Official Report: Tuesday 25 October 2016
The Assembly met at 10:30 am (Mr Speaker in the Chair).
Members observed two minutes' silence.
Mr Nesbitt: On a point of order, Mr Speaker. Today we deal with the Bengoa report, October monitoring and the rationalisation of the court estate. Yet, half an hour ago, three sets of papers on Bengoa were delivered to Members' pigeonholes, but I found nothing on October monitoring and nothing on the rationalisation of the court estate. Following your discussion with Committee Chairs last night on how we can do business better, can we reflect on the fact that the non-delivery of papers and information does not necessarily lead to good debate and scrutiny?
Mr Speaker: I will deal with at least one of those matters now. I have received notice from the Minister of Health that she wishes to make a statement —
Mr Attwood: On a point of order, Mr Speaker. This is on a different matter and refers to the Hansard report of the debate last week on health and cancer services. At the beginning of that debate, the Minister of Health raised a point of order that lasted over a minute and ran to 233 words. During the point of order, the person then in the Speaker's Chair at no time encouraged the Minister to bring her comments to a close. Will you review the conduct of that point of order?
Mr Speaker: I will look at the point of order that you have raised, Mr Attwood.
Members, I have received notice from the Minister of Health that she wishes to make a statement on Health and Wellbeing 2026: Delivering Together. Before calling the Minister to make her statement, I remind the Minister that Standing Order 18A(2) requires her to make a written copy available to Members at least half an hour before delivering it in the Chamber. The Minister did not meet that requirement this morning. Therefore, in accordance with Standing Order 18A(2), the Minister must state the reason for this prior to making her statement.
Mrs O'Neill (The Minister of Health): I apologise for the lateness of the statement. We had an Executive meeting this morning, and I endeavoured to get the statement into the pigeonholes. I believe that we did so at 10.00 am.
Mr Speaker, having received Executive endorsement this morning, I am grateful for the opportunity to make a statement setting out my ambition for a world-class health and social care system, Health and Wellbeing 2026: Delivering Together.
As I have said before, and I want to put on record again, I am proud and privileged to be the Minister of Health. I am proud of our health and social care service. I am proud of the dedication, the commitment and all the hard work of all those working right across our health and social care system. I am proud of the quality of the full range of health and social care services people here receive from staff whose key focus is to improve our health and well-being. I have witnessed at first hand the amazing work of Health and Social Care (HSC) and the positive impact it has on people’s lives. The depth of the dedication, commitment and compassion of all those who work right across our health and social care system continues to astound me.
However, the system itself is at breaking point. This is not news. Every person in the North and everyone working in our health and social care system understands this to be the case. Put simply, the system has not changed quickly enough to meet the demands and the needs of the population. While not always accurate, reports of long waiting lists and failed targets feature regularly in the media. This is why, in my first week as Minister, I made a statement to the House acknowledging the challenges but, more importantly, pledging my commitment to transform health and social care. I promised I would reflect on the expert panel’s report and put my vision for health and social care before you, and today I am doing so.
I thank Professor Bengoa and the expert panel and commend them for their work. I received the report, 'Systems, not Structures' in the summer and since then have spent time carefully considering the report, its implications and the next steps. Professor Bengoa has told us that we need whole system transformation if we are to meet the needs of the population. The expert panel’s report, alongside the Sir Liam Donaldson and Transforming Your Care reports, has been instrumental in developing Health and Wellbeing 2026: Delivering Together. To be clear, Delivering Together is now the only road map for reform.
As I have said, the case for change is universally accepted. When I addressed the Assembly in June, I spoke about the prevailing challenges that exist. By 2039, the population, aged 85 and over, will have increased by 157% compared with the position in 2014. Living longer is of course great news for us all, but, as we get older, we are more likely to live with one or more long-term conditions. In addition, our health and social care needs change, and we quite rightly have higher expectations. Our health and social care system needs to change if it is to meet the needs and the expectations of a growing population.
Health and well-being is shaped by many factors but above all by our social and economic environment. To our shame, the inequalities between health and social well-being outcomes across our society are stark. Where you live should not determine how long you live. A simple illustration of this is that people who live in Belfast city centre will live up to nine years less than those living at the top of the Malone Road. We should all be deeply concerned by that.
Across the North, the proportion of babies born with a low birth weight in the least deprived areas is lower than that in deprived. Children born in deprived areas are more likely to experience childhood obesity and to be in care. It is an outrage that, in 2016, your life experience may be predetermined by your social and economic circumstances. This must change, and that change must start now.
Like Ministers before me, I continue to increase investment in front-line services and in service developments and improvements, and this has gone some way to alleviating the pressures the system faces and the consequences for those requiring health and social care services. However, this is not enough. Our current delivery models are having an increasingly negative impact on the quality and the experience of care, and they are constraining the ability of the system to transform itself to meet 21st century health and social care needs. There are excellent examples of innovative practice, but these are often in pockets and not widespread.
The reality is that the current model is unsustainable. If we continue to provide services in the same way, using the same current models of care, demand projections show that ten years from now the HSC will need 90% of the entire Executive Budget — that is 90% of the entire Executive Budget.
Since coming into post, I have spent much time listening to HSC staff and to users. Not only are they ready for change, they want change and they are demanding change. They are not alone. The political summit hosted by the expert panel secured a mandate for change and the principles that underpin it. We have a "fresh start", supported by the Executive — it is not down to one Minister or one Department. There is total agreement across the Executive that this needs to be done.
Health and Wellbeing 2026: Delivering Together provides a road map for radical transformation in the way we receive health and social care services. This is not a quick fix. Given the size and scale of the challenge, I fully expect that the transformation process will take two mandates to properly plan, implement and embed, but we must start now.
In line with the Programme for Government and the Executive's population health framework, 'Making Life Better', my overriding ambition is for all of us to lead long, healthy and active lives. Health is a human right, and I believe in a universal health service, based on need, free at the point of delivery. I want to see a future in which people are provided with the information, education and support to enable them to keep well in the first place.
When care is needed, it should be safe and of high quality. Those who use services should be treated with dignity, respect and compassion. Staff are the system's greatest asset, and they must be empowered and supported to allow them to do what they do best. Put simply, I want to see a health and social care system that is efficient and sustainable, where best practice is the norm and where investment is made in areas that will positively impact on service users rather than prop up a failing structure.
My vision for health and social care is ambitious. It will require whole-system transformation across primary, secondary and community care, and a radical change to the way in which we access services. We will work across sectors to build capacity in communities. That will allow them to develop the skills and knowledge needed and the assets required to tackle effectively the underlying determinants of health and well-being. Tapping into their ideas and energy, we will build on and support the real strengths that they have. We will support the development of thriving and inclusive communities. Through building community capacity, developing social capital and investing in health-visiting and school nursing, we can ensure that every child and young person has the best start in life and is supported to fulfil his or her potential.
We will support those who are more vulnerable in our society, those living in deprivation, our older population and those with learning disabilities and mental health issues. We will help them to live the life that they want, maximising independence and maximising choice.
The early intervention transformation programme (EITP) is a good example of joined-up government, with the Department of Justice, the Department of Education and Department for Communities all working together to find ways of intervening earlier in their lives to improve outcomes for all our children. We will build on that success, including building the capacity of staff to work more effectively in delivering early intervention approaches.
We will also strengthen the work of the existing network of family support hubs available right across the North, which show how community, voluntary and statutory organisations can work together to help families doing their best as they face the challenges of bringing up children.
Improving the life chances of children and young people is a priority for me, particularly of those children for whom the state has taken on parental responsibility, or "looked-after children" as they are known. Those children experience much worse health, social, educational and employment outcomes than children generally have. That is not acceptable to me. I will expand the range of placement options and support available to them to support their mental and emotional well-being, educational attainment and overall health outcomes. We must and will become better parents for those children.
When people need care and support, very often, their first port of call is their GP. Primary care is the bedrock of our health and social care system, but it is still largely based on GPs working independently, with limited input from other skilled professionals, such as district nurses and social workers. There are many examples of how we have improved that integration, but we must go further. People do not live their life in silos, so we should not provide services in them. I will invest in our primary care services. I will put in place multidisciplinary teams embedded around general practice that will maximise the benefits that can flow from our integrated system of health and social care. Their focus will increasingly be on keeping people well in the first place and the proactive management of long-term conditions. They will be equipped to identify and respond to problems earlier, whether they relate to health or social needs.
The teams will include people from a range of disciplines, including GPs, pharmacists, district nurses, health visitors and social workers. I am also keen to explore new roles that are having positive impacts elsewhere, such as advanced nurse practitioners and physician associates. We need to be open to new ways of doing things, looking to approaches elsewhere, such as the model used in the Netherlands, where district nurses lead the assessment, planning and coordination of care in self-managed teams. I believe that the best of that approach and other approaches can be adapted and even improved on in our integrated health and social care system.
I recognise the challenges in recruiting and retaining GPs, and, given the importance of building multidisciplinary primary care teams, I will increase the number of GP training places to 111 a year, with 12 additional places next year and 14 beyond that the year after. Building on the increase in training numbers made earlier this year represents an increase of more than 70% in GP training places within a three-year period.
Alongside increasing the number of GP training places, we must make sure that general practice is a key part of the medical undergraduate curriculum. To that end, funding provided for undergraduate training will be redirected to support Queen's University in increasing the percentage of the undergraduate medical curriculum spent in general practice. I can also announce that 25 GPs have been accepted onto a GP retainer scheme, which was launched earlier this year. This has meant that GPs who may otherwise have been lost to general practice are attached to practices, are working in the out-of-hours service and have access to a supportive continuous professional development programme and mentoring.
I have initially commissioned five training places for an advanced nurse practitioner programme in primary care to start in February 2017 in addition to eight for emergency departments. I plan to at least double those numbers from September 2017 and then incrementally grow this cadre of staff for an increasing number of specialties over the next five years. By further extending the role of the nurse, I want to ensure that I still have sufficient nurses to continue to do the jobs they already do so well. Therefore, I am increasing the number of training places for new nurses by a further 100 from September 2017 to ensure that we will not be as reliant as we currently are on the international recruitment of nurses to fill vacancies in the years to come.
The role of physician associates (PAs) is one that I am keen to build on. I provided funding to support placements in primary and secondary care for an annual cohort of 20 PA students on the new postgraduate course being commenced in the University of Ulster in January 2017. I will also continue to invest in the practice-based pharmacist scheme, with close to 300 pharmacists expected to be employed across the North by 2020-21, taking the pressure off GPs, improving the use of medicines and supporting patients. The askmyGP online and phone triage system, which is allowing GP practices to see patients the same day and when they need to be seen, will be rolled out to a further 30 practices. These investments reflect some of the recommendations of the GP-led care working group, which reported earlier this year. I intend to provide a full response to the recommendations of the working group before the end of the year.
We must also make use of our valuable community pharmacies much more. They have an important role to play, particularly in supporting people to keep well in the first place and to use their medicines appropriately and safely. I want to develop a new framework for how we work with Community Pharmacy to fully realise pharmacists' potential.
There has been a long-standing ambition to shift more health and social care from hospitals to settings closer to people’s homes. I believe that this is the right thing to do, and I want to ensure that we realise that ambition. New models and services continue to develop and emerge such as acute care at home. For example, in the Belfast Trust and the South Eastern Trust areas, 460 frail elderly people have received enhanced or acute care at home services, avoiding 4,102 days in hospital. I want to ensure that patient-centred initiatives like this are implemented right across our health and social care system.
Ambulatory assessment and treatment centres are a further example of innovative patient-focused initiatives that I plan to develop further. These centres will provide a one-stop shop, allowing patients to be assessed and diagnosed and, if required, to receive a treatment or procedure all on the one day. In the Belfast Trust, in the past six months, over 9,000 patients have been treated in ambulatory care instead of waiting in the emergency department, and 81% of them were discharged home without needing to be admitted. Over 4,000 have received treatment on a planned basis through this approach without needing a stay in hospital. In the South Eastern Trust area, over 1,000 patients have benefited from this approach in the last six months. This and similar models in other trusts provide for a better experience for patients and a more effective use of our inpatient beds, and we need to build on the new services and expand their use.
Given the changes that I have set out for the rest of the system, it follows that the nature and focus of our acute hospitals will change. As well as enhancing the support received in primary care, we need to reform and reconfigure our hospital services. The expert panel has provided us with a road map to do so, and I plan to consult on the criteria recommended by it next month. Once agreed, this will form the basis of a programme of service reviews, seeking to ensure that our services are configured and built around what people need.
This is not a standing start. We have recently conducted clinically led reviews in pathology and imaging, and I intend to move to public consultation on these two important areas. In the future, the role of our hospitals will fundamentally change to focus on addressing the needs of patients requiring complex planned surgery or emergency care in an inpatient setting. There is strong evidence that concentrating specialist procedures and services in a small number of sites produces significantly better outcomes. Adopting this approach will mean that not every service will be available in every existing hospital, but, where those services exist, each and every one of us will benefit from more timely, safer and better outcomes.
Over the last few years, we have seen the development of very successful regional networks for a number of specialist services. These provide services to our whole population rather than to a small locality. We have seen that developed increasingly on an all-island basis, as in the case of the congenital heart disease network. I have already commenced a programme of work with counterparts in the Department of Health in the South to identify areas of mutual benefit and develop more cross-border and all-island services. I am keen to explore the potential benefits of this approach, particularly around delivering better perinatal services and support for new mothers, as well as considering ways that we can help young people who are struggling with mental health and addiction problems.
Evidence also shows that delivering planned and emergency care using the same facilities and resources can have an adverse impact on activity and, therefore, lead to an increase in waiting times. Far too often, scheduled appointments and surgeries may be cancelled when vital resources are diverted to deal with unscheduled care. Moving forward, elective care centres will be developed to carry out less complex planned treatments. These centres will make better use of the resources that we have through organising them differently. This may mean that a patient may travel further for their treatment, but there is strong evidence that elective care centres, such as those used in Scotland, can reduce waiting times and provide a better experience for staff and patients. I cannot tell you where these centres will be or how many we will have. The answers to these questions will be for the clinicians and professional managers in the HSC system to develop based on the evidence of what people need and working in partnership with service users and patient groups.
However, elective care centres are not the sole solution to the unacceptable delays currently facing patients. Rather, they are part of a long-term process moving towards a more sustainable model. This future model cannot succeed if it inherits the unacceptable waiting lists that blight our system. Urgent and sustained action is required to bring these under control. In light of the recommendations set out in the expert panel’s report, I intend to bring forward a strategy to reduce waiting lists.
I have set out the changes that I believe are appropriate for the delivery of services, but how we plan and manage these services is just as important. We need to reduce bureaucracy to make the decision-making process more streamlined and, importantly, to plan and manage services in a way that promotes collaboration, integration and improvement in service delivery. In the context of the decision to close the Health and Social Care Board, I know from speaking to staff that they are anxious about their future. They have already been involved in the design process, and that will continue. This is a priority for me and, now that the direction of travel has been fixed for the delivery of services, I will move very quickly on this matter. I will engage with the board staff as a matter of priority.
I believe that the approach that we take to transformation is as important as the transformation itself. From the outset, I was clear that this vision could be achieved only through partnership working and co-production. It is no coincidence that the document that I am publishing today is called 'Delivering Together'. It sets out in clear terms how I will bring forward transformation. We all have a stake in our health and social care system. It belongs to us all and, therefore, we all have a responsibility to work together to ensure that it is sustainable for the future. We must all work in partnership to design and deliver the changes.
The principle of co-production will underpin how we operate in the future, whether that be at a system level, designing how our services and hospitals should be configured, or at a service level, designing how care pathways and individual care should be delivered differently. However, very importantly, it also signals a collaborative approach between the people who provide services and those who depend on them. Care should be planned around the individual and the unique needs of that person, and this must be based on real and meaningful partnership. Our mental health recovery colleges are an excellent example of the benefits that can be realised through co-production, recognising and using the expertise that people with mental health difficulties have. We will now harness the energies of people who use all our services.
I want to align quality improvement and regulation far more closely to the voice of those who use our services and those who deliver them. We will replace a culture of targets and blame with one that focuses on outcomes and improvements. Outcomes should be shaped by what matters to people, not just by what is wrong with them. Improvements will be led by staff on the front line, not distant officials. This is already happening. Committed staff, working with the people they serve, are taking forward initiatives to improve outcomes, shorten waiting times and reduce bureaucracy.
Quality improvement initiatives, such as the integrated respiratory service in the west, are happening every day, designed and led by the staff on the ground. The community respiratory team provides patients with joined-up specialist support focused on self-management, and coordinated care. This is a much more streamlined and responsive service for patient, GPs and hospital services and benefits all.
Another example is the rapid assessment, interface and discharge team in the northern area, which is known as RAID. That innovative project is based on international best practice and recognises the links between good mental health and good physical health. Instead of the traditional approach to mental health referrals for people who go into emergency departments or are admitted to hospital, that team operates seven days a week, 24 hours a day to respond quickly to need. It also acts as a link to community mental health services, promoting recovery and well-being and ensuring continuous care and better outcomes.
Those are strong local examples, but they raise the question of why those services are not available to all the people of the North. I want to develop a system that will learn from such approaches and see them adopted across the system. As a first step towards that, I have asked that a group is convened of professionals and people who use services to establish an improvement institute. That will not be a new building or a new layer in our system, but it will help to bring existing experience and knowledge together to work in a different new way for a much greater impact. That will be supported by a new approach to learning and team working. Rather than concentrating power at the top, I want all those working in health and social care to feel able to effect change and improvement in care. We must support and equip teams to do what they do best — namely, provide excellent care — and not micromanage them and load them down with unnecessary bureaucracy. That means having greater collective clinical and professional leadership throughout the HSC, supported by skilled and able managers.
Too often, I have heard that the current culture in the HSC is characterised by competition and silos, and that must change. I want to see a culture where staff feel empowered and where collaboration and partnership working define the way things are done. The positive results of that way of working are clear to all. In one of our trusts, a head and neck cancer specialist nurse introduced a follow-up telephone aftercare service by working in partnership with patients, which resulted in a patient-led follow-up service that enables fast-track referrals to follow-up clinics. There are many more examples across the system, but that type of working needs to become the new norm. For that to happen, our staff need to be equipped with the tools that will allow them to lead change. That is why I have asked my officials to develop a system-wide HSC leadership strategy by next summer.
I am determined to realise the potential that modern information technology provides. The pace of technological change is rapid, and that is no different in health and social care. I want to ensure that the right information is available to the right professionals or, indeed, service users themselves when they need it and in the way they need it. We have too many systems; people often have to tell their stories or provide the same information over and over again. At best, that is frustrating, and, at worst, it is unsafe. I want to ensure that the double and triple handling of information ceases by consolidating our patient records, enabling greater access to citizens and freeing up health professionals' time to care.
That is a major undertaking. Even starting now, it will be a decade before we see real change right across our HSC system. However, progress is being made. Every day, more health and social care information and resources are added to NI Direct, and I expect to have a patient portal in place for dementia patients next year. We plan to roll out online access to health and social care records over the next five years, where service users and patients want it. As users of the service, information about us belongs to us, and having access to that information will help us to make informed choices about our lives.
This morning, I have set out what I believe to be a very ambitious vision for the future of HSC. What I am proposing is not a quick fix but a significant and radical programme of change. That is why I have been upfront about the time frame. However, I want to be really clear that the size of the task and the length of the journey will not dictate the pace of change. I have witnessed the pressure that staff are under every day. I know that 10 years is too long for them to see a difference, which is why I have set out my priority actions for the next 12 months: change starts today.
I am committed to taking a personal role in this process and will bring progress reports to the Assembly every six months. In short: I am up for this.
Change cannot happen, of course, without investment. We need to continue to deliver the existing HSC services to those who need them whilst developing and implementing change, so a period of double running will be necessary. Once I begin the process of co-production, I will be clearer about the financial requirement. What I can say today is that additional investment is needed.
I acknowledge that the cost of transformation may be significant, but standing still is not an option. There will be consequences if we do not deliver planned and managed change in our health and social care system. Even with the best efforts of all the staff, waiting lists will continue to grow, expertise will continue to be diluted and the best possible outcomes for our citizens will not be realised.
I believe that we have been given a fresh start. We are facing into a time of change, but it is change that must happen. Delivering Together sets out a direction of travel that I hope all our society can embrace and support in the challenging but potentially rewarding times ahead.
As Minister of Health, I will provide the leadership needed to drive change. I have no doubt that those working in the front-line service will not be found wanting in leading the transformation of the health and social care system. Today I hope that colleagues from all political persuasions will show the political leadership and courage needed to support the system in transforming itself. Together we can deliver the health and well-being outcomes that all our people deserve.
I commend the statement to the Assembly.
Mr Speaker: Before I call a Member to ask the first question, I inform the House that a very large number of Members have indicated their desire to do so. In order that I can get in as many Members as possible, I ask that those who get the opportunity to ask a question ensure that it is short, sharp, focused and relevant to the statement made by the Minister.
Mrs Dobson: I thank the Minister for her statement and for the eventual publication of the two reports. She talked about "a period of double running" and said that she will be clear about the finance when that begins. Does she recognise that Transforming Your Care (TYC) failed because of the lack of budget? What assurances can she provide to the public, patients and health professionals that this report will not fail? Was the Minister surprised by the apparently limited detail in the 'Systems, not Structures' report?
Mrs O'Neill: I start by commending the expert panel for the work that it did. The report that it produced was very clear and pointed out the stark challenges in our system. It was a very detailed and meaningful piece of work that engaged staff right across the health and social care system. I very much welcome the report. It has informed me of the direction of travel that we need to take.
I believe that, in going forward, we have no choice but to transform our health and social care system. If we are all invested in making sure that we have better outcomes for the population, we should all play our part and get on board for the transformation journey that we need to take. The Executive have endorsed a plan of action for going forward and realise that transformation costs money. They want to deliver better outcomes for our population. The clear direction of travel set out today shows that we will make a meaningful difference. We have to transform the system and support the staff who do an excellent job every day and are under pressure.
We have set out today a very clear programme for the implementation of change to make things better and deliver better outcomes. We should be focused on making sure that we deliver the best possible outcomes for all of the population. We have a real opportunity to make a meaningful difference and to be world leaders in what we provide through our health and social care system. We are already the envy of many areas that look towards our integrated system. Let us build on what is good, transform the system and put our health service on a sustainable footing. I believe that the rewards will be seen in the years to come, when we can stand over a first-class health and social care system in which staff, patients and carers are involved in the planning, production and design of the services that we provide.
Ms P Bradley (The Chairperson of the Committee for Health): I thank the Minister for her statement outlining her vision for Health and Social Care. Your vision is very ambitious, Minister, but I believe that, with consensus in the House, it is achievable. The statement mentions that tough decisions need to be made and refers to the Bengoa criteria. Will the Minister tell the House what process she intends to put in place to involve communities, front-line staff and political representatives in order to make that a reality? Will she also advise what preliminary work has been done to cost the proposals set out in her statement?
Mrs O'Neill: I thank the Member for her positive contribution. I look forward to working with you as the Chair of the Health Committee. We have a shared interest in delivering better outcomes for our population. This is a real opportunity, and I know that you will be happy to work with me to make sure that we deliver a first-class service.
We should not start the conversation about money. Obviously, it is very important and we need it to transform the system. However, the principle behind all this is transforming services to deliver better health outcomes for the population. I am deeply committed to universal healthcare that is free at the point of delivery for the whole population. For the first time ever, the Executive have collectively endorsed a programme of action and the plan for going forward. In doing so, they recognise that there is a cost. We will enter the Budget process in the weeks and months ahead and will, I hope, secure the transformation funding that we require.
The Member asked how we will work and build confidence in the system.
That is about meaningful engagement and listening to staff and patients. It is about making sure that the decisions that we take are clinician-led. If those decisions are clinician-led, people will know that they are about better health outcomes for them. It is about having a frank and honest conversation with individuals about the plan and about where we need to go. We want them to help us deliver the services. People are up for that; the staff and patients whom I am engaging with are up for that. I am, personally, going to embark on a process of engagement, and I will go anywhere that health service staff want to talk to me about getting involved in the conversation. I want to make sure that we collectively go on this journey, but I also believe that it is about genuine ownership — giving staff and patients ownership of the direction that we are going to take.
Ms Seeley: I thank the Minister for her statement and welcome the work that has gone on behind the scenes to get us to today. She has made it clear in the past that mental health is a priority of hers. Will she set out her plans in relation to mental health and how we can achieve parity of esteem for it?
Mrs O'Neill: I thank the Member for her question. I have said in the House on many occasions since taking up office that mental health will be one of my key priorities. When it comes to reshaping services, co-production and looking at how we are going to deliver services in future, mental health is one of those areas, through recovery colleges, where we can see how co-production works. I want to do more of that. We have to work towards the point where we have parity of esteem for mental health, which, to me, means recognising the true impact of mental illness on society. It is about a focus on recovery and greater involvement of experts and the experience of the service user and those who are living with mental illness. It is about investing in service developments where resources allow. It is about exploring the potential for all-island developments. As I said in my statement, there are a number of areas where we could work more collaboratively, particularly in perinatal mental health and in relation to young people who find themselves with a dual diagnosis.
There is so much that we have still to do. I am going to receive the review of the Bamford report action plan in the next month, and that is going to help me inform the direction of travel. I want to set out very clearly a plan of action for the next number of years, which will set out how we are going to achieve parity of esteem for mental health. It is so important that we help people to remain well and that we promote positive mental health messages. I want to prioritise this, and, as I said, over the next number of months, I will produce a plan for taking that forward.
Mr Durkan: I very much thank the Minister for her statement and welcome the publication of this report, which contains some extremely sensible and necessary proposals. However, the lack of specifics in the report and in the statement on the transformation or rationalisation of our hospital estate means that a spectre of doubt will loom over services in several areas. When will she be in a position to put more meat on the bones of this statement and let us know what this means for where?
Mrs O'Neill: We did not just arrive at this scenario overnight. The health service did not get to the state it is in overnight. This has been a process that happened over many years, and it is for a number of reasons, including an ageing population, growing expectation and demand, financial challenges, the Tories cutting the block grant and all the implications of all of that. I could list the challenges, which are well rehearsed and, I think, universally accepted. We have to get better about how we deliver our services.
What I set out this morning is a true reflection of the length of time that it is going to take to properly transform the system. There is no quick fix, so we need to have a sustained plan of action, which is what I have clearly set out. We cannot just sit back and wait for 10 years to go by and see what happens. We have to be part of everyday actions that are making a difference. I have clearly set out my plan of action for the next 12 months, which is very much focused on co-production and co-design. If I am serious about co-production and delivering services in conjunction with patients, carers and staff, I should not run too far ahead of the ball. That would not lead to meaningful collaboration or engagement. What I have set out, clearly, is a plan of action for the next 12 months, which is going to inform the year after, the year after and the year after. I think that what we will see is incremental change.
I would suggest to the Member that we should not allow any seed of doubt to be sown out there. This is a positive development. We all want to see better health outcomes for all of the population, and the best way to do that is to work together. I have said that I will come back to the House every six months throughout this journey to update Members on where we are and on how far we have got in our progress. I think that this is different from anything that has come before. We have an Executive that have put their full weight behind this direction of travel. We have an Executive that realise that we need additional funding to transform and that want to tackle waiting lists. I have said that I am going to bring forward a plan in January that will set out very clearly, over the next five years, how we are going to bring those waiting lists down.
That is the plan of action to deal with the backlog, but if we do not transform the system, the waiting list picture is not going to get any better and staff are going to come under even more pressure. I suggest to all Members that this is a positive day. This is a fresh start for health, and we should go out and tell the public that we are committed to delivering this transformation.
I, as the Health Minister, will not be found wanting in the leadership that I will show in driving forward meaningful transformation, because I am committed to tackling health inequalities and delivering first-class health outcomes for all the population.
Ms Bradshaw: Thank you, Minister. The reports are very good and very much reflect what we, as Health Committee members, have been hearing over the past few months. The increase in GP places each year to 111 is very much to be welcomed. As you know, however, the British Medical Association and the Royal College of General Practitioners have a lot of urgent and pressing matters that need to be attended to, not just about more places. I am talking specifically about more finances. How do you plan in the shorter term to address finance issues?
Mrs O'Neill: We all recognise that GPs are under pressure. The focus that I placed today on primary care will really help improve that picture and really help support GPs. The fact that, within the next number of months, all GP surgeries will have a named health visitor, district nurse and social worker shows in itself the commitment to multidisciplinary teams, which the BMA and GPs are asking for. The other thing is around working with Community Pharmacy. Our community pharmacists can do so much more, and they are crying out to do so much more, so I want to work with them. I will develop a framework over the next number of months with them. Whenever we come to agreeing a new contract, we can work more collaboratively with Community Pharmacy.
As a combination of building community capacity, all those things will make a real difference to primary care. When it comes to making difficult decisions in the future about where services are based, we have to invest in primary care. People have to feel that it is different in primary care. The initiatives that we have set out today are going to do that.
The GP-led working group has set out a number of asks, some of which we have addressed today. However, I will respond to the full report by the end of the year, and we will look at other areas in which we can work together.
GPs are the bedrock of primary care, so this is a good opportunity for us not just to give a nod to primary care but to make a real, meaningful difference. I think that the implementation of some of the initiatives that I have set out will make a real difference.
Mr Middleton: I thank the Minister for outlining the report. The expert panel report states that action must be taken to address elective care waiting times. The Minister stated that she intends to bring forward a strategy to try to address and reduce waiting times. Can the Minister outline what content she foresees being in the strategy?
Mrs O'Neill: I thank the Member for his question. I consistently say, and I say it again here today, that waiting times are unacceptable. They are unacceptable to me and, I think, to all of us. We share that.
I understand absolutely that, if you are waiting to be seen as an individual — a parent, a daughter or a son — it is so stressful and worrying if you cannot get to see someone as quickly as possible, so we need to do two things. We need to address the backlog, and that is what the plan will very much be about. Alongside that, we need to develop and transform our system so that we do not get to that point.
These are new ways of working. We are trying to operate a 20th-century health and social care system trying to deliver 21st-century care, and those two things do not marry. If we do not transform the system, our waiting lists are not going to get any better.
I have already done a large body of work on waiting lists and am bringing forward a plan. We are going to need additional funding to be able to do that. To build public confidence that what we are doing is the right thing, we need to address waiting lists alongside the transformation piece. Transformation is the longer-term solution. In the meantime, we have to bring forward a plan, which I am going to do by January, that will clearly set out how, over the next five years, we will try to bring down the waiting lists.
Mr Milne: Buíochas fosta leis an Aire as an ráiteas seo inniu. I thank the Minister for her statement this morning. Our community pharmacies are providing vital services every day. Can the Minister explain how she plans to utilise them better to help deliver the vision and changes that she has set out today?
Mrs O'Neill: I thank the Member for his question. I 100% agree that community pharmacies play a vital role in our health and social care system. Recently, when I was out visiting one of the community pharmacies, I saw at first hand how they contribute, which included doing things that you would not believe that a pharmacy does.
Quite often, they can be the first port of call for a lot of people, particularly in deprived areas, where people may be more likely to go to their community pharmacist than to their GP. They are crying out about wanting to do more. I want to work with them to do more. Our community pharmacies dispense over 40 million prescription items every year and have unequalled access to people in local communities. That gives them the opportunity to promote well-being through the best use of medicines and delivering important support about healthy lifestyles. When we look towards winter, pharmacy in the community has a critical role in supporting people to stay well and to make informed choices about HSC services.
I want to maximise the potential of Community Pharmacy: they are up for it, I am up for it, and we can make a real, positive difference. This is all bringing it back to the focus on primary care. It is about the GP. It is about the district nurses. It is about the allied health professionals. It is about the social worker. It is about the community pharmacists. It is about the community itself. It is about that partnership and collaborative working. If we successfully get to that point, we will see real, meaningful differences, particularly in tackling health inequalities and in making sure that we are reaching people at a very early stage. Early intervention and prevention are absolutely key when it comes to the health service.
Mr Robinson: I thank the Minister for her statement. Can she outline the timescale for the additional GP retraining to impact on the front-line of out of hours care in areas such as the western out of hours? In towns such as Limavady, there have been occasions when there is no GP service between 8.30 one evening and 8.30 the next morning.
Mrs O'Neill: I have outlined a number of areas where we will work with GPs, and one is recruiting and increasing the number of GP training places, but it is also about looking at the role that associate physicians can play. We need to explore new ways of working, and I have announced some moves on that. I also think of advanced practitioner nurses. A lot more people can support the GP in that setting. We need to move to the point where we truly have these multidisciplinary teams in place. GPs are under pressure, particularly in rural areas. We have seen some particular challenges in relation to that. I am committed to increasing the numbers of GP places by, I think, 12 next year and 14 the year after. We have also seen, in the last year, an investment package of up to £5·1 million in 2015-16 and a further £7 million this year. We are continuing to work with GPs. We have increased the number of GP places, but I will respond in due course to the recommendations of the GP-led care working group in the context of the Budget process.
Mr Butler: I thank the Minister for her answers so far and, indeed, for the report. The Minister thought it important enough to mention extending the role of nurses and midwives, and recommendation 3 talks about innovative approaches. I hope that she will agree that that is not an innovative approach. It is doing more for less. With that extension in role that she talks about, will she also recognise that an additional responsibility payment may be required for those people, and will she commit to recognising that our nurses, midwives and care staff are appreciated and treated fairly?
Mrs O'Neill: When I talked about innovative approaches, I meant supporting the staff to do what they do well. I pointed out a number of examples of when staff have gone ahead and developed innovative practices, and I think that we need to scale those up. If something works, let us do it across the board. Quite often, a lot of the innovative projects and initiatives that staff have taken are done in pockets, but we should replicate it across the whole of the North if it works.
As I have clearly set out, I will make a workforce strategy plan. We do not have a workforce strategy plan right across Health and Social Care, and so, if we are to transform the system, we also need to look at what our workforce challenges are. I have set out that I will take forward that programme of work. For me, that will allow us to make sure that we have the right staff who are trained in the right way and in the specialisms that we need. I think that it is innovative to look towards more areas such as advanced practitioner nurses and physician associates and see how they can support the staff to do the excellent work that they do. Try not to be too critical. I think that this is a good day for health. We should embrace it and take it on board.
Ms Dillon: I thank the Minister for her answers. Can she outline how her vision, set out in Delivering Together, will help address the health inequalities that exist?
Mrs O'Neill: This is one of the things that Professor Bengoa picks up in his report, and I went on to highlight it. The health inequalities that we face are stark. I do not think that we should ever be comfortable with that picture. However, I believe that the only way to tackle health inequalities is through collaborative working. The new Programme for Government approach allows us to do that.
It is not right that where you live determines your outcomes in life, but we know that that is the case. We know that deprivation is linked to health outcomes, job choices, employment and housing. We need to tackle them all. The vision that I have set out in Delivering Together is focused on keeping people well in the first place and on providing the education, information and support that they need to make informed choices, regardless of where they live. By building capacity in our multidisciplinary teams in primary care and ensuring that there is a named health visitor, district nurse and social worker for every GP practice, they will be better equipped to respond earlier and work with people to address the lifestyle choices that impact on their health and well-being.
What I have outlined is investment in, and development of, community resources. We will work with our partners and all the community to develop the strengths and assets to tackle the determinants of health and well-being. We have to tackle the root causes of health inequalities head on. We can no longer tolerate the correlation between deprivation and health outcomes. We can truly judge our system when we have improved that picture. I think that the direction of travel that we are going to take will lead to that improvement.
Mr Dunne: I too thank the Minister for her long-awaited report on what is a very important issue. How does the Minister see improvements to patient flow in our hospital system, given that bed-blocking has been critical and has had a serious knock-on effect throughout the system as many patients await community care packages?
Mrs O'Neill: Some innovative practices have improved patient flow. Our emergency departments are full, particularly in winter, and patient flow is very difficult. Often, older people cannot be discharged from hospital because there is no domiciliary care package in place, and there are particular challenges in relation to the workforce there.
In December, I will receive the report on the review of domiciliary care. I passionately believe in domiciliary care. These people, mostly women, are the lowest paid in our health service. Quite often, the trusts contract the work out to independent providers. Care workers do not get any mileage allowance and, if they work in a rural area, there could be 20 miles between one person's house and another's. That takes what are already low wages down even further. I am committed to supporting these people and helping them with their professional development. I look forward to the report, but I am passionate about making sure we do more to support domiciliary care workers, because support the system. They keep people at home longer and patients can be discharged from hospital more quickly.
Alongside this, in March, we will consult on the review of adult social care. That will also allow us to improve on how we deliver services and will make sure that we have settings to care for people that are appropriate and adaptable, because not everybody fits into the one approach. That is the conversation we will have about this matter.
Mr McGrath: I thank the Minister for the report. The statement suggests that there may need to be some changes to, or indeed closure of, emergency departments. Often, rural communities are impacted most by these changes, yet I note that there is no reference in the statement or the report — in what I have skimmed of it — to the Ambulance Service and the vital role that it plays in delivering front-line care to people in their moment of need. Will the Minister comment on whether the Ambulance Service will receive additional resources as part of this programme?
Mrs O'Neill: The Ambulance Service plays a key role in health and social care and has been very progressive in the new initiatives that it has brought forward to ensure, in particular, that an ambulance crew does not sit for a long time at a hospital waiting to drop a patient off into the care of a clinician. We need to do more of that.
Some of the challenges we have in the Ambulance Service are in relation to the workforce. We will look at every element of the health and social care system, including ambulance staff, to make sure that we have proper workforce planning and meet the needs of the service. I am committed to working with the Ambulance Service. The report does not talk about the Ambulance Service, but it is an integral part of the HSC system and we need to work with all elements of the system.
You talked about closures. We need to frame the conversation on the best outcome for individuals and on what delivers the best possible health outcome for individuals. The report that Professor Bengoa and the expert panel took forward very rightly focused on delivering better systems, not structures. I could have spent the next five years focusing on structures, but the outcomes would not have changed. If we get the system right, the structures will change in time. If we invest in primary care, we can make a real difference to what people get in their community. Let us remember that the traditional model of going to hospital is not a 21st century one; there is a recognition out there that we need to do things differently. People want to stay at home, and we should support them there as long as possible.
Only those who are acutely ill or are in for emergency reasons should be in hospital. If we can work towards that, people can see a real difference to the support that we provide in communities. Acute care at home is a really fine example of how that works. All the staff and clinicians go into people's homes and support them to stay in their own bed at night. That can make a big difference to someone who is not well. For me, it is about doing more of that. Structures will change in time. Let us invest in primary care. That is certainly my vision for what I want to do.
Mr Maskey: I thank the Minister for her important statement. Where does she think there is any further potential to deliver specialised services on an all-island basis?
Mrs O'Neill: There are definitely areas where we can build on that. Some of the collaboration that already exists, particularly in children's cardiac services and radiotherapy for cancer patients, shows that we have been able to develop really innovative services for the population on the island. That benefits not only patients but staff because they are allowed to specialise in the areas that they wish. There are so many more opportunities — for example, transplantation of organs and rare diseases. We have also developed a programme of work with the Department of Health in the South to identify other areas of mutual benefit. I set out in a statement areas where I think that we could collaborate more — for example, mental health and perinatal mental health in particular. There is no service on this island to support women with mental illness in pregnancy. I would certainly be very proud if we were able to deliver such a service, and I think that we could do it collaboratively across the island. That would allow us to develop it a lot more quickly than perhaps we could do individually. Recently, I have had conversations on dual diagnosis and young people and adolescents with mental health and addiction problems, and I think that, again, we do not have any service right across the island. If we include transplantation, those are just three areas where there is scope. A scoping study is ongoing, which I look forward to receiving. I want to take forward measures that allow us to develop a first-class service for the population.
Dr Farry: I thank the Minister for her statement. She has welcomed the report and commended Professor Bengoa and his colleagues for their work, but she has not taken the opportunity to systematically go through the recommendations in her statement or documentation and give her response. It is traditional for Ministers, when they receive reports, to give their view of the report as a whole. For the avoidance of any doubt, will the Minister clarify whether she fully accepts the report that has been presented by Professor Bengoa in its entirety and, if not, what aspects she does not accept?
Mrs O'Neill: I assure the Member that I do; I believe that I said that at the outset. I said that I endorsed the recommendations that the expert panel had put forward. I said that very clearly in, I think, the opening paragraph. Let me say it again in case you missed it: I endorse the expert panel's report, and I have set out my plan of action on how I will take those things forward.
Mr Kennedy: I refer the Minister to action point 12 on page 26 of the report, under the heading "Transformation":
"Establish and seek members for a transformation oversight structure with membership drawn from within and outwith the HSC."
That target is to be met by or during November 2016. Will the Minister outline what the size of the structure would be; how many members it would have; who would appoint those members — practitioners, academics or politicians; and how it would avoid duplication with those with existing responsibility?
Mrs O'Neill: It is clear that we have to drive change. I will provide the political leadership for change, but we need clinician-led oversight of service reconfiguration. November is next week. Over the next couple of weeks, I intend to set out what that panel will look like. Suffice it to say that it needs to be clinician-led. It also needs to include people from inside and outside the health and social care system. I am working up the detail of that and will make an announcement in the coming weeks. We can have a lovely direction of travel, but it is important to drive the implementation. I will drive it politically, but I am asking for clinicians.
I remember that, when I first came into office and was speaking at an event somewhere, my message to the health service was this: help me to help you. That is the message that I will leave as your answer: it is about how I can help the health service to do more and support it to deliver the first-class service that it is committed to delivering. I think that the direction of travel that we have set out here is the correct one. Hopefully, it will command universal acceptance. We need to recognise that, for the first time ever, the Executive have endorsed a plan, and they are committed to tackling waiting lists and delivering better outcomes for the population. To me, that is how we should be measured because, in government, you take tough decisions and deliver better outcomes for the whole population.
Mr McPhillips: I thank the Minister for her statement. I welcome it and the acknowledgement that the health service is at breaking point.
The Minister noted the need for change in the configuration of acute services. At this stage, does she have any information on where regional services will be provided, especially those in the Western Trust?
Mrs O'Neill: You cannot help being parochial. The expert panel has set out the criteria that it believes should be considered when it comes to service reviews. It also set it out very clearly that we cannot keep delivering every service in every hospital, so we need to specialise. That is good not only for patients and patient outcomes but for the staff who get to build their skills and knowledge. When it comes to the direction of travel, today is not about closures or hospitals; it is about changing the picture and about better health outcomes. What does that mean? Does it mean that you travel a little further to get a first-class service? If, for example, after a stroke, people have to travel 20 minutes extra, but their outcomes are better — they will live longer, their mobility will not be as reduced and their speech will be better — I think that they will be prepared to do that. This morning, I listened to Janice Smyth from the Royal College of Nursing clearly say that people will travel if they get a first-class service. People need to understand why you make changes, so I want to communicate with staff, patients, carers and families to make sure that we are all part of designing the services and that people understand the care pathways and why they have to travel to services. Let us not focus today on closures; let us focus on building a first-class health and social care system.
The criteria for service reviews will go out to consultation over the next number of weeks, and I look forward to receiving Members' views. When the criteria are agreed, let us get on with the service reviews and making sure that we design a first-class health and social care system.
Mr Nesbitt: I welcome the Minister's commitment to parity between mental health and physical health, but I also challenge her: parity will have real meaning only if she addresses the imbalance in funding and resource, so will she commit to that over the 10-year period?
Mrs O'Neill: Maybe the Member misunderstands what parity of esteem is. It does not mean giving the same resource to physical health and mental health —
Mrs O'Neill: The Royal College of Psychiatrists clearly said that in its report when asking for parity of esteem to be established. When I talk about parity of esteem, I am talking about moving towards true recognition, attention of resource and the Department's attention to the mental health issue. When we focus more on recovery and promoting good, positive mental health messages; when we invest in service developments; when we do more for perinatal health; and when we review the Bamford action plan — I have set out a plan for the next five years — you will be able to see how we will deliver parity of esteem. I am very committed to doing that, and I think that all Members share that aspiration. For far too long, mental health has not had the attention that it deserves. It blights all our communities, and people who find that they are vulnerable because of mental health issues need to be supported.
Mr Mullan: This is a follow-up to Mr Middleton's question about elective care. As far as the lack of care centres is concerned, does the Minister intend to increase capacity here, especially through new capital build projects in the public sector, rather than having a total reliance on the private sector?
Mrs O'Neill: Elective care centres are within the HSC estate, so they will be developed in line with need. As I said in my statement, we do not yet know the number or where they will be placed, but the service reviews will allow us to do that. Elective care centres will really help us to deal with waiting lists by allowing people who have been scheduled for minor surgery to be seen without interruption to the service. That, in itself, will bring down waiting lists in the longer term. We will consult on the criteria, and, next year, we will move towards deciding where the elective care centres should go, and I think that they will make a real, meaningful difference to patient outcomes.
Mr Dickson: Thank you, Minister, for your statement. Recommendation 6 requires additional funding for the transformation and transition. Have you secured that money from your Executive colleagues?
Mrs O'Neill: Yes. The Executive have endorsed the direction of travel and have endorsed the plan. In endorsing it, they have also recognised that transition is going to take additional funding. They also endorsed the fact that, in order to bring down waiting lists, it will need additional funding in the short term. So, for a time, we are going to have dual running. We have to keep the health service delivering every day alongside the transformation piece, but we cannot be distracted from transformation because, if we do not do it, the system will be in crisis in years to come.
Ms Armstrong: Thank you very much, Minister, for your statement. Recommendation 7 refers to the creation of a transformation board. Will the Minister confirm that — outwith what happened with Transforming Your Care, where there was no implementation plan — the implementation plan that is mentioned in part 5 on the actions will be followed and monitored regularly with published outcomes?
Mrs O'Neill: I am absolutely committed to moving to outcomes-based analysis; that is where we need to be. We will not do that overnight, but it is certainly what we are working towards. I will update the House every six months on the plan because that shows that we are serious about transformation and driving it forward. It is also about saying to Members that I want to work with them and deliver better health outcomes for all of the population. There is no danger of this falling down if there is genuine effort to implement it. I will not be found wanting in my political leadership. Also, the oversight structure that we have put in place, which is clinician-led, will make a real, meaningful difference and is something that has not happened before.
Mr Carroll: Will the Minister give a guarantee that this report will not lead to the further encroachment by the private sector into our NHS?
Mrs O'Neill: Obviously, I am working towards a position where we do not need to use the independent sector. In the meantime — it will take a number of years to get to that point — there are people on waiting lists and we cannot just leave them there. We are going to have to do a combination of things in the short term. We are going to have to make sure that we are at full capacity within the health service, but also, in the short term, we are going to have to use the independent sector. I cannot let patients suffer whilst we get to a transformed health and social care system. I believe that, in the short term, we are going to need the independent sector. Certainly, for me, the longer-term goal is universal healthcare, free at the point of delivery for all people who need health and social care services. We should not have to rely on provision outside of the health service to deliver all those services that are much-needed.
Mr Allister: So, here we go again. Another fresh start in health. The recycling of a great plethora of fine words from an Executive that, since 2011, have reduced beds in our hospitals by 10% and then are surprised by the chaos that results. How can the Minister come to the House with grand proposals that she has not costed? What is the costing of what the Minister is proposing? Surely any proposal, to be credible, needs to be costed before it is embraced.
Mrs O'Neill: It must be exhausting being so negative all of the time. [Laughter.]
I have clearly said that I have set out a direction of travel. I have also said that the Executive have endorsed that direction of travel, in the recognition that we need additional funding. We are about to go through the Budget process, and I would like to see, at the other side of that Budget process, that we will also have a funding allocation that allows us to transform the system. It is very clear that what we have here is a real road map for change and transformation; one that will deliver incremental change, year-on-year, that will see staff and patients supported and that will lead to an open and honest conversation about where we are going.
Mrs O'Neill: I have costed everything that I am talking about. With the Minister of Finance and my Executive colleagues, I am working through the due process of the Budget decisions. That will all become very clear to you, so do not be too worried. You will see it all in due course.
Mr E McCann: In light of the Minister's assurance that, in future, more attention will be paid to the perspectives and opinions of front-line staff than those of a manager sitting in an office with a spreadsheet — I paraphrase, of course — what steps will she take to ensure that we have no repetition of the grotesque situation that arose in the Western Trust area when £8 million earmarked for learning disability services was not spent on learning disability services? No explanation, of an adequate or clear nature, has been produced for this shortfall. We deserve to know this, and we do not know it. Will the Minister take steps at least to ensure that there is no repetition of this happening?
Mrs O'Neill: On the Western Trust issue, I have met the families and the carers, and I continue to do so. I have given them all reassurances that we will get to the bottom of it. What we seriously need to be about — this is the core tenet of what I am talking about — is co-production and co-delivery meaning that. It means proper collaboration. It means people understanding that, if you make service changes, patients need to understand why you are doing so. They need to know that it is about trying to provide a better service for them. They need to understand that and be given every piece of information. I am committed to that. In building capacity in communities, co-production, co-delivery and co-design are going to be instrumental in helping us deliver a first-class health and social care system. Openness, honesty and transparency are key. The trusts are up for that, and the Department is up for that. Together we can, as I say, deliver first-class health and social care outcomes for all the population. That should be the only aspiration that we all work to for the health service.
Mr McNulty: I thank the Minister for the report. 'Health and Wellbeing 2026' refers to ambulatory assessment and treatment centres. Are those similar to the community care and treatment centres that are planned for such places as Newry? Will an ambulatory assessment and treatment centre include facilities such as a minor injuries unit?
Mrs O'Neill: No, ambulatory care centres are a different set-up altogether. They allow people whom a GP thinks need to be seen by a consultant to go into a centre. For example, I visited one centre last week in the Royal, and there is also one in the Mater. One of the things that they do is, if you are referred to one, you can have your blood tests and X-rays, see the consultant and be assessed and watched throughout the course of a day. The stats show that quite often, as I said, you can then be sent home and do not have to be admitted to hospital. That is the ideal, for nobody wants to be in hospital unless it is absolutely necessary. If we can scale up the number of those ambulatory centres — the form that they take may be different, depending on where they are placed — that will make a real, meaningful difference to individuals. Again, it will prevent hospital admissions, which is what we should all be working towards. People to not want to be in hospital. I look forward to the development of these ambulatory centres. I think that they will make a real, positive difference to bed blockages and waiting lists.
Ms Gildernew: I also welcome the Minister's statement and the publication of the report. There is a lot in there that I welcome, especially on mental health, children and looked-after children.
The Minister is aware that there is a lot of pressure in the system on nurses, social workers and other front-line staff. I very much welcome the increase in GP places, Minister. You are aware of the increasing pressure on GP practices in rural areas, particularly in Fermanagh. In reference to an earlier question, do not forget that, when people are travelling further for services, the road goes both ways. Hopefully people will be travelling west for some services rather than us travelling east all the time. Do you see the increase in the number of GP training places having a very positive influence on the delivery of the report, given that most people's point of contact is their GP?
Mrs O'Neill: Absolutely. This is about trying to address the challenges for GP services, but it is very much about, as I said, building up that team. The multidisciplinary approach is going to make a real difference, I believe. The fact that GPs have a team around them that can interact and that can rely on one another will make a significant difference to primary care. Staff are working even harder and are under a lot of pressure, so we have to get this right. We have to do it. Social workers are telling me about the pressures that they are under. I constantly hear about social workers going home and having to sit up until 2.00 am writing up reports. That is not sustainable for anybody's working pattern. I want to do more to work with all those teams to make sure that they support one another. Furthermore, we have a real opportunity to make sure that primary care is embedded, multidisciplinary and action-based. This is really going to change the picture.
On rural services, I absolutely agree with the point about designing services. Although people are always happy to travel if they are getting a better outcome, we do not want to starve them. It does not mean that everything has to be centralised in Belfast, for example. It can be the case that services are spread across the North. I am not going to give examples, because people will seize on them, but there are really good, innovative things being done in each trust. Each trust has a crucial role to play in determining where we develop services and where they are safe, because at the core of all of this has to be patient quality and patient safety.
Mr Attwood: I welcome the statement and acknowledge that it is challenging work. I think that everybody recognises that the Minister is applying herself to this challenging work and there should be no doubt about that assertion. If it is the case that, in years 2 to 5 of this mandate, there will be increased health budget allocations in the existing structures and double running as the reforms are rolled out, have the Executive agreed this morning, and has the Minister of Finance confirmed to you, that double running will be permitted during this mandate and that, from year 2 to year 5, can you give a broad indication of the increased budget allocation that will be required to facilitate double running?
Mrs O'Neill: The Executive have recognised that we will need a period of double running, but they also appreciate that it will not be forever; it will be until we transform the system and put Health on a sustainable footing. We do not have a choice, because if we do not do it, the system will be in crisis and the entire block grant could be sucked up by Health. What would we do then for every other service and Department — for Education and roads and everything else that is important to people's lives?
We do not have a choice. The Executive have clearly committed to the plan and, in doing so, have clearly also committed to the transformation fund. We will see the allocation of funding as part of the Budget process in the next few weeks and months, and I am sure that we will discuss it in the Chamber. We do not have a choice. I cannot say that enough: we do not have a choice. We have to transform Health and Social Care, otherwise the system will break at some stage in the future. In recognition of that, the Executive are fully behind the strategy and the two-mandate plan. We have never had a two-mandate plan before, so that is really significant in itself. It sends out a very strong political leadership message that the Executive are committed to delivering this transformation programme alongside tackling all of the immediate issues that we have.
Mr Beggs: The Minister talked about investment in primary care. My constituents from Larne, Carrick and Newtownabbey have most of their care provided from Antrim and Belfast, so I welcome that there will be a greater focus on primary care. There needs to be investment in order that our GP practices can be improved and services provided. What investment will follow in capital and resource budgeting to enable more services to be provided locally from our GPs and other allied professionals?
Mrs O'Neill: I have already answered that in relation to the number of places that we have announced for GPs, nurses, named social workers, health visitors and district nurses and the roll-out of askmyGP to 30 more practices. All those things come with a cost, but I have decided that I can do them within the budget I have set out and that I am planning with the Executive. This is about real, meaningful change; it is about investment in the front line; it is about investment in primary care. For us to be successful in this transformation programme, we have to do that.
Ms Mallon: The Minister will not be surprised by the content of my question, which relates to the devastating, ongoing problem of mental health and addiction among our young people, not least in my own constituency of North Belfast. I wholeheartedly welcome the Minister's commitment to exploring specialist treatment, on a regional and all-island basis, for our young people who are struggling with mental health and addiction problems. Could the Minister shape her thinking on that matter further? Does it involve the provision of a specialist treatment centre or a unit for dual diagnosis, particularly for those at the most acute end of the problem?
Mrs O'Neill: I am committed to developing services with the Minister in the South. We have embarked on identifying areas where we can collaborate, but the issues of perinatal mental health and dual diagnosis stand out as areas where we can do something, because we do not have a service on this island. We are actively looking at what is available in the Twenty-six Counties, and we will then develop the conversation further.
We need to do more to support those young people, and there is a lot of debate about what that might look like. We need to have that conversation. I have met with you and Carál Ní Chuilín and Gerry Kelly about how we can do more, particularly given the challenges and recent deaths in North Belfast. I am committed to tackling mental health issues, and I am very committed to making sure that we support our young who find themselves in such a vulnerable situation and making sure that the health service responds to their needs.
Ms Ní Chuilín: I thank the Minister for her statement and wish her well. My question is in relation to — you will not be surprised as you have given me a namecheck — mental health. It is really in relation to dual diagnosis and the partnership with our health and social care staff as well as our partners and stakeholders in the community sector. I am aware that the Protect Life 2 strategy is out for consultation, and perhaps the Minister would like to wait until then, and Bamford, but can she give us some assurance that our partners in the community and voluntary sector will not become invisible when reforming our health and social care practices?
Mrs O'Neill: I thank the Member for her question, and I can absolutely give that assurance. The community and voluntary sector does amazing work and is very engaged in all our communities. It is absolutely part of the picture in supporting all those people who find themselves with mental ill health. Going forward, obviously, I am consulting on the Protect Life 2 strategy, the suicide prevention strategy, and I intend to engage personally on that issue as I believe we can continue to improve what is good out there and learn lessons where we need to do so. I want to work with the community and voluntary sector.
Recently, and you are aware of and attended it, the Future Search event in Belfast looked at bringing together all the partners across the community, voluntary and statutory sectors and looked at how, collaboratively, we can do more to deal with suicide in our society. I am very much committed to that collaboration, that partnership working, and I am very much somebody who wants to listen to those who are engaging with people with mental ill health, day and daily, in their communities at 12.00 midnight. I know the commitment of some of the community and voluntary sector individuals, and I really want to work with them in the time ahead.
Mr Speaker: Members, that concludes questions on the Minister's statement.
Dr Farry: On a point of order, Mr Speaker. We are about to hear a statement from the Finance Minister on the October monitoring round. The Minister is at pains to stress the new procedures that the Executive are now using, and I do not necessarily dispute their right to have a different approach to monitoring rounds. However, it is my understanding that very few Committees in the Assembly, if any, have had a full briefing on the financial situation as it pertains to their Departments.
We are also likely to be facing a situation where there is no draft Budget for the forthcoming financial year. We also see a curious line in the Minister's statement where the Executive are saying what is appropriate in terms of parliamentary scrutiny. I, and many others, are concerned that we are seeing a shift by stealth in the balance between the Executive and the Assembly regarding financial scrutiny; and, indeed, the deputy First Minister has been at pains in the past to stress that the Assembly has to be given its place in that regard. Therefore, Mr Speaker, I ask you to look into this matter and ensure that the Assembly — and its Committees, in particular, which have a statutory duty to hold Departments to account and provide scrutiny — is being given its proper place in the financial process.
Mr Speaker: That is more than a point of order; that is a speech in itself. I might be tempted to ask you to refer to which Standing Order you were making the point of order under. However, I note your comments.
I have received notice from the Minister of Finance that he wishes to make a statement on October monitoring.
Mr Ó Muilleoir (The Minister of Finance): In answer to Mr Farry — I know it is not my job to answer Mr Farry — I can assure him that I am giving this statement to the Assembly to give the Assembly, and all Members, their due place in our deliberations.
As I move through another lengthy statement, I apologise to Members because they have had a long morning already. However, they will be pleased with some of the statements in here, for example, in relation to the British Government being pressed on a fiscal stimulus in the autumn statement on 23 November. Also, there is a shot in the arm for our local economy through a small stimulus package here today, and some good news on financial transactions capital that will not be returning to the Treasury.
A Cheann Comhairle, ba mhaith liom buíochas a ghabháil leat as an deis seo a thabhairt dom an Ráiteas seo faoi Bhabhta Monatóireachta Dheireadh Fómhair agus faoi phacáiste Spreagthach an Fheidhmeannais, An Chéad Chéim a chur faoi bhráid an Tionóil inniu. Seo an dara babhta monatóireachta i mbliana a thagann sna sála ar mo Ráiteas i leith Babhta Monatóireachta an Mheithimh.
A Cheann Comhairle, sula labhraím ar Bhabhta Monatóireachta Dheireadh Fómhair, ba mhaith liom an deis seo a thapú uasdátú beag a thabhairt do na baill ar na cainteanna a bhí agam le cúpla lá anuas le Príomh-Rúnaí an Státchiste agus le hAirí Airgeadais na hAlban agus na Breataine Bige.
Mr Speaker, thank you for affording me the opportunity to present this statement to the Assembly today on the October monitoring round and the Executive’s First Step Stimulus package. This is the second monitoring round of this year and follows on from my statement on the June monitoring round.
Before turning to the October monitoring round, I will take the opportunity to update Members briefly on discussions that I have had over recent days with the Chief Secretary to the Treasury, David Gauke, and the Scottish and Welsh Finance Ministers, Derek Mackay and Mark Drakeford. Yesterday, along with my Scottish and Welsh colleagues, I met David Gauke. During that meeting in London, we discussed a number of important issues, including the outworking of the EU referendum decision. All three Administrations expressed concern at the impact on their economies and the need for the British Government to provide clarity on the way forward. We also discussed a number of specific finance issues, which I will touch on shortly.
Before turning to the detail of this round, I want to pre-empt questions that I expect will follow from Members about the monitoring round process adopted by the Executive. The approach now adopted by the Executive to the monitoring round process no longer requires the submission of bids by Departments. The submission of a wish list of bids did not give a good indication of real pressures and led to slow and cumbersome negotiation, as Members from all parties know. Instead, key pressures are now identified through ongoing engagements between my officials and Departments.
The new process allows the Executive to focus on and react quickly to the key emerging pressures. It is consistent with the position adopted in Scotland, Wales and the South of Ireland, where parliamentary scrutiny takes place through the Estimates process and focuses on in-year changes to budgets with no references at all to bids. In keeping with the practice in those jurisdictions, the Executive do not disclose their deliberations in reaching an agreed monitoring round outcome. The focus of scrutiny is and should be on outcomes. The swift conclusion of the June monitoring round and the fact that I am standing before you today providing details of the October monitoring round demonstrates the efficiency of the new approach.
Before we get into the detail of the monitoring round, it is important to highlight the fact that significant constraints face our resource DEL position in the current year. In that context, aside from meeting a small number of prior commitments, the focus in this monitoring round has been on the capital DEL position and measures that will deliver an economic stimulus to our economy. The starting point for this monitoring round is the outcome of the June monitoring round, which concluded with an overcommitment of £13·5 million on resource DEL and £11·4 million on capital DEL.
I now want to turn to the specifics of the October monitoring round, starting with a number of adjustments relating to centrally held items. Updates to forecasts of regional rate income, interest payments on borrowing and statutory salaries have resulted in a small easement of £0·2 million that can be made available to the Executive in this monitoring round.
Members may recall that, in the 2013-14 January monitoring round, as part of an agreement to provide £35 million of ring-fenced financial transactions funding to Ulster University (UU) for its greater Belfast development, the university agreed to return £7 million to the Executive from its accumulated reserves. Some £3·5 million was returned in 2014-15, and a further £3·5 million was to be returned in 2016-17. The Executive have now received the £3·5 million from UU relating to this year, and it has been made available for reallocation in this round.
In 2015-16, receipts from the carrier bag levy exceeded allocations to environmental programmes by £0·5 million. As receipts from the levy must be used to support environmental programmes, the Executive returned the £0·5 million to DAERA for that purpose in the June monitoring round. However, updated numbers have now been received, and the Executive must now return a further £0·3 million to DAERA for the carrier bag levy. That has been taken into account in this monitoring round.
The Budget for 2016-17 set aside £15 million capital DEL for allocation under the Delivering Social Change programme. The Executive Office has now advised that £7·1 million of that funding will not be required in this year and can be made available for reallocation by the Executive in this monitoring round.
Members will also be aware that the Executive’s Budget faces pressures relating to the renewable heat incentive scheme. I will say more on this later; however, the Executive have set aside £20 million of resource DEL in this year to meet pressures arising from the RHI scheme, and that must be taken into account in assessing the resources available to the Executive. In total, taking into account the opening overcommitment and other central issues noted above, it resulted in an overcommitment of £30·1 million on resource DEL and £4·3 million on capital DEL. That was before taking account of departmental reduced requirements.
Departments declared reduced requirements in this monitoring round of £11·6 million resource DEL and £16·2 million capital DEL. Full details are provided in the tables provided with the statement. On the resource side, the most significant reduced requirements declared include £8 million relating to employment services programmes and welfare support measures from the Department for Communities, and the Finance Department surrendered £3·2 million relating to the development costs of devolving corporation tax. On the capital side, the most significant reduced requirements include £4·3 million from the Department of Agriculture, Environment and Rural Affairs relating to the planned relocation of its headquarters; £4·5 million from the Department for Communities due to slippage on the subregional stadia programme; and £3·5 million from the Department of Health relating to the mother and children’s hospital.
It is good practice that Departments seek to manage any emerging pressures internally before bringing forward bids for additional allocations. Whilst the public expenditure control framework allows Departments scope to undertake many such movements on a unilateral basis, movements across spending areas in excess of the de minimis threshold are subject to the Executive’s approval. In some instances, Departments also seek permission to move allocations across spending areas to facilitate the transfer of responsibility for a particular function from one business area to another. The internal reallocations agreed by the Executive in this monitoring round are included in the tables for information. Departments may also, for a number of reasons, seek to reclassify expenditure from resource to capital or vice versa. All such reclassifications need Executive approval, and they are also shown in the tables accompanying the statement. All of those adjustments impacted on the total resources available to the Executive in this monitoring round. Once all of those issues were taken into account, the Executive had an overcommitment of £18·5 million resource DEL and £11·9 million capital DEL available to allocate.
Before turning to the mainstream allocations, there are other important issues I would like to highlight to Members, starting with ring-fenced financial transactions capital (FTC). The Executive concluded the June monitoring round with £17·2 million of ring-fenced financial transactions unallocated, and, as detailed in the tables accompanying the statement, Departments have declared reduced requirements totalling £4·5 million. As colleagues will recall, the Executive have agreed to establish a £100 million investment fund. The overall aim of the proposed fund is to promote investment, economic growth and jobs, with a focus on urban regeneration projects, including, of course, grade A property, energy efficiency and low carbon projects.
The preferred delivery option involved the European Investment Bank taking an active role in the delivery and ongoing monitoring of the fund. In August, I visited the European Investment Bank and met vice president Jonathan Taylor. During the meeting, Mr Taylor informed me that the European Investment Bank could no longer take an active role in the delivery of the fund. The European Investment Bank will, however, continue to work with the Department of Finance in establishing the fund and providing technical assistance, and the bank's president has now confirmed its position in writing. My officials are reassessing possible delivery models. I remain committed to the £100 million investment fund, and I will update the Assembly on the outcome of that work in due course. However, it is now clear that the fund will not be in place before 31 March 2017, and the £55·8 million of financial transactions capital set aside for the fund in 2016-17 is now available to the Executive for alternative use. Taking account of the funding held centrally and the reduced requirements declared, the Executive will leave the October monitoring round with £77·5 million of ring-fenced financial transactions capital DEL unallocated.
As recently as yesterday in London, the Scottish and Welsh Governments have also expressed concern over the use of financial transactions capital, and we took the opportunity to raise the issue when we met the Chief Secretary to the Treasury.
I raised some specific concerns that I have on the use of financial transactions capital. I requested from the Chief Secretary a special dispensation on the use of FTC that will facilitate the creation of the planned investment fund. I am pleased to say that my request was positively received, and I have now asked my officials to expedite the delivery of the fund.
I turn now to central funds. As part of Budget 2016-17, the Executive set aside £14 million resource and £15 million capital in respect of Delivering Social Change in this financial year. A range of allocations were agreed in the June monitoring round, leaving no resource DEL and £7·9 million capital DEL available for allocation in the October monitoring round. The Executive Office has advised that £0·8 million capital should be allocated to the Executive Office for capital grants to a range of projects under the social investment fund. The Executive Office has also confirmed that the remaining £7·1 million capital DEL will not be required for Delivering Social Change in this year and can be made available to the Executive for reallocation. As a result, there is now no resource or capital DEL remaining unallocated in the Delivering Social Change fund for 2016-17. Budget 2016-17 set aside £8 million resource DEL for the Atlantic Philanthropies programme. Following the June monitoring round, £2·6 million of that funding remained unallocated. The Executive Office has advised that £2·3 million should be allocated to DE for the shared education signature programme. Following that allocation, there is now £0·4 million resource DEL unallocated on the Atlantic Philanthropies fund.
The Fresh Start Agreement secured £60 million over five years to support the creation of a shared future. The Executive’s Budget 2016-17 set aside £12 million resource DEL in this year. Allocations totalling £11·5 million were processed in the June monitoring round. The Executive Office has advised that a small number of allocations should be processed in this monitoring round, including £0·3 million to TEO for shared future and Urban Villages and £0·2 million to the Department for Communities for arts and cultural programmes. My officials will engage with Treasury in securing access to that funding through the Westminster Supplementary Estimates. Following those adjustments, all the funding available for a shared future is now allocated.
Members will recall that, in line with the Fresh Start Agreement, the Executive’s Budget 2016-17 identified £10 million resource DEL to tackle paramilitary activity. Of that, the Executive contributed £5 million, with £5 million to be accessed from the British Government, the latter being subject to the Executive agreeing a strategy to address continued paramilitary activity. The Secretary of State has advised that UK Government funding will not be released until the Executive agree a more detailed action plan. The Department of Justice will progress this to ensure that access to that funding is secured.
The Executive allocated £1·3 million to the Department of Justice in the June monitoring round from the resources that they had set aside for this purpose. Following the publication of its strategy to tackle paramilitary activity, DOJ has now confirmed that a further £2·5 million should be allocated in this monitoring round for measures to tackle paramilitary activity. The most significant allocations are £1·7 million to DOJ, £0·2 million to the Public Prosecution Service and £0·6 million to the Department for Communities. That leaves £1·1 million of the funding set aside by the Executive unallocated following the October monitoring round.
Following June monitoring, a total of £97·3 million was allocated to Departments under the public sector transformation fund, leaving £77·7 million of the £175 million set aside by the Executive this year as unallocated. The public sector reform division has continued to liaise with Departments over recent months to identify easements on allocations agreed in the Budget and any new allocations to schemes with the capacity to deliver further savings for the Executive’s budget. Details of changes to allocations under the public sector transformation fund are detailed in the tables accompanying the statement. Following those changes, allocations under the scheme in this year total £75 million, leaving £100 million of the public sector transformation fund unallocated.
I turn now to the Executive's First Step Stimulus package, a prudent pick-me-up for the economy, if you wish.
The Fresh Start Agreement provides the Executive with flexibility to access the full amount of borrowing made available under the Stormont House Agreement when the voluntary exit scheme does not require all the funding available in any given year. In view of the latest forecasts of spend on the public sector transformation fund, the Executive have agreed to divert borrowing to deliver a short-term economic stimulus through accessing additional borrowing to support capital investment in our economy. While I envisage that a longer-term economic stimulus package will be agreed by the Executive in the near future as part of our capital budget process, it is important that we send an early signal of intent to our citizens through the stimulus measures that I will now outline.
The Executive have agreed to support two schemes in the Department for Infrastructure that will provide a boost to our local economy. First, we will provide £15 million of capital DEL for roads structural maintenance. That allocation will not only enhance our road infrastructure but provide a boost to our local construction sector. A further £10 million of capital DEL will be made available for the purchase of new buses, helping to improve our public transport services and providing a boost to our local manufacturing sector.
I am very pleased that the Executive have also agreed a £5 million community regeneration fund for 2016-17. That fund is specifically aimed at improving infrastructure in our most deprived and marginalised communities, which, of course, are working-class communities. That is a great opportunity. They will be relatively small-scale but focused interventions that improve the quality of key assets for local residents. I will work with ministerial colleagues to identify suitable capital projects in our communities in the weeks ahead and will provide an update to the Assembly in the January monitoring round. The allocations will be funded by accessing an additional £30 million of reinvestment and reform initiative (RRI) borrowing in this year. Full details of allocations under the Executive's First Step Stimulus package are set out in the tables accompanying the statement.
As previously indicated, the resource DEL position in this year remains constrained, and, as a consequence, the majority of allocations agreed by the Executive in this monitoring round are on the capital DEL side. However, while the position does not allow us to progress a full resource DEL monitoring round, there are a small number of prior commitments, totalling £8·9 million, that the Executive have confirmed in this round. Those allocations include £2·5 million resource DEL to the Department for the Economy for route development at the City of Derry Airport; £4·8 million to the Department of Health for Translarna muscular dystrophy drugs; £1 million to the Department of Education for nurture units and other pressures; and £0·6 million to the Public Prosecution Service for service pressures.
I turn now to the capital position. The capital DEL allocations in this monitoring round total £22·7 million and include £13 million to the Department of Education for minor works and the purchase of furniture and equipment for schools, which will please Members; £8·7 million to the Department of Health for essential maintenance and the purchase of ambulance defibrillators, which has also been a demand of many Members; and £1 million to the Department for Infrastructure for investment in LED street lighting, which is an invest-to-save initiative. Full details of the allocations are set out in the tables accompanying my statement.
Ring-fenced resource DEL is strictly controlled, and funding cannot be moved out of that area. Changes to that area are shown in the tables accompanying the statement. Colleagues will note that we exit this monitoring round with £4·1million of ring-fenced resource DEL unallocated. That funding may only be used to address pressures within the ring fence — depreciation and impairments — and is therefore not available for allocation by the Executive.
Members will be aware that a significant additional resource DEL pressure exists from commitments under the renewable heat incentive (RHI) scheme. The Department for the Economy has, through internal reallocations processed in this round, sought, where possible, to manage the budgetary impact of the RHI this year, and I welcome that. As mentioned earlier, the Executive have set aside £20 million of resource DEL centrally to meet pressures anticipated from the RHI scheme. The Executive will further assess the extent of that pressure in the January monitoring round. However, I understand that the Economy Minister is fully engaged on the issue.
I turn now to the October monitoring outcome. As a result of the allocations detailed above and the funding set aside for the RHI, the Executive exit the monitoring round with a £27·4 million overcommitment in resource DEL and £10·8 million in capital DEL.
I believe that, with the cooperation of all Ministers, this position is manageable over the remainder of this year.
As I have said before, I am strongly opposed to the austerity agenda. I think that that is true of Members across the House, or, if not of every Member, most Members. The austerity agenda places constraints on the Assembly and our capacity to provide much-needed funding for our public services. I will continue to fight against austerity at all levels, and, alongside that, I will continue to develop innovative funding solutions, as demonstrated by the first phase of the Executive’s economic stimulus package that I have announced.
I commend the October monitoring outcome and the first phase of the Executive’s economic stimulus package to the Assembly.
Mr Speaker: As was the case with the previous statement, a large number of Members have put down their names to ask a question. Again, I ask Members to be brief and direct their question towards the Minister's statement. I call Mr Stephen Smith.
Mr Smith: Thank you, and I thank the Minister for his statement. I appreciate that, from the Minister's perspective, this new monitoring round process may well be more efficient, if not open and transparent. To aid transparency, will the Minister detail what other pressures were identified in discussions between Departments and his officials and have not been addressed in this allocation? Without this clarity, would it be fair to assume that all other budgets, including that for Health, are adequate?
Mr Ó Muilleoir: Thank you, Mr Smith. Go raibh céad maith agat. If you want to wander into the office of any Minister in this Parliament, you will find that there are pressures on all fronts. I have yet to meet a Minister who says that he or she does not need any money or funding. Pressures are unremitting; but, as you know, while the demand is infinite, resources are finite. What I have done today, rather than focus on the process — you say that it is efficient, but it is more than that: it is a process, a delivery and an outcome that will accelerate growth, create jobs and give a boost to those who want to invest further. It will inspire confidence. I know that, in this House at times, people focus on the minutiae. I think that, instead of focusing on opposition, today our focus should be on delivery. I welcome questions and, certainly, if you want to focus on minutiae, I welcome it; but I think that we should focus on the delivery, the pledges made and the investment that we are making in our future.
Mrs Little Pengelly (The Chairperson of the Committee for Finance): I note that in the statement there is in and around £100 million unallocated for public-sector transformation. I am sure that the Member agrees with me that significant reform and change is urgently needed in the system if we are to ensure affordability while protecting front-line services. We have heard that outlined already this morning in terms of Health.
Will the Minister inform the House what actions or special measures he has taken to ensure that good projects and initiatives are coming from Departments that will best meet the need for public-sector transformation across the system?
Mr Ó Muilleoir: I thank the Member for her question. As she will be aware, one of the reasons we are able to deliver October monitoring in October — last year, June monitoring was delivered in November — is what I refer to as a common-purpose Executive. You can see the benefits of that. The Executive met this morning, and Ministers are resolved to bring forward proposals which will provide greater efficiencies and better services and, in particular, schemes that involve investing to save. In that regard, we have reduced the number of Departments that serve our people. It does not make sense to have repetition across former Departments or structures. All Ministers are now focused on outcomes and, in that regard, therefore, instead of trying to protect fiefdoms or trying to ensure that systems that were there in the past have to endure, they are saying, "If we have nine Departments instead of 12, perhaps we do not need people doing a particular job that can be done somewhere else."
At the same time, the voluntary exit scheme (VES) offers those who wish to take redundancy an excellent package, and it frees up money for us to deliver and place in the front line of the services for our people. We are now speaking in particular to the arm's-length bodies. There has been a taking of the burden by some Departments, including the Department of Finance and the Civil Service, and I think that other Departments will now look at what they can do in the time ahead to deliver a more efficient government service. I will work closely with Ministers in that regard.
Mr O'Dowd: I thank the Minister for his statement and his answers thus far. We were continuing to face austerity measures from the Conservative Government when he came into post, and he has outlined his position on that. There were dire predictions of further cuts in the in-year monitoring rounds but, thankfully, he has avoided any cuts in the June and October monitoring rounds. How has he achieved that?
Mr Ó Muilleoir: I would like to claim that it is all my own work but the principal never let me away with that in school, so I will not get away with it here. What is happening is that, instead of going back to the past, where every Minister paddled their own canoe, made all their own bids and demands and insisted that they could not make any efficiencies, we now have a united Executive which are trying to be as efficient as possible to deliver real value for money. That common purpose is feeding through into our budgets.
As well as that, it is very interesting and should be noted now that six years after the austerity agenda was launched by UCUNF and the Conservative Party in Britain, we have had six years of pain, hardship, penury, unemployment and emigration for people. Members on both sides of the Chamber are saying this, because the DUP also opposed Tory austerity while some parties helped to introduce it. Throughout those six years, we said to the Conservatives that they should end austerity because it is a self-defeating strategy. The good news is that yesterday, in London, the Chief Secretary to the Treasury all but confirmed that in the 23 November autumn statement they will agree that there should be a fiscal stimulus, that austerity has failed and that they are now going to embark on a new start in relation to infrastructure stimulus. Unfortunately, our argument to the Chief Secretary that he should also stop the austerity pressure on our resource budget has not got through yet. Certainly, part of the message that we have been giving for many years about investing to grow the economy is now getting through and we will get a boost to infrastructure spend in the 23 November statement.
Mr Mullan: Does the Minister agree that Executive secrecy is no way to do business in the House and that bypassing the Finance Committee's scrutiny of the draft Budget and the full Budget does not facilitate a proper scrutiny process?
Mr Ó Muilleoir: I thank the Member for his question but I do not agree. I have appeared at the Finance Committee twice and I am happy to appear again at its request. What you have seen here is a division between those who want to oppose and those who want to invest, those who want to complain and those who want to build, those who want to find a reason to pick at a scab and those who want to heal. What we are seeing here today is a first-step economic stimulus, which we have not tried for many years. We tried it at the height of the crash. We are seeing money being released for defibrillators in ambulances and to maintain and repair our roads. Money is going into our schools to buy new equipment and to maintain, do up and enhance the school estate.
For me, those things are what today is about. I will make neither excuses nor apologies to anyone for delivering on behalf of this Executive. In fact, had I come here today and said that we are facing an October monitoring round of further cuts, then there would be something to apologise for. Instead, we are coming here and saying that we are able to buy more buses and ensure that we have a 21st-century bus fleet for Translink. We are saying that, for the first time, we are trying to partner community organisations in a very focused way over the next few months to try to buy some key properties in working-class areas so that they can continue the work of building a shared future. So, I am sorry for the Member, but I do not agree with him.
Dr Farry: I thank the Minister for his statement. He will be well aware that, before the reforms announced by the Minister this morning, healthcare inflation was running at 6% but the Budget increase for the Department of Health this year was only about 2%. However, in this statement, the only money for Health is in the form of the very welcome muscular dystrophy funds.
Is it safe, therefore, to assume that the Department of Health can live within its budget this year and there will not be recourse to monitoring rounds to fund healthcare, as there has been in previous years, and that we will avoid what happened last year, when a last-minute bid for waiting lists was not fully spent on waiting lists?
Mr Ó Muilleoir: I thank Mr Farry for his question. I see that our efforts to take the politics out of health have not made it to the afternoon.
My commitment to the Minister of Health is that we know that there will be a cost to the new path on which she has set all of us in this society. She is outlining a vision of trying to manage change rather than managing crisis. The Executive as a whole will have to step up. I hope that one of the lessons or messages from the joint meeting of the Executive today was that we all understand that this is a priority, and, when Professor Bengoa says, rather forthrightly, that if Governments across Europe cannot control expenditure on health, health will take up the entire public purse.
The Health Minister is setting us on a bold and ambitious path. It is a path that requires partnership not only among the Executive parties and with the Minister of Justice but across the Assembly where we take the politics out of health and commit ourselves to trying to improve outcomes in a more efficient health service.
We stand ready to support the Health Minister as she comes forward with her request. The allocation of resource DEL is as outlined, but the Member will not have missed the point — he was here for the Minister of Health's statement — that there will be an added requirement on all of us to make sure that we have the fiscal firepower to deliver the change that everyone wants to improve our health service.
Ms P Bradley: I thank the Minister for his statement. I welcome the money that has gone towards health through the allocations, albeit that we could probably have had a lot more. I am sure that the Minister came to you with many emerging priorities.
I want to follow on from what my colleague, the Chair of the Finance Committee, said about the transformation fund. Will the transformation fund be used to support the healthcare reform as the Minister outlined earlier?
Mr Ó Muilleoir: Reform and improvement have to go together. We are now set on a path of improving, changing and transforming our health service in a way never seen before. I heard the Minister refer to the two-mandate challenge, and there will be a role in that for the public sector transformation fund. However, let us be clear about this, and I know that the Member will agree with me: we will protect front-line services in health and, of course, in education. The Ministers will manage their budgets and will do so in partnership with the entire Executive. Common purpose means that we are very understanding and sympathetic of pressures when they emerge, but it also means that Ministers give the lead. In that respect, we saw strong leadership this morning not only from the Minister of Health but from the Executive.
Ms Dillon: I thank the Minister for his statement and his answers so far. He referred to a more efficient process, which a number of Members mentioned. How does the timing of this year's delivery of monitoring rounds compare with previous years?
Mr Ó Muilleoir: It is no surprise to the public that, because we have an Executive facing in the one direction and firmly focused on a shared and prosperous future and on making the investments we need to build a strong economy, I have had the good fortune to be able to deliver the monitoring rounds in a more expeditious fashion than heretofore. I spoke about the difference in timings between now and last year. More important than that is this new start, this fresh start and this Executive, who, despite deep political differences, are able to make common cause on these key issues. I think that people on the ground will see the difference in that. If I was a school principal or governor waiting for urgent moneys to repair classrooms or improve and enhance a school estate, I would be pleased. I would be more focused on the outcome than on any concerns about the timing of the announcement.
In all these matters, alacrity is important, and I am really keen to work with the Committee, the Assembly and my Executive colleagues to deliver as we promised. That means June monitoring in June, October monitoring in October and January monitoring in January. The added bonus is that, if we work together, we can identify the pressures that are most urgent. As Executive Ministers, we are making choices together, not just in our own little patch or silo, and we are making decisions that are for the good of all the community and all of society rather than just on behalf of our Departments.
Mr Storey: I thank the Minister for his statement. I have campaigned and continue to campaign for nurture units, so I am glad that there is an allocation of an additional £1 million in his statement. Given that Holy Family in Londonderry received the nurture quality mark just this week, it will be welcome news to those involved in nurture.
May I specifically ask the Minister about the planned investment fund and his request to the Chief Secretary for special dispensation? Will he consider widening the urban focus of the planned investment fund beyond the two cities of Belfast and Londonderry so that areas in my North Antrim constituency, such as Ballymena, Ballymoney and Ballycastle, could benefit?
Mr Ó Muilleoir: I thank the Member for his question. My concern extends to his constituency and wider. That said, when I was in Portrush last week, I was deeply impressed by the plans to develop the town to coincide with the Open. What made a real impact on me was the number of small, indigenous businesspeople in the private sector who want to make a contribution and want to invest. They now see an opportunity that would be good for them as businesspeople and really good for Portrush. I have visited Ballymena and Ballycastle, and, as you know, in Ballycastle, evidence of an investment can be seen in the hotel right on the beachfront. That has made a difference.
I say to the Member that we will have the investment fund. We did, of course, have a difficulty with the European Investment Bank that we did not expect, but the response is not to abandon ship but to find an innovative and novel way in which we can have the investment fund. I agree absolutely that TLC is needed not only in the jurisdiction's two large cities but for the opportunities that exist outside them.
My final point is that perhaps still the most impressive initiative that I have visited since my appointment was the South West College in Enniskillen, and I know that it hopes to get new premises. There are opportunities like that across the region — I hope that they will not depend on the investment fund — and I hope that we can seize them, not just those in Belfast and Derry.
Mr Nesbitt: Earlier, the Minister encouraged us to move away from the fine detail and focus on delivery, so let us do that but include non-delivery, such as the £5 million that the UK Government are not delivering to address paramilitary activity because the Executive do not have a proper plan. This is an either/or question: is the Minister embarrassed that the Executive have to submit their homework to London for marking, occasionally getting an F for "failure", or is it UCUNF's fault?
Mr Ó Muilleoir: I thank the Member for his question. I am happy for you to focus on minutiae. In fact, I know that it is an area of expertise for the Opposition, but I am focusing on delivery. I made it clear to the Chief Secretary to the Treasury yesterday that we would ensure that we deliver stable, sustainable budgets and that we would work in partnership with them on Fresh Start funding but, ultimately, our Ministers would make the decisions. I am confident that the Minister of Justice will be able, in negotiation with our colleagues in Treasury, to deliver an action plan, as they desire.
For me, the overarching point is this: we have taken decisions today that are to the benefit of the community. We have taken decisions that will accelerate economic growth. We have taken decisions that will create jobs. We have taken decisions that will make a real difference in the heart of areas such as east Belfast, Tiger's Bay, the Creggan and Ballymurphy.
It does not surprise me, because the Member is focused on opposition for opposition's sake, that he can see nothing worthy or to be lauded in that. Instead, he wishes to give succour to the British Government, who have created perhaps the greatest economic mess of our time [Interruption.]
I know that the Member would like to interrupt, but I will push on. He is very fond of and close to the British Government. He was involved in the architecture of the Tory austerity programme at the very start in 2010. We will focus on making a step change in delivery for our people.
You have my full blessing to focus on minutiae, if you wish. I am happy to go there with you as necessary. You have my full blessing to support the NIO and the Treasury in what they do. However, what I say to Members is this: regardless of taking the politics out of health, let us take the politics out of creating a better future for our people. Let us applaud what deserves to be applauded and criticise where criticism is necessary. To give no welcome at all to this first-step economic stimulus or to our efforts to grow jobs and to create a better future says everything that needs to be said about the failed austerity politics of the British Government, which, of course, were brought into being in the company of our friends in the Ulster Unionist Party as part of the gloriously named UCUNF.
Ms Archibald: I welcome the Minister's statement and the first phase of the economic stimulus package. Will the Minister elaborate on his discussions with the Chief Secretary on protection for financial transactions capital going forward, le do thoil?
Mr Ó Muilleoir: Gabhaim buíochas leis an Chomhalta as a ceist. I should put it on record that, at our meeting yesterday with the Chief Secretary, David Gauke, at the Treasury in London, we had full and firm support from our colleagues in Scotland and Wales. Of course, when we speak together, we speak for 10 million people, not only in our opposition to austerity and our demand for a fiscal stimulus in the autumn statement but in our particular difficulty with financial transactions capital because of the new approach taken by the European Investment Bank. I am pleased to say that, with the three Governments speaking together, we put our case. The Scottish and Welsh also brought up issues that the Treasury — I do not want to say "gave ground on" — moved to a compromise on.
I am now confident that we have £77 million financial transactions capital. Some of my colleagues in the Ulster Unionist Party were fretting in the newspapers that it would be lost to our Budget. If they had called into my office to speak to me first, they would not have made the mistake of thinking for a minute that we would allow any of our resources to go back to London, resources that are given to us to build this society. I am confident that the Treasury will work with us now; that we will not lose any of the financial transactions capital, even if it is unallocated at year end; and that we can now move confidently forward to create the investment fund, the idea of Simon Hamilton when he was Finance Minister. The investment fund concept has been really welcomed by the business community, and people are lining up to engage in new projects if they can get some of the investment fund. We are on course, and it is appropriate to thank David Gauke for his flexibility on the issue.
Mr Stalford: I thank the Minister for his statement to the House. I also want to briefly welcome the allocations that the Minister detailed for Urban Villages and the social investment fund. Does the Minister agree that it will be essential for the work of the Executive Office in China to become a baseline budgetary item, particularly as Northern Ireland becomes more outward looking and tries to secure international investment?
Mr Ó Muilleoir: I do not think that the First Minister and deputy First Minister would allow me to take over their budget or budget priorities. However, I will say this in agreement with the Member. I was speaking at the weekend with Shaun Kelly, the global CEO of KPMG, who sits on the north-east USA advisory panel for the Minister for the Economy. He is just back from China and met our lead representative there, Tim Losty, who did sterling work for the Executive in Washington and, before that, when the Member was still at kindergarten, for LEDU on investment in working-class areas of the city.
I have found any project that Tim Losty has led on behalf of this Government to have been a worthy one. There are great opportunities there. They require diligence and focused effort. I am pleased to see Ulster University, Queen's University, Belfast City Council and the Executive really lining up together to make sure that we seize those opportunities. I am very sympathetic to efforts by the First Minister and the deputy First Minister to ensure that our efforts in China have adequate resources in the time ahead.
Ms Hanna: I share the concerns of other Members about the bypassing of Committees. My question refers to the £5 million community regeneration fund, which is referred to in writing as "improving" key assets but which the Minister just described as "buying" key properties. Can he outline the process for applying to the fund, what the maximum capital will be for projects and whether he can guarantee that this will be transparent and not an invite-only fund like the previous social investment fund?
Mr Ó Muilleoir: I thank the Member for her question. When we were here for June monitoring, the Member discovered allocations that were not made and issued a statement immediately saying that my wonderful officials had got it all wrong, so I am glad that at least this time she accepts the figures. We are making progress. I hope that by January monitoring she might be in a position to welcome the investment that we have made in our health service, our education service and other projects.
The Member might not understand this, but allocating capital DEL is quite a challenge at this stage of the year. It really means that, if, for example, you take the Ballybeen autism centre, which is a really imaginative, innovative and important project in the heart of a working-class area, we could not allocate funds to build because you could not tender and build at this time of the year. Other projects, such as an Cultúrlann McAdam Ó Fiaich, are being well advanced. As everyone in the Irish language sector — pobal na Gaeilge — knows, it has a really inspiring plan to build up what is already the country's greatest Irish language arts centre into a beacon of progress for the entire city at the heart of the Gaeltacht Quarter. It has a project that involves the swift allocation of capital moneys. There are, in fact, projects already on the table. Members who work at the grass roots will know about some of them.
The Member and I share concerns about the speed of delivery. The window of opportunity of £5 million to make transformative investments largely has to go into property or land acquisition or into equipment in some cases. What I will say to the Member is that she and I share the desire that this money be allocated before 1 April, so it cannot be a long-run process. I think that it will be a process that will be welcomed across the community. It is a test for us, because, when I talk about First Step Stimulus, what I am really presaging is what I hope will be the Executive coming together and saying that, from the capital budget for 2017-2021 plus whatever additional infrastructure Barnett consequential there is on 23 November plus hopefully a £200 million loan facility for councils from the European Investment Bank, we are able to fashion a much more strategic, large and meaningful stimulus package — really a Fresh Start package — in our budgets next year.
For now, this is a first step in a stimulus package. For me, it was important that we did not do the First Step Stimulus package without putting some into the communities that have not received enough of the peace dividend. I represent South Belfast, parts of which have done well and some not so well. For me, the First Step Stimulus package would have been incomplete if we had not made a commitment to communities that have great opportunity and are really thirsting for a brighter future.
Mr Humphrey: I welcome the announcement of a £5 million community regeneration fund. It is not enough, but it is a good start. I also welcome the £15 million for roads structural maintenance. That is vital. The Minister will recognise the importance of Belfast as a tourism and transportation hub for Northern Ireland. It is Northern Ireland's economic driver.
Despite the politicking of last week, does the Minister agree with me that the York Street interchange is vital to Northern Ireland, particularly in terms of industry and commerce? It connects three motorways, the George Best Belfast City Airport with the west, and the port of Belfast. Does the Minister agree with me that the York Street interchange remains a key priority for the Northern Ireland Executive?
Mr Ó Muilleoir: I thank the Member for his comments. I note that he waited until Mervyn Storey left before he turned the focus back on Belfast. I agree with him: York Street interchange is a key project for the Executive. I go further: I believe that, together, we will deliver the York Street interchange.
I made the point yesterday to David Gauke that, if I were to build a new home and I had the money to build 60% of it, it would not be prudent to move ahead, build 60% and hope that I get the other 40%. The Member will understand that we moved the British Government on their commitment. At first, there was no guarantee over EU funding. They then moved to guarantee a certain degree. Now, they have moved to guarantee until an exit, if it happens. Yesterday I said to David Gauke, "Look, go the extra mile and commit to funding. Even if it comes a month after you exit, you should still commit to cover that". There is still a gap there that we will start focusing on with the British Government in the time ahead.
As the Member knows, the commitment was made that no funding or projects would be lost. I hope that, in the days and months ahead, we get that commitment. That will enable us to really press ahead with all types of projects that could have funding streams coming and letters of offer issued after March 2019. The Member and I are agreed on the importance of York Street interchange, and I hope that we will see it delivered by our Government.
Mr McAleer: As my party's infrastructure spokesperson, I very much welcome the announcement of the £15 million additional money for road structural maintenance. Coming on the back of the £10 million rural roads initiative, it is very welcome news.
Yesterday, Minister, you joined your Scottish and Welsh counterparts in calling for a shift from austerity to stimulus. How confident are you that that message will be heard? What can the Executive here do to inject much-needed economic stimulus?
Mr Ó Muilleoir: I would love to say that David Gauke and Theresa May took my advice, but I will quote from what the 'Financial Times' has been saying about stimulus for some time, not only because borrowing rates are at historic lows. It said:
"Stimulus policies cannot reverse the long-term effects," —
of the uncertainty following the EU referendum, but it can:
"lessen uncertainty and mitigate the shock."
That is true of a stimulus package at this time. It also said that a stimulus package can accelerate economic growth and improve opportunities. There has been a Damascene conversion on the part of the British Government on the issue. Members will know that we asked for additional investment over many years at the height of the lunatic drive towards ideological austerity, and we did not receive a hearing. Now, because of, whatever about our import and influence, the voices of influential bodies, including newspapers like the 'Financial Times' and economic commentators like Robert Reich, the British Government realise that they need to invest in infrastructure. We will get a Barnett consequential from that, and we will then put our shoulder to the wheel to create, I hope, with the agreement of the Executive, a greater stimulus package.
Mr Ford: Since I never had any connection with UCUNF but did have a small part in setting up the three-person panel on paramilitarism, I hope that the Minister will give me a straight answer. I welcome his statement, but he acknowledged that only £3·9 million out of £10 million budgeted for tackling paramilitary activity has been allocated at this late stage in the year — the last occasion for planned realistic changes to budgets. That is largely because of the failure to publish the proper action plan that was due in June of this year. Given the expertise that the Minister and his Department have, will he advise the House whether he has given any advice to other Ministers about their complete failure so far to put together the action plan that is so sadly needed? It means that we are losing out on £5 million of Treasury funding.
Mr Ó Muilleoir: I thank the Member for his question. The last time I saw him, he was on the stage with the Belfast Community Gospel Choir singing, 'Oh Happy Day'. I thought, perhaps, you would give us a few verses of that today in response to this first step economic stimulus.
When Claire Sugden was appointed, she asked, "Who will I turn to for advice?", and I said, "David Ford, of course". Here you are today, giving her advice. I do not know whether it is tinged with envy; I am not going to suggest that it is. I am confident that all Ministers will deliver and that the Justice Minister, in particular, will deliver on her promises and pledges based on the budget she has been allocated; that that money will be spent and that none of it will be lost, and that it will do the work that the Member worked towards in uniting our community and tackling paramilitarism. I am confident that it will deliver on that pledge in the time ahead.
Mr Swann: I thanked the Minister earlier for his blessing in dealing with the minutiae, because I will do that. The Minister refers to renewable heat incentive (RHI) and to the Department for the Economy's management of a number of internal reallocations, such as £1·4 million from apprenticeships and youth training, £600,000 from shared skills and £1·7 million from Invest NI to cover a shortfall of £3·7 million in the RHI scheme. What period does that £3·7 million cover? Has any of the £20 million that has already been brought down by the Executive been utilised yet?
Mr Ó Muilleoir: I thank the Member for his question to go with the minutiae. The good news is that the Economy Minister is up for questions shortly and you can probe him on how he made his allocations.
One of the things that pleased me greatly over recent weeks is that, first, we moved £20 million to the centre, as you know, in June. That has not been used yet, but it is a contingency, and we know that RHI is causing us problems. You will know about this, more than most, since you chair the PAC. I was pleased that the Economy Minister and his Department tried to absorb some of the pressure rather than coming back to October monitoring saying that they needed an extra £7 million or £8 million. The Economy Minister will have to answer in more detail as to why he was able to do that. We will take that money and see how it can be used to offset the costs of RHI.
The second thing that I would say to the Member — I know it will please him as well — is that I think we are making progress with regard to RHI. Last week, your colleague talked about the exorbitant costs if we do not get it in check. I hope that the Economy Minister, at Question Time in the near future, will be able to able to give you some comfort in that regard. We are absolutely united in making sure that we control the RHI cost and that we, as far as possible, eliminate it in the time ahead because it is a drain on our budgets.
Mr Robinson: I thank the Minister for his statement. Will the very welcome £2·5 million resource DEL allocation to Eglinton Airport be used for new national or international routes?
Mr Ó Muilleoir: I thank Mr Robinson for his question. As the Member knows, some of this was trailed previously in the press in relation to drugs and the city of Derry investment. It is the hope of the City of Derry Airport that it can actually create a jobs boost by locating a manufacturing or maintenance facility at the airport which can use the resource that the airport has — for example, the hangars, not only the equipment but the airport itself. I hope to hear more news coming out of the City of Derry Airport on its plans. We know that all airports are under pressure, not least because of air passenger duty, and there were a couple of body blows to the City of Derry Airport earlier in the year. I am confident that the City of Derry Airport realises that it has to use this money in a way in which it will actually try and base jobs there and perhaps create a new initiative. I hope that that happens in the time ahead.
Mr Attwood: I thank the Minister for his statement. Referring back to your meeting yesterday, did you raise the issue of corporation tax with the Chief Secretary to the Treasury? Given Mr Gauke's previously stated views that this will happen only when his Government agree a reform package with this Government, has the issue of corporation tax devolution, 18 months from now, been put firmly on the back boiler?
Mr Ó Muilleoir: I think that the RHI has got you confused; it is the back burner that you put things on. We have many boilers going in the RHI.
I can tell you this about Mr Gauke in all honesty: to save his own blushes, he did not pretend for a minute that the delay in corporation tax was on our side. Let us be honest: these are the guys who have no idea what they will announce about their own corporation tax on 23 November. This is the Government who have created what Mr Hammond refers to as "economic turbulence" at this time. This is the Government who cannot tell us with absolute certainty what they will do with our resource budget in the time ahead. There were indications yesterday but not absolute certainty.
The Chief Secretary, by the way, did not mention the issue of reform at all, but I went back over the rule book with him. I am committed and confident that we will introduce a reduced rate of corporation tax on 1 April 2018. We will do so to create thousands of jobs and a step change in our economic growth, which will benefit, in particular, communities that have not seen the economic bounty that they should have in the past. I am taking his own views from him on the issue. The Member will know — he has spent many years in the corporation tax furrow — but he understands that there is a negotiation ahead. He also understands that, until the 23 November statement, which is around the corner, and a clear declaration of where their corporation tax is going, we cannot have the type of intense negotiation that we need to have, but we are on track.
If the Member wishes to put pressure on the British Government in this regard, he can be my guest. Let the British get the 23 November statement out of the way. Will they commit to 17% or something else? I think that there may be no change, neither that suggested by George Osborne nor by the papers at the weekend. We will do our bit, and I am committed and confident. We will make it affordable, because that is in the Fresh Start Agreement as well. We will make sure that it opens up a discussion and conversation with the British about how we grow the economy in the time ahead and how they make sure that we have all the fiscal measures to do that, not just corporation tax. We are very much on course; it is not on the back burner at all.
Mrs Overend: I thank the Minister for his statement. Many schools across the country continue to lobby MLAs. They are crying poverty, and the wells have truly run dry. Many redundancies have been made, and the delivery of the entitlement framework is under threat. While I welcome the £13 million capital budget given to the Department of Education for minor works and the purchase of furniture and equipment for schools, I am disappointed that there is no resource budget allocation. Has the Finance Minister had any discussions with the Education Minister about the way that schools can spend the money allocated to them, so that they have more control and can achieve better value for money? If not, will he commit to doing so?
Mr Speaker: Minister, I must ask you for a short, sharp and concise answer.
Mr Ó Muilleoir: I thank the Member for her question and would be happy for her to put that question to Peter Weir. I welcome her welcome of the extra injection of capital funds into schools.
Mr Speaker: The Business Committee has agreed to meet at 1.00 pm. I propose, therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The first item of business will be Question Time. Questions on the ministerial statement will resume after Question Time, when the next Member to be called will be Richie McPhillips.
The business stood suspended.
The sitting was suspended at 12.59 pm.
On resuming (Mr Deputy Speaker [Mr Kennedy] in the Chair) —
Miss McIlveen (The Minister of Agriculture, Environment and Rural Affairs): Officials from my Department first learned of the incident in the early afternoon of Saturday 8 October 2016, and on-call officers from DAERA's Northern Ireland Environment Agency (NIEA) and inland fisheries division immediately travelled to the scene. By late afternoon, the source of the spill had been traced and samples taken with a view to enforcement action. Inquiries at the source site also quickly determined the precise nature of the chemical involved in the incident and thus the detailed ecological and toxicological information on the potential hazards that it poses. Officials from my Department promptly notified, and have continued to work closely with, a range of other agencies to ensure that every possible risk to the environment or public has been considered and addressed.
As far as the potential ecological harm posed by the spill is concerned, there are three broad lines of inquiry into mitigation: first, the absolute necessity of protecting public health; secondly, an assessment of the pollutant's effects on fish and fauna in the river; and, finally, an assessment of any potential damage to commercial shellfish beds where the river enters Dundrum Bay.
As far as the risk to public health is concerned, the data on this chemical confirms that although it is toxic to fish, it does not pose a significant risk to human health. Nevertheless, my Department has worked closely with relevant agencies, including the Food Standards Agency and Newry, Mourne and Down District Council, to ensure that all possible risks are considered and addressed. All of the evidence to date confirms that there has been no risk to or impact on public health.
With regard to the effect on fish and fauna in the Annsborough river, the chemical involved is toxic to fish. Inland fisheries officials have confirmed that in excess of 1,600 fish were killed, including adult salmon and sea trout, and this will undoubtedly have an effect on the river for many months to come. However, the inland fisheries division is already working with others to consider how the river could be restocked. NIEA is also carrying out a biological survey of insects in the area.
Mr McKee: I thank the Minister for her answer thus far. Does the Minister agree with me that until people in public bodies, such as NI Water, begin to be held to account for these incidents of pollution, the current penalties will continue to prove ineffective?
Miss McIlveen: I thank the Member for his question, and I agree with him about those responsible for pollution incidents such as this, be they from public bodies, in business or private individuals. There is a process within which my Department has to operate, but we also need to look at education and advocacy alongside our enforcement rules. While NI Water has admitted that it is responsible, there is an ongoing investigation.
Mr Easton: I thank the Minister for her answers so far. I understand that Northern Ireland Water has accepted responsibility for the fish kill at the Annsborough. Has it been associated with many fish kills previously?
Miss McIlveen: I thank the Member for his question. Since 1 January 2012, there have been 44 major or moderate fish kills in Northern Ireland where the cause was a polluting discharge. Northern Ireland Water has been determined by NIEA as the source of two of the 44, with a further two incidents, including last week's in the Carrig river, at various stages of the enforcement process. In 2010, a moderate fish kill associated with Tandragee waste water treatment works resulted in a £5,000 fine, and, in 2014, a moderate fish kill associated with the pumping station in Ballynahinch resulted in a warning letter from NIEA, and £1,600 in fishery restoration costs were recovered from Northern Ireland Water.
Mr Lunn: The Minister is aware, as she commented herself, that this is only the latest in a long string. We have had the Faughan, the Ravarnet, the Comber river, the Lagan — I forget some of the others — the Sixmilewater and the Three Mile Water just in recent times.
Mr Lunn: Does the Minister agree with me that, in fact, the sanctions and the punishments are available through the existing law to deal with this kind of pollution incident much more seriously, but the courts very rarely impose a fine that to the rest of us would seem commensurate with the actual offence? The fines are piffling.
Miss McIlveen: I thank the Member for his question. Obviously, the whole issue around pollution is something that I do take seriously, and it does cause me concern. It has happened in rivers in my constituency, and I understand the impact that it has on the habitat and on those who use the rivers. Very often, as you say, it does not seem that the fine is commensurate with the crime that has been committed. I am happy to have further conversations about this and to pursue it, and I am open to conversations with Members as well.
Miss McIlveen: The Department introduced the Clean Neighbourhoods and Environment Act (Northern Ireland) 2011 to allow councils to issue fixed penalty notices of up to £80. The number of fixed penalties issued by councils for litter offences increased to 4,443 in 2014-15, up from 3,268 in 2011-12. Where the case is dealt with by the courts, a fine of up to £2,500 can be imposed. I will continue to keep the situation under review, taking appropriate action where necessary.
The Department also introduced the carrier bag levy in April 2013, which has reduced the number of bags dispensed in Northern Ireland by tens of millions every year, and thereby reduced the number of bags littering our public spaces. The levy is the most extensive of any of the carrier bag charging arrangements on these islands and has generated millions of pounds for local environmental projects, including anti-litter projects. A review of the charge, as Members are aware, is currently under way.
Education is a vital component in the fight against litter, and, to that end, DAERA works closely with councils and NGOs to develop and support educational and promotional campaigns aimed at achieving behavioural change. For example, my Department provides significant financial support, nearly £945,000 in the period 2014-15 and 2016-17, to Keep Northern Ireland Beautiful, which runs a number of programmes, including Eco-Schools and Live Here Love Here. As of January 2015, Northern Ireland was the first country to have every school signed up to the Eco-Schools programme. Additionally, NIEA runs a fly-tipping partnership programme with councils to clean up fly-tipped wastes. My Department is using a combined approach of legislation, education, awareness and enforcement to tackle litter in Northern Ireland.
Mrs Cameron: I thank the Minister for her answer. I am very aware of how successful the challenge fund has been in south Antrim, in particular, especially around the eco-schools. I am thinking in particular of Ballycraigy in Antrim and Fairview in Ballyclare and the tremendous work they are doing and how that education goes home to the parents as well. I very much welcome that. Have you any plans to reopen this fund?
Miss McIlveen: I thank the Member for her question. I am delighted to announce today that an initial £400,000, sourced from the carrier bag levy, will be available for the challenge fund in the current financial year for not-for-profit organisations delivering projects that aim to improve the local environment and boost civic pride. This funding of £400,000, with potentially further support later in the year, will enable local communities, schools and voluntary organisations to undertake small-scale projects to improve the environment and deliver environmental education. Community groups, for example, can use the funding to enhance their local area through tidying a local beach or neglected beauty spot or by creating and enhancing areas where the public can enjoy the local environment.
I am pleased to be able to deliver further resources for the fund and ensure that this good work in our schools and communities can continue. This competitive fund will award moneys to organisations delivering projects on civic pride, access and recreation, education and awareness, and environmental management.
To date, more than £4·6 million has been awarded from the challenge fund, enabling almost 600 environmental projects to be carried out. I am pleased to be able to deliver further resource to ensure that that good work continues.
Mr McPhillips: The Minister has touched on the subject of my question a number of times. Do you agree that the plastic bag tax has greatly contributed to a reduction in litter in urban and rural areas?
Miss McIlveen: I thank the Member for his question. I do, indeed. The challenge fund has made a huge difference, particularly in getting schools and communities involved. That is why I am particularly keen that, in this new element of the fund, we include the theme of civic pride, because that is incredibly important. As elected representatives, we all engage with our local communities and village groups and understand the pride that they have in their local area, and this is just to help encourage them to do that. This is therefore an incentive as much as anything else, but it has made a tremendous difference.
Mr Smith: Minister, you mentioned in a previous answer fixed penalties for littering. As two councils seem to account for 67% of all fixed penalties and with the bill for street cleaning topping £40 million for the first time, what plans do you have to encourage other councils to use their fixed penalty powers more?
Miss McIlveen: I thank the Member for his question. There is a disparity there. An education programme needs to be carried out not only in our communities but alongside our local councils. I am aware, given the changes to local councils and changes in personnel, that there are probably a variety of policies still being looked at and addressed by each council. Therefore, following on from today, I will be content to have conversations with councils, particularly with my officials leading on that to ensure that their use is encouraged. In the first instance, however, we need to try to have an education programme to avoid littering.
Mr McAleer: Has the Minister given any consideration to working towards having a zero-waste policy?
Miss McIlveen: I thank the Member for his question. A zero-waste society does not necessarily mean that we produce no waste. It is about trying to reduce the amount of waste that goes to landfill. There is currently a policy of promoting reuse and recycling, which will hopefully lead to zero waste. The Department published 'The Road to Zero Waste' in September 2014, and it is something that we are working to achieve. There are a number of projects in each council area around the circular economy and encouraging business to get involved with that. In my constituency, I am aware of a large business that says that it has zero waste. It has invested a considerable amount of money in its plant to ensure that everything is recycled or reused. It is about trying to encourage that and about changing the mindset of people and their attitude to waste.
Miss McIlveen: My Department is responsible for the conservation and protection of salmon and inland fish stocks on Lough Neagh and for the issuing of licences for commercial fishing of eels and scale fish. It also provides financial assistance to the Lough Neagh Fishermen's Co-operative Society towards the eel restocking programme, which is a conservation measure outlined in the EU eel regulations. The Department is satisfied that the cooperative is complying with the conditions of funding contained in the letter of offer. That funding is not related to the issue of commercial permits.
The fishing rights for Lough Neagh are owned by the cooperative, and it is a matter for that organisation to manage its own interests, including the issuing of permits to allow fishermen to fish for eels and scale fish. The Department has no role to play in that process. The rules regarding the issuing of permits to fishermen are agreed by the cooperative, and any applications for permits are considered against the criteria. Although under no obligation to do so, the cooperative has provided my officials with clarification and supporting documentation on the processes for administering applications for permits, and, indeed, it has been the subject of two judicial reviews in the past.
The lough's fish stocks are a finite resource, and the cooperative must control fishing intensity to ensure the long-term sustainability of the fishery. The serious decline of eel stocks across Europe has intensified the need to manage stocks effectively.
DAERA inland fisheries officials are currently finalising a fishery management plan for Lough Neagh, which aims to ensure the sustainable management of fish stocks on the lough and to maximise the socio-economic benefit of the fishery for communities around the lough shore, the local economy and the ecology of the lough. One of the recommendations in the draft plan, which was agreed by stakeholders, was the introduction of a scale fish permit system, and this has now been achieved.
Mr E McCann: I thank the Minister for that. I know that the Minister is aware of the very strong feelings that exist among some fishermen around Lough Neagh, particularly on the part of those fishermen who, although they are members of the Lough Neagh Fishermen's Co-operative Society, find that they have not been able to and cannot get from the cooperative —
Mr E McCann: Given that background and given that the Department has, at the very least, because of the public money involved, an overall supervisory role, will she agree to meet a number of the fishermen who are aggrieved and discuss the matter with them further?
Miss McIlveen: I thank the Member for his question. He may be aware that, in the last mandate, I chaired the Committee for Culture, Arts and Leisure for a number of years, and, during that time, I met the fishermen on a number of occasions and went to Toome to meet the cooperative as well. I am more than happy to meet the fishermen to discuss their issue. Although I have met with them, I am happy to do that again with this particular hat on.
Mr Swann: The Minister is well aware of this issue. Minister, can you give us an update on what actions are being taken to tackle salmon poaching and illegal fishing on Lough Neagh and illegal fishing in full? I am also aware that her predecessor promised a full audit of all of the fish stock in Lough Neagh. Has that been completed yet?
Miss McIlveen: I thank the Member for his question. I am happy to have those conversations in relation to the audit. I was not aware whether it had been completed or not. I do not have that information, but I am happy to provide it.
Mr Ford: The Minister indicated that officials had discussed the allocation of licences with representatives of the cooperative. Can we take it, therefore, that she has not yet had discussions with the members of the cooperative who are currently not allocated licences and are currently in dispute with the cooperative?
Miss McIlveen: I thank the Member for his question. The conversations that I had in the past were when I was wearing a different hat. My officials speak regularly with the cooperative, and, over the last number of years, they have spoken regularly with members of the cooperative who do not have permits. I was in attendance at those meetings as the Chair of the Culture, Arts and Leisure Committee. I have not met them in my current role, but I am happy to do so. My officials will accompany me at the meetings.
Mr Humphrey: Minister, what is the current position regarding commercial eel fishing in Lough Erne?
Miss McIlveen: I thank the Member for his question. In December 2008, the UK submitted 15 eel management plans, including the trans-boundary plan for the Erne system, for individual assessment to the European Commission, covering the river basin districts as defined under the water framework directive in England and Wales, Scotland and Northern Ireland. These plans were approved by the Commission and the management committee for fisheries on 4 March 2010 and are being implemented in accordance with the regulation.
As the Member will know, the eel fishery was closed in 2010 as a condition of the EU approval of the north-west eel management plan, and some 17 Lough Erne fishermen who applied each year for licences and permits issued by the former DCAL to fish for brown eels could no longer do so. Following the closure, local eel fishermen were entitled to tender for participation in the trap-and-truck conservation fishery, which catches silver eels and moves them downstream off the two dams. This provided potential to an alternative source of income for the fishermen after the closure of the commercial eel fishery. A range of conditions and actions in the eel management plan are being kept under regular review, and progress on these is reported to the EU. To date, there has not been any variation or amendment to the conditions applied to the eel management plan.
Miss McIlveen: In 2015, my Department provisionally approved applications to the regional reserve and the young farmer payment from young farmers who had become head of holding and were not in a position to provide all the required evidence to support their applications. My Department has sought the necessary information in recent weeks in order to prevent any delays to the 2016 payments. I am pleased that many young farmers have provided the information required. My officials have assessed the information speedily and have issued advance payments to those who have satisfied the criteria. Where there are outstanding issues with an individual’s young farmer payment and where possible, my Department has made an advance payment on the other elements of their claim. I strongly encourage all farmers yet to provide the required evidence to do so as soon as possible to ensure that full payment is issued to them in December.
Mr Girvan: I thank the Minister for her answer. How many or what percentage of young farmers have received an advance payment?
Miss McIlveen: I thank the Member for his question. Of the 1,780 successful applications in 2015, 593 have been paid an advance young farmer payment in October. Advance payments on the basic payment scheme and greening have been issued to 548 applicants with outstanding issues around the young farmer element of their payment. Therefore, 1,141 young farmer applicants from 2015 have received an advance payment for one or more elements of their claim in 2016. The majority of the remaining applications from 2015 have yet to provide the evidence necessary to make their young farmer payment in 2016. A small number with evidence supplied are yet to be assessed. Of the 746 new applications for the young farmer payment and/or young farmer regional reserve in 2016, 458 have been paid an advance payment. The remaining applications are being assessed or have been rejected.
Mr McMullan: Minister, the young farmer scheme has turned out to be very successful. Have you plans to put any new measures in place to encourage more young farmers to come forward? They are the future of the industry.
Miss McIlveen: I thank the Member for his question. Each year, there is an opportunity for new entrants to apply if they meet the criteria. I want to ensure that our agrifood sector is growing and is sustainable in order to encourage young people to get involved in the agriculture sector. I want to see a future for them in the industry. You will be aware that the Young Farmers' Clubs of Ulster and the Ulster Farmers' Union have been doing a considerable amount of work on succession planning. I look forward to having a meeting with them in the near future to see how we can assist them with that project. You will also be aware that additional weighting is given and will be given to young farmers in the capital element of the farm business improvement scheme to encourage those young people to get involved in farming and invest in their business going forward. It is critical that all of us support the farming industry and that those young people see a future in it and are encouraged to become involved.
Mr McGlone: Will the Minister outline for us details of any discussions or otherwise with Westminster on a replacement for the basic payment scheme?
Miss McIlveen: I thank the Member for his question. He will be aware that my Department has been working alongside Westminster on what future support for farmers might look like. He will be aware that I met Andrea Leadsom last week. I also hosted George Eustice in Northern Ireland. That visit allowed George Eustice to meet industry representatives and stakeholders and gave him an opportunity to look at the vision that he has for any potential support. It is about looking not at what we currently have but at what we could have. It is not about picking something off the shelf and applying it to Northern Ireland or the United Kingdom; it is about having a model that is bespoke to our needs here. There are ongoing conversations between me, my Department and Westminster on what a support system might look like.
Mr Allister: Will the Minister undertake to look at the departmental guidance on the young farmers' scheme, particularly with regard to the bizarre and seemingly unnecessary stipulations on partnership agreements? For some unknown reason, there is a stipulation that, although one is head of holding, one has to consent if a partner wishes to leave the partnership. That is unheard of in partnership law, yet it has become an obstacle to some young farmers who otherwise qualify qualifying for the payment.
Miss McIlveen: I thank the Member for his question. I am aware that that is a particular issue for Mr Allister and one of his constituents. I am happy to meet him and officials to discuss the issue and will make arrangements with him to do so.
Mr Aiken: I thank the Minister for her remarks so far. Is she aware that there is a great deal of anger amongst many young farmers about their applications and what they see as unwarranted checks on paperwork? Will she explain why her Department waited so long and so close to the issuing of this year's payments before contacting young farmers and asking them for the appropriate documentation?
Miss McIlveen: I thank the Member for his question. I am aware of the issue, which has been raised with me on a number of occasions. Very recently, I attended the Fermanagh group meeting of the Ulster Farmers' Union, and a number of young farmers raised the issue in the body of the meeting and spoke to me privately about it. I have raised with officials the issue of why the request was so late in the year. My understanding is that they wrote to relevant applicants in September, as they were unable to get the required evidence earlier to meet the deadline for receipt of the advance payments. I understand that a number of them have been able to get their information in on time and have been able to qualify for advance payments in October.
Miss McIlveen: With your permission, Mr Speaker, I will answer questions 5, 6 and 13 together.
The agrifood sector is much more important to the local economy in Northern Ireland than is the case in the rest of the United Kingdom. The percentage of total employees is 5·5% in Northern Ireland compared with 2·4% in the United Kingdom as a whole. In 2014, the Northern Ireland food and drink sector generated sales of £4·5 billion and employed well over 20,000 people. Around 28% of Northern Ireland food and drink sector sales are exported compared with 10% for the United Kingdom as a whole. Therefore, future trade arrangements will be important.
Over the past weeks and months, I have met a number of Ministers to discuss the important issues that need to be resolved. Last week, I met Andrea Leadsom and hosted a visit by George Eustice to Northern Ireland. I impressed on them the unique position of our agrifood sector. We had meetings with a range of agrifood, environmental and fisheries stakeholders and departmental officials. Yesterday, the First Minister and deputy First Minister attended the first Joint Ministerial Committee meeting on exiting the European Union, where they emphasised the strategic importance of the local agrifood sector and sought assurances that we would be kept closely and directly involved in the agricultural, environmental and fisheries policy and trade agendas as they unfold.
Mr Frew: Despite the doom-and-gloom merchants and the "Remoaners" in the House, it was really encouraging to see the EFRA Minister here last week at your invitation. You have already mentioned this, but it seemed that George Eustice was thinking outside the box. Can you give us any more specific details about support after we leave the EU?
Miss McIlveen: I thank the Member for his question. As I said to him earlier, George Eustice shared some of his early thoughts on what any support package might look like. He wants to be visionary. He is looking for fresh ideas and is not closing the door on anyone with ideas on what they might look like.
We do not necessarily have to look to what we had before; there is the opportunity for something dif