Official Report: Minutes of Evidence

The Chairperson (Ms Maeve McLaughlin): Folks, you are very welcome. Richard, you have been getting a baptism of fire at the Committee in the last few weeks. Richard Pengelly is the permanent secretary in the Department, and Julie Thompson is the deputy secretary of the resources and performance management group. I welcome you both and will hand over to you for your presentation. We will then open the meeting up to members.

Mr Richard Pengelly (Department of Health, Social Services and Public Safety): Chair, I have only a few brief comments to make, so, rather than taking up the Committee's time with me talking, you will probably want the opportunity to ask a few more questions.

I am grateful for the opportunity to come along to brief the Committee on the deployment of the £80 million that has been made available to our Department through the June and October monitoring rounds. As the Minister announced in his recent oral and written statements, given the scale of the financial challenge facing us this year, even that additional funding means that there will still be consequences for the provision of health and social care services. Put simply, it will just not be possible to maintain current levels of service in the absence of all the required funding. That amount was originally stated to be in the region of £160 million.

Moving forward, the Minister has considered the range of competing pressures and priorities across the health and social care system, and, at all times, his clear focus has been to ensure that services are safe and effective while seeking to achieve financial balance. He has, therefore, decided that the £80 million additional allocation will be directed at providing a number of critical front-line services. We have outlined those in the briefing paper, but, in summary, some £31 million will be provided to unscheduled care and patient flow with the aim of reducing the number of breaches in emergency department waiting time standards including through the challenging winter period in particular. It will also be used to invest in domiciliary care and to minimise the implications of trusts' contingency planning proposals for locum and agency staff.

There will be £14 million of investment in elective care. However, that is much less than the full extent of the pressure, thus the current restrictions on the use of the independent sector will continue. In addition, elective care activity will focus on those urgent procedures that clinicians have assessed and prioritised.

Support will be provided so that National Institute for Health and Care Excellence (NICE) drugs and treatments can continue to be provided. Investments will be made in the Altnagelvin radiotherapy centre and to support the cath labs in Altnagelvin so that they can continue to provide a vital 24/7 service. Together, those specialist services will benefit by some £8 million. Allocations of £18·5 million will be provided to a range of regional priorities: £8 million will be provided to support Transforming Your Care; £4 million will be made available to support increased nurse staffing levels to maintain safety and quality on acute wards; £3 million will help to meet some of the increased demand in children's services; £2 million will be made available to resettle mental health and learning disability clients; and £1·5 million will be allocated to support some vital public health initiatives.

Alongside those additional investments, measures must be taken to contain spend and to prioritise front-line services. In that context, the trusts are in the process of implementing a range of contingency proposals. While a number of those proposals will cause concern in local areas, each trust has provided assurances that their services will remain safe with appropriate staffing levels in place. Such proposals, including the temporary closure of some minor injuries units, the closure of some beds and the amalgamation of wards and outpatient clients, will be implemented on the understanding that alternative arrangements are put in place to maintain safety and to mitigate the impact on patient flow. In parallel with that, other measures that the Department is taking forward include restraint over pay, although pay progression will continue to apply; applying reductions to the spend of arm's-length bodies; the Department's own administrative costs; and pharmacy spend. Unfortunately, looking ahead, those financial challenges will continue in 2015-16, and we are assessing the impact of the draft Budget, which the Executive agreed last week.

That is all that I wanted to say by way of introduction, Chair. I am happy to take members' questions.

The Chairperson (Ms Maeve McLaughlin): Thank you, Richard. I have a number of direct questions. The statement that the Minister issued on 30 October said:

Is that a change? Quite rightly, we are all aware of the public reaction to the £34 million that was paid to senior consultants for bonuses by dint of clinical excellence awards. Are we now saying that that is gone?

Ms Julie Thompson (Department of Health, Social Services and Public Safety): We are certainly going to consult on those awards not being paid for those two years in question. The plan at the moment is to put that out to consultation very shortly.

The Chairperson (Ms Maeve McLaughlin): What length of time would that consultation take? Is it a standard 12-week consultation?

Ms Thompson: It might need to be slightly shorter. It might be an eight-week consultation. The detail of that is yet to be worked through, but it certainly would mean that those awards would not be paid for 2012-13 and 2013-14, if that was the result of the consultation process.

The Chairperson (Ms Maeve McLaughlin): So, potentially, those awards could be stopped or not paid for that period.

Mr Pengelly: Yes.

The Chairperson (Ms Maeve McLaughlin): Thank you for that clarity on that. The other issue is in relation to pay. I noted from the Minister's statement that he:

Specifically, I am asking about the definition of top of the pay scale and how that would maybe tally with protection of front-line services and, I suppose, low pay. Was there any consultation in terms of Agenda for Change? Did the Department consult, for example, nurses before that decision not to award the 1%?

Mr Pengelly: I do not think that there is a normal consultation process on pay awards. Agenda for Change was the subject of much dialogue before its implementation. The pay progression that is referred to in the Minister's statement is the entitlement to pay progression through the Agenda for Change pay position. To be honest, a better way of putting the 1% is really that it is 1% for people who are not entitled to pay progression, as opposed to people just at the top of scales. As I said, we are still working through the detail because the decision has been taken so recently, but the intention is that it will. Also, to clarify, for people whose pay progression would amount to a sum less than 1%, we will be looking at making that up to 1% so that everyone gets a minimum of a 1% pay award.

The Chairperson (Ms Maeve McLaughlin): To be clear, Richard, I am using my own notes here, but the statement clearly said that the 1% pay award would be made for people who are at the top of the pay scale. I think that that needs to be clarified.

Ms Thompson: Obviously, there is a running pay scale for each band, and, if you happened to be at the top of that pay scale for your particular band, rather than experiencing no uplift because you are not entitled to an incremental uplift, the intention is to give a 1%. If, for example, you were only to get something that worked out at 0·5% of an uplift through an incremental rise, you would get the balance made up to a minimum of that 1%. So each pay band has a top of its pay scale, and you will get to the top of that pay scale as your incremental entitlement. That is part of Agenda for Change, and this does not change that. The contractual entitlements are still in place. If you happen to be at the top of that pay band and therefore not entitled to any incremental uplift, you will get a 1% rise instead.

The Chairperson (Ms Maeve McLaughlin): I think that it would be useful to clarify that, Richard, because the statement does specifically mention people who are at the top of their pay scale. If we are saying that they are not entitled to the incremental increase, let us clarify that.

Mr Pengelly: That is more a reflection of the speed at which we are operating, rather than any intent to confuse people.

The Chairperson (Ms Maeve McLaughlin): OK. Have we any indication of how the £31 million that is referred to in the statement for unscheduled care will be spent?

Mr Pengelly: There is a range of issues in that. It is to keep flow in emergency departments and to address some winter pressures. There are out-of-hours issues, and there is also domiciliary care in it. The single most significant component of it is that the trusts' contingency plans originally included some quite significant reduction in the use of agency and locum staff, which would have a significant impact. So it was really providing funds to mitigate the need for withdrawing a lot of agency and locum staff, and that is the single biggest component of the £31 million.

The Chairperson (Ms Maeve McLaughlin): Again, Richard and Julie, it would be useful to have that information shared with us specifically, because obviously there are a lot of important pieces of work in that unscheduled care sector. I am thinking specifically of the trusts' contingency plans and the GP out-of-hours work. So, if we could have that breakdown, that would be important. That leads me nicely to the issue of the reference in the paper to spending money on front-line services and the current issues in relation to the direction in which trusts are heading. Can the Department indicate the direction that, within the governance structures, it gives to trusts on how it protects front-line services? I make no apology of using the example of the situation in Dalriada, because it is a regional service, not a constituency-based service. How can the Department assure us and the wider public that, although it says that it wants to protect front-line services, it can exercise that authority on trusts to ensure that there are fewer impacts on front-line services and that they are protected?

Mr Pengelly: To be honest, that point is probably of more significance and relevance in the discussions that we will continue to have in 2015-16 and beyond. The nature of looking at 2015-16 and beyond is that there are many more options open to us. As a point of principle, the Minister is absolutely explicit with us, and we are explicit within the system, that front-line services must be given priority over administrative functions. There is absolutely no question about that.

We are seven months into the financial year. In achieving financial balance this year while protecting the safety and quality of services, we have to go to those areas where we have some flexibility to reduce spend. The simple point is that the vast majority of the likes of administrative functions are provided by staff who are on normal employment contracts, and it is not possible to avoid that spend for the remainder of this year. We have to look at areas where spend is more discretionary. That is why the measures in the trusts' contingency plans are, at this stage, temporary. The Minister has been explicit in stating that there must be full consultation if they are to be made any more permanent. However, this year we are doing what we can to achieve what we need to. We still have a heavy eye on prioritisation and taking measures that have least impact, but it is a different position because we will have many more options in the approach that we can take when we come to consider 2015-16 and the years beyond.

The core answer to your point is that, in every discussion that we have with the board and trusts, we are about protecting the front line. The front line is why we are here. The administrative capacity exists only to support the front line.

Ms Thompson: The primacy, therefore, is the safety of those services on the front line. Some of the changes are really about ensuring that that is and will remain the case. It is about consolidating staff, ensuring that they are all used to full effect and that, where services potentially need to be provided, on a temporary basis, in a different way, they are. So, in the Dalriada instance, the provision of those services in alternative areas or alternative places would be part of the proposal. That will still save the trust money that means it can bring staff back into the likes of Causeway and Antrim and allow the saving to be made. However, the primacy in all those conversations with the trusts' chief executives has been ensuring the safety of services while at the same time balancing the books. Those are the two tenets of the decisions.

The Chairperson (Ms Maeve McLaughlin): To query that a bit further, can the Department honestly say that, given the direction that the Department is going in protecting front-line services, the trust's decision to close this facility, in terms of the regional service that it provides, is in line with current policy?

Mr Pengelly: The policy is to protect the front line, and, to deal with a point of detail, the trust is not closing the service. The service will still be available to patients. The trust is proposing to change the way that it delivers that service. I think that that is an important distinction, Chair.

The Chairperson (Ms Maeve McLaughlin): I am reluctant to get into the detail around it, but that is not the view of the wider public, in terms of the here and now and issues around that. I will pick up on that with you after the meeting, Richard, if you do not mind.

Mr Pengelly: Sure. Certainly.

The Chairperson (Ms Maeve McLaughlin): In a similar vein, I noted that you talked about the here and now and the future direction of travel in relation to spend. Is it within the Department's remit for you to instruct, guide or advise trusts to complete full equality impact assessments on the decisions that they are taking?

Mr Pengelly: The trusts are in the process of completing —

Ms Thompson: What they are doing is looking at the equality screening of individual proposals and identifying whether equality impact assessments are necessary. That is a part of the process of them working down through all the proposals. They may still need to temporarily close those services in order to maintain safety and break even. That work is ongoing, but they are certainly looking at the equality screening and, where necessary, they will do equality impact assessments. Equally, as Richard has already said, if there is a need to change and do anything on a permanent basis then, obviously, full consultation is a part of what they need to do.

The Chairperson (Ms Maeve McLaughlin): Will the Department have a role in ensuring that that happens? We are all aware that there are different processes around screening in, screening out and full equality impact assessments. It is a fact that a lot of the proposals coming from all the trusts that I can see currently read like an attack on front-line services.

Ms Thompson: Certainly, we have been in touch with all the trusts around ensuring that they are doing equality screening on the full gamut of responsibilities within their own equality schemes, and we will keep in regular touch with them as they move through that. However, there will not be full consultation unless those changes are moved to a permanent basis. So that is part of the monitoring that we are doing.

Mr Pengelly: The other point that I would make on that, Chair, is that we need to recognise that, where there is an obligation on the trusts to do something, they have a highly capable and effective staff. At a time when we are trying to reduce the administrative burden and push money to the front line, I, personally, do not feel that it is the best use of our limited resources if we ask the trusts to do something and then the Department immediately marks every piece of homework and, effectively, re-performs the work that they do.

The Chairperson (Ms Maeve McLaughlin): I am not suggesting that. I am suggesting, in terms of accountability and governance, that if there is a statutory requirement on trusts to fulfil equality impact assessments on some of the really difficult decisions that they are proposing, the Department should have an oversight mechanism to make sure that that happens. I am not saying that the Department should do the work for them.

Mr Pengelly: We have an oversight mechanism which is that we say to them on a regular basis "Have you and are you discharging all your statutory obligations?" The point I make is that we do not, every day, visit every trust and take every statutory obligation and re-perform the work that the trust should have done to make sure that it was done to a standard which we feel satisfies that obligation. It is very much a position of trust. They know what their obligations are. We ask them whether they are fulfilling those obligations, and they provide us with that assurance.

The Chairperson (Ms Maeve McLaughlin): But they are only now working through —

Ms Thompson: No, to be fair, they have been working on this. I would say that the closures potentially need to happen before all that has been fully worked through. However, they are working on it. They know — to back up what Richard is saying — that that is part of their statutory responsibilities, and they are working in line with their equality schemes. That is what they are currently working on. Absolutely.

The Chairperson (Ms Maeve McLaughlin): OK. A number of members wish to ask questions.

Mr McCarthy: Thank you very much for your presentation. I have three questions. The first is about the journey that we are on: Transforming Your Care. Does the Minister regard it as a strong means for using resources more effectively, and will there be more transparency around how resources are transferred to support new interventions, for instance?

My second question is on the back of that. Would you like to comment on the logic of the cutbacks on minor injuries units? The Transforming Your Care journey is about seeing the best use made of the accident and emergency services. If we close minor injuries units, we will obviously put more pressure on accident and emergency services. There does not seem to be any logic in that. Perhaps we should be seeking to ensure that more people use the existing minor injuries units to keep them away from accident and emergency.

My third question is in relation to the £31 million. The Chair mentioned it; and I was disappointed that you are not able to break down how you are going to use it. Perhaps we will hear that in due course. You mention, in the £31 million, domiciliary care, so that is more money going into domiciliary care. You mentioned that you had been in touch with your trust. I can tell you that in my trust, for instance, they are going to reduce domiciliary care. That is a contradiction in terms, surely, and not in the best interests of the community. The trust will now replace two of every three domiciliary care packages. How can you square that circle? There is more money going into domiciliary care, but my trust is cutting it down. Are there other trusts that are doing the same?

Mr Pengelly: I will say something on your first point on TYC, but come back to me if I do not fully address the point that you make. We are absolutely committed to that as a direction of travel. On the point of transparency, we are committed to that, but I suspect that there is a point of detail in there. Perhaps you want to provide us with more information if there is some specific gap that you feel you do not have a clear line of sight on.

Mr McCarthy: There does seem to be a general feeling that there is not sufficient transparency. I think at last week's meeting we went into this in depth, and you people really did not seem to be telling the public and particularly the Committee how you are using the funding. We had to squeeze it out of you, Julie, about how you spent some of the £83 million in Transforming Your Care. We had not knowledge of that until you announced it last week, if you can recall. It was £13·8 million for the 2013-14 year.

Mr Pengelly: From that session, I think we are coming back to the Committee with some further information.

Ms Thompson: That has already gone to the Committee, as far as I am aware. I echo Richard's point that there are issues around Transforming Your Care that we need more information on. In our bidding information to you I have given you quite a bit of information about where the money would have been spent and how it would have been allocated, so there is a fair amount of work around that. We provided the information on 2012-13, 2013-14 and the shift left. I am more than happy to provide anything else that the Committee wishes.

Mr McCarthy: But it should not be dragged out of you. You should provide it. The next one was on the logic of cutbacks in minor injuries —

Mr Pengelly: To be fair to us, we do not always know what you want. At times we can rightly be accused of bombarding the Committee with information in an attempt to hide things in the detail of it. It is difficult to get the balance right, but we are very happy to provide any more information that you want.

Was it the minor injuries unit?

Mr McCarthy: The logic in closing the minor injuries unit when we are trying to keep people away from accident and emergency.

Mr Pengelly: It is incredibly difficult to take issue with what you say, but I refer you back to my comments to the Chair. In 2014-15 we are dealing with a very difficult problem in a very limited window of opportunity, so we have to find areas where we can reduce expenditure. I emphasise the temporary nature of the measures that are being taken for the remainder of this financial year. Obviously we want to take people away from the emergency department and towards the minor injuries unit, but in this case the closure of the minor injuries unit will free up some additional resources for emergency departments to deal with anything additional, so it is a better way, financially, of deploying the limited resources.

It is not exactly where we want to be as we do our planning for 2015-16 and beyond, but I cannot emphasise enough that we can only spend the money that we have. When that money runs out, we do not want to be in a situation where we cannot provide basic, safe and effective services across the whole range of health and social care. These are very much the least worst options, not the best options.

Mr McCarthy: I hear what you say, but I can tell you as a member of the Committee for quite some time that the Minister and the author of Transforming Your Care came to us on a regular basis and said that Transforming Your Care was not about saving money but was about doing better and more efficiently. It seems to be that now it is about saving money by cutting the minor injuries units away.

Mr Pengelly: I do not think that is necessarily internally logical, because if you are saying that TYC is now about saving money, surely, if we are in the middle of a financial crisis, we would be accelerating the direction of TYC with all possible speed. TYC is about better-quality provision of healthcare. The issue at the moment — I can understand the point that it runs counter-strategically — is about living within the limited funds that are available to us for this financial year and, in that context, absolutely maintaining the integrity and quality of the whole range of health and social care provision in Northern Ireland.

Within the £31 million, the figure for domiciliary care is £8 million. On a separate issue, one of the very significant pressures that is not necessarily entirely linked to the current financial position is the ongoing demand for domiciliary care packages and the growth in that. The position that the board is taking is to try to bring a greater degree of efficiency to that, so I think that that is maybe where you are seeing the contradictory pressures when we are saying that more money is going in. We are trying to lever every bit of value out of every pound that is spent on a package, so, for each and every package, it is about asking whether it is the minimum package that is required to achieve the health outcome that we are aspiring to. So, whilst you may see, on some individual packages, the pressure financially to squeeze them down, the additional money going in means that more packages will be available, albeit of a slightly lower individual value.

Ms Thompson: We expect that, at the end of the year, there will have been growth in domiciliary care spend levels during the year despite what is being proposed because, as Richard said, the growth in there is significant. Again, it is an area that can be looked at between now and the end of the year, and it is the same as the other proposals in that, if we had more money, absolutely we could do more in this area but, unfortunately, we do not. That is effectively where we have to make sure that we live within the resources that we have as efficiently as we possibly can.

Mr McCarthy: You are getting £8 million for domiciliary care, yet people in my street are going to be refused domiciliary care packages. How am I going to explain that to them? Is it not correct that you are getting another £8 million from here to the end of March, yet you are cutting —

Ms Thompson: Effectively, the £8 million will go into addressing a lot of the ongoing pressures that are already there. The Committee is well aware that the trusts have significant financial difficulties caused by significant pressures, and domiciliary care is one of those. That money will go in to help to support and provide those domiciliary care packages, but, unfortunately, we cannot do everything that we would want to do. That is where the contingency plan proposals are effectively cutting that cloth back a bit. That is where the two do match, and that is the reality of where we are at the moment.

Mr McCarthy: Finally, I agree with what you are saying to a certain point, but how are we as public representatives going to answer to the people on our street who are being denied domiciliary care? At this time, we are having to face that. The community care people who go in do not have the time to do the work that is there to be done, and yet you are getting £8 million extra with less work being done. That is the problem.

The Chairperson (Ms Maeve McLaughlin): We are mindful that the trusts will implement the trusts' decisions, but it goes back to the issue of the Department's governance and your commitment to the protection of front-line services, which is very welcome on paper. How can we ensure that that direction of travel is translated into accountability and direction to the trusts? It is right to point that out, not only in domiciliary care. The proposals across quite a number of trusts are at odds with the policy direction that we are hearing here. That is the issue.

Mr Pengelly: Chair, with all due respect, if we want to get into a debate about accountability, I think that we are better having a session to discuss the accountability mechanisms. I think that, if we take any individual item of care provision, we will find people who feel that we are not doing enough. That is the reality, but we are dealing with the finances available, so I think that there is a risk that we could conflate the accountability model with the quantity of care that is provided. There will always be people who are unhappy about not getting a domiciliary package. That is not necessarily to do with an accountability mechanism. It is either that they individually do not meet the criteria —

The Chairperson (Ms Maeve McLaughlin): Accountability in terms of policy direction.

Ms Thompson: On accountability, the mechanisms are well in place between the Department and each organisation across the whole gamut of services. We have regular discussions about governance issues, resourcing, service delivery and performance. There is a range of targets in place. All of those are monitored between the Department and the trusts. In terms of where Richard is describing it, we do that in the round. It is not that you necessarily pick any individual area and focus in only on that. We focus across the whole matrix of performance and service delivery, along with financial performance and along with statutory duties around quality, for example, and ensuring that they are meeting their requirements around Quality 2020. When accountability is in play, which is on a daily basis, it is not just through very formal mechanisms; it is about the Department liaising with those trusts.

Equally, they have to do their job. They are arm's-length bodies with their own structures, and they have to ensure that they report, through their trust boards, what they are doing and hold themselves to account through their trust board mechanisms and back through the Department to the Minister. There is a complex framework that is not about individual areas per se; it is about the whole framework.

The Chairperson (Ms Maeve McLaughlin): I accept that. We are returning to this issue, Richard, because the Committee is looking at the budget going forward. Before your evidence session, we raised the issue of the additional oversight mechanism that is being led by the head of the Civil Service. We are keen to see the outworkings of that.

Mr McKinney: Thank you for your presentation. Given that this is about not only accountability but finances, it is very thin. Your briefing paper is four pages long; there is £80 million. Having looked at the table and the accompanying narrative, I could not walk out of this meeting and say that I know anything about how the £80 million is being spent. Do you accept that?

Mr Pengelly: I cannot accept what you know or do not know.

Mr McKinney: Sorry, from what I learn from this.

Mr Pengelly: It is important to contextualise £80 million in a budget of £4·5 billion.

Mr McKinney: I think that colleagues share this opinion. Do you accept that a line on £31 million and a line on £14 million is less than clear?

Ms Thompson: The background to that is that all of it goes into the substantive work that we have done with the Committee on the October monitoring bids, for example. Each of those areas and the needs within them have been fully explained to the Committee. We had two evidence sessions at the end of September and the beginning of October. The level of detail in this paper leans on the information that is already in play and in the Committee's knowledge, and on the ongoing discussions that we have had on the 2014-15 situation. I think that there have been at least three meetings since the beginning of September. This is the next stage.

Mr McKinney: The figures, of course, do not measure against the earlier narratives. Take, for example, Transforming Your Care, which is now getting £8 million. You will recall the conversation that we had when you said that it felt like £14 million or £15 million, and now it is £8 million. Will you explain what will be done with the £8 million? Specifically, what is the wage level for those who are carrying out the Transforming Your Care work in the Department? Does it form a major part of that £8 million?

Ms Thompson: You are absolutely right about the spend level. The spend in 2014-15 is likely to be of the order of £13 million or £14 million. It is the same across the board; we know that the £80 million will not give us everything that we will need to meet the existing spend levels. That is where things like pay restraints, for example, have to come in to take some of that back and away. I absolutely agree that we expect to spend £13 million or £14 million in 2014-15. From the £80 million, £8 million has been set aside against that. The rest of it will have to come from within internal resources. The make-up or balance of how all that will be bridged will be a combination of the measures that are described in the latter part of the paper, such as pay restraint, the cuts to the arm's-length bodies and the trusts' contingency plans. The matrix of all those things brings you back to a spend level of £13 million or £14 million, £8 million of which will come from the £80 million.

Mr Pengelly: There was a question about salary levels.

Mr McKinney: To what extent is that accommodating staff costs for the board for the TYC function?

Mr Pengelly: It is not a significant element. There is some support in the board for the management of the TYC programme, but the vast majority of it is for initiatives on the ground that are delivering care to patients.

Mr McKinney: You are clearly looking at figures that are breaking it down. Chair, why are we not seeing those figures? I find this completely unsatisfactory. We need to see a breakdown. I am having to second-guess you on figures that you have, when we could be looking at them and making this a much more effective evidence session.

Ms Thompson: Take the service changes, for example. They go back into areas such as atrial fibrillation, strokes and so on, which we discussed with the Committee in relation to October monitoring.

Mr McKinney: You are telling me about bits that you are picking out. I believe, Chair, that we should see this in its entirety.

The Chairperson (Ms Maeve McLaughlin): Yes, absolutely. I referenced it in relation to the £31 million for unscheduled care. In your response to me, you listed a number of key pieces and areas of work, but we do not have the detail. We have a heading and an amount, but we do not know where that is going.

Mr McCarthy: Yes, it was only when Julie was pressed on it that she gave us the figure of £8 million for domiciliary care. She did not give that figure to you, Chair.

Mr McKinney: We need to see the figures, Chair, and I want us to request them formally. However, in the absence of figures, I will have to deal with the issues thematically, because I am not going to look over the hedge at your figures, read them upside down and have you tell me something that you want me to hear.

How are the trust cutbacks that have been announced consistent with Transforming Your Care, keeping care in the community closer to home and dealing with people as close to home as possible? How are the cutbacks that have been announced unilaterally — I say "unilaterally" even though they came as separate announcements — consistent with Transforming Your Care?

Mr Pengelly: I made the point that they are not always consistent with TYC, because of the nature of the problem that we face in this financial year.

Mr McKinney: Do we not now have two conflicting strategies — if we could even call them that? One is —

Mr Pengelly: This is not a strategy.

Mr McKinney: This is just protecting the front line.

Mr Pengelly: That is what we need to do. This is an operational issue to maintain the integrity of services and ensure that we do not spend more money than we have available this year.

Mr McKinney: I understand that.

Mr Pengelly: It is not a strategic approach that replaces or trumps TYC in any shape or form.

Mr McKinney: However, does it not do that de facto? I say that because you have not been able to demonstrate that it is consistent. We can go from the anecdotal to the factual. Let us look at Dalriada, for instance. In reality, that is a community-focused facility. It is a step-down element; it is not A&E or a very expensive hospital site. It has that local focus. It is being cut. I do not see how that is consistent in any way with Transforming Your Care, yet we continue to invest in a strategy that is about restoring things to the community, trusts are doing their own thing, and you say that they are protecting the front line.

Mr Pengelly: To use a very poor analogy, in many ways it is like your car coming to the end of its life, and you are in negotiations with a dealer to buy a new car. At the same time, you have an ongoing responsibility to get to work every day, so you need to get a new set of spark plugs or something to keep your car going. That is the analogy we are in. You said that I have not demonstrated that these contingency plans are consistent with TYC. I have specifically said that they are not necessarily consistent. I hope that it is not that I am failing to do something that I set out to do. We are in November. This set of temporary contingency measures will maintain the integrity of services and achieve financial balance in the four and a half months remaining in this financial year. In parallel with that, Julie is leading on extensive planning work for 2015-16 and beyond, which is very much guided by the strategic framework of Transforming Your Care and on taking that forward. It remains a key part of our aspiration for the way in which we design health and social care in Northern Ireland. This is the here and now, however, and the problem that we have to deal with.

Mr McKinney: I hear what you are saying, but is there not a danger that some trusts will be able to cut back on their facilities, including domiciliary care, accident and emergency and, of all things, minor injuries units, which, as Kieran said, are about keeping people out of the expensive side? You agree that it is not consistent, and one is undermining the other.

Mr Pengelly: I do not think that the scale that we are talking about —

Mr McKinney: Try telling that to the people in Whiteabbey who will now have to go to the Royal or wherever else; tell it to the people in Bangor who will have to go to Dundonald; tell it to the people of Strangford who will have to go to Dundonald or elsewhere.

Mr Pengelly: I am not in any way trying to pretend that these contingency measures will not have uncomfortable implications at an individual level. I am here today talking strategically about the management of the health and social care system in Northern Ireland and delivering high-quality care to 1·7 million people across the Province.

Mr McKinney: Are the trusts acting consistently with that strategic focus?

Mr Pengelly: The trusts are absolutely consistent in that they are developing contingency measures in a very difficult and challenging financial context to maintain the integrity and safety of the services they provide to the public.

Mr McKinney: So they can maintain that approach. In my view, and from what I have seen and heard about cutting those services, they could undermine the other approach, which we are investing scarce resources in.

Mr Pengelly: The easiest way for me to answer that is: would you prefer —

Mr McKinney: No, do not ask —

Mr Pengelly: Let me ask, hypothetically: would it be better to maintain a minor injuries unit that is unsafe to the public but is consistent with TYC? We are in the difficult place of having to make those sorts of choices. Safety and patient care must come first.

Mr McKinney: Yes, but a balance comes into the argument. It is a bit like a bike slowing down and eventually falling. I appreciate the delicate nature of the way that you are describing it and that we have to try to maintain two strategies. I am not just raising the issue at today's meeting; consistently throughout the year, the Committee has looked at and asked questions about targets, measurables and TYC investment, and now the trusts are cutting back on elements that are consistent with that, but which you say are not consistent with front-line provision. That leaves us with a big question.

Mr Pengelly: I am saying that they are not necessarily consistent with TYC but are absolutely consistent with a priority to protect the safety of front-line services. That is the position that we are in for the remaining four and a half months of the financial year.

Mr McKinney: That has the potential to undermine. We all agree that we see value in the TYC aims and objectives about putting facilities in communities closer to people's homes. The Minister keeps telling us that. The Minister tells us that, every time we go up the ladder — as he calls it — it is more expensive for the system. Unless we confront it from that perspective, we will end up with more expense and greater demand, which will increase costs. You will have to admit that there is at least the potential that this is undermining the ambition of that.

Mr Pengelly: Absolutely not. I do not accept that. I would accept that if we had announced today a wide-ranging series of permanent measures that were counter-strategic to TYC. I am not trying to downplay the fact that individual measures could have significant implications on individual patients across Northern Ireland, which is obviously a matter of deep regret. In the overall context of the health service, we announced short-term measures for four and a half months. Anything longer than that will be subject to consideration, with public consultation and in the strategic context of the 2015-16 position. They are short-term measures, and, in the grand scheme of things, they are fairly limited. At best, they offer us a pause in moving forward in TYC, but it is not a backward step.

Mr McKinney: I have one more point. I have not been able to get into details here, and I felt forced into a wider narrative. I heard several interviews with Valerie Watts on the BBC, and I did not hear any assurance at all that some of these short-term measures would not turn into long-term ones.

Mr Dunne: Thanks very much for coming in. You have heard the tone of the meeting. I concur with the sentiments of other members. The important thing is that we are elected representatives who represent our constituencies and are very much aware of the issues. The initial cuts are rather drastic and are not well thought out. Easy, soft targets were picked. With the Dalriada situation and the situation in Bangor — I will talk about that later — front-line services are being hit. They are relatively low-cost facilities. If you took a close look at them, I wonder what real savings are to be made. I will put it into perspective. The Belfast Trust has about 20,000 people working for it, but what savings are being made there? Every year, £1 billion is probably spent. Could savings not be made on sites like that, which would be much easier and would have much less impact on the ordinary man and elderly person in the street? Has the trust looked seriously at the implications for real people? I had discussions with the Minister about it. We feel that civil servants are driving the matter in a sterile manner and have no real link with patients and human beings, which is, to be frank, most unfortunate.

Look at the Bangor minor injuries unit. As someone who has been an elected representative in north Down for over 30 years, I can say that we fought hard in Bangor and, as Kieran knows, in Ards. Bangor and Ards councils set up a committee 30 years ago to fight this very thing. Eventually, we were left with two small hospitals. It is most unfortunate that the trust will now undermine what we have left. Other areas such as in the west of the Province fought the same changes but in many cases got new builds. We never got a new build. Bangor never got a new build. Ards has never had a new build. There has been no investment by the health trust in those areas in years. I find the proposal to close the minor injuries unit unacceptable.

As was said by my colleagues from various parties, it is totally contrary to Transforming Your Care to close the minor injuries unit in Bangor. As elected representatives, we do everything that we can to encourage people to stay away from A&E departments. We are all aware of the pressures on the Ulster Hospital, which brings me to another point about which I feel strongly. How is the Ulster going to cope? The Ulster is struggling because of the changes brought about by the closure of A&E at the City Hospital and the fact that, for various reasons, people, particularly from south or east Belfast, are reluctant to go the Royal. So they join our constituents from Ards, north Down and south Down and go to the Ulster, and if the facilities are not there, they are not there. I must say that it is unacceptable to close the minor injuries unit in Bangor and to push patients towards Ards Hospital.

In the last few days, I have heard from so many constituents in places like Bangor who said that they had gone to the minor injuries unit and had a first-class service. We know that it is relatively low-cost when you consider the budgets of the trust and the Department, which is working with £4·5 billion and is closing minor injuries units. Then there is Dalriada, which I have no link with, but I think that it is despicable of the trust to even contemplate its closure.

The Chairperson (Ms Maeve McLaughlin): Do you wish to respond to Mr Dunne?

Mr Pengelly: I am happy to respond, Chair. It is a question of whether the Committee wants to listen to me repeat the series of points about the financial position that we are in. Regarding the specifics of closing Bangor minor injuries unit, of course there will be some impact on the Ulster Hospital. Has that been assessed? Yes, it has been assessed by the senior management team in the trust. I think that the closure of the minor injuries unit will allow some redeployment of resources. So whilst the facilities will change, the staff available will be subject to some enhancement. Their professional view is that they can manage with this. However, as I say, these are temporary measures to get us through to the end of the financial year.

Mr Dunne: Richard, how long ago was it that ambulances started to be turned away from A&E at the Ulster because it could not cope? What assurance does that give our constituents that the Ulster can cope coming into winter pressures? I am sorry but I really do not get it.

Mr Pengelly: I am not disputing that point. The only thing that I will say is that, since then, work has focused on improving flows in emergency departments. Work on how to improve the management of emergency departments has been headed by the Chief Medical Officer and the Chief Nursing Officer to prevent that sort of issue arising again. However, I cannot sit here and pretend that this is not going to be difficult and that there will not be some potentially adverse implications along the way. We are managing an incredibly difficult position.

The Chairperson (Ms Maeve McLaughlin): It goes back to the context and policy direction and the variance with TYC, what we are hearing about front-line services and decisions that are being taken at a different level in the delivery of health services. That is the challenge, and the two seem to be at odds, a point that has been well made today by a number of members. Richard, you keep saying that these are temporary, eleventh-hour decisions.

Mr Dunne: We have seen it all before.

The Chairperson (Ms Maeve McLaughlin): In a recent evidence session, the Department told us that you have known of the trusts' problems since August 2013.

Mr Pengelly: When the financial issue was analysed, pressures were presented in the June monitoring round. In previous years, we have been successful in securing resources in monitoring rounds. The one thing that we will all absolutely agree on around this table is that, in a choice between implementing the contingency plans and securing additional resources from the Executive so that we do not have to do that, we would all obviously prefer the latter. That was the strategy that was adopted. Those bids were tabled with a reasonable expectation of success, but the wider macroeconomic environment changed, and the Executive were not in a position to allocate additional funding to the Department.

The Chairperson (Ms Maeve McLaughlin): None of us is naive enough to say that we are not aware of the difficulties and pressures in a number of Departments, no less so in the Health Department. The story about an additional £200 million to the Health Department is good, but we wish it were more. I think that we can all say that. The difficulty is that that is almost lost because we have a series of proposed front-line cuts across the trusts that seem to be at odds with the very policy direction that we were all told was the great hope for the future delivery of health. I will finish at that because I think that the point has been well made to you.

Ms McCorley: Go raibh maith agat, a Chathaoirligh. On a point of clarity — I know that the Chair raised this at the start — can you say categorically that all nurses will get the 1% pay increase?

Mr Pengelly: Yes.

Ms Thompson: They get either their incremental and contractual entitlement or, if they are at the top of their pay band and not entitled to that incremental increase, they get the 1%. They do not get both. If you are entitled to an incremental uplift that is more than 1%, you will just get that incremental uplift. On the other hand, if you are at the top of the pay band and do not have that incremental uplift, you will get the 1% instead. It is either, up to a max of 1%.

Ms McCorley: Does that satisfy the commitment that they feel they were given?

Ms Thompson: In Agenda for Change, the contractual commitment is to give those incremental uplifts, and those are being paid.

Ms McCorley: We are hearing from nurses about the 1%. I want to be clear that they will not feel hard done by if they just get an increment and were expecting the increment plus the 1%. You are saying that they would not be expecting that.

Mr Pengelly: I think that they strongly hoped for that, which goes back to a recommendation in the pay review body report.

Ms McCorley: Was that the commitment that was given?

Mr Pengelly: It was not a commitment; it was a recommendation. In England, they rejected the recommendation of the pay review body. In Wales, they rejected the recommendation. It was implemented in Scotland, and the position here is that one step progression is applied but not the 1% on top of progression. It is basically providing for a minimum 1% increase for staff.

Ms McCorley: I am trying to work out whether the nursing staff who are not at the top of their scale and who receive an increment that they would have been entitled to anyway will feel that they did not get any increase. Is that the way it will be left?

Mr Pengelly: It is, but in the circumstances that you outline, the individual concerned will get a pay rise. His or her pay will increase as a consequence of the pay progression.

Ms McCorley: Yes, I know. I am just trying to work out whether that is what they feel they were promised.

Mr Pengelly: Obviously, I cannot account for what they feel. I will acknowledge that there was certainly a hope that they would get both, based on the pay review body recommendation, but it was only a recommendation to Ministers. There was never a commitment by Ministers to implement it. Different parts of the UK have responded differently to that.

Ms McCorley: I agree with Fearghal that the information in your paper is so scant and gives so little detail that it is hard to know what to talk about. I do not find it helpful at all. In fact, in a Committee that I was previously a member of, officials were sent away because members felt that, on the basis of the information provided, it would be a waste of time. They were sent away and asked to come back with fuller information. I almost feel that we would have been better doing that today, but we are where we are.

I am concerned about Transforming Your Care and about what it means, because it is always the people on the ground and the people whom we meet on the streets who will feel the effects of the cuts when it all works its way down. People were promised a big future, and it was anticipated that they would receive great care.

Now, it is all starting to crumble. I am looking at the domiciliary care. People who have been working in the field for years have been stretched to the limits, and now, I imagine, they will probably be expected to work for nothing. I know people who practically worked for nothing in some cases. They were working and were not getting paid for it. People's emotions have been used by the system. Somebody goes in and cannot bear to leave a sick elderly person. They are not getting paid for it, but they feel that they have to do it. Advantage is being taken of people. Advantage is taken of the good nature of people who work in that field. It looks to me like it will be stretched even further. What would you say about that?

Mr Pengelly: Julie made the point earlier that more money is going into domiciliary care, but, given the demand on it, it is being stretched wider and wider across all clients.

There are two points that relate to the last point that you made. There are obligations on employers and national minimum wage rates apply. Employers have obligations to be sensible and sensitive. That said, I absolutely get the point that you are making that the sort of people who work in domiciliary care are hugely committed to providing high-quality patient care. On a daily basis, they step well across the line that they need to by staying longer and doing more. I can easily see how that feels like unpaid labour. There are obligations on the employer, but, in many ways, we are dealing with a group of special people here who work in this sector and provide this care.

Ms McCorley: I know, but I still feel that it is such an unsatisfactory situation that the trusts almost rely on people's going nearly ten extra miles. It is a very sad reflection that that is taken for granted.

Can I have a wee bit more detail, please, on the 2·5% cuts that are being applied to arm's-length bodies? Will that be across the board or will each individual arm's-length body be cut by 2·5%?

Mr Pengelly: It is each individual body.

Ms Thompson: It will be each of the smaller bodies. It basically applies to the ones that are outside the trusts, effectively. They have been asked to identify 2·5% cuts to their budgets. Every single one of those bodies will then have to live within that reduced budget going forward.

Ms McCorley: Who specifies where the cuts will take place or what element of work or service will feel that?

Ms Thompson: Similarly to the trusts, which have their contingency proposals, the arm's-length bodies have each identified where they believe they can most appropriately take out that 2·5%, again, in a manner that is achievable between now and the end of the year. They have, if you like, put those proposals forward and will then have to live within that lower, reduced budget for the remainder of the year.

Ms McCorley: So, they tell you where they would make cuts? Do you have plans from those arm's-length bodies?

Ms Thompson: Yes. They have each had to advise us that they can live within the reduced budget and what the implications of that are.

Ms McCorley: So, for instance, where would the Ambulance Service make cuts?

Ms Thompson: The Ambulance Service is viewed as being the same as the trusts. The proposal of 2·5% affects the smaller arm's-length bodies, which are not the trusts. So, the six trusts are, if you like, set aside. This affects all the other, smaller arm's-length bodies, such as NIPEC, NIMDTA, the Social Care Council, and the Fire and Rescue Service — those bodies as opposed to the trusts' bodies.

The trusts have really been the basis of the rest of the conversation that the Committee has had. This is then saying that the other bodies need to contribute as well and cannot just live with the full budgets that they previously would have had. They need to live within that reduced level in order to get the overall books to come back to balance.

Ms McCorley: We know that there have been huge difficulties in the Ambulance Service. What sort of cuts will it make, and how will they impact on the service? I wonder where the cuts will go. We know that there are huge sickness levels and a massive reduction in staff morale. That all flags up internal problems, which mean that there is something else going on.

Mr Pengelly: There are a number of issues in the Ambulance Service. There are no specific, hard plans for the Ambulance Service to contribute to in the remainder of this year. In the longer term, obviously, as we move forward and the financial position continues to tighten, the bigger challenges for the Ambulance Service are about recruiting, motivating and managing its workforce, rather than necessarily all being financially motivated. It is about getting the right people in. As you mentioned, it has had some problems with sick absence. It needs to manage that. It needs to work with colleagues on rotas and coverage.

Ms Thompson: Its issues tend to be more about managing the increasing demand that it has on its budget as opposed to taking money out.

Ms McCorley: Has it been left to resolve its own issues internally or is there oversight?

Mr Pengelly: It does not have a problem that manifests itself here in 2014-15. We will continue to work with it going forward. It will certainly work very closely with us on the generality of the 2015-16 financial position. As regards specific support for issues that it faces, we of course have a division in the Department that works very closely with it. We will support it in every way we can to address those issues and match resources to demand properly.

Mrs Dobson: I apologise for missing your briefing. Just as I came into the meeting, I caught the end of your comments, Chair, so my question may already have been covered. If it was, I will look forward to reading Richard's answer in the Hansard report. It relates, again, to the additional budget oversight by the head of the Civil Service. On Monday, in the Chamber, I asked the Minister a specific question on that, but I did not get a response. It probably has been covered, but maybe we could tease this out a bit more if you indulge me.

Richard, can you give me your views on the impact that additional budget oversight will have on the Department, especially in relation to the October monitoring round and also future spending? Do you agree with that additional oversight?

Mr Pengelly: I am afraid that I can talk only conceptually because we have only very recently become aware of the additional oversight that was announced by the Finance Minister. It is not something that we have had any dialogue on at all with our colleagues in DFP or the office of the head of the Civil Service. We await that dialogue.

At a conceptual level, I have nothing to worry about from additional oversight. I have been in the Department since 1 July. I have huge respect for the way in which the financial position is managed. Julie leads on this. She does an absolutely fantastic job for us. I now work very closely with Julie. I have nothing to fear. Of course, I would say that, but I am absolutely genuine. I have no difficulty at all with any amount of oversight or scrutiny of anything and everything that we do. There can be a completely open-book policy whereby people can come in and look at what we do and how we do it.

The one concern that I have is that if that oversight person comes in and wants to spend a huge amount of time with Julie and me, it would then become a distraction for us from doing the job of managing the position to that of explaining to someone else how we manage the position. I am happy to work with him and have nothing to fear, but I hope that it is a light touch that does not take us away from the onerous task that we face.

Mrs Dobson: So, are you saying that you have just been made aware of this?

Mr Pengelly: We were made aware by the announcement of the Executive decision. Certainly, if they had tried to negotiate it with us beforehand, we might have pushed back a bit.

The Chairperson (Ms Maeve McLaughlin): Jo-Anne, may I jump in, if you do not mind? I find that just incredible, Richard. The Finance Minister, in the June monitoring round — and the previous one, but specifically in the June monitoring round — raised issues of concerns about mismanagement or management of the current health budget. It is something that the Committee and I have raised consistently; where spend currently goes and the need for additional oversight in health. I now hear the permanent secretary saying that this is the first time that he was aware of it. I have to say that I find that hard to believe.

Mr Pengelly: Perhaps, I could clarify that, Chair. I did not say that I had not heard the Finance Minister make those points. The question raised the very specific point about oversight by the head of the Civil Service. My issue was that the first I knew about that was when I was told about it. There was no mention of it before that, so I think that, by definition, I could not have known about it.

The Chairperson (Ms Maeve McLaughlin): Again, Richard, I find that difficult to comprehend, I have to say. People across Departments, the system and wider society were reflecting on the guidance. When any Finance Minister gives guidance to a Department, you sit up and listen. So, regardless of whether the decision to implement it was new or you have only just become aware of it, I would have thought that, in view of the advice that was given — in black and white on one occasion and referenced on the earlier occasion — at least conversations would have been taking place.

Mr Pengelly: Chair, either you or I are confused about what has happened here. There is nothing happening here that reflects that we have not been doing something we should be doing. We are in full compliance with all the DFP guidance on monitoring rounds and budget processes. We have to acknowledge this: in the draft Budget position, the Health Department is in a much better place than other Departments, in terms of the protection afforded to us by the £200 million that you mentioned. Equally, what we received in the course of the in-year monitoring rounds — in June, we received £20 million; in October, we received £60 million — is much better than any other Department. The understanding that I have, from very informal dialogue, is that this is part of the consequence of us getting what is perceived by other Departments — many other Departments are articulating huge concerns about their own financial position; that there is some additional burden being put on the Department from the centre. My point is simply a factual statement: if DFP and the head of the Civil Service want to put an additional burden on us, I cannot know about that until they tell us about it. So, my answer is that I knew about it very recently when I was told about it. We are absolutely in compliance.

You make a point about the Finance Minister's comments in June. Those comments were very much focused on his concerns about the financial management that led to the overspend in 2013-14. The then Minister was very clear in his analysis that that was not any form of financial mismanagement; it was a clear, conscious decision not to scale back services in such a way that would have rendered them unsafe or unfit for purpose. So, I think that there are —

The Chairperson (Ms Maeve McLaughlin): OK. Apologies for jumping in, Jo-Anne. I do not accept that timeline. Go ahead.

Mrs Dobson: I totally agree with you, Chair. It seems incredible that this is all new to you, Richard. I am taken aback, as the Chair is. So, have you been briefed, Richard, on how the mechanism will work in practice? Are those details being discussed?

Mr Pengelly: No, as I said, I have not had any dialogue. I am not sure that the mechanism has been developed. I assume that colleagues in DFP will be thinking about how they want to do this and then they will talk to us about it. It is their process; it is not my process.

Mrs Dobson: It is their process to take oversight of your role.

Mr Pengelly: The difference is that it is not management of our role. They are not replacing our role or supplanting us in anyway. My reading of it, and this is a personal perspective, is that it is their way of providing assurance to all the other Departments that are perhaps a bit frustrated about the level of investment in the health service; an investment that I, personally, feel is absolutely warranted. That is how —

Mrs Dobson: That is probably why the Minister was not able to answer me on Monday when I raised it with him in the Chamber, because you were only hearing about it as well. So, you have no detail of the mechanism for it. It is correct, then, that an independent longer term strategic review is also set to be ordered? Are you aware of that? Is that correct?

Mr Pengelly: I am aware that it is there, but I do not know the detail of it, what it will do or how it will do it.

The Chairperson (Ms Maeve McLaughlin): Jo-Anne, for your information: I raised that at the start, under Chair's Business. We will seek clarification on those two issues. So, that will be coming back in writing, and we can reflect on it then.

Mrs Dobson: OK. I was going to ask about domiciliary care, but everyone seemed to think that that is a big concern.

Mr Pengelly: The only point that I would make, about seeking clarification from us, is that it was not an announcement made by my Minister. The announcement was made by other Ministers. It is not unreasonable that my Minister does not know the full detail of something that another Minister has announced.

The Chairperson (Ms Maeve McLaughlin): Let me clarify that. We are writing to DFP —

Mr Pengelly: Sorry.

The Chairperson (Ms Maeve McLaughlin): — to get that advice, but again, Richard — without opening up that whole issue — there was a very clear commentary around the health budget spend, which was not something that came out of the blue and which, in my view, has been very apparent from June, if not before then. I will close it at that, but my analysis of the situation is slightly different.

Mr G Robinson: I thank the team for the presentation. A few months ago, we had a situation where many care homes, throughout Northern Ireland and in all our constituencies, were to be closed and so forth. Because of the budgetary constraints that we are all suffering from at present, are we back to one of those situations again? The other point that I want to make is about the new cancer unit at Altnagelvin. Is there any danger that that new build will be suspended? Is it still on stream? My third point is about the increase in nurses' pay. When do you envisage that that will take place?

Mr Pengelly: Is your last point about the generality of the pay rise?

Mr G Robinson: Yes. When will that be in their pay packets?

Mr Pengelly: On your first point, about the care homes, I hope that you will forgive me for saying that, when that issue broke, I was not here, so I do not have the memory of it that others have. What I would say at the moment is that the issues we are talking about — I apologise for sounding like a broken record — are temporary. Any permanency alongside them will be subject to consultation and consideration of the strategic points that particularly Mr McKinney made. I do not know how that resonates with what happened in the past. Julie might want to come in and say something.

The nurses' pay rise is just an administrative process, to be implemented.

Ms Thompson: It is about working through processes, such as getting approvals from DFP and the like. It is an ongoing process that we will conclude as soon as we possibly can.

Mr Pengelly: And what about the Altnagelvin cancer unit?

Ms Thompson: As the Minister has already confirmed, both in his statement and to the Committee, the moneys that are needed in 2014-15 to keep the radiotherapy centre project at Altnagelvin moving in the right direction will be provided in 2014-15. That is where we currently are. Obviously, as Richard says, we need then to look into 2015-16, 2016-17 and whatever, but the money needed to keep that position moving forward has been made available in 2014-15. On the capital side, the money is also available to keep the build going. So, it is all still moving, fully ahead.

Mr G Robinson: So, there should be no delay in provision.

Ms Thompson: There is no delay to current plans.

The Chairperson (Ms Maeve McLaughlin): I have a couple of things, some smaller than others. I think that the members have indicated clearly that there is concern that what is proposed throughout the trust areas is somehow at variance with the policy direction of Transforming Your Care and the protection of our focus on prevention, early intervention, primary and community care. That is at odds with what we hear in relation to the budgetary commitments. Policy direction is something that the Committee will be very active on and very mindful of. It is proper that we get the full written breakdown of the £80 million that is proposed today, because it is not appropriate that we do not have those costs. We have loose headings, but we do not have the breakdown. I would appreciate it, Richard and Julie, if that could be supplied to the Committee in writing as soon as possible.

Mr Pengelly: We will obviously need to take that request to the Minister, Chair. We will do that when we get back to the office.

The Chairperson (Ms Maeve McLaughlin): OK. Thank you for your time.