Official Report: Minutes of Evidence

The Chairperson (Mr Gildernew): I welcome Neelia Lloyd, finance director; David Kennan, financial planning unit; Brigitte Worth, director of the investment directorate; and Linda Carter, head of the capital resources unit. I ask the officials to please go ahead and brief the Committee.

Ms Neelia Lloyd (Department of Health): Thank you, Chair. I will provide the opening remarks on the resource budget, and then I will hand over to Brigitte to provide the opening remarks on the capital budget.

You will have received our briefing on the 2019-2020 resource budget position, spring Supplementary Estimates and the 2020-21 resource budget forecast requirement. I would like to draw out some of the key points in these opening remarks for you. For 2019-2020, the Department received an opening resource budget settlement of £5·6 billion, an increase of 3·8% against the comparable funding levels in 2018-19. Whilst the Department of Health received a measure of protection compared with other Departments, that funding was not sufficient to maintain existing services, and a significant funding gap remained. Historically, Health and Social Care cost pressures have been increasing at a rate of around 6% per annum, primarily owing to an ageing population with greater and more complex needs, increasing costs of goods and services and growing expertise and innovation, all of which have resulted in increased funding being required each year just to maintain our existing levels of service and meet demand.

This gap of around 3% between the funding and the increasing costs has been met through a combination of savings and in-year slippage, together with an increasing reliance on in-year allocations through monitoring rounds. This is far from ideal as it requires that the Health and Social Care service makes those reductions that can be achieved within the time frame of the current financial year.

A challenging target to deliver £77 million of savings and other measures in 2019-2020 was set, as referred to in your briefing paper. As noted, the trusts have, in particular, struggled to deliver these savings this year and to identify and implement recurrent savings measures. The target was to be achieved largely through cost controls or low-impact savings measures. The latest forecast indicates that, against their target, the trusts are delivering around £23 million and none of that is expected to be recurrent into next year. Some £42 million of non-recurrent slippage has been made available to the trusts to support them towards financial balance or to live within a resource-control total set by the Department.

The medicines optimisation target of £20 million is expected to be exceeded by some £12 million, largely as a result of efficient procurement of medicines, targeted interventions for cost-effective prescribing and cost of medicines lower than budgeted costs. The over-delivery of that aspect of the savings target has been important in supporting the delivery of overall financial balance. In addition, the Department secured non-recurrent funding in 2019-2020 of some £86 million through the June, September and January monitoring rounds. That funding, together with a number of technical adjustments and funding in relation to the increased employers' pension contributions, has resulted in a budget of some £5·87 billion.

Your briefing paper provides you with details on the spring Supplementary Estimates, which have been prepared based on the opening budget position for 2019-2020 as subsequently adjusted through the in-year monitoring process. The spring Supplementary Estimates are the final stage in the 2019-2020 budgetary and legislative process, and they will be presented to the Assembly for debate and approval later this month.

The Budget Bill NI 2020 is to provide legislative authority for the Executive's revised spending plans for 2019-2020 as a result of in-year monitoring adjustments that have taken place since the Main Estimates were approved in Westminster in October 2019. It is also worth noting that, while the Budget Bill NI 2020 also includes a Vote on Account to allow Departments to continue spending into the early months of 2020-21, that does not constitute setting a 2020-21 Budget. The Assembly's authority for expenditure against the 2020-21 Budget will be sought through the Main Estimates and associated Budget (No. 2) Bill in June. The Finance Minister is in the process of holding bilateral meetings with each of his Executive colleagues to discuss the 2020-21 Budget, and that will provide an opportunity for some discussions on the timing of the Westminster Government's upcoming Budget and its implications for the Executive's Budget process.

Turning to the Department's 2020-21 resource budget forecast requirement, it will be helpful if I take you through some of the key figures in the paper. The Department anticipates a significant funding gap in its 2020-21 resource budget as the current £5·758 billion budget baseline will not fully meet the forecast costs of maintaining our existing services. A summary of the 2020-21 forecast funding requirements is set out for you in table 1. The top half of the table indicates the forecast expenditure requirements for 2020-21, and the starting position for that is the 2019-2020 forecast funding requirement. We have then factored in new inescapable pressures to maintain existing services and New Decade, New Approach commitments, which results in a total expenditure requirement of £6·49 billion. The bottom half of the table sets out the funding sources. The projected total funding requirement to maintain existing services and meet New Decade, New Approach commitments is £661 million. That includes the Executive's commitment of £170 million for pay parity and safe staffing. The Department requires a £492 million increase on this year's budget to meet the inescapable costs of maintaining existing levels with no growth in transformation and to meet the Agenda for Change pay award and safe staffing levels. In other words, that is the minimum additional funding requirement of £322 million referred to at paragraph 31 of your paper plus the £170 million commitment for pay parity and safe staffing.

The absolute minimum additional funding requirement of £322 million assumes that £72 million of savings will be made across Health and Social Care services in 2020-21. That includes a £20 million target for medicines optimisation and a 1% target for trusts. It will represent a challenging savings target given increased demand and the scale of the financial pressures faced. It is also not without risk given the level of recurrent savings expected to be delivered in 2019-2020 against the £77 million savings target that I mentioned. It is expected that the trusts will identify more recurrent savings over a longer time frame. Indeed, longer-term financial and service planning could help move trusts away from so-called firefighting of short-term pressures and assist them in developing longer-term and better value-for-money solutions. Delivery of the Health and Social Care commitments in New Decade, New Approach will require a further £169 million of funding. Therefore, the total projected funding requirement for 2020-21 is £661 million.

I now hand you over to Brigitte, who will talk you through some key aspects of the capital budget.

Ms Brigitte Worth (Department of Health): I will start by passing this jug of water down to my colleague David, who I do not think has managed to get any yet. Thanks, Neelia. I thought it would be useful to talk you through some of the key points in the capital section of the paper, which starts at paragraph 51.

The first two tables give you some background on our budget over the last five years. Table 1 is a breakdown of the movements in our budget, and table 2 shows the key elements.

The aim of our programme is to facilitate the delivery of modern, fit-for-purpose services through the provision of appropriate infrastructure. Our ability to transform the way we deliver our services is directly linked to the level of capital resources available. Over the last number of years, our capital needs have been considerably in excess of our budget allocations, and we have had to constrain our programme to match budget availability. That has led to a gradual deterioration of our existing facilities and a lack of investment in the modernisation needed to support changes in service delivery. Our existing programme needs to balance the prioritisation of our ongoing major projects, some of which are highlighted in the paper, with the need to maintain our existing infrastructure.

Looking to the future, over the last year, we have been undertaking some long-term capital planning, working with our stakeholders in our arm's-length bodies to develop a draft 10-year programme for the period to 2029-2030. The work completed to date has been used to inform the information we have provided to the Department of Finance on our needs, and those are set out in the table 3. The subtotal of that table is taken just below what we regard to be our critical needs, which include a number of new projects where redevelopment cannot be delayed any further. As you can see, the paper shows that we need just over £300 million to meet our needs in the financial year 2020-21. Beyond that, the numbers increase, and it is clear that £300 million will not be sufficient in future years to meet those needs.

Neelia and I are happy to take any questions you might have on the paper.

The Chairperson (Mr Gildernew): Thank you. One of the first questions that occurs to me is about the detail supplied in the paper. It is quite high-level on what the spending needs are. Can you give us some more breakdown on the different areas that you are planning to spend in, such as mental health, and how you plan to increase that level of spending? Can you break those figures down for us into areas of work?

Ms Lloyd: I am very happy to lead on that from the resource budget perspective. What we factored into Budget 2020-2021 in forecast expenditure are new inescapable pressures, as set out in table 2 of your briefing pack. Those are increases in costs and the types of areas deemed to be inescapable for next year, for which we will require extra money. You mentioned learning disability and mental health. Mental health in particular has a figure of £20 million set against it as being an inescapable pressure for next year that we would need to meet to continue to deliver the services behind it.

The key aspect of the inescapable cost pressures is the pay angle. We have £160 million factored into that as well. Where we focus on maintaining our existing services, it does not include any service developments or additionality, for want of a better description; it is simply to almost stand still where we are today. Beyond that, a number of commitments for Health in New Decade, New Approach are factored into the number work that you have here today, and they all have funding consequences associated with them. The estimated cost pressures are set out, which, if the funding is achieved or established, will enable those to be taken forward next year.

The Chairperson (Mr Gildernew): I still have no sense of how much is spent on mental health or on social care. Was a more detailed breakdown of the figures provided to Finance?

Ms Lloyd: The figures that you have here today are absolutely in tandem with the figures that we provided to the Department of Finance. Whenever we do our financial planning for a future budget year, our starting point is always the current year that we are in. For example, for 2020-21, our starting point has been what we expect our forecast expenditure to be at the end of 2019-2020. That is almost our baseline starting position, if you will. On top of that, we identify what we need above and beyond that to continue going with the services that we have on the ground.

The information you have here is absolutely the same as what we provided to the Department of Finance. We have been working with those colleagues for a number of months on our financial planning, and we have been informing them of the scale of the pressures. They are very much on a similar basis to this. If there is a preferred level of detail you would wish to see, I am very happy to consider it and take it forward.

The Chairperson (Mr Gildernew): We would like to see more of a breakdown, because we cannot assess how much we are spending on mental health, social care or cancer if we do not know what is being planned for, nor can we decide how appropriate those levels are or how you will increase them as needed. I think we would need a further breakdown. It is very hard to get a sense from these figures of where the money goes.

I noticed the Minister said that an additional £169 million is required to deliver the New Decade, New Approach commitments. Does that figure include the money for the development of the north-west medical school, and how much of it is within the £169 million?

Ms Worth: Shall I take that one, Neelia?

Ms Lloyd: There is a resource element to it. I will take that and then pass it over to you, Brigitte. Yes, it does include revenue funding within the £169 million. It is a very small amount for 2020-21, but, notwithstanding that, it is likely to have a lifespan of something like —. I think it ramps up to £25 million by year 10 in terms of a resource requirement, but for 2020-21, the figure is very, very small.

Ms Worth: On the capital side, because it is a further education project, we expect the capital spend to be factored in by the Department for the Economy on the further education side. There is no capital factored into the figures for that.

The Chairperson (Mr Gildernew): On transformation, dealing with GP provision west of the Bann and, indeed, dealing with the locum issue and the amount of money that is being paid out to agency staff, it is crucial that that project is moved ahead.

The final question from me is about the £1·06 million that was allocated by Conor Murphy, as Finance Minister, for those who had been affected by the contaminated blood inquiry. Can you outline what plans are in place to ensure that that full money goes to those people in the short period allotted to it?

Ms Lloyd: I can outline that from a financial perspective. There will be full utilisation of the £1 million that we received in January monitoring. You will also see in your pack a reference to a further £1 million sitting within year 2020-21 inescapable cost pressures, and that is obviously to reflect on the fact that it is not a non-recurrent issue but actually goes into another financial year.

The Chairperson (Mr Gildernew): There will be £1 million provided to those people within this year. Is that correct?

Ms Lloyd: The £1 million will be fully utilised within 2019-2020, in the current year, based on the money that we got in January monitoring. How exactly that will work in practice and what will go to those affected will be a separate policy area. From a pure financial perspective, all efforts will be made to have that £1 million spent fully in the current financial year.

The Chairperson (Mr Gildernew): We received an assurance from Richard Pengelly at an earlier briefing that that would not be used to fund core services for those victims but would be used to bring in parity with other areas.

Ms Lloyd: There are absolutely no plans to use that for any other core services. That is correct.

The Chairperson (Mr Gildernew): I will now invite questions from members. We have allowed about 45 minutes for this, so I encourage members to ask a maximum of two questions, and, if there is time, we can take a second round.

Mrs Cameron: I was going to ask about the infected blood payments, so that is good for clarification. Thank you, and thank you for being here today. Could you talk to us a wee bit more about the budget process? The move towards a three-year budget from next year is very welcome. Could you tell us a bit more about long-term budget planning, forecasting and consultation as we move towards that three-year budgeting period?

Ms Lloyd: Budget 2020-21 is a single-year budget period, so our focus has very much been on that one-year planning period. We have been focusing very much on that one year. As I said, there is an absolute need for financial planning to be on a much more longer-term, sustainable basis to enable us to, both operationally and financially, plan to deliver our services in a more sustainable way. A multi-year budget period would absolutely permit us to do that. We would then not be looking at spending all our money in the confines of a single financial year but looking at how it is a sustainable pattern of expenditure through one, two or possibly three financial years.

Ms Flynn: Thanks very much for the update. I want to ask a few questions on the proportion of the budget being set aside for mental health. I am conscious that the Minister and the Department have a never-ending list of issues that you have to deal with, and it is always about trying to balance them. I want to ask about the £20 million for mental health referred to in table 2. First, it is in with learning disability. Could someone explain why learning disability is in the same category as mental health?

You just mentioned that the £20 million was required to continue to our deliver services as they are. The percentage spend on mental health in the North is in and around 5%. Is that £20 million holding us where we are at the 5%, with no increase in mental health spend at all? In our Committee papers, there is a report from the NI Affairs Committee, and one of its recommendations is to increase the percentage spend on mental health. It referenced the gap between here and England, where I think it is up to 13%. Mental health is everywhere at the minute, and I know the Minister has come out publicly to show his support for it. Are we sticking with the in and around 5% spend, or is there any hope of increasing it?

Furthermore, I know that the 'New Decade, New Approach' document mentioned £2·7 million for the mental health strategy and action plan. I assume that is separate to the Protect Life 2 suicide prevention strategy, which I know you are probably talking in and around £3 million to £4 million for. Has that been factored into the £20 million, or, again, is that additional money? There are also important business cases in the system for perinatal mental health and Holywell Hospital. Again, it just seems a wee bit bleak. I know the system is under pressure, and I understand that, but can you clarify this: are we still at the in and around 5% spend, or is there any hope of trying to lift some of these projects and get some additional spend into our mental health services?

Ms Lloyd: I will pick up on the resource aspects; there are a number of issues there. First, on your reference to the £20 million, we described that as "learning disability and mental health services" because it is referring to additional funding to support, for example, children who are due to transition to adult services, adults whose family care arrangements break down and complex discharges from hospital. The learning disability element of that relates to the cost of resettlement for complex discharge patients. That, hopefully, helps with the £20 million part of the question.

You are right on the wider point about mental health. New Decade, New Approach very much has a commitment to a mental health strategy and the implementation of an action plan, and the figure that we put into our forecast expenditure requirements for 2020-21 is £2·7 million. That can be broken down into the work that will be required and associated costs to develop a mental health strategy, which is the first action in the mental health action plan. On top of that, there is further expenditure required to, for example, look at perinatal mental health services to put in new networks. Things like that will require a further £2·3 million from the £2·7 million.

In global terms, as regards the mental health figures I am aware of for 2018-19 and 2019-2020, the mainstream funding — that is the total expenditure that is spent on that programme of care — is sitting at around £280 million. Confidence and supply funding of £10 million was provided to the Department of Health in 2018-19 and 2019-2020. That is being spent on a variety of mental health services. On top of that, in 2019-2020, money has been provided from the confidence and supply transformation funding. So, there are a number of different funding streams.

Ms Flynn: The confidence and supply and even the New Decade, New Approach commitments are additional. So, when we are talking in the context of the Health Department's overall budget, are we still sitting at the figure of 5% or 6% spend on mental health?

Ms Lloyd: I think that, when we take into account the sum of the parts, we probably are, but I would prefer to go back and check that that is the absolute position for the latest financial year for which we have the programme of care analysis. I will get back to you on that.

The Chairperson (Mr Gildernew): Will you come back to the Committee with that figure, because it is a key figure?

Ms Lloyd: No problem.

Ms Worth: I was just going to pick up on the Holywell comment. In table 3, you will see some figures for mental health design fees. In the absence of a Minister, the Department had given a commitment to progress the mental health facility at Holywell into the future. Obviously, it is subject to the Minister's confirming that he is content with that direction of travel, but the proposals that we have put to the Department of Finance have design fees for Holywell to go forward next year. Obviously, that also assumes that the budget settlement will allow it.

Ms Bradshaw: I have two questions. The first may be quite simple to answer. It relates to paragraph 3, where you talk about the resource budget of £5·6 billion, which does not include money for transformation, EU exit or pensions. Why are pensions, in particular, not included in that budget?

Ms Lloyd: It is just the way in which we have expressed the budget at that particular point. We got money in two tranches. In 2019-2020, we got budget cover. We had £74·3 million in our opening budget settlement. Then, during the course of the 2019-2020 financial year, we secured the balance that we required to meet fully the increased employer superannuation rate, which increased by some 6% on 1 April 2019.

Ms Bradshaw: My second question may be slightly more complicated. Last week, we had a presentation on waiting lists. When I asked the officials about the conversation that they had had with the independent sector — for example, about an estimation of how much money it would take to use the independent sector to clear waiting lists — they said that they had not had contemporary conversations with the independent sector to come up with that figure. I am concerned that, in paragraph 50, which mentions some of the transformation projects, one line refers to a review of stroke services and breast assessment centres. My understanding is that the consultation process and responses to it have not been signed off and that there are ongoing discussions and assessment of those two issues.

How do you know how accurate those figures are with regard to your estimates for the year? The outcome of the transformation process could change drastically, based on what the Minister decides to do under those two elements. My question is, first, about the veracity of the information that you are getting, and, then, how you can be sure that, if money is set aside for those transformation projects that may not materialise this year, you are not starving services for existing projects that really need it and have to find budgetary cuts.

Ms Lloyd: I think that you are referring to the £150 million that we have identified under New Decade, New Approach commitments for transformation funding.

Ms Bradshaw: Yes.

Ms Lloyd: There are a number of elements in that. Picking up your point about the robustness of the figures, the figures are worked out from high-level estimates of projected costs for 2021. Further work — you are absolutely right — is continuing in the transformation space, subject to future decisions being taken. At this point, we have been able to identify that the figure would be £150 million, which would cover a number of things going into 2021: the sustainability of existing projects and those under New Decade, New Approach that are required to continue to transform the health service.

Ms S Bradley: I just need some points of clarification, particularly looking at resources in tables 2 and 3. I note that there is an estimate of £30 million for elective care waiting lists, yet the 'New Decade, New Approach' document refers to £50 million. My question is similar to an earlier thread: is that additional money, so there will, in effect, be £80 million put towards waiting lists? Does the £150 million that is referred to exclude capital? Is it purely resource DEL?

I also note that you have an allocation of £10 million under "Safe Staffing". I am curious to know whether that £10 million is to be directed at recruitment and trying to bring up safe staffing levels, or is it in-year expenditure that will be committed to agencies to cover an immediate pressure?

Ms Lloyd: OK. I will pick up on your query about the elective care waiting lists and the two figures that you mentioned. They are two different and separate figures and both are additional. The £30 million is an estimated cost requirement to address those who are on the red flag of the really urgent waiting list. The additional £50 million, on top of that, is to address the commitment that was given by the Executive in the 'New Decade, New Approach' document. It is £80 million in 2021.

On your other point about safe staffing and the £10 million, that was a New Decade, New Approach commitment. It was also a key commitment in resolving the industrial dispute. We have £10 million factored into our expenditure for 2021. It is for 'Delivering Care: Nurse Staffing Levels in Northern Ireland', which is the agreed policy direction for formulating safe staffing for nursing and midwifery. Work is being taken forward by policy colleagues in the Department about what that £10 million will be needed to do. It is work in progress, but it ties in with New Decade, New Approach and, of course, the ability to deliver on it is contingent upon receiving the funding associated with it.

Ms Dolan: We are all aware of the high cost of relying on agency staff. Is there any progress on plans to reduce spending on agency staff? Target 33 of the briefing paper says there will be savings and cost reductions of £77 million. Can you highlight any plans for how those savings will be made?

Ms Lloyd: You are right: there is significant expenditure on agency and bank nurses in particular to ensure that safe and effective services are sustained. Obviously, the Bengoa report and the health service transformation are critical for changing the model of care. Therefore, we are very much aware of the pressure points, and the Department remains committed to tackling the issue of rising agency locum costs across Health and Social Care while ensuring that safe and effective services are provided. Ultimately, a key factor will be the need for long-term investment in our workforce, which ties in with the safe staffing issue that we talked about a moment ago.

The savings target has been set at £77 million for 2019-2020. Of that, £20 million was in relation to the medicines optimisation regional efficiency programme, and approximately £50 million was set for trusts to deliver savings on low-impact cost-control measures, bearing down on costs to enable those savings to be met. As I said in my opening comments, some savings have been delivered in the current year, but it is accepting that they have not been done in full or on a recurrent basis.

It is important to set against that that, while there might have been under-delivery for the trusts in some of their savings targets, over-delivery in the medicines optimisation programme has helped to offset the gap that otherwise would have remained.

The Chairperson (Mr Gildernew): What confidence do you have in the overall figure if the trusts are only identifying £23 million out of the £50 million target that they were set, and it is non-recurrent? How can you rely on that figure for budgeting?

Ms Lloyd: I will focus on the figure for 2019-2020 and managing our budgets and living within them as we are required to do. The figure of £23 million is what the trusts are saying we can deliver in total for this year, through a range of cost-saving measures, but we cannot repeat that next year. However, one of the key planning assumptions for the 2020-21 budget has been to factor in an element of savings and a target of £72 million for budget 2021 notwithstanding that. It is a challenge, but I think that it is where our target has to be to ensure that services are as efficient as they can be, particularly given the backdrop of a very challenging public-sector-wide financial position.

Mr Easton: Thank you for your presentation. You have identified £54 million savings out of the £77 million, so there is a shortfall of £23 million. Where will that come from?

Ms Lloyd: The shortfall that has been achieved purely within the savings target envelope has been partly offset by the achievement of some non-recurrent slippage or easements in 2019-2020. The figure in your paper of £42 million has been identified in-year, which partly addresses the gap that you identified there around the £77 million not being fully achieved. That £42 million has been identified through natural slippage, delays in procurement or delays in projects being up and running versus what the initial expectation might have been on timings.

Mr Easton: So, the £77 million has been found?

Ms Lloyd: Yes.

Mr Easton: Could we get a paper on the breakdown of the savings that each trust has had to make?

Ms Lloyd: You want to see a breakdown of the savings by the trusts to meet the £77 million.

Mr Easton: Yes, what each trust had to save.

Ms Lloyd: Yes. I can take that away and give it some consideration and see if we can get it pulled together for you.

Mr Easton: Lastly, you need £6,491 million for next year's budget. Have there been any initial discussions with the Finance Minister on trying to get that?

Ms Lloyd: Officials have been working very closely with Department of Finance colleagues for a number of months and are fully aware of the pressure and our additional funding requirement. I mentioned in my opening comments that a series of budget bilateral conversations is being held at present, so the Minister will have those conversations with the Finance Minister imminently and will be able to have a conversation about the scale of the gap and the funding pressures for next year. It is important to note that the Department of Finance is very aware of the scale and the gap that we face.

Mr Carroll: Apologies for missing your presentation. I have two quick questions. There is £140 million in savings over two years: the £75 million that Jemma mentioned; and a projected saving of £72 million for 2020-21. You mentioned slippage. For clarification, will you expand on that? Is it that projected costs have come down? Is it front-line services? Is it staff?

The commitment for IVF treatment is £8·1 million. There was a debate on Monday about that. Is that all allocated to private clinics or is any of it being ring-fenced for the expansion or enhancement of in-house IVF treatment?

Ms Lloyd: I will take your slippage point first, if I may. When I referred to the £42 million of non-recurrent slippage that was made available in the current year to support a balanced position, in general terms, natural slippage emanates from two main sources: money is not allocated to service providers or money is allocated to service providers, for example, trusts, but is not capable of being spent as initially anticipated. For example, in the area of the revenue consequences of capital expenditure, if there is a natural slowing down of a particular capital programme, that, in turn, has a knock-on consequence for resource funding requirements and expenditure. That is an obvious example of where we would generate some natural slippage, where there is a slowing down from a previous anticipated position. I hope that that answers your question sufficiently.

Mr Carroll: I think that it would be useful, following Alex's point, to get a breakdown because it is a big figure and members here do not often know the detail of it, so a breakdown would be useful.

Ms Lloyd: On your question on IVF, under New Decade, New Approach, there is £8·1 million associated with taking forward that commitment. That estimate is based on the current funding of 750 women a year accessing fertility treatment, and it includes funding for the extension of the eligibility criteria. It is work that the regional fertility centre will be taking forward to address that New Decade, New Approach commitment.

The Chairperson (Mr Gildernew): As a follow-up to that, the figure to provide three full cycles was costed by the Department last year at, I think, £3·5 million. How has it increased to £8·1 million?

Ms Lloyd: The estimate that we are looking at today is the latest assessment of the figure work. Apologies, I do not have the detail here to explain how we have got from the lower figure that you mentioned to that figure. The figure that we have provided now as the pressure for next year is £8·1 million, and that will cover 750 women a year to access fertility treatment, including funding to extend the eligibility criteria and to include women in the 40-42 age group. I am happy to take that to policy colleagues who are responsible for the area and the piece of work to try and distil out why there has been that growth and that change in the figure work.

The Chairperson (Mr Gildernew): There appears to be a gap.

Deputy Chair, I am aware that you asked only one very brief question at the start, so I will give you an indulgence for it.

Mrs Cameron: It would be great to get clarification on the IVF figures. It does seem quite a large increase, but we expect it to be costly.

On workforce planning and the cost of and reliance on agency staff, the Department is on record as stating that, in the 12 months to April 2019, the cost of temporary workers across the HSC totalled just over £200 million. The cost has increased year-on-year, rising from about £76 million in 2014-15. Can you tell us more about progress on plans to reduce agency and locum spending?

Ms Lloyd: It is a separate policy area, and the Department has a responsibility for the workforce strategy and all the workforce planning. It is not my policy area, but I can say, from a general perspective, that it is connected with the work that is ongoing on transforming the health service. The workforce is a key element of that, and I know that a lot of work, time and money has been invested into it over the past couple of years. That work needs to continue at pace to ensure that expenditure comes down.

Mrs Cameron: Can you give any assurance that money that has been allocated for transformation will not get sucked into the services pot?

Ms Lloyd: The transformation money is clearly ring-fenced, so the money that we have this year and the money that we got last year came associated with the ring-fencing tag, for want of a better description, so it cannot be used for anything that is not transformative. I think that that is the absolute assurance that I can give you, and I hope that it is sufficient. I understand that policy colleagues are coming to talk, possibly next week, about the transformation programme of work. Your briefing paper gives you a flavour of the type of things that we have been doing and the expenditure that we have incurred against the budget that we have been allocated in that space. Those colleagues will be able to give you more colour and depth.

Mrs Cameron: That is great. Thank you.

The Chairperson (Mr Gildernew): Given that there is now an onus on the Department to co-produce and co-design services, what co-production or consultation has there been on how these figures have been allocated?

Ms Lloyd: On the budget figures for 2020-21, as part of our financial planning work and our normal processes, we worked very closely with, predominantly, Health and Social Care Board colleagues, who, in turn, worked very closely with health and social care trust colleagues on finance and on commissioning. That feeds into the work that we do and the figure work that we have today on that. We have also engaged closely with our other arm's-length bodies outside the trusts, as you would expect, to understand their pressures and, in that co-produced way, factoring in and taking on board the scale of their financial pressures, understanding where they have particular pressure points, and where we can help to address that by securing additional budget cover.

The Chairperson (Mr Gildernew): Or, indeed, where they may be able to suggest improvements that, were they properly resourced, could lead to stabilisation or, indeed, reduction. It is crucial that there is more engagement with them. There are a number of project boards with carers, and I think it is crucial that that comes into the figures because, if it is not resourced, the chances are it will not happen.

Thank you for the presentation. I think it is safe to say that this is only the first meeting of what will probably be an ongoing issue. There are issues around how opaque the figures are, and how hard it is to drill down to where they are at.

Many of us have probably been dealing with issues across several trusts where learning disability budgets have been underspent year-on-year-on-year, so there are issues with how the systems are talking to one another. If money is assessed as being needed in a trust and a directorate in a trust, that money should be going to the people who it was allocated for.

We will probably be coming back to this. We would like to see a greater breakdown in the figures so that we can understand which services they apply to. Thank you very much for your presentation, and we will see you all again soon.