Official Report: Minutes of Evidence

The Chairperson (Ms Maeve McLaughlin): I welcome from the Department Julie Thompson, deputy secretary of resources and performance management; Deborah NcNeilly, deputy secretary of the primary health care group; and Jackie Johnston, director of secondary care. Can I ask you to make a presentation, and then we will open it up to members' comments?

Ms Julie Thompson (Department of Health, Social Services and Public Safety): Yes, certainly. Thank you for the opportunity to discuss the Department's final budget for 2015-16. The Committee also asked for information on Transforming Your Care (TYC), the pharmaceutical price regulation scheme (PPRS) receipts and the specialist medicine fund. You have received a briefing paper on all three. In overall terms, I will highlight that, compared with the draft Budget, the final Budget that the Executive approved in January did not provide the Department with any additional funding, other than £4 million for five change fund projects. That was most welcome. That means that the final Budget presents significant financial challenges for 2015-16.

The briefing paper to the Committee provides an overview of the budget position at this stage. Having assessed the current cost pressures and identified some £157 million of opportunities, we see that there is an unresolved gap of £31 million for 2015-16. Our assessment, therefore, is that, whilst we will continue to pursue any and all available savings, we will be unable to close the gap through that approach. Thus, additional funding will be required for the Department through the monitoring rounds in 2016-16 to avoid unacceptable service consequences.

In making this assessment, I will highlight two significant consequences for the DHSSPS budget. Firstly, the savings opportunities in the trusts and the Department's other arm's-length bodies (ALBs) are extremely challenging to deliver in the context of rising demand and patient expectations. It is likely that those savings will have some impact on the way that services are delivered.

We are working closely with the board, the Public Health Agency (PHA), the trusts and the ALBs to finalise their savings plans for 2015-16. The boards of the relevant organisations will consider their plans, so I will not be able to provide information on the detailed individual savings proposals until that process has been completed.

Secondly, the scenario that I just outlined does not allow for new service developments. Potential and desirable service developments are estimated to amount to over £100 million in 2015-16 and to include developments in areas such as elective care, unscheduled care, new National Institute for Health and Care Excellence (NICE) drugs and public health initiatives. Such new developments are critical in ensuring that patients and clients in Northern Ireland continue to have access to the latest treatments, therapies and drugs. There is a clear public expectation that those will continue to be available in Northern Ireland in line with the rest of the UK.

Turning to TYC, transitional funding of £15·6 million is planned to be invested in 2015-16. As we previously advised the Committee, we estimate that, by the end of 2015-16, some £45·3 million will have been shifted left from hospital to community services and invested in community services to avoid hospital admissions and reduce time in hospital in line with the TYC vision.

Finally, as outlined in our briefing paper, returns from the PPRS in 2015-16 will be reinvested to support financial pressures associated with the growth in branded medicines. That mirrors the approach adopted in 2014-15. In light of the significant financial pressures that I outlined and the continued growth in demand for specialist drugs, the Minister has indicated that prescription charges would provide a sustainable funding mechanism and a sustainable infrastructure to meet that additional demand.

We are, of course, happy to take members' questions on any of the issues.

The Chairperson (Ms Maeve McLaughlin): Thank you, Julie. I just want clarity on the £83 million target for the shift left, the £25 million that was shifted and the extra £2·5 million last year, giving a total of £27·5 million shifted to date. I thought that the paper indicated that the 2015-16 target was to shift £0·93 million.

Ms Thompson: I will ask Deborah to go through the detail of that, as the figures are a part of our reply to you and were focused on the hospital-to-community shift. In the letter of response in December, we also talked about investment in community services and how that is part of the TYC vision. Maybe Deborah will clarify that for you.

The Chairperson (Ms Maeve McLaughlin): I am happy to discuss that, Deborah. I just want to be clear about this: are you now saying that the £0·93 million is the shift from hospital to community?

Ms Deborah McNeilly (Department of Health, Social Services and Public Safety): The additional shift in 2015-16 will be approximately £1 million; yes. I refer you to the paper that came before Christmas that set out the three strands that we have been looking at in the TYC shift left. I will take you through those three strands.

A narrow view has been taken of what shift left has been. The top part of the paper that was sent in December referred to a figure of £28·46 million by the end of 2015-16. That was purely a shift involved in moving a patient out of a hospital into the community or by providing more dialysis in the community, for example. We have been working with the partners who are delivering various programmes, and, in our view, as well as resettling people in the community and moving people out of hospital activity into the community, shift left is about managing the demand. We are trying to avoid people going into hospital in the first place. That is part of shift left in the overall vision that was set out in the TYC document.

In thinking about how the figures are adding up to the £45 million that has been quoted today and was reflected in the paper before Christmas, a £0·57 million shift in 2015-16 was also referred to as a result of hospital avoidance. We can take the Northern Ireland Ambulance Service pathways as an example. Instead of taking a patient straight to an emergency department (ED), the new pathways that are being introduced in the Ambulance Service mean that the care is being provided in the community. A pilot is ongoing in some areas whereby, if, when the Ambulance Service is responding, it believes that a community nurse can deal with the patient, when, for example, a catheter is involved, they can call the community nurse. That avoids them going to ED. It is very much about hospital avoidance and keeping the vision of having the patient remain in the community.

The third part adding to the £45 million relates to new services being commissioned in the primary and community sector. Those services are aimed at keeping people out of hospital and at avoiding the need for them to go to hospital in the first place. An example is telecare medicine, which means that patients are monitored in the community, so they do not have to go to an outpatient appointment or a hospital if their condition deteriorates. Another example is the development of crisis response teams in mental health. That means that there can be emergency access to psychiatric support in the community, which will avoid the need for admission to inpatient beds.

All those things taken together in three parts add up at this point to the £45·3 million that we are quoting today and that was set out in the paper in December. In response to a question for oral answer at the beginning of February, the Minister said that he viewed the trusts as implementing the vision of TYC on the ground on an ongoing basis. In other words, that is the vision for it. He referred to it being difficult to quantify if smaller projects are all taken together as part of business as usual and working in line with the new vision, as opposed to one of the TYC projects that the board is taking forward as part of a suite, which are all complementary. We are doing more work to dig under the trust work that is going on to support the overall vision of TYC to provide better services and to focus on the community.

The Chairperson (Ms Maeve McLaughlin): I get the wider impact of shift left, but, to clarify, £27·5 million was shifted. The paper that I have in front of me from December talks about the £0·93 million that would be shifted in 2015-16. Are we now saying that a total of £45 million will be shifted left by the end of this financial year?

Ms McNeilly: For 2014-15, £16·31 million of services are identified in primary care. One such service is telemonitoring, which keeps people in the community to be treated. They would not previously have had that service. The figure for the totality across 2014-15 is about £44 million. The additional shift in 2015-16 will go from £44 million to £45 million, largely as a result of the £0·93 million figure that was referred to, which is for dementia care in the community.

The Chairperson (Ms Maeve McLaughlin): To be very clear, why would we say that only £0·93 million was shifted if we are actually going to shift a total of £45 million?

Ms McNeilly: The £0·93 million is the additionality. Given that the figures are incremental, the totality for 2014-15 is £44 million. Maybe I should take you through the table —

The Chairperson (Ms Maeve McLaughlin): It would be useful to get that in writing.

Ms McNeilly: We can do that.

The Chairperson (Ms Maeve McLaughlin): I will go back to our most recent evidence session. There was an indication that, in 2014-15, £2·5 million was shifted. That gave us our figure of £27·5 million. We were then told that, going forward, it was £0·9 million. Are we now being told that, by the end of 2015-16, £45 million will have been shifted? Is that accurate?

Ms McNeilly: Yes. The previous figures that you quite rightly talked about — the £2·53 million, the £27 million and the £28 million — are very narrow. Perhaps you have taken a patient out of a hospital setting and resettled them in the community, or perhaps you have taken someone from a hospital setting where they used to get dialysis and are now providing dialysis at home. The figures that add up to £28 million are very narrow, and they apply to situations such as when a person is taken out of a hospital and resettled or when a person now gets a service in the community. The additionality is referred to in the bottom two paragraphs. In reflecting the full shift in investment and focusing on service in the community, those are the figures that add up to £44 million and £45 million.

The Chairperson (Ms Maeve McLaughlin): So, can we have a written breakdown of that £45 million, exactly how it shifted and where it is invested?

Ms McNeilly: Absolutely.

The Chairperson (Ms Maeve McLaughlin): Is £83 million still the target?

Ms McNeilly: It is.

The Chairperson (Ms Maeve McLaughlin): By when?

Ms McNeilly: It was rolled forward into 2015-16. It will be very challenging. As I said, the Minister mentioned that work is ongoing all the time in the trusts, with the vision of TYC driving the change. Therefore, the challenge for us is to capture what the financial impact of that has been on the ground, rather than focusing purely on the narrow definition of TYC, which has been the case so far.

The Chairperson (Ms Maeve McLaughlin): OK. You can provide us the breakdown of the £45 million as of today.

According to your paper, the £200 million in additional money for 2015-16 going forward has been reduced to £150 million.

Ms Thompson: In the paper, the uplift in the budget is £150 million, because £200 million went in and savings of £49·5 million were then taken off. I outlined the net effect in the paper, because that is the only additional income. If you look at our actual budget uplift, you will see that, between 2014-15 and 2015-16, the net budget uplift is £150 million.

The Chairperson (Ms Maeve McLaughlin): Where did the £49·5 million go?

Ms Thompson: The £49·5 million was an assumed saving when the Executive were looking at the Budget and when DFP was assigning the Budget allocations to Departments. As the paper sets out, we need to achieve an awful lot more than £49·5 million. In fact, we are setting out to achieve some £157 million of savings and opportunities. I guess we have managed that £49 million and more. I brought in the additional income, but we are also bringing in £157 million of savings and opportunities that will be added to that. That gives us just over £300 million to meet against the service pressures.

The Chairperson (Ms Maeve McLaughlin): Your appendix looks at savings from the trusts of £157 million. Is the £49·5 million additional?

Ms Thompson: No, the £49·5 million is encompassed within it. Effectively, that £50 million will be made up from the opportunities in the Department's budget, the ALB budgets and the family health services (FHS) budget. That will more than meet that £49 million. We also have to achieve savings in trusts and are setting out to achieve £157 million through that. The maths of the budget are that I effectively have an extra £150 million. We will bring savings and opportunities of another £157 million, giving us a new spending power of just over £300 million to match against our cost pressures. That is the maths of how it works. We are not settling with £49 million; we are at £157 million of savings going forward.

The Chairperson (Ms Maeve McLaughlin): But the £49 million is included.

Ms Thompson: It is included in that. Absolutely.

The Chairperson (Ms Maeve McLaughlin): There is evidence coming from England that commissioning has driven up costs to the health service there. Is there an opportunity to save money there or to abolish commissioning altogether? What are your thoughts on that?

Ms Thompson: We looked at every possibility of where savings can be achieved across the budget. That has been challenging for everybody. A review of commissioning is planned, and Deborah can maybe talk a bit more about that. In the currency of 2015-16, we have brought £157 million of savings and opportunities. If we can get more, that would be good, but it is about doing it in a way that maintains patient safety and protects the front line. That is the challenge of what we are looking at, but a review of commissioning is ongoing, and it will look at that to see whether we can do it in a better way.

The Chairperson (Ms Maeve McLaughlin): Is there thinking on different models of commissioning or on a simpler model that could be used and its cost-effectiveness?

Ms McNeilly: You are absolutely right, Chair. The Minister announced that the Department will undertake a review of commissioning as one of the responses to the Donaldson report. We will look at the beginning to the end of the current procurement process. That will involve doing some research into the models that operate in other areas to see what is the best model for us in Northern Ireland. It will be about making sure that the money goes to address needs in the most efficient and effective way in line with the priorities that are set out and that it is being managed to achieve value for money. As part of the review, we will look at other models. We may well have to look at whether there should be commissioning or whether there is a better way to do this.

The Chairperson (Ms Maeve McLaughlin): So, that has been considered.

Ms McNeilly: That has absolutely been considered.

The Chairperson (Ms Maeve McLaughlin): Has cost analysis been done of that at this point?

Ms McNeilly: Not yet. We are also trying to get some support through some case study work done, so we hope to see that.

The Chairperson (Ms Maeve McLaughlin): Finally from me is the infrastructural support programme through the Department, which involved a smallish pot of money but went out to in the region of 60 organisations. I talked to the permanent secretary on this a while back, and there were to be some radical changes. Where is that at now? I do not see it anywhere.

Ms Thompson: We are currently financing £4·7 million to the voluntary and community sector, which adds on to the significant amounts of money it gets from the HSC for commissioning services. We are still considering what the impact on that will be for 2015-16, and the voluntary and community sector is aware of that. It is fair to say that it has not been factored into the number work at this stage, but, equally, we still have a £30 million gap to address. Work is ongoing in that space. That money goes out to a very wide range of bodies, some very small and some very large. We need to consider whether that is the best and most appropriate use of funds. That work is ongoing. We have not reached an outcome for it, and, therefore, I have not yet brought it into this number work. Then again, I am short by £30 million. The work is planned and ongoing to see what we should do about that £4·7 million, which, as I say, is a small fraction of what they get from the rest of the HSC, and whether we can do that in a better way.

The Chairperson (Ms Maeve McLaughlin): It is a small amount of money with a big return. My worry is that there are a lot of very key organisations that are, quite often, doing the work of the service. I am thinking of organisations like the Voice of Young People in Care (VOYPIC), the Children's Law Centre and Gingerbread to name but a few. At this stage, they are actually sitting and waiting to see what will happen by 1 April. That is only a number of weeks away.

Ms Thompson: It is. At the moment, I suggest that there will not be a change by 1 April; there could not possibly be a change in that time frame. It would be inappropriate to do so. I can certainly provide that reassurance. I cannot answer at the moment as to the exact stage of the work, but I know that we are looking at it to see whether we could and should do something better with that money. It may be about moving it around, if you like, between bodies and how that might potentially get us to a better place. We are very conscious of what you are saying about the impact that this might have on particular organisations and the services they provide. The small amount of money from us may mean a big deal to them, but you need to understand what it is — organisation by organisation by organisation — and what our money, the bit that we provide, is doing for that organisation.

The Chairperson (Ms Maeve McLaughlin): You are saying that there will be no change for 1 April.

Ms Thompson: Not on 1 April, no.

The Chairperson (Ms Maeve McLaughlin): Are there guarantees that there will be proper consultation and engagement?

Ms Thompson: There will be engagement ongoing on that, absolutely.

The Chairperson (Ms Maeve McLaughlin): Can you come back to the Committee on that as that progresses?

Ms Thompson: Yes, as it progresses.

Mrs Cameron: Thank you for your presentation. In your paper, you refer to service developments. It states that you are working on the assumption that there will be no service developments in 2015-16; however, last week, the Minister announced that £200,000 will be allocated from departmental funds in 2015-16 to contribute towards a new cardiology hub. Is that not a service development?

Ms Thompson: I am not sure whether Jackie can answer on the specifics of the cardiology hub. In general terms, we have looked across the range of services, and, effectively, the line in the Department and the board is that we do not have the funding at this time to meet those service developments. Where there is a choice about it, they cannot happen. It may well be that some are already so far down the line that we have had to look at where staff are already committed and where staff have already been recruited and that sort of thing. You might not see the service yet, but staff recruitment has already happened.

Obviously, work is ongoing around paediatric congenital cardiac services (PCCS) generally in that space as well. When we have been looking at it, we have been trying to identify where everything is at in the process. It is very difficult to draw a line at 1 April because some things will be in play from this side of the year end that you might not initially see on the ground, but where, effectively, the commitment is already in place. That may be what the distinction is in this case.

Mr Jackie Johnston (Department of Health, Social Services and Public Safety): Yes, the £200,000 was a commitment that we covered for last year in the expectation that we would have moved faster to introduce the all-island network. It has rolled forward to cover transitional costs. It will cover, for example, the cost of the additional cardiac nurse and the funding liaison nurse while children are still going over to England for surgery. It will also cover the administrative costs of setting up the network, but just for the one-year transition. By the end of 2015-16 we expect the network board to have a fully costed business plan which will show the distribution of costs North and South. The Northern Ireland element will then be funded from our recurrent budget, which is about £5 million at the moment. This is therefore a transitional cost, rather than a new service development in the strictest sense.

Ms Thompson: We received £1 million from the change fund for paediatric congenital cardiac services (PCCS) transitional support, and that money has to be spent on that area, as does all change fund money, which is ring-fenced to the area concerned.

Mr Johnston: That £1 million will be spent, for example, on two additional intensive care beds for Northern Ireland children in Our Lady's. They are quite expensive beds. We will require enhancements to telemedicine and IT between North and South. We will also look at strengthening the network in Northern Ireland through telemedicine training. Moreover, there will be a requirement to backfill posts in Belfast once our cardiology team starts to go down from 1 April, because anaesthetists, for example, have responsibilities in the hospital other than for paediatric cardiology patients. All of this is really seed core money to establish the network and get the transition going. We will then have the full costed business plan in the course of the year.

Our Lady's has invested in a new cath lab. Minister Varadkar cut the sod for it last month. It will be up and running by the end of the year. This is a transition cost rather than a strictly new service development. It is part of the move from the current service to the new service.

Mrs Dobson: My first question regards carried-forward pressures from 2014-15. Paragraph 5 of your paper states that £236 million of pressures will be carried forward from 2014-15 to 2015-16. Can you explain how that works?

Ms Thompson: The Committee is well aware that we have had financial challenges in the currency of 2014-15. As we looked into the year, we were £160 million short of our assessed need. Effectively, the £236 million is the full-year effect of the £160 million. Elements of funding have been invested during the currency of 2014-15, for example in a capital scheme that is open part-way through the year, or in the provision of a National Institute of Clinical Excellence (NICE) drug to an individual part-way through the year. We have had to add up all that and identify what it would come to in pressures as we head into 2015-16. What we have not done is then leave it at that. We have looked to see what can be brought to that, where we can reduce spend, and what would that look like. That drives the £157 million going the other direction. Basically, we looked at the £160 million gap in 2014-15, rolled that forward into 2015-16, accounted for all those part-year effects, and identified £236 million in pressures that need to be funded. Against that, we have the income we are getting from the Budget. We have the savings, and the bottom line is that we are £31 million short as we enter next year.

Mrs Dobson: Are you saying that in 2014-15 the Department, in effect, committed itself to pay for things in 2015-16 that it cannot afford.

Ms Thompson: We are certainly short of funds to meet some of those commitments. It is the same, I guess, as going into 2014-15, where we were £160 million short. We took action to address that in 2014-15, as the Committee knows. A lot of those actions and the reliance on in-year monitoring money are non-recurrent, and therefore the difficulty remains as we look forward into 2015-16. People have gone on to NICE drugs during 2014-15 and they need to be sustained into 2015-16. We have also opened capital schemes.

We now know our budget, and setting the budget and savings against those commitments addresses most of the shortfall, but we are still £31 million short. We then have the service developments issue to deal with as well. That is where we are now. We are not saying that this is where we will end up. We continue to try to identify further opportunities on the way through, but that is where we are now. That is, I guess, the net impact on the bottom line.

Mrs Dobson: My question regards new projects and buildings. I was informed yesterday, in response to a question for written answer, that the budget constraints for 2015-16 might result in the delay of the new paediatric unit at Craigavon Hospital. What other projects could be delayed as a result of constraints to this budget?

Ms Thompson: That question relates to funding from the capital budget: up to now, I have been describing the revenue side. I will give you some highlights. We have a capital budget of £210 million, including £203 of routine capital and £10 million of financial transactions capital. Out of that money, we have to meet our contractual commitments. We have looked at them, and they are currently estimated at £134 million. There are then a number of priority projects, which are well down the line because of the business case or whatever. We have assessed that we can fund some, but not necessarily all, of that. We also have pressures, as you will appreciate, on the fleet and on general capital to maintain the estate and for ICT. The net result of all of this is that it is challenging to commit to anything new while staying within the £200 million capital envelope. Having examined our contractual commitments and got that down to £134 million, we have got £70 million less, but, given that we would normally spend upwards of £80 million on more routine stuff, such as the ICT and the fleet, general capital, we have very little left for new projects coming down the line. We are trying to find a way to manage that, but we do not want to mislead people. We are working through to profile on contractually committed stuff. A lot of those schemes will go between years and will not necessarily complete in 2015-16.

Mrs Dobson: If I had not asked that question, I would not have been aware that the new paediatric unit in Craigavon was under threat. How do we find out what other projects could be delayed, other than submitting questions for written answer on every possible project? Can you provide us with a comprehensive list of what is under threat? As you can imagine, there is a lot of excitement in our constituencies about a new project such as this, only to be told that it is going to be delayed. It would be very useful for us to have that list.

Ms Thompson: Yes, we will be doing work in the next couple of weeks to figure out what we will do with the remaining £70 million. That would be a sensible time to update the Committee. We have concentrated today on the revenue budget, because that is the one that —

Mrs Dobson: Seventy million pounds is all that remains in the capital budget.

Ms Thompson: Yes, after we get through the contractual commitments. The capital budget is under a lot of pressure across the piece going into 2015-16, probably a lot more than normally. We will, of course, as we would normally do, look to an in-year monitoring bid to deal with some of the routine work that can be picked up during the year; but it is certainly under more pressure, and I am happy to come back to the Committee to give an update on commitments, probably in two or three weeks' time.

Mrs Dobson: That would be useful, Chair. I am concerned that we are only finding out exactly what is at risk through questions for written answer. I will ask another question, if I may, Chair. I refer to the section of your briefing on the pharmaceutical price regulation scheme (PPRS), about which we heard a very powerful presentation a few weeks ago. Again, in a response to a question for written answer, the Minister told me that the 2015-16 returns from the PPRS:

In your briefing today, no mention is made of these pressures. Why?

Ms Thompson: As we look at 2015-16 and the financial plan in the paper, the PPRS receipts are assumed to offset the growth in branded medicines. That is why it is in the financial numbers. One offsets the other, effectively, in terms of growth. The PPRS receipt is very welcome because it enables that to happen.

Mrs Dobson: But why is there no mention of the pressures in the paper today?

Ms Thompson: There was no intention not to have them there. The intention in the paper was to advise that the PPRS receipt is offsetting the growth in branded medicines. That is certainly what we intend to do again in 2015-16, as we have already done in 2014-15.

Mrs Dobson: I do note that you tell us that the next PPRS will be used, as you say — and I wrote down your quote earlier — to:

yet the Minister points to pressures across the service. Is the PPRS money being used across the service or solely on branded specialist medicines?

Ms Thompson: The growth in branded medicines is in line with the PPRS receipt, so it will offset it. I can assure you that it is in the numbers and that the growth in branded medicines will be offset by the PPRS receipt we are receiving. That is our current assumption.

Mrs Dobson: So, the money is not being used across the service?

Ms Thompson: No, the money is being used against branded medicines.

Mrs Dobson: Solely on branded specialist medicines?

Ms Thompson: In terms of the numbers on that, we have assumed, in 2015-16, that we will receive a receipt in the order of — and you know that the PPRS are estimates — £36 million, but we have growth from 2014-15 and 2015-16 of a very similar number, somewhere in the order of £37 million or £38 million. The growth we are experiencing in branded medicines — which is in the numbers — is being offset by the PPRS receipt as we look forward.

Mrs Dobson: Julie, can you confirm for us that the PPRS returns have not been, and are not planned to be, spread across pressures in our health service?

Ms Thompson: In terms of what has happened in 2014-15, our current assumption is that we will get a receipt in 2014-15 of the order of £14 million or £15 million, but that we experienced growth in branded medicines of the order of £20 million to £22 million, so it is not even enough to compensate for that growth. It is in the overall plan, but the income will offset the growth in the medicines. That is where the two match.

Mrs Dobson: Yes or no? I am aware of all of that, but will it disappear into the black hole that is the health service?

Ms Thompson: No, it is not disappearing; absolutely not.

Mrs Dobson: It will not be offset, other than by branded medicines.

Ms Thompson: It is in branded medicines growth.

The Chairperson (Ms Maeve McLaughlin): I think this is an important point, and it is new information, Julie. We have been told throughout the discussion that PPRS would go to fund general pressures in the system.

Mrs Dobson: That is right. That is what I have been told.

Ms Thompson: In looking at the financial position, we have been doing a lot of work on that. It is a fact that the growth in branded medicines is more than the receipt from PPRS, so the two —

The Chairperson (Ms Maeve McLaughlin): I accept that, and I appreciate that clarification, but it is certainly different to what we have been told.

Mrs Dobson: In a written answer to me, the Minister said — I can quote it; I do not know which one of you wrote the answer — that the 2015-16 returns from the PPRS:

You are telling us today that this is not the case, and that it will not disappear into the black hole; it will be used —

The Chairperson (Ms Maeve McLaughlin): For branded medicine.

Ms Thompson: In that the branded pressure is across the HSC, the two can conflate with each other, but what I can confirm to the Committee is that the growth in that branded medicine —

Mrs Dobson: But will the money be used specifically for branded medicine and not be absorbed into the system?

Ms Thompson: We are experiencing growth in branded medicines, which is being offset by the PPRS receipt. As we look at the financial plan for 2015-16, those two elements are factored into that analysis.

Mrs Dobson: Why would I have got an answer to my written question saying that it:

It does not mention that specific —

Ms Thompson: Answers to more recent Assembly questions — and I apologise, I do not have them with me — have included the growth in branded medicines. Looking at the numbers, that is where it sits. There is at least as much growth in branded medicines as we are receiving in PPRS receipts.

Mrs Dobson: We are hearing two different stories and that is —

Ms Thompson: We do not have enough money for the IFR process, which the Committee was talking about a couple of weeks ago, nor do we have funding available for new NICE drugs. I am talking about the expected growth in existing branded medicines going into 2015-16. To be clear, no funding source has been identified at this stage for the new IFR process or for the new NICE drugs. That is where the current consultation —

Mrs Dobson: Was the Minister's reply to me wrong, then? That is not what you are saying.

Ms Thompson: The growth in branded medicines is across the HSC, so it is a subset of —

Mrs Dobson: But what about support pressures? It does not clarify; it just says pressures across the HSC.

Ms Thompson: More recent answers to Assembly questions talk about the growth in branded medicines. As we have looked at the growth in branded medicines, the PPRS receipt is offsetting against that.

Mr McKinney: The figures are different because you are getting more money from PPRS than you have indicated today. Where is the excess money going?

Ms Thompson: What more money?

Mr McKinney: From my understanding, you will get £45 million in the 2015-16 financial year.

Ms Thompson: No, that is an accounting issue. I am thinking about where you received that information. The last portion, which is for the last quarter of 2015-16, sends the figure up to £45 million, and is accounted for into 2016-17, so we will eventually get that last wee bit. We can only go, in terms of accounting treatment, between the moneys accounted for up to December 2015 and which will come into 2015-16. That is the £36 million amount that I have talked about. The last quarter will go into the next financial year. This is the way it is accounted for. If I may digress a little bit; the reason for that is because the sales driving the PPRS receipt and from which it is calculated will not come into usage. They have to come through the wholesalers into the community pharmacists and the medicines budget etc. By matching those two together, there is a one-quarter lag all the time. That last quarter in 2015-16 is accounted for in 2016-17, so it will ultimately come but all I can bring into 2015-16 is the amount up to December 2015, which is why it is £36 million.

Mr McKinney: If, in answer to an earlier question, you are spending money next year that you do not have, surely you can spend it this year if you get it next year.

Ms Thompson: In accounting speak, no.

Mr McKinney: Well, in accounting speak, you seem to be able to do it your way when you need to. What is your understanding of what the PPRS scheme is? As I understand it, the deal is about the provision of cancer drugs and specialist medicines additionally.

Ms Thompson: It is about encouraging innovation in that specialist drugs area. The industry is supporting that to happen.

Mr McKinney: What point of innovation is simply about paying off the branded medicines bill that you have?

Ms Thompson: In that branded medicine is the work that is coming through by way of the NICE procedures and all that working its way through. I know that you understand the mathematics of this and that it is, obviously, a national deal. We get our proportion of that. As we have looked at that, at the growth that we are experiencing locally and at the PPRS receipt for this year and next year, the PPRS receipt, which is very welcome, is offsetting the work that we have got but it does not reach or cannot afford —

Mr McKinney: It is not going to innovation.

Ms Thompson: It is working through and supporting NICE and the work done there. It is all gone by the time we do that; there is no further funding available to do that.

Mr McKinney: I take on board what you are saying about the accounting period, but there is a dispute there. That is contested space.

Ms Thompson: I do not have a dispute with the numbers you are talking about; the timing of when they get accounted for is the only issue with that. I have looked at that and I am broadly in line with that analysis. I have no reason to say no to that.

Mr McKinney: In the context of the scheme, which is about providing innovative drugs — and the wider politics is about addressing inequalities here because those drugs are not available here — the money you say is offsetting is not going to innovative drugs.

Ms Thompson: It is going against the growth in branded medicines. By the time we have done that, there is nothing further available.

Mr McKinney: Yes, but the scheme is about innovation, and the money is not going to innovation.

Ms Thompson: It is about capping the growth and managing the growth in branded medicines.

Mr McKinney: Do you accept that it is not going to innovation?

Ms Thompson: I accept that it is not going to non-NICE-approved drugs. When we look at our current analysis, the NICE-approved drugs are all that can be afforded through the PPRS receipt. Therefore, it cannot act as a funding source for non-NICE-approved drugs, as we look at it. That is the reality and the mathematics of it.

Mr McKinney: With regard to the contested space around the figures, I suggest that it could go some way to —

Ms Thompson: In terms of the figures, I suggest that the mismatch you have is around timing as opposed to one on the figure work per se.

Mr McKinney: What figure did you get in year one?

Ms Thompson: Currently, we have £11·2 million. We are estimating it as being £15 million in total. Against that, our branded drugs have increased by £22 million for NICE. There is a small element of funding for the existing individual funding requests (IFR) process within that. Other than that, effectively we have £15 million in, but we have spent more than that in the growth in branded medicines.

Mr McKinney: This year, you will get £30 million at least.

Ms Thompson: We are estimating that to be £36 million. That £36 million has to fund the pressure coming forward from 2014-15, because it is still there. Those drugs still have to be bought. We then have to buy new drugs, and there is new growth in the currency of the 2015-16 year as well, and the two will match off against each other.

Mr McKinney: To be clear on that, you are saying £22 million in this year. What are the increased figures for spend?

Ms Thompson: We estimate a growth factor of £16 million for next year.

Mr McKinney: On top of £22 million.

Ms Thompson: Yes, on top of £22 million, and a receipt against that of £36 million.

Mr McKinney: But you accept the argument that this is not going to what it was designed for. You are offsetting your bill, but it is not going to what it was designed for.

Ms Thompson: It is certainly going into looking at capping the growth in the branded medicine sector.

Mr McKinney: That is about finance.

Ms Thompson: Then you get into the NICE process and all of that, and how it works. I do not know whether Jackie wants to add to that.

Mr Johnston: The scheme is designed to control the growth in branded medicines by providing rebates based on actual medicines expenditure. It is not directly aimed at promoting innovation; it is about controlling the expenditure growth in a way that helps the public service to manage it effectively and not have the cost run totally out of control. I think that the innovation is more likely to come from the Minister's other recommendations in the IFR evaluation; for example, if we remove the current exceptionality clause — and there is some indication that that may be preventing trials coming to Northern Ireland, for example — that will, hopefully, encourage more innovation for trials of drugs in Northern Ireland. It is more likely to come down that route.

Mr McKinney: If that is the case, and you see the end game there, then given the extended process that might occur around prescription charges, are you going to decouple those two issues now?

Mr Johnston: This is a different issue. I think that we have to get through the first stage of this, which is the consultation on the top-line proposals. As you know, the Minister has indicated that he wants to fund those proposals through introducing a prescription charge. That could take some time, and I accept that. The Minister is keen to improve access as quickly as he can, and he is very patient-focused on this. I think that he will look for other opportunities if he can and discuss with the Executive to see whether he can bring in those changes more quickly if the public consultations are in favour, while we take through all the work that would have to be done on the prescription charges

Mr McKinney: So, we could see a provision for the IFR process without putting the prescription charge cart in front of the IFR horse, if you like.

Mr Johnston: Over the longer term, it would have to be funded by a prescription charge. In the short term, we could look at in-year bidding, for example, but there are competing pressures around that. We would have to look at how that would be prioritised in those bids.

This public consultation will give us a good indication of where the public stands on this. That will provide a platform to move forward.

Mr McCarthy: That is an alternative. If the prescription consultation does not go the way that the Minister thinks it might go, are you saying that there is an avenue through this PPRS that will help us to get over that hump? Patients, particularly cancer patients, should have the same access as their counterparts across the water, but they do not.

Mr Johnston: It is not an alternative. In the longer term, a prescription charge will be required to fund this. It is a possibility to try to bring it in quicker if we were able to identify money being available to do that. I would not want to give the indication that it is a concrete —

Mr McCarthy: But it is there.

Mr Johnston: It is a possibility.

Ms Thompson: I guess that what you would potentially be looking at if the public support was there is going to the Executive through an in-year monitoring bid to provide the support in 2015-16 and having a more sustainable prescription charges facility available to support it in the future. Is there a means to bring this in quicker that the Executive would be willing to support? As Jackie says, there is a range of pressures here, not least the bottom line, which does not balance at the moment.

Mr Johnston: You also have to take on top of that the new approved medicines that will be coming in, where we have a funding pressure as well.

Mr McCarthy: Finally on that issue, what do you say in response to the statement about the impact on industry and patients of persistent misrepresentation of the 2014-18 PPRS? Who is misrepresenting who? That is a statement from —

Mr Johnston: We would not accept that at all. There is no misrepresentation here. The facts that we present are the facts that we have. There is no intention at all to misrepresent anybody.

Mr McCarthy: I will go back to cutbacks now. How and when will the impact of trusts' final savings plans be communicated to staff, patients and, indeed, the wider public? You know what I am saying. You know what I mean.

Ms Thompson: Indeed. A lot of work has obviously been ongoing in trusts to identify what savings proposals might look like. With regard to process, those are getting to a stage where, as I understand it, they will be going through trusts' boards very shortly. Combined with that, each trust will be considering the very engagement that you are talking about with staff and stakeholders. Obviously, if there are then individual proposals within those plans that require full and proper consultation, that will have to be factored in as well. As I understand it, the plans are being finalised at the moment and would go through trust board processes because, until they go through those trust board processes, they are obviously not, if you like, fully endorsed at trust board level.

Mr McCarthy: Is there a time limit on that?

Ms Thompson: I would expect it to happen within the next few weeks. I cannot be precise about that. It is not months away.

Mr McCarthy: Finally, the Public Health Agency is being disproportionately hammered by a 15% cut in its budget of £2·8 million and the reduction of 45 staff. Surely, that defeats the purpose of Transforming Your Care, because the Public Health Agency carries out enormously good work in prevention and all the rest of it. If you reduce that by 45 staff and £2·8 million, we will be back to square one, with more people going to hospitals and the defeat of Transforming Your Care. I have been speaking to them. They could accept a much smaller reduction of maybe 5%, but 15% is huge in anybody's terms.

Ms Thompson: The first point of clarification is that 15% has been applied to its administration budget, not to its whole budget. It is being applied to the £18 million that is being spent on administration, not the full budget, which, by now, must be upwards of £90 million or something of that order.

This is very difficult, because, if we do not apply that sort of rigour to administration-type costs, your only answer is to go to front-line services. Even with doing what we have done, we are still £30 million-odd short against the current pressures that we have. You are quite right: what we have done is ask the PHA for 15%. We have also asked for that amount of money from the board and the BSO.

All three regional organisations have been dealt with in that way. We are waiting for their proposals to come back in detail, where they need to explain what it is and the impact on all that, but the remaining programme budget is still in play for them. We have focused this particular bit of it on administration, which, given where we are financially, is what we have to do in order to reduce costs and administration costs.

We are looking, as the Committee will be aware, across those regional bodies and with the Department at what we can potentially do better between the three big regional bodies to identify whether that would assist them in delivering their savings. In the first instance, we are asking the organisation to consider it on its own. We will then bring that back alongside the board's return and what we in the Department are doing, and we will work those together to see where that can be achieved. It is hard, but the reality is that, if we do not do that with administration, we are pushing an additional saving onto front-line care.

Mr McCarthy: I accept, Chair, that administration is front-line jobs. If those people are not there to carry out this screening and all the rest of the good work they do, would you not admit that we are going to go back to not administering Transforming Your Care and we will end up in a far worse place?

Ms Thompson: We need to understand the proposals, what they can do and what we can bring to the piece between all three regional bodies. That is the work that we are doing.

The Chairperson (Ms Maeve McLaughlin): In terms of the commissioning plan, at the recent evidence session, we heard reference to the 14 targets being rolled forward. There were four new targets, all in relation to acute care. From memory, I think that only three of the targets in the commissioning plan had any reference to public health or health inequalities. Surely, again, that is at variance with the shift left.

Ms Thompson: I do not know whether Deborah wants to comment on the detail of the commissioning plan, but, certainly, as far as the savings are concerned, we have looked right across the board and have not put any saving on the programme side of the PHA's delivery of services. That means that the vast bulk of its budget does not have a target applied to it, which is very different from the other organisations. The reality is that, if we do not do that, we will end up putting pressure somewhere else in the system.

I suggest that every organisation is finding that exceptionally challenging to deliver, and we need to see the detail of the proposals. There is no doubt that the Minister wants, as far as possible, to protect those front-line services, and if he can do that by reducing administration, that is good and we should do that. That is what we are trying to achieve.

The Chairperson (Ms Maeve McLaughlin): Do we now, by any stretch of the imagination, have an agreed definition of "front line"?

Ms Thompson: We did answer an Assembly question on that. It was basically front-line patient care and all the stuff that supports it. You cannot box it off in an easy way, and when we were here in November, that is where the conversation went. Equally, the front line, as the Executive have advised in a paper about front-line health and social care, which means, like other front-line services, for example, the fire service, are not included within that particular definition. We have defined it, as best we can, through an Assembly question to members.

The Chairperson (Ms Maeve McLaughlin): Can you share that definition with us here?

Ms Thompson: It is already on the Assembly record.

Ms McCorley: Go raibh maith agat, a Chathaoirligh. Thanks for the presentation. The paper refers to £15·6 million that is predicted to be spent on Transforming Your Care initiatives in 2015-16. Can you give me some examples of those initiatives? It refers to initiatives that have commenced.

Ms Thompson: Yes, the distinction is that this is taking on, and continuing, the work of TYC. We have not stopped the investment in TYC. It is still there and ongoing, and that £15·6 million is reflective of that. Deborah can maybe take you through some of the examples of that. Are you happy to do so?

Ms McNeilly: Yes. Some of the underlying details in relation to that are, for example, that it will allow the continued delivery of the alternative care pathways that have been taken forward by the Ambulance Service. There is also a range of services being taken forward in terms of the integrated care partnerships. For example, within the Belfast Trust, there is a planned spend of £1·7 million in relation to frail elderly and acute care at home. That is a service where the GPs can refer patients, on a 24/7 basis, to this active care team. That can provide limited 24 hour or 48 hour — over a short period of time — care for that patient in the home, to administer intravenous antibiotics, for example, or to help with services such as rehydration. That will continue.

There will also be respiratory services, which is looking at maintenance and making sure that home oxygen therapies are working and targeted at the right place. In the Belfast Trust's stroke services, early supported discharge is continuing. That is the reach in piece to the hospital to make sure that arrangements are in place at an early stage for a patient to leave, including support in the home.

There is primary prevention through chronic disease hubs in the Belfast Trust. A high-risk patient in terms of lifestyle regarding health, alcohol activity or whatever can be referred to that one-stop shop hub to get support and advice on lifestyle changes. Those are just a few examples of the integrated care investment, which is continuing into 2015-16.

Ms McCorley: What are the initiatives that you had hoped to commence that will now not?

Ms McNeilly: The board has received bids, if you like, from the integrated care packages and is still working through those. One was for a pilot for atrial fibrillation — do not ask me any more about that — in the northern LCG to avoid strokes. The ICPs have brought forward proposals to the board, and the board is working its way through the business cases for those. Those are the sorts of things that they would have liked to have brought forward. It will be those types of things that they continue to look at and assess and that we will, hopefully, be trying to bid for in a monitoring round. We talked about the significant financial pressures. It is difficult to tell whether there are any funds coming in a monitoring round.

Ms Thompson: Just to confirm, we have the £15·6 million factored into the financial positions, but any new work within that would have to come through a funding source designed to meet those service developments, of which there is a long list.

Ms McCorley: What initiatives would TYC be looking at to help to deal with or manage the types of lifestyle choices that people make that are ultimately damaging to their health?

Ms McNeilly: I mentioned the hub approach in the Belfast Trust. From memory, they are proposing three hubs. They refer to them as one-stop, one-referral places for high-risk patients who have maybe been identified as being smokers, being inactive or as having obesity issues. There would be additional support from the voluntary sector, which might be for smoking cessation and so on. The hubs are reaching out a bit more to give people a one-stop shop that might help them to manage, address, learn and get better information in relation to healthy lifestyle choices. They are specifically targeted at high-risk patients.

Ms McCorley: Are you looking at anything really innovative, for instance, new ways of managing diabetes? You hear talk about ways of using new technology to help people to manage their blood sugar levels, which could be really useful in preventing the advancement of the disease.

Ms Thompson: Work is ongoing in the South Eastern Trust around, as you described, using technology to help people to manage themselves, and filtering that information back into the clinical side to get care at the point when people need it in order to prevent conditions getting worse. It is about how and whether we can spread that. Different ICPs are at slightly different places. As Deborah said, they are all looking at high-risk patients, but there is certainly work ongoing in the South Eastern Trust that I am aware of. It may be ongoing in other places as well, but that type of initiative is very much on the TYC agenda.

Ms McCorley: So, it is just really in the South Eastern Trust, as far as you are aware.

Ms Thompson: I know it is ongoing in the South Eastern Trust, but what I do not know is whether it is in play in other places. If is it not already in play in other places, it will not happen unless we can identify a service development source of funding for it.

Ms McCorley: Are you looking at what is happening in the South Eastern Trust as a pilot?

Ms Thompson: Yes, at this point, it is a pilot.

Ms McCorley: Is there a timeline for that?

Ms Thompson: I do not know. We will need to come back with the detail of that to see what the timing of it is.

Ms McCorley: Is it something that you are prioritising? You hear about diabetes all the time and that it is an ever-growing disease. Ultimately, in some cases, it is preventable.

Ms Thompson: Diabetes is one of the areas that is being looked at. I cannot answer you specifically on exactly what stage that has got to in the rest of the Province, but I am happy to come back on that.

Ms McCorley: That would be useful. If something was really innovative and looked at new ways of dealing with and helping to prevent disease, I would like to hear how it is progressing.

Mr McCarthy: Can you also add to your list the chronic shortage of services available for addiction, particularly for young people? I know that there have been cases where there is no hope for young people and no help for them at all. We can all understand how parents feel when they see a son or a daughter just going. I understand that there is a chronic shortage of beds or whatever treatment is required for addiction to drugs or whatever.

Ms Thompson: I guess that there are so many pressing issues that could be addressed if the funding was made available. Looking forward, understanding all that and understanding the priorities around it, the first and foremost issue is to identify how we address the £30 million problem that we have at the moment and how we deal with those service developments. There are so many things like that which are compelling in nature that people would want to put in place. The financing simply does not exist at the moment to do that. That is something that we need to continue to work at, but it is highly likely that we will need the support of Executive colleagues to deliver.

The Chairperson (Ms Maeve McLaughlin): On that issue, it was of concern that the targets around addiction and substance misuse were taken off the commissioning plan, particularly when we look at the cost: the £250 million that it costs the health service here in the North and somewhere in the region of £800 million that it costs across the island. There is a clear need and demand that needs to be met.

Ms McNeilly: Obviously, the Committee wrote to the Department on a number of queries, and I understand that there is a draft response that is awaiting ministerial clearance, so I do not want to get too far ahead of the Minister. A new target has now been built into the commissioning plan in light of the concerns that were expressed. I am just trying to find the right piece of the briefing, but I think that it may be a two-year period to roll it out. There is a target now in the plan.

The Chairperson (Ms Maeve McLaughlin): Is there a target now for addressing addiction?

Ms McNeilly: Yes, for substance issues.

The Chairperson (Ms Maeve McLaughlin): That is welcome.

Ms Thompson: That is building on the current work and looking at integrated services, which I think was the issue that the Committee raised. It is in the new commissioning plan.

Mr McKinney: I have one very specific point, and you may have touched on it through how the trusts are meeting at board level. Is there any sense, in a headline way, about the extent to which the contingency plans will now become permanent?

Ms Thompson: I guess that trusts are assessing where they are as they look forward at the financial position for 2015-16 and what they might need to do, so it is difficult to give you a specific answer to that. I guess that the general answer to your question is that they are all looking at that at the moment. They will be considering it and, I guess, identifying what has happened through the currency of the autumn to winter period in particular and what impact that has had on patients and clients. They will then be looking at their financial position for 2015-16, which is exactly the work that they are finalising at the moment, and considering from there what that means for the service changes that they put in place during that winter period.

Mr McKinney: Can you give an assurance that all impact assessments will be carried out as some of them may drift from temporary to permanent?

Ms Thompson: Any trust needs to consider how the departmental guidance and their own PPI schemes around consultation apply. That includes equality screening, and, if necessary, equality impact assessments.

Mr McKinney: How, therefore, could the trust responsible for Armagh explain the removal of all of the equipment from the minor injuries unit in Armagh if it was only temporary?

Ms Thompson: I guess that they are temporary changes, and we know that that has applied in other places. It is partly about what has been removed and whether it could be put back. The trust will obviously be going through the process that I described to establish what happened, whether other services have been able to manage the demand of the people who used to be treated at Armagh, and the impact that that has had on other services, particularly given that a minor injuries unit is a fairly local issue for the local area. That work is ongoing. From there, it will need to consider what it does about engagement and, if appropriate, consultation. I do not know whether Jackie wants to add anything, but that is really where we are at.

Mr McKinney: I can understand that as a process, but can you understand the anxiety or worry of the public in Armagh when they see none of those processes being pursued and yet the equipment has been removed?

Ms Thompson: The trust needs to clarify where it is with its savings plan and what it believes it needs to do. It needs to engage with the public and the relevant stakeholders in the area about that.

Mr Johnston: We do not know the detail of the equipment that was removed. If it could be deployed elsewhere effectively during the temporary closure, that would be a sensible thing to do to support other front-line services. If there is any intention to move from temporary to permanent, the board will have to follow the guidance that has been given in terms of engagement through its PPI scheme and consultation as necessary. It is for the trust to determine initially. If it reopens, the equipment, hopefully, can be moved back quickly.

Mr McKinney: OK, but the point I am making is this: can you understand the concern —

Mr Johnston: I fully understand why people would be concerned about that.

Mr McKinney: Particularly given that it is a further erosion of services in the city and there is no replacement.

Mr Johnston: I understand those concerns.

Ms Thompson: The trust will certainly be looking at what the effect of that change has been, where services have been impacted and what it has meant for the other services in the area, and it will then come to a view. It will take into account the service side alongside the financial. Like all trusts, it will identify what the proposed way ahead is with that, and it will take forward the necessary processes from there.

Mr McKinney: To wrap up a few of the conversations that we have been having this afternoon, and just in relation to your final comment, while we all understand the financial, is there not a danger that the financial is taking priority over the patient?

Ms Thompson: No. The safety of the patient and client has primacy through everything. Equally, we have a duty to live within our resources, but the Minister is very clear that the safety of the patient and client has primacy. When we are looking at savings proposals, we have to understand what the impact is. That does not mean to say that you do not change anything; I do not mean that. It is about understanding that safety will be maintained. If there is some sort of change to an existing service, an alternative will be in place or the demand will be managed in a different way. Those are the assurances that we expect every trust board to consider. Every trust board has that responsibility with its executive and non-executive team.

Mr McKinney: I understand that. In terms of an ambition and a Minister's instruction, it is OK, but when patients are being driven past the South West Acute Hospital in Fermanagh and on to Derry, people in Fermanagh, and when this is replicated in other areas, ask whether it is about safety first.

Ms Thompson: Safety is first, but we do not have the resources to provide every service in every locality. At that point, you are saying, "Well, can that service be provided in a different area? What would the impact be? Is that actually maybe a safer service for that patient, depending on what it is, than doing it in the alternative location?". It is not a one-size-fits-all situation. I can provide assurance that safety is the primary concern, but, equally, it is about living within the budget. Because of the nature of the conversation today, we end up talking about a lot of numbers as if the patient and client are irrelevant. That is not the case. The patient and client are the top priority. What I am explaining to you is the financial impact of that.

Mr McKinney: I understand, but when blue lights are driving past a hospital that should have sufficient resources to deal with, for example, cardiology, there is a real risk to the patient.

Ms Thompson: Again, it goes back to the nature of the service and whether it is better for it to be in particular locations. A lot of investment has been put into cardiology in particular areas. I am sure that Jackie could talk for a long time about where that will get the best benefit for those patients, get them stabilised as quickly as possible and, hopefully, on the road to recovery.

Mr Johnston: With the PPCI service development, we now have two hubs: one in Belfast and one in Altnagelvin. They are deliberately designed to meet the highest possible quality standards in getting the patient to the right centre at the right time with the right resources. For example, I know that there are cross-border discussions going on to see whether Altnagelvin can start to take patients from the border counties in the north-west, such is the level of service that that centre can provide. That centre offers people from Fermanagh right up to Altnagelvin a good, safe service.

The Chairperson (Ms Maeve McLaughlin): Finally, just to clarify a point, will the infrastructural programme be paid out on 1 April as normal?

Ms Thompson: I could not tell you about the timing of the payment —

The Chairperson (Ms Maeve McLaughlin): The new contracts are out on 1 April.

Ms Thompson: — but the contract will apply from 1 April. I cannot tell you whether that will be in play for the whole of the 2015-16 financial year. You asked me whether they would receive an element of their funding on 1 April. We have no plans to cut it from 1 April. If we are looking at it, we will do so with a lead-in time, which, I think, is the issue that you are looking at.

The Chairperson (Ms Maeve McLaughlin): OK. Will you clarify the issue of monitoring rounds for me? Are you looking towards monitoring rounds in terms of budgetary processes?

Ms Thompson: We will be, yes. Between now and June, we will be looking to understand whether we can address the £30 million. As we look at it at the moment, I would suggest that it would be a challenge to get that all worked through and substantially address where we are currently. We will have an element of current service provision and then we will look at service developments and try to identify which of those will go through into a monitoring round process.

The Chairperson (Ms Maeve McLaughlin): Is that a shifting position, yes or no? When the permanent secretary was here in, I think, November, he very clearly stated that it would be done within the strategic prioritisation framework that the Minister had laid out and would:

Ms Thompson: The service developments are in exactly the same place as they were in November. They were not funded in November, and they are not funded now. Therefore, if they happen, they will need to happen through an in-year monitoring round process. When we were here in November, we said that we thought that we could manage the bottom-line position to a break-even position on the basic service provision. There is now a £30 million gap between cost pressures and —

The Chairperson (Ms Maeve McLaughlin): It has changed.

Ms Thompson: That bit has changed, but the service developments bit has not. If Richard was here, he would say that we do not want to live on in-year monitoring rounds and we are striving as much as we can to see what we can do to address that £30 million. It would be remiss of me to say that we think we can do that between now and June. I know that the Minister will wish to engage with his Executive colleagues about what that looks like. That position is no different from where we were going into that draft Budget process. Unfortunately, we did not get any more money from draft Budget to final Budget, so that bit of it is the same. No additional finance was provided to us, so we have the same position going forward; indeed, it is slightly worse.

The Chairperson (Ms Maeve McLaughlin): OK. A number of members indicated that they would like feedback on particular issues. The detail on the £45 million that will be shifted left now will be critical, and we need to get access to that. Thank you for your time today.