benefit review for the purpose of abolishing health prescription charges as has been carried out in Wales; and to review the list of conditions that currently entitle patients to free prescriptions in order to reduce anomalies.
Child and Adolescent Mental Health Services
Mr Deputy Speaker: The Business Committee has agreed to allow one and a half hours for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to wind up the debate. All other Members will have five minutes. One amendment has been received, and it is published on the Marshalled List. The proposer of the amendment will have 10 minutes to propose and five minutes to wind up.
Ms S Ramsey: I beg to move
That this Assembly expresses concern at the current state of child and adolescent mental health services, particularly the lack of child and adolescent in-patient beds and dearth of trained staff to run these services; and further calls on the Department of Health, Social Services and Public Safety to take urgent action to address this situation in keeping with the Bamford Review.
Go raibh maith agat, a LeasCheann Comhairle.
I thank the Business Committee for allowing this motion to appear on today’s Order Paper. I tabled the motion last Tuesday and its inclusion sends the clear message that the rights of children and young people are a priority for the Assembly.
I accept the amendment proposed by Dolores Kelly and Carmel Hanna, which adds to the strength of my motion, and I thank them for that.
(Mr Deputy Speaker [Mr Dallat] in the Chair)
During the debate, I shall refer to the cases of young people who recently died as a result of suicide. I offer my heartfelt sympathy and condolences to their families. I hope that they will understand that I am referring to their loved ones in order to bring about action that will help to prevent other young people and their families from suffering in the same way.
Last week, several young people died as a result of suicide in west Belfast. That is more than a tragedy. At least two of those young people were being treated for mental-health difficulties. One of them, Bronagh Gallagher, was the teenage mother of an 11-week-old baby. Bronagh had struggled with mental-health difficulties and had been admitted to hospital twice — in June 2006 and at Easter 2007 — following paracetamol overdoses. When Bronagh died last week, she was still waiting to be referred to a psychiatric nurse. The tragic loss of Bronagh’s life might well have been prevented if the North had the type of mental-health services that she needed, which offered the support that could have helped her through her difficulties.
Members will be painfully aware that our communities have been struggling for quite some time with the suicides of young people such as Bronagh.
In 2005, Daniel McCartan died as a result of suicide on the evening of the day on which he had requested to be admitted to psychiatric care. His request was refused because he was considered to present a low suicide risk and no adolescent in-patient beds were available. A complaint lodged by Daniel’s parents is being investigated. The results of that investigation should be reported soon, which, hopefully, will shed more light on what can be done to prevent such tragedies.
Between 2005 and 2007, what has changed for those young people who badly need access to professional care and support? The Bamford Review has been initiated, a suicide strategy has been formulated, and there has been a small injection of funding, but it appears that, in practical terms, very little has changed. I am gravely concerned about our ability to provide the services needed by children and young people who face mental-health difficulties.
In 2005, 213 people died as a result of suicide in the North. Of those, approximately 35% were aged between 15 and 34. In 2006, there were 291 reported suicides. West and north Belfast have some of the highest levels of suicide, with the rate in west Belfast standing at twice the regional average. Make no mistake: that experience is not limited to the North — it affects communities across the island.
There is a dearth of adolescent inpatient beds in the North, as well as in the Twenty-six Counties. In each year from 2002 to 2006, 60 or more local young people had to be placed in adult psychiatric wards because of a lack of appropriate beds.
The local child and adolescent psychiatric inpatient unit cannot operate at full capacity because of a lack of trained staff. There is evidence that, even now, the unit is operating under strained staffing levels that prevent it from using all its available beds and providing adequate staff cover for lunch and breaks. I commend the staff of the unit because they are working under enormous strain. I heard this morning that, on several occasions, no female members of staff are on duty, particularly during the night.
Added to that, and equally worrying, are reports that some of the anti-depressants prescribed for children and young people may have adverse effects and increase the risk of suicide. Surely the Minister will agree that we need an urgent review of the drugs that are prescribed to young people under the age of 18 and the impact of those drugs.
In January of this year there were 30 vacant posts in the mental-health profession, specialising in the treatment of adolescents. That requires a radical and urgent response. The response that young people need is much more complex than solely increasing the number of psychiatric beds or the number of health professionals — necessary though that may be.
It is estimated that 10% to 15% of adolescents face mental-health difficulties; locally, that means about 16,000 children and young people. However, only a tiny minority will need the sharp-end psychiatric services because many community-based services, if provided early, will make a real difference. It should be — and is — possible to provide the kind of care that young people need. The Assembly knows that the difficulties with child and adolescent mental health services (CAMHS) are not simply at the sharp end but also in the wait for appointments and in providing young people with the kind of early intervention that can prevent at least some of them from needing more intense services.
Often, that requires a catalyst in the system that can co-ordinate and enable access for young people, and that needs to be developed and supported at community and family level. We need a focus not simply on mental health but also on emotional well-being. Good emotional well-being and mental health means having the capacity to build positive relationships and to cope with the ups and downs of life; it means young people being able to realise their potential and having the opportunity to develop emotionally and socially. We need to consider the whole of young people’s lives and not just focus on particular disorders or treatments.
There are proven models. For example, the Mount Sinai Medical Center in the United States offers a service that is centred on the young person: even if young people attend with a physical condition, they are offered a full review of their mental-health needs. That results in those needs being addressed quickly and successfully.
There is a need for both community-run mental-health services and more specialist tier three medical units to integrate and triage their provision. We have, at times, two tandem services: GPs refer to child and family clinics; and social and community services use community-based mental-health services. For example, community and voluntary organisations used to be able to refer a young person straight to CAMHS. Now, however, the pressure on the system is such that no new referrals are being taken and the community services are having real difficulty in accessing services. Children using triage need the right service at the right time.
I recognise that the Minister has just taken up his post and I want to thank him for attending today’s debate. However, I am sure that he will feel the tragedy of the situation affecting young people and recognise the need for urgent action. Although the outworking of the Bamford Review will make a difference, its sheer complexity and volume mean that we could lose sight of the urgent action that is needed now. Since the Minister is here, I want to ask him some questions.
Does he agree that there is a need for the following actions: an urgent review of the anti-depressant drugs that are prescribed to those under the age of 18 to ensure their safety; the development of a regional service that draws on international best practice for children and young people at risk of suicide; workforce training and development for all staff in the health and personal social services and in schools and youth and community work so that they can be a point of contact for young people at risk of suicide or with mental-health problems?
Does the Minister agree that there is a need to increase the resources available at community level for early intervention prevention services? Will he agree to look at the better integration of community and medical services? Will he ask the Regulation and Quality Improvement Authority to carry out a review of CAMHS provision at the Knockbracken Healthcare Park? Will he immediately address the staff shortages that prevent the full functioning of the child and adolescent inpatient unit at Knockbracken? Will he make funding available for the development of a full range of services and ensure that it is ring-fenced so that the funding cannot be used for other services?
I also encourage the Minister to consider the development of a children’s task force for areas of high deprivation where children and young people face severe problems. Organisations such Barnardo’s have been promoting that for some time.
I have asked the Minister several questions; I hope that if he cannot answer them today, he will read Hansard tomorrow and get back to me on some of those issues.
3.15 pm
There are Members still to speak in this debate who have, for a long time, championed the rights of children and young people. I hope that they will support the motion.
Mrs Hanna: I beg to move the following amendment: At end insert
“and provide an action plan with a timescale for implementation.”
My amendment calls for an action plan with a timescale and targets for implementation of the proposals contained in the Bamford Review. Its purpose is to add sharpness and focus to the motion.
Our community is emerging, slowly and painfully, from more than three decades of intense civil strife. There has been a significant fallout for our young people as a result of the killing of 3,700 people in our conflict and the injuries and trauma suffered by more than 30,000 others. Children and adolescents have either themselves been victims or have watched our society being brutalised. A breakdown of law, order and family values has occurred in many areas. We are reaping the whirlwind, and that price will continue to be paid by the vulnerable in our society, and those vulnerable young people who, even in a peaceful society, may find it difficult to get a decent start in life.
Before I entered politics I was employed as a registered nurse and midwife. I worked in the casualty department of the Mater Infirmorum Hospital through most of the Troubles. More recently, however, I worked for the South and East Belfast Health and Social Services Trust. Its headquarters are at Knockbracken Healthcare Park, which was formerly known as Purdysburn. That word still strikes a chill in the heart of many people of my generation, who grew up with a feeling of stigmatisation about mental health. As children, we were warned that we could be sent to Purdysburn.
The Bamford Review and other reports have, thankfully, shed some light and fresh air on mental health and have helped to destigmatise it. However, even in recent times, separate provision has not been available for children and young people with mental-health issues. Many still have to share wards with adults, and with psychiatric patients, often with far more serious conditions.
The Bamford Review made it clear that, because of Northern Ireland’s higher levels of social and economic deprivation, its civil strife and the higher prevalence of psychological morbidity in adults, the incidence of mental-health disorders in children and adolescents in Northern Ireland is greater than in the rest of the United Kingdom. The Chief Medical Officer for Northern Ireland, Dr Michael McBride, has reported that more than 20% of our young people suffer significant mental-health problems before they reach 18 years of age. That encompasses young people with eating disorders, substance and alcohol abuse problems, and with developmental difficulties often associated with mental-health issues. As Sue Ramsey said, it includes those at risk of suicide and young people who have committed suicide. We must explore the underlying factors in order to reduce and prevent any more of those awful tragedies.
In recent years, there has been a huge increase in cases in all of those areas, which underlines the urgent need to put an action plan in place with a timescale and targets. The Bamford Review did an excellent job in setting out the required actions. Now we must set aside the resources that will make those actions a reality and in an achievable timescale. I am sure that some Members know of the problems that are caused when no bed is available for a young person suffering an acute mental-health crisis. He or she is either not admitted to hospital at all, or is not admitted to the most appropriate setting. It is never what is best for that young person.
The Department of Health, Social Services and Public Safety and the trusts are aware of those problems, and more beds are becoming available.
I am not sure that the exact number of beds required has ever been quantified, but it must be done. The level of provision needed will become more apparent when other parts of the strategy, including good mental-health promotion and early intervention within the community, are in place. When that happens, it will be easier to quantify the exact number of acute beds required.
More importantly, as with healthcare in general, prevention is better than cure. We must get to grips with and tackle the causes of mental-health problems in young people. Early intervention, at a stage where the impact of the illness on the young person may be less severe and where there is a far better chance of early recovery, is necessary. The positive health agenda must be tailored towards the needs of young people so that more of them will never have to consider using and abusing alcohol and substances.
Many in society are obsessed with celebrity, body image, competitiveness and consumerism, with the aim of making some people a lot of money. Many of those obsessions can impact badly on young people — who perhaps do not have much self-confidence to begin with — lowering their self-esteem. Parents, educators and anyone who is in contact with children need to spend more time listening to them. That issue will feature in this afternoon’s debate on children who are looked after by the state.
The Bamford Review mentioned at length the need for professional staff and training in the education sector, because schools have been found to have been very effective settings for intervening in aggressive and acting-out behaviours and involving pupils in initiatives to promote better behaviour. In order for schools to play an effective role, teachers need greater access to training in the skills and knowledge necessary to address the mental-health needs of young people, including fostering good mental health in the classroom and knowing when pupils need to be referred to more specialised staff.
Where appropriate, mental-health professionals should work in schools, providing help to individual children who are beginning to show signs of mental-health difficulties. Those difficulties sometimes arise because young people are vulnerable, perhaps due to domestic violence, bullying, parental alcohol and substance abuse, and family separation. Providing well-delivered services can help young people to develop coping skills. That requires the Department of Health, Social Services and Public Safety and the Department of Education to work together.
The need for the training and development of the workforce that delivers mental-health services is covered in detail in the Bamford Report. Qualities such as a positive attitude and sensitivity must be developed. Although caring for young people with mental-health problems can be very challenging, it is also very rewarding. Good working conditions for staff are imperative, as is appropriate, regular and updated training.
I wish to refer to the rights of the child in relation to the issue of mental health. The United Nations Convention on the Rights of the Child has been ratified by the UK Government, and its principles and practices must be the basis of all our actions. The UN Convention gives children the right to the highest attainable standard of mental-health care that is culturally and medically appropriate and is provided in a safe environment. Mental-health provision should not discriminate, but should always be in the best interests of the child, and the child’s view should be respected.
I appreciate that the Minister is still getting to grips with the most complex of all Government briefs, of which mental health is a specialist area. I wish the Minister well in his term of office, and all Members will wish to be supportive. After responding to the motion, I hope that he will bring a detailed action plan and appropriate timescales before the Assembly in due course.
Mrs I Robinson: I add my condolences to those already expressed to all families in Northern Ireland who have suffered the tragedy of a suicide. Suicide knows no barriers, be they of religion, colour or creed.
Most Members agree that the entire area of mental-health provision is abysmal. A root-and-branch reform to tackle the deficit of provision across all areas of mental health, including for depression, anorexia, potential suicide victims, self-harmers or children who are abused and at risk, is required.
The key theme of the Bamford Report for children and adolescents is the development of a holistic and integrated mental-health service for children and young people that crosses organisational and institutional boundaries. Closer partnerships and better working relationships will be vital if such a vision is to succeed.
I want to take this opportunity to concentrate on the role that collaboration with the education sector can play in child and adolescent mental health. The Bamford Review’s July 2006 report — ‘A Vision of a Comprehensive Child and Adolescent Mental Health Service’ — recognised the important role of the education sector and its interface with children and young people. It was recommended that the Department of Education and the Department of Health, Social Services and Public Safety should aim for greater co-operation in planning and commissioning services in mental health and education — even through the establishment of firm interdepartmental links.
Schools have been found to be very effective settings for intervening in aggressive and acting-out behaviours, as was recognised in the Audit Commission’s report ‘Misspent Youth’. The crucial contribution that could be made by people in the education sector — both in schools and in youth services — must be appreciated. Partnerships with other agencies will enhance the effectiveness of school-based interventions and are to be encouraged. Practitioners in education need to have greater access to knowledge and to training in the necessary skills to allow them to address the mental-health needs of children and young people. Such skills will include the fostering of positive mental health in the classroom and awareness of when it is appropriate to refer someone on to more specialised staff.
Another recommendation in the Bamford Report was that a study of the mental-health needs of children in Northern Ireland should be commissioned as soon as possible; otherwise, we will not have the most reliable information for the planning of services. The Hardiker model of four levels of need is used extensively in the planning of children’s services; the Bamford Review proposed a similar four-tier model. An opportunity exists for health and social services planners and commissioners to co-ordinate their services much more effectively. That would encourage the development of common language across the services in social care, education and mental health.
It was suggested that the promotion of mental-health services, and the prevention of mental-health problems, in the school setting should be developed across all schools to include independent schools’ counselling services, the health-promoting school and pastoral-care initiatives. There is a need for educational, health and mental-health professionals to work in schools to provide early assistance for children who are beginning to show evidence of mental-health difficulties. Independent schools’ counselling services provide children and young people with a listening ear and someone to turn to in the school setting. Those services provide accessible one-to-one support for vulnerable children and young people in coping with a range of issues including domestic violence, bullying, parental abuse and family separation.
This topic is so vast and wide that five minutes is insufficient to consider all the problems that we all acknowledge exist within the mental-health structures. However, when the Committee for Health, Social Services and Public Safety sits, I would like to think that it will undertake an in-depth review of the outpourings of the Bamford Review and that it will hear from the people delivering the services at the coalface about what they think of the Bamford Review.
Rev Dr Robert Coulter: When Members consider how to tackle and treat mental-health problems, we can see that one of the biggest problems is found in society itself; and when we remember that the answer to mental-health problems in the Victorian age was to lock people away, and when we realise that there may be a patient in Northern Ireland who has spent the past 38 years in an institution, we begin to realise that the difficulties remain.
The existing mindset is one of the greatest challenges to attempts to change attitudes to mental health.
3.30 pm
Those who were involved in the development of the Bamford Review believe that it lays the foundation for future policy in Northern Ireland. It is one of the most important policy papers to be produced during the last two decades on the treatment of children and adolescents. The review recommends not only an aspirational framework, but a practical set of guidelines that should govern how we assess the success or failure of the treatment of young and adolescent mental-health patients. The proposer of the motion painted a vivid picture of the difficulties that are experienced by families affected by teenage suicide, which makes one realise that the time has come for politicians to take this matter seriously and to do something about it.
We have undoubtedly inherited a legacy of neglect, but the Bamford Review shows where we must travel. Now that we have assumed responsibility for our own affairs, we must strive to make the Bamford Review a reality, instead of an aspiration. The norm should be individualised, comprehensive, inclusive services with minimum restrictions, a family focus, early intervention, a guaranteed transition between child and adult stages, and a case-management approach. Make no mistake: that will take time.
There are major cultural requirements. A widespread understanding of mental disorder is required, which must include an understanding of the differences among mental problems, disorders and illnesses; the grades of severity and recurrence among those states; what constitutes normal and non-normal behaviour; and the importance of environmental factors in the treatment and diagnosis of problems. Above all, we need understanding and tolerance, and an open-minded and positive approach.
Mental-health issues recently hit the headlines due to the Muckamore case, on which I do not wish to dwell. However, that case taught us that there was a problem in the system. Members must be vigilant and ensure that there are no more hidden defects.
The Chief Medical Officer has estimated that one fifth of all young people suffer significant mental-health problems by their eighteenth birthday. It has also been estimated that 45,000 children and young people, aged five to 15, suffer from moderate to severe mental problems, and that 340 of those people should be hospitalised to some degree.
Of the young people suffering from mental-health problems, 38% are homeless. That brings a new dimension to the problem because history and statistics have proven that young people who suffer from mental defects experience a series of mental problems later in life. Furthermore, children with learning disabilities are more vulnerable to the full range of mental disorders, and it is believed that one in 10 children indulge in self-harm. It is sobering to think that one in six people who were killed during the Troubles were under the age of 19. The time has come for Members to take this matter seriously and do something about it.
Mr McCarthy: As an Alliance Party representative on the all-party group on mental-health issues, and as an ardent supporter of the recommendations contained in the excellent Bamford Review, I support the motion and the amendment. Everything that can be done to improve mental-health provision for children and adolescents in Northern Ireland must be a priority for the Department of Health, Social Services and Public Safety.
As Members have said, the 2006 Bamford Review contains many recommendations. Paragraph 4.6 states:
“The Department of Education and DHSSPS should set up an inter-departmental group to facilitate joined-up planning and commissioning of services in mental health and education”.
Recommendation 2 states:
“A study of the mental health needs of children in Northern Ireland should be commissioned as soon as possible.”
That recommendation is based on paragraph 3.68, which states:
“One of the targets set in the CAMH policy statement was that a commissioning strategy for delivering services based on identified need, and meaningful and measurable objectives should be in place by 1 April 2000. While there has been some progress towards a commissioning strategy the issue of properly identifying need was never addressed.”
As has already been said, the Northern Ireland Commissioner for Children and Young People (NICCY) has highlighted the importance of the United Nations Convention on the Rights of the Child, which has 54 articles and was ratified by the UK Government in 1991. Article 27, paragraph 1, states:
“States Parties recognize the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development.”
The Government are responsible for assisting parents and other persons who have responsibility for children to implement that right. Carmel Hanna referred to that issue in her contribution.
It has been noted that children who live in deprived areas are very vulnerable. Save the Children launched the annual child poverty report for 2007, ‘A 2020 Vision: Ending Child Poverty in Northern Ireland’, in this Building today. It refers to the Department of Health, Social Services and Public Safety’s ‘Investing for Health’ 2006 update, which offers section 75 analysis of suicide and self-harm in Northern Ireland. There is much to be gained from reading that report.
Many Members have referred to the Bamford Review, and I cannot praise it highly enough. Recommendations 5 and 15 are important on the issue of child provision in mental-health issues. Recommendation 5 states:
“Practitioners in education must be given training in the necessary skills and knowledge to address children’s and young people’s mental health needs, including fostering positive mental health in the classroom, and referring to more specialised staff when appropriate.”
Recommendation 15 states:
“Mental health promotion and prevention in the school setting should be developed across all schools to include Independent School’s Counselling services, the health promoting school and pastoral care initiatives.”
Members had the pleasure of debating the Bamford Review in the Transitional Assembly. Every party agreed that, when we are in a position to do so, we should implement the review. The Minister of Health, Social Services and Public Safety is still in the Chamber, and I implore him to implement the review when he has the opportunity to do so. That implementation will take some time, but we must make a start and be seen to do that.
Northern Ireland needs more professional staff and funding for good mental-health provision. For too long, mental health has been the Cinderella of the Health Service, a fact that has been acknowledged by everyone involved in mental-health issues.
I offer my sympathies to the proposer of the motion, Sue Ramsey, who has experienced suicide in her area. Throughout Northern Ireland, we are all affected. In my constituency of Strangford, there has been a number of suicides.
Mr Deputy Speaker: The Member’s time is up.
Mr Shannon: Am giein ma’ bakin tae tha ammendement an aa’ unnerstaun that tha topick is emoativ an taks in a wied range o’ issues an proablims.
Tha issue o’ “inpatient caer” is sumthin aa’ wush tae haylicht especially as it hiss’ bin broucht tae my attentshun by my constituents twa mony tiems in shokin an sad waes.
But nae metter aboot tha different coverin o’ tha single proablim tha unnerlyin issue still houls aa’ disturbinly saem soart o’ theem – an that is aa’ lack o’ suppoart.
I support the motion completely. This emotive topic spans a wide range of issues and problems. I wish to highlight the issue of in-patient care, because my constituents have brought it to my attention in shocking and saddening ways too many times. No matter how it is cloaked by the individual problems, the underlying issue retains the disturbingly similar theme of a lack of vital support.
I want to dwell upon the issue of children with autism, as the lack of time allocated to this debate prevents me from highlighting all the issues that I would like to. I am familiar with the scenario of the care of one autistic boy. His parents do everything for him — they wash him; dress him; cook for and feed him; they clean, bath and toilet him; they amuse him; and they hug, kiss and love him. He depends on his parents for his every need. When he is at school, they do the washing, ironing, cleaning, shopping and try to find time to work in order to pay the bills. They love their son with all that they have and all that they are, but, sadly, love is not enough to get the family through the sheer exhaustion and the emotional and mental strain.
It is up to the community and to us as elected representatives to step up to the plate and help that boy and his parents. We can do that by supporting them and offering them the best that our society can to ensure that they do not reach the point of no return.
The major problem with the current system is simply that there are not enough places available. That is an issue worth highlighting too. It is estimated that one in 100 children has some degree of autism. That means that more than one in 100 parents has the additional stress of caring for a child who needs extra care and attention. Depending on the severity of the disability, that care can range from helping with a few extra hours of homework to doing everything for the child for the whole of his or her lifespan, which is likely to be just as long and healthy as anyone else’s.
For example, I know one family with an autistic son and two young daughters. The mother, who gave up her job to care for the family as best as she could, applied for respite care to enable her to take a break and spend time with her other children. She was put on an emergency waiting list, but, two years later, she still has not had a weekend off. For three hours a week, a trained professional provides care for her son to allow her to spend time with her daughters, but that is the sum of her relief.
She has sought help from all the organisations and charities, such as Home-Start, and they have tried to help. However, the crux of the matter is that the volunteers are not trained to deal with her troubled son. Autism is a severely misunderstood condition, and only trained professionals with patience and understanding know how to deal with autistic children. Even those who are trained can find the work a strain, due to the unpredictable nature of the disability.
There will not be enough resources to deal with the ever-increasing numbers of children suffering from autism. The Welsh Assembly has found that the number of children diagnosed with autism in Wales has increased by 124%. I might table a question to the Minister concerning the figures for Northern Ireland, because I believe that there has been an equal increase here.
There is no long-term plan in place; there is insufficient funding, and, therefore, there is no hope for the parents and the children. To be forewarned is to be forearmed. The number of children with autism is rising, and we sense the effect that that is having on society and on individuals. I cited two examples of families in my area who are suffering. We must stand up for those people and develop a plan so that we and the Department of Health, Social Services and Public Safety can do everything possible to help.
These families are not asking for much. They are not asking for more than they are entitled to. We are being asked to give them only what they need and what we can provide, which is support. I therefore support the motion.
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Mr Savage: Mr Deputy Speaker, I congratulate you on your elevation to high office. I know that you are very capable of carrying out the duties of your new post.
I share the concerns of those who have already spoken in this debate. The current poor state of the child and adolescent mental-health service is unacceptable in twenty-first century Northern Ireland. The lack of trained staff to run mental-health services, coupled with the lack of child and adolescent inpatient beds, is appalling. I accept that no single agency can deal with these problems on its own, but as a matter of urgency I call on the Minister of Health, Social Services and Public Safety to meet with the various agencies with an interest in this in a bid to resolve this crisis while, at the same time, keeping within the recommendations of the Bamford Review.
Some months ago, I attended a school in Dungannon for the education of mentally handicapped children and adolescents. On my arrival, I met a young lady with triplets of seven or eight months old, one of whom was mentally handicapped. She handed me the child, which I held in my arms. I knew what the child required in terms of funding and support methods. Yet when the child’s mother asked me about funding and support, I could only state what was currently on offer, and it was pitiful, to say the least, that I had to tell her that there was little or no help available. I vowed that day that if ever I got into a position where I could help in the area of mental health, I would do my utmost.
This situation is untenable. We must never forget that we are talking about human beings, and we are obliged to note that we, as elected representatives, have the ability to help as the terms of reference of the Bamford Review state:
“to recognise, preserve, promote and enhance the personal dignity of those with mental health needs”.
At some time in their lives, one in four people will be affected by mental illness, which is the equivalent of 27 Members out of the 108 in this House. That is a shocking statistic. Carers of those with mental-health needs must not be forgotten — they continue to play a key role in caring for those in our society with mental illness. Carers and their work are often forgotten. If we are to solve these problems, carers should be afforded the right to make an input, as they have the experience and understand what needs to be done. We must provide immediate solutions that are imaginative, practical, even radical, cutting right to the heart of the matter and meeting the needs of all those with mental illness. This can only be achieved with collaboration and co-operation with all relevant stakeholders, from both inside and outside the health and social services sector.
The solution must, in all ways and at all times, reflect the needs of the children and adolescents with mental illness.
I am pleased to support the motion.
The Minister of Health, Social Services and Public Safety (Mr McGimpsey): It was said earlier that this is a very complex issue, and that is no exaggeration. First of all, I put on record that I am committed to improving the mental-health services for children and adolescents. It is essential that our children and young people receive mental-health services that meet their needs, and that is why I intend to implement the recommendations of the Bamford Review for children and young people. Indeed, I accept all of those recommendations.
As Members are aware, the full report of the Bamford Review is due to be published this summer. However, the section dealing with children and adolescents was published last July, and some of its recommendations have already been implemented. It is clear that prevention will be the key element in improving services for children and adolescents. Indeed, the Bamford Review revealed the staggering statistic that more than 20% of young people could have significant mental-health problems by their eighteenth birthday. It estimates that 45,000 children and adolescents in Northern Ireland, aged between 5 and 15, could have a moderate to severe mental-health disorder that requires intervention from specialist child and adolescent mental-health services. The estimates also suggest that around 340 children and adolescents need inpatient services.
Those statistics give some indication of the size of the challenge that we face. Of course, mental health has been the Health Service’s Cinderella service since time immemorial; indeed, Bob Coulter talked about the Victorian approach of locking people away in their hospital beds. However, we have moved slowly away from that culture.
The statistics highlight the extent of the problem that our young people face, and they also make clear the need for all of us to take sustained and determined action. After all, children are our future, and if people are our biggest asset, then children are of utmost importance. They are our responsibility. We want to prevent young people from suffering as a result of mental ill health, and we want to promote good mental health by providing accessible and effective treatment services. We can do that by developing a comprehensive and high-quality range of services, from early intervention right through to specialist inpatient treatment. If we have effective services upstream when young people first face mental-health problems, we can reduce the risk of those young people’s developing more serious problems that require inpatient hospital treatments at a later date.
Some Members may be aware that the post of director of mental health and learning disability, the establishment of which was a key recommendation of the Bamford Review and which was announced in March last year, has now been advertised twice. Although interviews were held in March, we have been unable to appoint anyone to the post. In order to avoid any further delay, I have made the key decision to not advertise the post nationally and regionally again but to appoint immediately a board of experts who will advise ministerial colleagues and me about the implementation of the Bamford Review. That board will fulfil the role of the director.
As Members are aware, mental health and learning disabilities are two distinct streams, and this board can act as a champion for both streams — a new mental health and learning disability board to give greater impetus to the Bamford agenda. The Bamford Review will finally deliver in full this summer. The role of the board will be to challenge my Department and others who provide these vital services to some of our most vulnerable. Until the post is filled, Bamford will not be driven forward seriously enough.
I hope that that step will go some way towards meeting some of Carmel Hanna’s concerns about implementing an action plan. The board will drive the process and will challenge my Department. Having a body of experts to advise me on mental-health issues reflects the fact that we are making a priority of this issue, and it shows clearly that it is a complex and diverse subject that needs urgent attention.
The new arrangement will ensure that innovative thinking and different perspectives will be brought to bear on many issues. I have asked officials to let me have proposals on how we will put this in place, and I expect to see that work completed quickly.
It is no secret that there have been, and continue to be, difficulties in the local statutory provision of specialist mental-health facilities for children and young people. Sue Ramsey made the point that there are difficulties in accessing appropriate treatment and that when inpatient treatment is necessary, the shortage of beds has been a problem. Currently, there are 15 available beds for young people up to and including the age of 13 in the child and family centre, and eight beds in the interim unit at Knockbracken.
As Members know, there have been major problems at Knockbracken, not least of which was that it took until 2006 to recruit a replacement for the consultant who was suspended in 2004. At one stage, when one unit was closed down as a result of that suspension and another had been burned in an arson attack, there were no beds available for adolescents. That major shortage of beds is being rectified, but not quickly enough. By the summer, 12 additional beds will bring the total number available to 27.
In addition, the health and social care trusts are taking steps to deal with recruitment difficulties. Highly specialised skills are required, and the trusts are striving to bring staff levels in the units up to the necessary levels. It is often a question not of finding beds but of sourcing the staff to man them.
Progress is also being made on two new specialist mental-health facilities at Forster Green Hospital, for which significant investment plans are in place. The one for adolescents, costing around £5 million, will replace the existing facilities and provide 18 beds. The second facility will replace the current child and family unit and will have an important educational facility and a specialist psychiatric hospital for children. It will also replace an existing 15-bed unit, giving an anticipated total of 33 beds by 2009, which is well within the range suggested in the Bamford Report. However, the report also stated that the number of beds should be reduced and that ways should be sought to deal with mental health conditions outside the hospital environment, with inpatient care as a last resort. The conclusion of the reassessment was that 33 beds would be sufficient for the community service infrastructure, and that is the situation as is stands. I accept that it is not wholly satisfactory, but the focus is on early interventions to reach children with mental-health problems at the earliest stage, and the recruitment of staff with appropriate skills will be crucial in achieving that.
No one can deny that mental-health services for children and adolescents have suffered from chronic underinvestment. That must change. Significant funds are being, and must continue to be, invested. New money has come from the children and young people funding package, and another key factor to come out of the Bamford Review was the establishment of crisis intervention teams.
To some extent, that relates to the point that was made about urgent intervention and action to prevent suicides. One such team is already in place in the Eastern Board area and encompasses several skills. The first of the crisis intervention teams, which will have the ability to treat patients immediately or involve other specialists as necessary, will be operating by June 2007. It is hoped to increase the number of teams to one per board in order to provide immediate intervention, help and referrals.
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Those proposals do not provide all of the answers, but they show that steps are being taken and that the situation is being addressed. Crisis intervention teams will assist in providing appropriate, timely clinical intervention for young people, with the aim of preventing patients’ problems from developing into more serious conditions. In some cases, they will remove the need for inpatient admissions. Around £500,000 is being channelled into the crisis intervention teams for 2006-07, and a further £1 million will be invested in the following year.
Although there have been some difficulties in recruiting staff, the boards have used in-year funding to improve other services to children and young people with mental-health problems; for instance, waiting lists have been addressed. Waiting lists are too long, but I am told that they have been halved in the past two and a half years. At that time, over 1,000 young people were awaiting a first appointment, but that number has been reduced by half. The waiting lists remain too long and are unacceptable, but progress has been made.
Mrs Robinson mentioned the important role that schools have in promoting mental-health services. Additional money has been provided from the Department of Education, through the children and young people’s fund, to provide counselling support to pupils so that problems are identified and dealt with as early as possible. Funding of £750,000 was provided for 2006-07, and £1·8 million is being invested in 2007-08. That investment has enabled all post-primary schools to have access to counselling. I share Members’ concerns about the need to do more to develop those services, and I will ensure that those issues are urgently responded to and treated as priorities.
As Members know, the Bamford Review has a major resource implication. Total funding for mental health in Northern Ireland is around £175 million per annum. The Bamford Review conservatively estimated that that figure needs to be doubled. The additional funding will not be granted in one year, because the required staff skills are not available, but that is the level of resource implication involved. However, we must make provision for those funds. We are doing approximately half of what needs to be done, and our efforts need to be literally doubled.
I accept the Bamford Review and its recommend-ations. I share the concerns of the proposers of the motion, and of the amendment, and the other Members who have spoken. I will seek to ensure that the Department performs appropriately and shows urgency in dealing with the issues that have been brought before the House. I have stated some of the measures that are being brought forward, but there is still much to do.
Mrs D Kelly: All parties in the Transitional Assembly welcomed the publication and recommendations of the Bamford Review, and we all shared the dismay of mental-health practitioners, sufferers and their carers at the failure of direct-rule Ministers to give any additional financial resources to implement the recommendations. I thank the Minister for attending the debate. Such a show of support already shows the dividends of a devolved Assembly. Across Northern Ireland, there are high expectations that the devolved Assembly will listen to, and act in the best interests of, the people.
Several Members talked about the conflict and its impact on the mental health and well-being of our children and young people, as did the Bamford Review. It is unfortunate that neither the First Minister nor the Deputy First Minister was able to secure any additional funding for a peace dividend to look at the emotional, psychological and physical needs of our children and young people.
The SDLP has no difficulty with the content of the motion, but we were concerned that, like the Bamford Review, it did not set out a clear action plan with detailed objectives to be achieved within a reasonable time frame. The Bamford Review on child and adolescent mental health services contains a number of recommendations that do not necessarily require additional funding, but rather new ways of working.
We heard the Minister referring to the unfortunate failure to have the new director in place in March 2007. However, I welcome his commitment to having a panel of experts. My only plea is that they should be real and true advocates and not be tied to a trust, Department or board for any source of funding — they should be true advocates for the people who are suffering.
The Bamford Report sets out a four-tier approach to working together, and we have heard many Members speaking about the need for collaboration between the Department of Health, Social Services and Public Services and the Department of Education. Indeed, the Minister has also given a commitment to having more coherent working in his Department, as regards health and social services personnel, as well as interdepartmentally.
Levels of deprivation are much higher in Northern Ireland, and there is also poverty. One Member mentioned the launch of the new report from Save the Children, the fact that 100,000 children are living in poverty in Northern Ireland and the impact that that has on their mental, emotional and psychological well-being. However, the report also refers to funding deficits, and the Minister has said that we are only half way towards getting the funding that is needed.
Many Members highlighted personal experiences and have spoken well about the people they have known as friends, neighbours and children who took their lives because of poor mental health and, perhaps, other factors. Everyone in the Chamber can relate to someone who has taken his or her life, and it is unfortunate that services were not there at the point of need, and that not enough beds were available. I welcome the fact that the Minister has said that additional beds will be made available. However, as he rightly said, there will still not be nearly enough.
Specialist beds are required for different conditions. Members talked about the particular needs of carers — for example, those who care for people with autism and other learning disabilities. Although there is a need for inpatient services and treatment intervention, respite for carers is needed also. When the Minister is looking at the provision of services, I trust that he will look across the whole of Northern Ireland and, in particular, to the region west of the Bann. Parents who may have other children, and other caring responsibilities, should not have to trek across to Belfast on a regular basis to visit their children.
The Minister outlined clearly a number of actions that he is already taking. In fairness, and given that the Health Service is complex, he does seem to be hitting the ground running, and I congratulate him.
However, perhaps he will confirm that one of the key recommendations of the Bamford Report was that a study of the mental-health needs of children in Northern Ireland should be commissioned. That is long overdue, and indeed some work and a report were to have been completed by 2000. Planning to meet needs must start from a baseline, and I ask the Minister to ensure that commissioning that study will be one of the key actions he will take on board quickly. I trust that he will report progress to the Assembly at the earliest opportunity, and well within the year.
Ms Ní Chuilín: Go raibh maith agat, a LeasCheann Comhairle. I am delighted to hear the Minister’s remarks about the Bamford Report, and that he accepts the report in its entirety. That is very welcome.
Every Member who spoke in the debate has pointed out the lack of attention that has been given to services for children and young people. There has certainly been a lack of coherent planning and investment.
Our higher levels of deprivation have also been mentioned, and the legacy of 30 years of political conflict on mental health and emotional well-being has not yet been fully realised. Child and adolescent mental health services are wholly inadequate and have resulted in some of the cases that Sue Ramsey mentioned earlier. The difficulty is that young people and their families wait for months and sometimes years for appropriate treatment.
We have learned that young people are now being transported to England for treatment, with no regard being given to the social disconnection and distress that that causes them and their families.
Despite the practical and technical difficulties that the Minister outlined about securing staff and resources, the fact must not be ignored that that is a flagrant abuse of the rights of children and young people under the United Nations Convention on the Rights of the Child. The Assembly must ensure that everything that can be done will be done. It must invest heavily in mental health services for children and young people to ensure that that culture does not continue. Financial investment is needed, and many young people need individualised care. Pathways will evolve through the integrated provision of services that includes the Youth Justice Agency and other agencies from the education, community and voluntary sectors.
I accept the points that were raised by other Members, who acknowledged the role of the education sector at the interface with children and young people. That has been widely recognised. The Bamford Review recommends that the Department of Education and the Department of Health, Social Services and Public Safety should set up an interdepartmental group to facilitate and collaborate in that field. That group must be established as soon as possible. The Minister of Health, Social Services and Public Safety must contact the Minister of Education on the matter forthwith.
Much has been said in the debate, all of which is welcome. Members are encouraged by the Minister’s prioritisation of mental health for all and, in particular, for children and young people. I support the motion and the amendment. Go raibh maith agat.
Question, That the amendment be made, put and agreed to.
Main Question, as amended, put and agreed to.
Resolved:
That this Assembly expresses concern at the current state of child and adolescent mental health services, particularly the lack of child and adolescent in-patient beds and dearth of trained staff to run these services; and further calls on the Department of Health, Social Services and Public Safety to take urgent action to address this situation in keeping with the Bamford Review and provide an action plan with a timescale for implementation.
Mr Deputy Speaker: The Business Committee has allowed one and a half hours for the debate. The Member who proposes the motion will have 10 minutes to speak, with 10 minutes allowed for the winding-up speech. One amendment has been received and is published on the Marshalled List. The Member who proposes the amendment will have 10 minutes to speak, with five minutes allowed for the winding-up speech. All other Members will have five minutes to speak.
Ms S Ramsey: I beg to move
That this Assembly calls upon the Minister of Health, Social Services and Public Safety to set out his plans to improve the outcomes for children “looked after” by the state and for the implementation and resourcing of the Care Matters Strategy.
Go raibh maith agat, a LeasCheann Comhairle. I applaud the Business Committee for accepting this important motion. It gives the Assembly the chance to throw a spotlight on a vulnerable and needy group of children, particularly when Members consider the subject of the previous debate.
I have no difficulty in accepting the amendment, and I want to thank its proposers. I agree that the issues that affect children and young people cut across several Departments. It is important that the Executive prioritise those issues. That would send out a strong, clear message that children and young people are important in the Assembly.
It is crucial that the debate takes place in the Assembly because it allows locally elected Members to deal with the issues that affect children and young people and to take actions that will make a difference. I thank the Minister of Health, Social Services and Public Safety for his attendance. I hope that he is not fatigued after attending three debates back to back. I hope that he will listen to my questions and return to me with the answers if he does not have them today.
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Paul Goggins recently launched ‘Care Matters in Northern Ireland — A Bridge to a Better Future’. I am conscious that the Minister of Health, Social Services and Public Safety is being asked to respond to a policy document to which he had no input, but, based on his last speech, he will be influential in determining its success or failure. I know that the Minister shares my view that this issue demands to be prioritised as much as acute hospital services, trolley waits and prescription charges, which we debated earlier.
Children who require state care are among the most vulnerable in society, and, as evidenced in other places, their life chances are not the same as those for children who have not been in care. Key statistics that are recognised by the Department of Health Social Services and Public Safety show that only one in 10 school leavers who have been in care achieve five or more GCSEs at grade A to C, compared with three in five for school leavers who have not been in care; children who have been in care are 10 times more likely to leave school without any qualifications; looked-after children aged 10 and over are 10 times more likely to be cautioned or convicted for a criminal offence; care leavers are six times more likely to be unemployed than school-leavers who have not been in care; and more than 25% of women who have been in care become pregnant before their twentieth birthday.
Clearly, there is great cause for concern, and it is fair to say that the current situation does not offer much hope for the 2,500 children who are currently in the care system.
Research and consultation with young people who have experienced care paints a picture of instability, insecurity and, often, isolation. Frequent placement and school moves, ever-changing professional input and a lack of support to deal with the traumatic experiences of their childhoods have all been voiced as key issues by that group of young people.
It is against that backdrop that my party welcomes the consultation paper, ‘Care Matters in Northern Ireland – A Bridge to a Better Future’, that the Department of Health, Social Services and Public Safety published in March. It goes beyond the Westminster Green Paper, ‘Care Matters’, and sets out a challenging vision of how Members might improve the outcomes for children in care and, more importantly, for those who are on the fringes of needing care and their parents.
The document was produced by various Government Departments and has proposals that transcend children’s pathways through the care system. The proposals also dovetail with forthcoming legislation and policy on adoption and with the Children (Leaving Care) Act (Northern Ireland) 2002, which was passed by the previous Assembly.
The consultation document considers how family support measures for children on the edge of care could be improved and makes radical proposals to restructure social services to facilitate early intervention, therapeutic support and new ways to work with families. The document also makes interesting proposals for specialist foster parents, with links to residential units, and for lead individuals to ensure improved health and education outcomes for children in care. For looked-after children, there are useful proposals that are designed to ensure that they have the best opportunities while in care and during outside activities.
The document seeks to improve safeguards for looked-after children through innovative proposals to reform the independent visitor role and to ensure that the new health and social services trusts and trust boards exercise corporate responsibility. That is particularly welcome. In addition, there are proposals to enhance opportunities for children in school and further education.
I appreciate that the document is subject to consultation and that that will limit what the Minister can say and the commitments that he can make. However, ‘Care Matters in Northern Ireland – A Bridge to a Better Future’ is innovative and challenging and has been well received. Members will be glad to know that it is not controversial. Although many of the proposals can be implemented without resources, others require funding. I seek assurances from the Minister and wish to hear his Department’s thinking on how outcomes for those children will be taken forward.
Before doing that, I wish to put down a marker about the funding of family and childcare services in general. During the last debate, the Minister for Health, Social Services and Public Safety said that the mental-health service was a Cinderella service. I go further, and say that services for children and young people are the Cinderella services of the Department. Therefore, I ask that the Minister gives an assurance that the funding for childcare services will not be cut back and that additional money will be provided.
For some time, it has been documented and accepted that spending on family and childcare services in Northern Ireland has been low in comparison to the average figure in England.
Recently published figures from the Department of Health, Social Services and Public Safety for the year 2004-05 put average personal and social services spending per capita at £287 in the North, compared to £402 in England — a large gap that features year after year in previous comparisons.
(Mr Deputy Speaker [Mr Molloy] in the Chair)
The considerable investment in the children’s fund and, more lately, in the children and young people’s funding package has been extremely welcome, but we are seeking to implement policies such as Care Matters from an unacceptably low baseline. That matter has been recognised by the Children’s Commissioner, and Sinn Féin looks forward to receiving a copy of the research on funding of family and children’s services by the Department of Finance and Personnel and NICCY (Northern Ireland Commissioner for Children and Young People). Hopefully, that will underline the need for investment in Care Matters and other services to families and children.
Does the Minister agree that work should begin on the implementation of that agenda, particularly now that proposals do not require funding? Will he seek to appoint a task force to advance those proposals?
Given the creation of five new super-trusts — one with 22,000 staff — will the Minister also assure the House that boards will exercise their responsibility for corporate parenting as a matter of priority? Is the Minister prepared to write to the chief executives and chairpersons of the five new trusts to emphasise that point?
I am conscious that I have only a few minutes. I have a number of questions for the Minister, and I will write to him if need be.
Will the Minister advise the Health Committee on developments at the end of the consultation period at the earliest opportunity? Will he confirm that he intends to ensure that the measures included in the family support strategy — which are important because of their relevance to Care Matters — are funded from the children and young people’s funding package? Will the Minister confirm that the recently announced £4 million for family support will continue beyond 2007-08?
The ‘Care Matters’ consultation paper is silent on the issue of funding. How will the Department resource the strategy, and what is its estimation of the cost of the full implementation of the proposal? Will the Minister offer a guarantee that, within the Programme for Government and funding bids for his Department, he will ensure that this strategy gets a high priority?
The Minister showed great enthusiasm during his speech, but the Assembly has formed similar strategies in the past. I thank the Minister for his interest in this matter, and I will listen carefully to his response. I hope that we will soon be able to demonstrate much-improved outcomes for children and young people, particularly those in care, and I hope that the consultation document and this debate act as a bridge to a better future.
Mr Easton: I beg to move the following amendment: Insert after “Assembly”
“encourages the Northern Ireland Executive to make the protection of vulnerable members of society one of its key objectives, and”
It has been said that a society can be judged by how it treats its most vulnerable. Going by Northern Ireland statistics, that is not very well, particularly in relation to looked-after children. Positive outcomes for that group have been unacceptably low. Protecting the most vulnerable members of society should be a prime focus for the new Executive.
Some 9% of looked-after children of school age were suspended from school in 2002-03, compared to 1·7% of the total school population of Northern Ireland. A further 1·7% of school-age children were expelled in 2002-03 — slightly higher than the figure for the same group in England, which was 1·1%, and much higher than the rate among the total school population in Northern Ireland. Some 22% of the 1,263 school-age children who are looked after by local trusts in Northern Ireland at 30 September 2003 had a statement of special educational needs, compared with 27% of the same group in England, and 4% of the total school population in Northern Ireland.
The proportion of care-leavers achieving five or more GCSEs at grades A to C compares very badly at 11% with that of all Northern Ireland school-leavers, 59% of whom attain such grades.
Care-leavers in Northern Ireland are in general 10 times more likely than school-leavers to leave care without gaining any qualifications. Indeed, 51% of all care-leavers left care without gaining any qualifications, compared to 5% of all Northern Ireland school-leavers. Only 11% of young people left care having gained five or more GCSEs at grades A to C, and a further 26% left with one to four GCSEs, grades A to C, in 2002-03.
Some 57% of the care-leavers whose economic activities were known were involved in education, training or employment. That compares poorly to the figure of 91% for all 16 to 18 year olds in Northern Ireland. Ten per cent of the 986 looked-after children aged 10 and over in Northern Ireland were cautioned or convicted in 2002 and 2003, compared to 10% of looked-after children in England and 1% of all children in Northern Ireland. Of those who were convicted, nearly 66% — almost two thirds — were boys.
The Care Matters strategy is an innovative and far-reaching document that goes beyond its English equivalent. The estimated costs of implementing its recommendations are in the region of £30 million to £40 million over three years. That seems to be an enormous sum, but it must be weighed against improving children’s lives and achieving better outcomes where reducing pregnancies and improving mental health and social functioning are concerned. It is argued that many of the proposals will not require any funding; rather, political will and leadership from the DHSSPS and other Government bodies will be necessary. Given that the Department has not committed to resourcing the strategy, I do not understand why it has included it in its bids. I look forward to hearing what the Minister has to say about the subject.
Mr Elliott: I thank the Members who moved the motion. I can speak on the subject with some personal knowledge, as I am a registered foster carer.
Given the enormity of the situation, few people have a good understanding of it. There are 2,436 looked-after children, 53% of whom have been looked after for more than three years. Administrators of social services must ask the key question: what is best for the children? We should all should identify with that. However, I question a system that keeps children in care for many years without their being adopted to make them a permanent part of a family.
Most children are fortunate enough to have significant adults in their lives: parents, family members and teachers. All act as mentors and role models, and, occasionally, advocates. Not every child is fortunate enough to develop those relationships, but every child in care should be facilitated so that they can have that type of mentor. Not only will that person offer befriending, support and advice to young people, he or she will do so from a position of independence from the care system.
I understand that social services in England and Wales have a duty to provide an independent visitor for every child in care who has had little contact with their birth parents. Those visitors are often volunteers who offer a befriending service for children who have infrequent contact with their parents. The visitors’ role is set out in The Children (Northern Ireland) Order 1995 and regulations.
The potential to develop that role goes beyond children’s contact with their parents. Children could be provided with an independent source of advice and encouragement, and, where a child wishes, advocacy. Research on children in care has shown how much they value the role of the independent visitor. It is vital that all children experience stability and permanence in their family. Those factors facilitate positive attachments and resilience and provide the basis for a transition to independent living and adulthood.
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Most children are provided with a stable family life by the family into which they are born. However, we need to be proactive in supporting children without immediate family or wider networks by finding families to provide consistent care for them. Where children cannot be adequately cared for, it is imperative that the authorities move swiftly to restore their sense of permanence, security and normality by giving them an alternative family environment.
Thankfully, for many children care is a positive experience. Foster carers and staff in residential units devote a lot of energy and commitment to the children whom they look after. However, we know that some children in care have a different experience. Sadly, too many find themselves in placements that do not meet their needs. In 2002-03, over 20% of all children who had been looked after for more than a year had changed placement at least once. Fourteen per cent had changed placement only once, 3% twice, and 4% three times or more. We know that the lack of permanence and stability in the lives of children and young people in care can contribute to poor educational attainment, low-self esteem, and disruptive and challenging behaviour, leading some of them into conflict with the law.
In Government documents, we often see pleasant phrases such as “child centred planning approaches” or:
“tools such as lifestyles planning, mapping and pathways” .
Let me be clear: none of those things can compare with the real love and stability of a permanent home and family. Many children remain in care throughout their childhood up until the age of 17 or 18, at which stage they need to become self-reliant. I make a plea for Government officials to become more proactive.
Mrs Hanna: I welcome this strategy. It proposes many radical changes that are long overdue. The strategy sets out a comprehensive and holistic package of proposals addressing the problems that children in care in Northern Ireland may suffer from. We have many children who are not in school, who have mental health problems, who have alcohol or drug problems, or who are teenage parents or young offenders. Put simply, that is unacceptable and needs to change.
The strategy has sound principles: family support, partnership and a multidisciplinary approach. The underpinning vision of the strategy is to reduce the number of children and young people in care by 20% and to improve outcomes for young people in care, so that we at least double the proportion of care-leavers who are in employment, education or training at age 19. Yet, while targets are important, we must remember that sometimes a care placement is the best place for certain children at certain points in their lives.
In Northern Ireland, there is a lack of high-quality foster and residential carers — that is not to take away from the excellent carers that we do have, but we need to encourage more people to take on this demanding but extremely worthwhile role. Being a carer is a very challenging task and it is something that requires support. Proper, up-to-date training needs to be provided for carers — training in communication, in managing bad behaviour and, indeed, in encouraging and nurturing the young people and showing them affection. Improvements in training for residential carers and in the general standards of care homes are long overdue.
There is important research on the value of kinship and keeping siblings together, but, again, the proper support, training, financial support and monitoring need to be in place. The strategy outlines the importance of care plans for children who are in care. I believe that the role and purpose of the care plans need to be clarified and made more user-friendly.
It is important that the children are involved. The issue of advocacy has already been mentioned and it is certainly addressed in the consultation document as well. A good example of children’s advocacy, VOYPIC — the voice of young people in care — is mentioned. That should be developed further.
Questions of implementation and resourcing are rightly highlighted in the motion, and they need to be addressed to bring this strategy forward. At all times the child’s needs must be put first, and confidentiality for the child is paramount. Many social care professionals working on the ground with children in care have expressed their concerns that confidentiality of the child’s private life is essential if their trust is to be retained.
The strategy also emphasises the need for specialist training for professionals in the field. Social care workers, health professionals and professionals in the education and library boards require proper training in how to deal confidentially with the complex needs of children in care.
A key message in the Care Matters strategy is early intervention. That is particularly important for children who are at the edge of care. Early intervention can pay off. Sometimes the resources will have to be redirected to preventative services so that social care provision can focus on this rather than crisis management.
Education is also addressed in the strategy. Health is mentioned too, although I would like there to have been more focus on this, especially on mental health. I am very supportive of the objectives of the strategy; namely, to improve the outcomes for children in care — children who are the most vulnerable in our society. Lastly, evidence suggests that insufficient joined-up working has caused some of the barriers to improvements across relevant authorities — both statutory and voluntary. There now exists an opportunity for a fresh start.
Mr McCallister: The Care Matters strategy, which aims to improve outcomes for children, is a vitally important part of what this Government is about. If the Government exist to do anything for people in our society, it must be to protect and defend the weakest and most vulnerable members of that society. Therefore, it is absolutely imperative that these measures are adopted and taken forward.
The whole process needs to be much more streamlined. For example, the average time from care to an adoption order was three years and 10 months during 2003-04; a wholly unacceptable delay in a child’s life.
Much of the Government policy actually works against, and prevents, the spirit of the idea of placing children permanently with families as early in their lives as possible. Many children in care are moved in excess of 12 times in the first six years of their lives. There needs to be an immediate overhaul, not only of the social services procedure but of the legal process, to streamline bureaucracy and red tape in order to place these young children.
I know from my discussions with my Friend and party colleague, the new Minister, how vitally important he accepts his role to be in this respect. He wants to get in and actually break this cycle of school expulsions, low academic achievement, unemployment, unplanned pregnancy and low self-esteem; and to replace hopelessness, and in some cases real individual human tragedy, with a sense of hope.
Therefore, I have no difficulty in supporting the motion.
Mrs M Bradley: It could be said that there is a general assumption that when children are taken into care, their lives are back on track and that they have, in a way, been rescued. Nothing could be further from the truth. This is only the beginning of the story.
In my own constituency, it is evident that in the case of older children, the same problematic behaviour displayed in their natural home is still very prominent in their care facility — be it a statutory place of care or a foster home.
It is easier to assume that there could be something of a strain within them that naturally gives rise to their bad behaviour, non-compliance and their generally obvious talent for antisocial behaviour. However, the sad fact is that long before these children reached the clutches of our social services, many of them lived a life of fear in an environment filled with disrespect, poverty and general misguidance. Others arrived there, perhaps, through poor parental health or marital problems. They are simply visitors to the system and manage to leave relatively unscathed.
Surely the main aim of our care system should be to attempt to repair whatever damage has been done and help instil the care and respect that these children have been denied, in order to help redirect their lives and nurture a positive experience while they are in care. Unfortunately, this is not the case in many instances, and the experience becomes one that is fraught with difficulties, misconceptions and general failure — failure by those charged with the caring role to care in the true sense of the word. The stigma attached to being in care can be a huge barrier to a child’s well-being and self-image.
We need to do more to improve the very heart and soul of care. The effects of the review of public administration (RPA) — which could for a time destabilise and structurally challenge many statutory bodies charged with delivering the very core of looked-after services — will have a huge impact on how those improvements to care can be achieved.
Many looked-after children’s lives have been marked by uncertainty and disrespect, and many have been largely ignored, with their feelings and opinions undervalued for years. Is it any wonder that they do not know how to communicate with anything other than defensiveness? Their entire mental and physical being must be convinced that they have worth and that, more importantly, someone cares enough to allow them to establish a firm foundation that they can build upon to form an approach to adulthood that will benefit them and those around them. In a fast-changing world, we need long-term solutions — not quick fixes and then a hop, skip and jump onto the next casualty of life. Positive, sustained and valuable support after the rescue is vital.
The transition from childhood to adulthood is a rocky road for those making the journey with the support of their family. So, a child in the care system needs to get information and advice such as that education is important and parenthood is no bed of roses. The latter is a hard and thankless task in many instances. Good mental and physical health is essential and the wisdom to know when to ask for help is vital, something that the young people themselves identified. They want to know when the time is right for them to ask for help. Those are only a few of life’s lessons that every child needs to learn – and learn before he finds himself sitting in the middle of all the difficulties trying hard to climb back out.
Many of our young people leaving, or who have just left, the care system find themselves in those situations almost immediately. Teenage parenthood is the most common scenario for those either in care or just leaving it. It is my fervent hope, as a mother and a grandmother, that the pending strategy will make a difference to the lives of those thousands either in the system or teetering on the edge of it. Furthermore, I hope that the Minister charged with the responsibility of Health, Social Services and Public Safety will take the opportunity to ensure that it is properly implemented in conjunction with all the relevant statutory bodies so that it will be effective in real time and not effective in one area and totally non-existent in others. A holistic approach is our only hope to give vital help to those who need it and to show them that this will not be a piecemeal approach but a real and honest attempt to give them back their self-respect, while teaching them how to live a safe, peaceful and happier life than, perhaps, they were used to.
Minister, I wish you well in the job that you have undertaken. It will not be an easy one. I hope that you will see that this strategy is one that will be very effective for the good of all our young people.
Mr D Bradley: Go raibh míle maith agat, a LeasCheann Comhairle. Gabhaim mo bhuíochas leat as an deis labhartha a thabhairt domh ar an cheist thábhachtach seo na bpáistí atá faoi chúram altramais. Ós rud é gurb é seo an chéad uair domh ag labhairt agus tú féin sa Chathaoir, déanaim comhghairdeas leat as ucht do cheapacháin chuig ard-oifig LeasCheann Comhairle agus guím gach rath ort sa todhchaí.
Tá suim ar leith agam sa cheist seo ar dhá ábhar: sa chéad dul síos, is múinteoir scoile mé; agus sa dara cás, is tuismitheoir altramais mé. Ar an dá ábhar sin, tá suim ar leith agam sa cheist seo.
4.45 pm
I have a special interest in this issue, as I am a teacher and a registered foster carer. Looked-after children are among the most vulnerable pupils in the education system, as other Members have said, and they need, deserve and have the right to the best possible education that our system can provide.
Unfortunately our education system has not served those children well, and there is much room for improvement. I support the view that our approach to the education of looked-after children must be firmly child centered, and that home, school, social services and out-of-school activities should work in a co-ordinated way to ensure the maximum emotional, physical and intellectual growth of those young people.
I accept that many looked-after children are doing extremely well in the education system, and I welcome that very much. However, I am deeply concerned that at the other end of the scale there are young people who feel, and, indeed, are, alienated from the education system. It is also a cause for concern that looked-after children are more likely to underachieve and underperform, and are disproportionately represented in statistics for expulsion, suspension and poor attendance.
One of the key elements in supporting looked-after children is ensuring that they have permanence in home and school placement.
The fostering achievement scheme, which is unique in the UK, has benefited from the children and young people’s fund. The scheme has been effective in supporting young people in ways that enhance their educational development, improve their self-confidence and esteem, and help them in tackling basic difficulties in literacy and numeracy. It is important that the scheme should be expanded to include younger children and young people leaving care.
I referred to permanence earlier, and the system should endeavour to ensure that young people have permanence in the future. Where appropriate, fostering should become adoption, as was mentioned by Mary Bradley.
The fostering achievement scheme has helped to empower foster carers to become educational advocates for the children in their care. Statistics show that many foster carers are, like myself, in the 40 to 60 age range — and I will not reveal to which end of the scale I am closest. Many foster carers are no longer au fait with the changes in the education system since they attended school. The teaching of the basics in education has changed so much, and fosters carers must be kept abreast of those changes if they are to support fully the children. They must be made aware of curriculum changes at primary and post-primary level if they are to be the strongest possible advocates for the education of children in their care. If foster carers are familiar with the education system, they will know better what they can do to help and support those children.
When foster carers are supported to engage with schools as strong advocates for their children, as other parents do, the children can only benefit.
Mr Deputy Speaker: Time.
Mr D Bradley: I hope that in future, the fostering and achievement scheme will be expanded as I have outlined, a LeasCheann Comhairle.
Mr Deputy Speaker: I have been very lenient on time, as this is a very serious subject.
The Minister of Health, Social Services and Public Safety (Mr McGimpsey): It is only right that children should be a key priority for the Executive. That was touched on in the previous debate. People are our greatest asset, and children are a key part of that. My Department has special responsibility for 2,500 children in care and 1,600 children on the child protection register. I am particularly aware, therefore, of the duty that we have to meet the needs of children and young people, many of whom also have difficulties or mental health problems.
We have a statutory responsibility to children and young people through our laws, and also through our commitments to international standards such as the United Nations Convention on the Rights of the Child. Our special responsibility to children in care requires that we should strive to provide the best possible care. Our expectations for them should be the same as they are for our own children.
I want to see young people sitting at the heart of the Executive’s wider programmes to tackle the problems faced by the most vulnerable groups in our society, including the children, young people and families whose needs the Care Matters strategy is designed to meet.
Outcomes for children in care are often poor in comparison to their peers. Sue Ramsey said that they are one of the most vulnerable groups in society; she has never spoken a truer word. Such young people, who often do not have their mothers and fathers to defend them or speak for them and do not have their wider family group to look after them, are the most vulnerable among the vulnerable.
Common problems include poor educational attainment, conflict with the law, high likelihood of being the victim of a crime, low self-esteem, poor job prospects, greater risk of mental health problems, uncertainty about the future and numerous placements in foster care or children’s homes. Recently, one agency told me about an eight-year-old who had had 41 placements in his short life. The instability that that creates for a child is horrendous.
We need to develop new approaches in order to dramatically improve the lives and outcomes of this particularly vulnerable group. An imminent joint report will highlight the fact that children’s services in Northern Ireland have been underfunded, historically, in comparison with Great Britain. That issue will inform this debate, and I call on all Members to support me in ensuring that the disparity in funding is addressed as a matter of urgency. We need to provide necessary and sustained investment, right across Government, to support Northern Ireland’s most vulnerable children and families.
Through Care Matters we have a unique opportunity to tackle these issues at every level. The document outlines a radical new approach to developing and enhancing services with a view to improving the lives of looked-after children. This is the start of a process that will significantly improve services for children in care. I will do all that I can to ensure that we deliver the best possible services for vulnerable children and young people in Northern Ireland. The Care Matters strategy provides us with a very positive starting point.
There are three key pillars of Care Matters: first, to prevent children from coming into care by improving family support services; secondly, to improve the quality of life in the residential care or foster care setting; and, thirdly, to prepare children to leave care. One of the problems that we have seen is that children leave care at 18. The average age for children leaving home in Northern Ireland is 22, but this most vulnerable group are on their own at 18.
That is one example of the problems that the strategy must address. It will make a real difference to all children in care, who are entitled to the same opportunities in life as children with parents.
The strategy sets out a number of ambitious goals, including reducing the number of children and young people in care by 20% from around 2,500 to 2,000, and increasing the proportion of care leavers who are in education, employment or training at age 19 to at least 80%. Again, the numbers are tragically low in that area.
When the Care Matters strategy was launched in March it received widespread support and endorsement from key local stakeholders, including Barnardo’s, the National Society for the Prevention of Cruelty to Children and Children in Northern Ireland. By working in partnership with such groups, we can deliver a strategy that will work and that will, ultimately, improve the lives of children in care.
The proposals are centred on six main areas: strengthening support to families and children at risk of being taken into care while ensuring that children are properly protected; ensuring that children who come into care are in the right placement and have stable placements, be that in foster care or children’s homes; ensuring that the new trusts have the necessary arrangements in place to act as corporate parents for children in care; improving education opportunities for children in care; providing children in care with opportunities to take part in activities outside school and care; and strengthening support to young people leaving care, as they make the transition to adulthood.
Sue Ramsey was assiduous in asking me questions, but she will have to put them in writing because I caught only a few of them. Some £4 million has been set aside for family support, but that is for 2007-08 only, and further funding will have to be bid for as part of the comprehensive spending review process in order to mainstream the funding beyond March 2008. The comprehensive spending review provides us with opportunities under a three-year budget and Programme for Government, but a commitment has to be included in the spending review otherwise the opportunity will be lost.
I was asked about corporate parenting, and that is included in the six key areas identified in the proposals.
I was also asked about the adoption strategy, ‘Adopting the Future’. It has been consulted upon and new legislation will be brought forward. Funding is needed to improve the adoption services, including post-adoption support services. The new adoption strategy will make it easier to place prospective adoptees with adopters more quickly.
Those are some of the points that were raised, but I did not catch all of them. Members will have to write to me with any other questions, and I will happily reply or talk to them.
The Care Matters strategy is very much the start of the process. It is an excellent illustration of departmental collaboration. This is not just a matter for the Department of Health, Social Services and Public Safety; it concerns other Departments, too. It involves the Department of Education and the Department for Employment and Learning, working closely with staff in the trusts, the education service, careers service and further and higher education establishments to improve outcomes for children in care.
The document has been published for consultation to start discussions on issues that affect children in care. As part of this consultation process, we are arranging, in partnership with the voluntary sector, specific events targeted at children and young people to ensure that we maximise their opportunity to have their say. It is not simply a matter of adults discussing the future of children in care; it is vital that we listen to and learn from their experiences. When we have considered all the views of the stakeholders, we will be able to finalise this important policy.
I was asked about the funding implications of the Care Matters strategy. As with all funding matters, funding for the strategy will be considered by the Department and a bid will be submitted to the Executive as part of the Programme for Government and comprehensive spending review considerations.
The holistic approach outlined in the document requires the support of a number of Departments, and I hope that I will be able to enjoy the full support of my colleagues in taking it forward.
I have listened with interest to the views expressed here today. The Care Matters strategy contains proposals designed to deliver long-term fundamental reform of services for children in care, and it is essential that we get it right. They are one of the most vulnerable groups in society and they have been sadly neglected over generations.
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Dealing with their problems, and the issues and challenges involved, is vital. If that does not happen then the cycle will be self-perpetuating. That will be tragic because every instance represents one young life — and every single life is precious. That is why the Care Matters strategy is so important.
Mr Shannon: I am happy to give the winding-up speech on the amendment. Bringing the motion and the amendment together will cement what we are all here to achieve for the people we represent.
Statistics on children who are coming out of care are very scary. Those young people, who are in care through no fault of their own, are six times more likely to experience a teenage pregnancy; 10 times more likely to leave education with no qualifications, and are less likely to carry on to full-time education than other children.
The questions are: why are those awful statistics happening in what is supposed to be a modern country; why are children leaving care at the age of 18 to go on the dole and not into training or employment; why are they less likely to involve themselves in community activities such as sport and drama, and how can the failures that have been permitted for so long be justified? The answer to the final question is that those failures cannot be justified.
Changes can be made through taking small yet significant steps, and it is up to Members to begin the process by ensuring that the reforms set out in the Care Matters strategy are implemented fully and as soon as possible. We must at least double the number of children in care who carry on to higher education. They are just as capable as other children, given the opportunity, but they have not had the same encouragement as those from more suitable and satisfactory home lives.
Considering that up to 10% of children in care have had 10 different social workers during their time in care, it is easy to see how any encouragement to stay at school carries little weight with them. Those children have not had the chance to bond with, or develop a respect for, the person who has been working with them before that person has been moved on. There must be continuity of care to enable workers to get to know the children and gain their respect so that in conversations about the future, each child feels that the person they are talking to understands their capabilities, whether it be attending university or doing a plumbing course. Such encouragement would form a large part in getting past the mentality of worthlessness that is, unfortunately, so prevalent to those in care at present.
Up to 40% of children are in inappropriate care — that must change as a matter of urgency. In addition, a large part of the problem is that children leave care at the age of 18, and, as the Minister said, other children normally remain at home until the age of 22 and are encouraged to do the right thing, to get that job and perhaps, promotion.
The fact that children coming out of care are left to get on with their lives at the age of 18 cannot continue — a future-care programme must be established. I welcome that the Minister has responded positively, and Members will be monitoring his progress on the issue.
The Care Matters strategy is worthy because it means that steps will be taken to ensure that the statistics highlighted will never again be seen in Northern Ireland and that funding will ensure that there is a high level of accountability throughout the system. Members must remember that these are not simply statistics, they represent the lives of the children of our Province who have done nothing wrong and who deserve a better start to their adult lives than the current abandonment that they are faced with at present.
The proposed team must be asked to: track the progress of looked-after children in education; deal with all referrals of looked-after children with regard to concerns about attendance; prepare, maintain and monitor the implementation of the personal education plan for each looked-after child; liaise with the child’s school and provide training for social services, foster carers, staff in residential settings and school staff.
Training and support must be developed for foster carers, whom I admire. They deserve credit for what they do, and training and materials must be there to help equip them. The benefits of training must be actively marketed. Foster carers and key workers need more training in child development.
Other Members have spoken of the need for everyone to work together. A child’s personalised education plan must include input from foster carers and key workers as well as the assigned member of the looked-after children team. The policy of extending alternative education placements beyond the compulsory school-leaving age, particularly for young people in care, should be considered.
Care Matters offers a comprehensive package for improving outcomes for children in care. It will not be easy for the Assembly, but we must take the first tentative steps towards ensuring that improvements in those children’s daily lives actually take place.
Ms Ní Chuilín: Go raibh maith agat, a LeasCheann Comhairle. As we have heard, Care Matters sets out a framework in which we can adapt and enhance the rights of children in care or on the verge of going into care. Care Matters is an excellent framework for action, and though we all have some reservations — I particularly share those outlined by Sue Ramsey — we want Care Matters to be a live strategy with clear, time-bound, costed actions as soon as possible.
As cited in the 2006 children’s strategy by the Office of the First Minister and the Deputy First Minister, the Assembly has committed itself to the overarching goals that children and young people should be healthy, have opportunities to learn and achieve, and live in safety and with stability. They should have experience of economic and environmental well-being and live in a society that respects their rights.
Sadly, as we have heard, for too many children this is not the case. Only today Save the Children has launched a report, which says that 100,000 children are living in poverty in the North. It is important that we give children and young people the support and care that they need to reach their full potential. To hear of one child being placed 41 times is nothing short of horrendous. Children and young people in care are being looked after by the state; they must want for nothing. Those children deserve the best-quality care, delivered by highly trained professionals.
There should be no equivocation about this. There should be no corner-cutting or arguments about budgets. As Sue Ramsey and other Members have said, the Care Matters strategy has been passed to the Minister of Health, Social Services and Public Safety, and we ask him to fast-track the implementation of its recommendations. As has already been said, that will require cross-departmental actions, as well as investment. We will raise these and some other issues with the relevant Departments and with businesses both North and South. We need the assistance of agencies such as the Children’s Law Centre and other youth justice organisations in order to implement the Care Matters strategy.
We must ensure that not just some, but all the children of the nation are cherished equally. I support the motion and the amendment. Go raibh maith agat.
Question, That the amendment be made, put and agreed to.
Main Question, as amended, put and agreed to.
Resolved:
That this Assembly encourages the Northern Ireland Executive to make the protection of vulnerable members of society one of its key objectives, and calls upon the Minister of Health, Social Services and Public Safety to set out his plans to improve the outcomes for children “looked after” by the state and for the implementation and resourcing of the Care Matters Strategy.
Adjourned at 5.09 pm.
