Official Report: Minutes of Evidence

The Chairperson (Mr Gildernew): I welcome, via audio link, Ms Anne Speed, chair of the NICICTU health committee and member of UNISON; Ms Claire Ronald, vice-chair of the NICICTU health committee and member of the Chartered Society of Physiotherapy (CSP); Ms Karen Murray from the Royal College of Midwives (RCM); and Ms Tanya Killen from NIPSA. In person, we have Mr John Patrick Clayton, policy officer for UNISON.

I welcome you all here this morning. We are very conscious that you play a crucial role in the design and delivery of healthcare. I now invite the witnesses to brief the meeting. Anne Speed will speak first, and she will then introduce other members of the panel. Anne, I invite you to give us your briefing, please.

Ms Anne Speed (UNISON): Good morning, Committee members and colleagues. I am sorry, but there is an echo on the line here. I am not —.

The Chairperson (Mr Gildernew): We are hearing you clearly, Anne. It may be difficult for you, but there is no echo here. It may be awkward for you, but we can hear you.

Ms Speed: Fine. Thank you. I will briefly tell you that the NICICTU health committee is composed of various unions affiliated to the Northern Ireland Committee, Irish Congress of Trade Unions. Our main focus is on policy development and implementation. In our work, we engage with the Department of Health; arm's-length bodies such as the Health and Social Care Board (HSCB) and the Public Health Agency (PHA); and healthcare trusts.

We do not engage in collective bargaining on behalf of our members. That process is undertaken by a separate structure. This morning, however, we have tried to construct our evidence into three parts. First, we will convey our overall concerns at a policy level. John Patrick, Claire, who is our co-chair, Karen Murray from the Royal College of Midwives and I will participate in that discussion with you and give evidence to the Committee. Thereafter, there are specific health workforce planning issues to raise, and we have invited our colleague Tanya Killen from NIPSA to participate in that discussion along with Claire and me. With your agreement, we will conclude our evidence by discussing social care. We know that the Committee has given the issue a lot of attention.

We submitted evidence to you on the live-in project. We know that it has caught your attention in particular. In that part of the evidence session, we will invite our colleagues from the Royal College of Nursing (RCN) and the GMB to join us to give their evidence and to answer any questions that you may have. The reason that we have structured the meeting in that way is to give the different cohorts of the workforce an opportunity to participate and to make sure that we bring to your attention a broad policy concern and the specific areas of concern for the workforce.

We find ourselves at a little bit of a disadvantage as a result of the announcement that was made on Tuesday by the Minister, in which he undertook to reform the Department of Health's governance structures. That has brought us to a position in which the policy structure that we had been engaging with appears to have been set aside. We had been engaging with the transformation advisory board (TAB). The TAB structure is of major importance and has attempted to play a significant constructive role in the transformation process, but, as I said, that appears to have been set aside. Although we were initially encouraged by the reference to ‘Health and Wellbeing 2026: Delivering Together’ and the need to work in partnership and bring together all relevant individuals and groups when changes to systems or services are suggested, we are now not sure where that conversation will take place. We would certainly insist that trade unions are social partners that represent the whole health and social care workforce and that discussions on the health and care system, and, indeed, on all the major challenges that we have had to rise to during the COVID-19 pandemic, have underscored the importance of a partnership approach and our role in dealing with all the challenges.

When we entered the COVID-19 pandemic, we had been through a period of sustained austerity. We are aware that the cost of providing care services increases by around 6% annually, and that level of investment is just to allow services to stand still. In the past decade, investment has not been forthcoming. That has left our members working in a service that is under-resourced and under pressure. I can tell members that, in the past nine weeks, I have engaged substantially with the infrastructural initiative that has been undertaken by the Department of Health to support the preparation of the acute sector in developing COVID-19-focused care; dealt with the Regulation and Quality Improvement Authority (RQIA) in its role as an oversight and guidance body for the social care independent sector; engaged with the PHA to try to define and determine guidance for our workforce; and liaised with the health trusts regularly to ensure that engagement with the workforce is absolutely guaranteed.

We have therefore been working at a mile a minute. We have been pressed to deal with crisis issues as they emerge. We have had difficulties with complicated guidance or absence of guidance; problems relating to personal protective equipment (PPE), such as undersupply; and difficulty with there being a lack of conduits between the independent sector and the public sector. Eventually, after a period, we acknowledge, and this happened with a great deal of support from us, that the public sector was able to wrap its arms around the independent care sector, for both domiciliary care provision and nursing-home provision.

We are extremely concerned that the COVID-19 pandemic will further widen health inequality in our society. The virus is particularly dangerous for persons with underlying health conditions. I am sure that the Committee has heard a great deal of evidence from the health service about the concerns over the slowdown in provision of general healthcare and the increasing number of people who are now on waiting lists for critical care, coronary care and cancer care. We will play a major role in the restarting of services. We have had briefings with the critical care team at departmental level, and we have made submissions for its consideration.

There is anxiety across the workforce.

We believe that there is a lack of confidence in the community with regard to entering back into care across the health service. We discussed with employers this morning how to make the public more confident about taking care and seeking help.

We have issued detailed proposals of the measures that will be required in health, social care, social protection, how it will impact on education, housing poverty, the rights of workers and taxation and public spending to ensure a new deal as we emerge from COVID-19. There needs to be a complete and cross-departmental strategy pulled together to assist the emergence out of the lockdown. The Health Committee and your particular scrutiny and oversight of what is happening across the health service is of primary importance, and we will certainly look to support, now and in the future, the Committee ensuring the full accountability and scrutiny. [Interruption.]

The Chairperson (Mr Gildernew): We are getting a lot of feedback and echo on your line now, just in the last few sentences. Can everyone on the line check to make sure that their devices are on mute. Anne, can you hear me?

Ms Speed: I can hear you now.

The Chairperson (Mr Gildernew): That seems to be better now. You were just concluding your remarks.

Ms Speed: Yes. I will invite John Patrick to add his comments and then invite Claire to add her comments.

Mr John Patrick Clayton (UNISON): I do not have a lot to add. Anne has opened up the position very fully. The transformation structures that were established under Delivering Together might be of interest to the Committee. Anne referred to the transformation advisory board or TAB. As the Committee will be aware, TAB sits alongside the transformation implementation group (TIG). As Anne has already mentioned, we had an announcement from the Minister this week and a plan in relation to rebuilding Health and Social Care (HSC) services and the creation of this management board.

I have represented the NICICTU health committee on TAB since it was established by Minister O'Neill in 2017, and, possibly during your questions, we can get into the detail of how that has operated since then. As Anne has alluded to, our concern is where TAB finds a place in those new arrangements. We do not yet have any clarity on that. It is not particularly clear from the Minister's announcement or, indeed, from the plan or from the proposed changes to the HSE framework document in relation to the creation of the management board. So, obviously, we have concerns in that regard.

Speaking from the UNISON perspective, as the policy officer with UNISON, the concern that we have around the management board is the potential that this may become another layer of bureaucracy in the health service. As Anne alluded to, we already have a split between commissioning and providing of services. We have a number of trusts and a variety of HSE structures. So, where the management board sits in that regard and where room will be found, particularly for the voice of the workforce and the representative trade unions, would be our primary concern in relation to the management board. Perhaps we will let Claire come in if she has anything that she would like to add, and then, we will be happy to take your questions.

Ms Claire Ronald (Chartered Society of Physiotherapy Northern Ireland): I do not want to add too much, because I want to give the Committee time to ask us any questions that you think are relevant. The only thing that I want to highlight is the fact that, often what we are told when we talk about staff engagement and staff involvement is that there is the strategic partnership forum. This is something that trade unions fought for for a long time. It has been in abeyance for quite a while, and it is important that it gets up and running. It will be interesting to see how it will run with social distancing, because it is quite a large group, and it is about facilitating discussion and collaboration. It is not about negotiation, and it should not take the place of negotiation. Instead, it is focusing much more on how we can influence the future strategic directions, so it is for looking at where we want to be in four or five years' time and at what decisions need to be made now. That does not replace the involvement of trade unions in decisions on what is happening here and now, so we need to be able to separate out the two of them. The strategic partnership forum is not the answer to trade union engagement in how we relaunch services post-COVID. That is the only thing that I want to add at the moment.

The Chairperson (Mr Gildernew): Thank you, Claire. We will now open up to members for a question-and-answer session. My first question is in relation to the management board. I have noted the comments about where the conversation would take place. Have there been any contacts to date at all in relation to that issue with NICICTU or with the unions?

Ms Speed: No. I think that we were told about an hour before the Minister was about to make a public statement.

The Chairperson (Mr Gildernew): We heard within the past number of weeks about a rapid-learning initiative in the care home sector, a sector that we all realise has suffered greatly as a result of this and from which there is indeed to be rapid learning. Are the unions engaged in that rapid-learning initiative? Have you had any contact in relation to that?

Ms Speed: Again, the answer is no. That is news to us, Chair.

The Chairperson (Mr Gildernew): That was evidence given in Committee a number of weeks ago. That is a concern, I suppose, in that the lessons from that rapid learning need to be gleaned very quickly in order to improve any further responses in relation to further surges.

Mrs Cameron: Thank you, panel, for your attendance at the Committee today. I suppose the main issue is around the newly announced strategic framework on rebuilding services. Do you want to tell us some more about your assessment of that new framework? How does correlate with your own document, the blueprint that was agreed?

Ms Speed: I will answer that, and maybe other colleagues might want to come in. Our initial reaction is that this looks like a centralisation of existing functions, bringing it more tightly together. We do not see any evidence of it presenting any new opportunities, but we do see evidence of an obscuring of the role of TAB or a deletion of the role of TAB.

We certainly wish the Minister well, and we will work with him in a difficult period around all of the challenges of restarting services. We will play our full part in that. He did talk about a two-year framework for this, but there is not any indication of where that journey is going to take us. Unless we are part of that conversation about that journey, involving the principles of co-design and co-production in a plan for the future, I cannot seem them being adhered to. This is not a blueprint for the future, and perhaps the Minister might agree with us. If that is the case, then we need to hear from him about how we will have that conversation and about how we will develop that strategic, new, innovative thinking, because everybody at the table on that management board are the existing deliverers of the service, and all we can see is that they have come together in a tighter managerial function. I will leave it to other colleagues to add to that.

Mr Clayton: Thank you for the question, Deputy Chair. All that I will add to what Anne has said is that what is not entirely clear from the change, particularly for the HSC framework, is around the future of commissioning in this new structure. One reading of the change to the framework would seem to suggest that commissioning is potentially being put on ice, so I think that some clarity is needed around that. There seems to be, on a reading of it, a suggestion that the commissioning plan that is in operation will effectively roll on for the next two years, and I think that there needs to be some clarity around that. That could be quite a significant change to how the system as a whole operates, because the Department currently issues the commissioning direction and then the Health and Social Care Board issues the commissioning plan and then the Trusts implement that. As trade unions, we have always taken the view that we wanted to see the abolition of the commissioner providers because we thought that was a layer of bureaucracy that was not the best use of the health service's resources. We wanted to see a much flatter structure across the board that would be much more around a public health model. Given the context of COVID-19, that is, arguably, even more important than it ever was. That might be an issue for the Committee to explore further with the Department, and with the Minister more specifically.

To add to Anne's point on engagement, as I said earlier, there is a lack of clarity about TAB. When it was established by Minister O'Neill under Delivering Together, it was to play an advisory role to the Minister. The Minister was to be at the TAB meetings, and at that time, we went through a period when there was no Minister. Minister Swann came in in January and, alongside other TAB members, we sought an engagement with the Minister as a meeting was agreed, and then, because of the pandemic, that meeting was postponed. Therefore, I think that clarity around the future role of TAB is very important. We feel that there is the potential for TAB to play a very constructive role, and it has not really had the opportunity to do that yet, in the fullest sense, because there was no Minister in post for several years. Therefore, I think that is very important going forward. It is also for the reasons that Anne has alluded to, as well, because on the management board structure, from what we can see, it does seem somewhat narrow in its construction; it is chief executives of trusts, senior officials from the Department and so on. Therefore, it is important to think about how the voice of the workforce can feed into those conversations, because that is integral to the principle of co-production and co-design, which is at the heart of Delivering Together.

From a union perspective, partnership working is something that we wanted to see move from being at the fringes of the system, where you might have individual programmatic areas when unions are involved in partnership working. From UNISON's perspective, that is something that we have pioneered over a number of years with individual trusts and some independent sector providers. Something like that needs to be much more mainstream in the system as a whole.

Mrs Cameron: Thank you.

The Chairperson (Mr Gildernew): With regard to commissioning, John Patrick, are you saying that the commissioning model that you believe is being rolled out — I am not clear on what you mean by that.

Mr Clayton: I think that it is difficult to say at this stage. This is on the initial reading of the framework document that I undertook last night in advance of appearing before the Committee. The change seems to suggest, on my reading — and I think that clarity is even needed on this point — that the 2019-2020 commissioning plan will, in a sense, carry on. The delivery targets and the targets that are set for trusts under the commissioning plan will probably be revised in the light of COVID-19, which seems, in one sense, understandable, and in light of the resources that are available. However, it is not entirely clear whether there will be a further period of commissioning over the next two years. That is something that needs to be considered.

The other issue that needs to be considered in that context is that, as the Committee will be aware, the intention was to close the Health and Social Care Board. If I recall it correctly, that was a decision initially taken by Minister Hamilton in 2015, and then Minister O'Neill supported it when she was in post. Obviously, that plays a very important role in commissioning, because it is the Health and Social Care Board which develops the commissioning plan. The framework document refers to the proposed future closure of the Health and Social Care Board, and in that sense there needs to be some clarity about commissioning in the future.

The Chairperson (Mr Gildernew): OK. We can follow that up.

Mr McGrath: I thank the panel for the presentation. I reflect on where we are: we have Delivering Better Services, the Compton report, the Bengoa report, TIGs and TABs, and now we have a management board. If we hear "board", "forum", "panel" or "review" one more time, people's heads are going to explode with all the information. I feel that we end up being almost report- and board-heavy but action-light with the Department. The health structure itself has the Health and Social Care Board, trusts, the Department, the Public Health Agency and commissioning bodies. To me, it seems that there should be management, staff and public, and that the three should work together in what they are doing. We have this management board announcement, and it does not feel like the allied professions, for example, are represented on it at all. In my experience, when these boards are set up, it is sort of intra-departmental. All their little officials get together, and you have to fight to get the other agencies, the staff and the views on the ground onto it. Do you feel that this management board is going to be like that? Are we going to have to fight to make sure that the allied professions — which is, what, 13 different agencies that are being ignored — are on this management board? How are their views going to be heard? How are the views of those staff who have worked so hard through COVID going to be heard and reshaped? Or are we just going to end up with this being another management board report that goes on the shelf in a year's time? What are the trade unions' views on that?

Ms Tanya Killen (Northern Ireland Public Service Alliance): Chair, I suggest that Claire Ronald, who represents the allied health professions, respond to that question.

The Chairperson (Mr Gildernew): Yes. Go ahead, Claire.

Ms Ronald: Thank you for picking up on that huge gap that exists. As Anne and John Patrick have said, the framework document is something we are still working our way through. It is still quite new to us. Obviously, we only got it on Tuesday. However, as others have already said, it feels as though that management board is replicating existing structures and not looking at transformation.

Our allied health professionals have been front and foremost in the response to COVID, and they are going to be front and foremost in the next steps to rehabilitate COVID patients and the patients who have not had care while we have been dealing with the acute care of COVID, and yet they are nowhere on that board. The chief nursing officer (CNO) does a fantastic job, and allied health professions sit under her remit, but to expect the CNO to sit on that group to represent nursing, which is the largest professional group, and 13 diverse professional groups underneath that is not appropriate. Those 13 groups need to have a seat and a voice. If you take all the allied health professions together, we are the third-largest professional group in the acute and community side of health and social care, and yet we have no voice. The trust chief executives will be going back to their trust boards where, again, allied health professionals come under nursing, so we are further removed and further away. It is the view of some of the unions that, if you want to seek transformation, you need to have that board in a different way. Karen might want to come in on this.

Ms Karen Murray (Royal College of Midwives): Thank you. When I read through the strategic framework document, my concern was that there is no mention of maternity services at all, nor is there any mention of the impact of the COVID emergency on maternity services. We had a maternity strategy that ran from 2012 to 2018 which involved significant work to develop midwifery-led services, which have largely been dismantled as a result of COVID. The three free-standing midwifery-led units were all stood down. Causeway's maternity services were closed to facilitate the paediatric surge plans, and it looks as if there are some difficulties around re-establishing that service. I have concerns around a future maternity strategy.

Following on from other points, if we are taking a public health approach to health services moving into the future, maternity services have to be central to that, through preconception care, birth and the first 1,001 days. That is how we will deal with the social, economic and physical aspects of public health, and I have a significant concern that, yet again, maternity services are on the periphery and are not being considered as a central part of it.

Mr McGrath: The Committee should write to the Minister and the Department to say that the allied professions need to be represented on that management board, or else it will just become too narrow. I may bring that up at the end.

The Chairperson (Mr Gildernew): It is a missed opportunity in that sense. To do things differently, you need to have a broad input, including from service user voices and carers. There are lots of other perspectives that should and would be of value, so that is relevant.

Ms Bradshaw: I thank the panel for coming this morning. During the pandemic, MLAs have found it very useful to hear directly from front-line workers about their working conditions etc. In your briefing, Anne, you mentioned that you have had briefings on the rebuilding process and that you have made submissions off the back of that. Just step back a bit: how have you been able to communicate with the Department during the pandemic to feed in concerns about workers' welfare? Have your submissions been responded to positively or not?

Ms Speed: Thank you for the question. That probably brings us to the second part of our evidence, which is to do with the particular needs of the workforce. In our evidence, we highlighted a number of headings, and I would like to refer to them. First, to answer the member's question, we have had a weekly dial-in with the Department, which the HR directors have attended. As the issues emerged, we sought and received responses, although sometimes with delays. That allowed us to raise a number of questions under the headings that are in today's submission, such as testing, PPE, the impact of COVID on black, Asian and minority ethnic (BAME) workers etc. We also engaged — I did, in particular — with the external agencies that I mentioned earlier, like the RQIA, the PHA, the Chief Medical Officer and the Chief Nursing Officer.

As the surge emerged, there were a lot of questions to be answered. We had a portal for urgent responses which worked in some instances and did not work in others. It has been patchy, but that is how we have been able to engage. However, that only emerged after we insisted on having a quick access panel. We had to ask for that, and eventually we got it, but that is how we dealt with and have been dealing with all those issues. The workforce concern continued on from the dispute period that we had, where we had hundreds of vacancies. The challenges are that we have to convert temporary posts to permanent; safe staffing is a huge challenge, and we have not been able to progress that; and the reduction and elimination of exorbitant levels of agency spend.

Moving on, we have had to engage in extensive discussion around frequently asked questions, documentation that has to be cascaded to the workforce, risk assessments, strategies, health and safety concerns and testing. We had to press very hard to ramp up testing, particularly for workers in the independent sector. We had to meet many challenges on PPE. There were problems with its type and availability. There were some shortages. There are all those issues and, as I mentioned, the BAME concerns. They are the kind of workforce issues that we now have to get resolved. We have to get real progress if the restart of services that the Minister wants to lead is to be safe and effective, and the public must feel confident and have confidence in the availability of services. The number of workers to deliver these services is going to be crucial.

The social care issue, and in particular social workers' role in that, has been very problematic. If the member is satisfied with the response, I suggest that we invite in Tanya to address that one. Perhaps member Bradshaw would like to continue questions.

Ms Bradshaw: I am satisfied with that, and I am happy to move on to Tanya. That is fine.

The Chairperson (Mr Gildernew): Tanya, go ahead there, please.

Ms Killen: Thank you on behalf of NIPSA for the opportunity to address some of these community workforce issues. We are all aware that COVID-19 has created a profound shock to society and has presented the most challenging and complex set of issues ever to face the health service, both for employers and for employees. Key workers, as we all know, have been the heroes of this pandemic. For weeks, people took to the streets clapping for care workers — I noted carers in your introduction, Chair — and also for shopworkers, refuse collectors, postal services and education services, and rightly so. However, unfortunately, very little has been heard about those who work every day to protect and safeguard the most vulnerable in our society: our social workers, social care workers and the admin workers who support them and who are the backbone of the health service.

NIPSA, along with our sister trade unions, wants to impress upon the employers, the public and the Committee that the NHS is not solely hospital trusts. It saddens me that social workers, social care workers and admin members in the community report feeling like second-class citizens, undervalued, an afterthought and playing second fiddle to colleagues on the acute side of the health service. This is premised on the unacceptable delays in guidance and advice and inefficient PPE in the early days of the pandemic. Social workers and carers are extremely passionate about the role, and they are incredible in their

persistence and response to people in need. The jobs are already stressful, and these have been exacerbated tenfold by COVID-19. [Inaudible.]

The Chairperson (Mr Gildernew): Karen, I am sorry. I must interrupt you there. That feedback is back on the line. I ask all members who are not speaking to ensure that they are placed on mute. Karen, you were a little faint there anyway. Maybe you could hold the phone up a wee bit closer or something. It was just a little hard to hear.

The Committee Clerk: It is Tanya, Chair.

The Chairperson (Mr Gildernew): Tanya, sorry. My mistake.

Other members, please ensure that you are on mute, and, Tanya, please carry on.

Ms Killen: OK. COVID-19 has increased pressures on vulnerable children and families. It has also impacted the way in which social work and social care are able to interact with them. There is no doubt that social workers and social care workers have had to adapt and to make radical changes to the way in which they have carried out their duties. However, they have felt vulnerable and exposed by minimal safeguards when direct client contact has been limited, which has made assessment very difficult. They struggle with the knowledge that they are discharging patients from hospital without sufficient care packages or into homes that have had inadequate PPE; we are all aware of those issues. Sadly, the impact of this crisis for adult and child protection is likely to be felt long after the threat of the virus itself has receded.

Going forward, public acknowledgement is needed of the valuable work that those staff undertake, and there must be assurances that they are not left carrying responsibility for gaps in the system.

As the Committee will be aware, prior to the pandemic, the trade unions were engaged in industrial action on safe staffing. There were 500 social work vacancies and 1,000 admin vacancies. COVID-19 has in many ways masked those difficulties as services have been stepped down and activity has dropped. However, as Anne mentioned, as they are being re-established, those staffing issues will emerge with a vengeance. Front-line vacancies have already had a detrimental impact on patient care and staffing. It has compromised the safety of staff and patients alike and contributed to long waiting lists and added pressures on the workforce. Vacancies will increase due to people shielding or being off ill, which will put additional pressures on services. The pandemic will worsen the already serious recruitment issue. Unfortunately, the NHS has become an extremely risky place to work, and urgent action is needed to rectify the situation.

It is crucial to point out that low pay lies at the root of the recruitment and retention crisis. Serious and committed engagement is needed regarding the volume of vacant posts, delays in recruitment, training, career progression and work-life balance. Social work needs to be at the fore and an intrinsic part of any decisions that will impact on the fabric of society for years to come. That would be much more rewarding for our members than a clap.

I want to bring to members' attention the scale and complexity of issues facing our members in residential childcare. Our members have worked daily with risk-taking and non-compliant behaviours from a cohort of young people. While there is no doubt that most are trying to avoid COVID risks through compliance with government directions, some young people are, concerningly, weaponising COVID with their peers and with staff. Our members have given us examples of young people deliberately coughing or spitting at staff. Those scenarios are key factors in the spiralling levels of absence due to self-isolation and stress-related conditions. It is NIPSA's view that an unambiguous steer from the Department on the public protection agenda relating to young people who are deliberately putting themselves or others at risk is absent, and that must be rectified. We believe that there is a compelling duty on the Department to act on a reinterpretation of the duties of the Children Order in a way that can ensure trust and that people can continue to act as responsible parents in fact as well as in theory in terms of public protection and promoting the safety of children and young people in care, who have a reasonable expectation of health trusts endeavouring to protect them from COVID risk rather than exposing them to vicarious risks, as the current policies do. It is important to have active risk management rather than risk mitigation or containment, and that is absent from the Department's guidance. We feel strongly that that needs to be a focus.

We also feel that the guidance does not address the issue of staff being required to do sleep-ins as part of their shift, which is a major oversight that further exposes staff.

Our views on that are very well known: there is a health and safety risk with sleep-ins.

When re-establishing services, it is critical that PPE, testing and social distancing are at the fore of dealing with the return of staff to the work environment. It is NIPSA's view that the health and well-being centres are not fit for purpose in that regard.

I will briefly mention childcare, which is not normally in the remit of trade unions. Childcare has been extremely challenging during this time. Older parents who had provided childcare may now be shielding, and daycare facilities have been closed. Going forth, and in preparation for people returning to the workplace, it is our view that childcare has to be addressed very seriously. For instance, 700 people in the Belfast Trust are off work shielding. Therefore, the numbers returning from working at home or schooling from home will be even more significant. The childcare issue will have to be addressed.

Mrs Cameron: First, I declare an interest: I have a family member who is a nurse.

Staff who were upskilled at very short notice and with very little training have been doing the most dangerous but vital work in, for example, the ICUs dealing with the most seriously ill COVID patients. What conversations, if any, have been ongoing with the Department and staff members to ensure that they are on the appropriate pay scale and band?

Ms Speed: Thank you for the question. NICICTU and the RCN have significant nurse membership, and there are parallel conversations about the utilisation of student nurses, the new intake, terms and conditions, contracts of employment and the skill levels required. That is an ongoing process. It is a bit slow-moving, but it is occurring, and we are keeping a very close focus on that.

Mrs Cameron: Does that include staff going from one band to another when moving from, for example, a high dependency unit to an ICU? I know that there is differentiation in the pay bands, but the work is very similar, or even the same, certainly during COVID.

Ms Speed: Yes, this issue has come up in a couple of the acute sites, and that discussion has commenced. We are trying to deal with that through the banding structures.

Mrs Cameron: Thank you.

Ms Flynn: Before asking my question, I want to make a point to Claire, who spoke about rehabilitation work streams. When the Minister was in front of the Committee last week, we asked him whether he was going to follow the approach of Scotland and Wales by appointing a chief allied health professions officer to lead on that work. His answer was a bit vague, but he said that they were looking into it. I followed that up with a question for written answer. However, I agree with Colin, and I will be more than happy if the Committee wants to follow up with a letter to try to get more detail for you.

In my constituency, we have had plenty of queries from overworked staff with concerns about safe staffing. A line in your report stood out:

Are you concerned that that will continue to be the case, or possibly even worsen, under the new management board? What could be done to improve on this and give your members confidence that the new management structures will treat this as a priority?

Ms Speed: Those issues have come to the fore in the bargaining structures. We came out of a dispute period and had commitments to engage in a process of negotiation. In the past two weeks, that has been suspended. We demanded that that come back on stream. This morning, at a meeting with the Department, we insisted on getting dates for conversation and discussion on those issues: filling posts, developing risk assessment strategies, dealing with childcare and all those important supports that the workforce will need to restart services.

If we do not get prompt responses from the Department, the restart will be delayed. Committee scrutiny of the length of time that it takes to get responses from the Department and whether it is responding promptly enough certainly could be of assistance to us.

Mr Clayton: I can think of several examples of transformation and workforce planning over the past three years — Claire may be able to think of some points on this as well — when the Department introduced major policy initiatives on the reorganisation of services such as stroke services and breast assessment services. From my perspective, those initiatives were not accompanied by a detailed analysis of workforce requirements and workforce planning.

Many reorganisations seem to be motivated by a general comment such as, "Our staff are spread too thinly across too many sites", "We don't have enough staff" or "We're not able to grow the workforce sufficiently". That goes back to the overall point about the lack of workforce planning over many years that got us to where we are. There is also a lack of real substantive analysis of the implications for the workforce of service reorganisation.

As Anne mentioned, that is being looked at through our bargaining structures, but it is also a major policy development issue. The Department tends to put itself in a position whereby it thinks about policy changes or service reorganisations, but the workforce piece gets a bit neglected or overlooked. That is vital and has to be at the initial stages of the conversation. That is what we have always impressed on the Department in those fora.

Mr Carroll: Good morning, panel, and thanks for your presentation. For the record, I am a member of Unite.

I want to talk about care homes. There is a lot of talk about the independent sector, but there is a view that the independent sector relies heavily on the state through getting finance from trusts and the Department. There is a concern about that generally.

I would like to ask, maybe Anne in particular, whether there is a concern about certain care homes not recognising or obstructing trade unions. How does that tie in to people being able to raise health and safety concerns safely?

When it comes to transformation or even a return to normal services, is there a concern that there may be an over-reliance on private sector organisations through the use of agency staff or staff from other outlets? Is there a concern that the NHS is not always the first port of call when commissioning services?

Ms Speed: First, we noted the Minister's response to a question in the Assembly on Tuesday that he does not intend to initiate a privatisation programme. That was reassuring, and I hope that the full management board adheres to that approach.

On collective bargaining and negotiations in the independent sector, there has been reluctance and, at times, downright hostility to the presence of trade unions in domiciliary care provision and the care home sector. UNISON has called for and focused substantially on a bargaining forum. We have called on the Minister to lend his authority and provide leadership on this by initiating a forum at which employers; the Department, from the perspective of funding arrangements and overall policy; and trade unions that have membership in that sector should be present. This is essential if we are to lift standards, lift the profile of the workforce and give those in the workforce the respect and recognition that they deserve. The right to collective bargaining and the obligation, as far as we are concerned, of employers to recognise the rights of workers to negotiate for themselves has to be achieved.

We cannot continue in the current environment. I found it especially difficult when we were attempting to reach agreement on support for the homes. We put a lot of effort into agreeing a policy of support with the DOH for a sector that was refusing to talk to us. We did the right thing. We supported the Department in offering public provision and support inside the homes that were having difficulties. We endorsed the call for PPE. We contributed significantly to the award of additional funding from the Minister. Employers now have to give due regard to the role that trade unions have played.

Chair, we have more to say on the independent sector. I will leave it to your direction as to when you want us to offer those views. Our colleagues from the RCN and the GMB are here today and will want to contribute.

The Chairperson (Mr Gildernew): Yes. I think that it would be better to hear from them in the next session.

Gerry reminded me that I should have declared an interest. My previous career was as a social worker. I am a member of NIPSA and on a career break from one of the trusts.

Mr Easton: Thank you for your presentation. I am trying to get to the bottom of the Transformation Advisory Board. I note that a meeting to be held on 24 March was, understandably, cancelled because of COVID. Have there been any meetings of TAB since the Assembly got back up and running? Were there any meetings before or after the Assembly was suspended? I want to see how effective it was.

Correct me if you want, but I sense a great deal of frustration from you at the lack of engagement. On issues like PPE and testing, responses have been very slow to get to you. You also have concerns about the clarity on commissioning should the Health and Social Board close and the lack of a maternity strategy not being addressed. Am I correct in reading from your tone that there is huge frustration about the lack of consultation and engagement with you? I want to ensure that I am correct.

Mr Clayton: I will deal with the TAB issues, if that would be helpful, and Anne and her colleagues will come in more generally about engagement on PPE and the other issues that you raised.

By way of context, TAB was established by Minister O'Neill in 2017. The NICICTU health committee was invited to nominate a representative to that, which was me. TAB also has representatives from the community and voluntary sector and from the patient and service user experience. It is very much rooted in the idea of public and personal involvement — there is a statutory duty around that — as well as co-production and partnership.

TAB had one meeting with the Minister, the exact date of which eludes me right now. I think that it was in February 2017, when Minister O'Neill was still in post. Then, we went into an Assembly election in March 2017, and the Assembly did not sit for several years, as we all know. During the period when the Assembly was not sitting, departmental officials invited us to take part in meetings with them. Those meetings were, in a sense, more informal, in that they were generally an opportunity for officials to share information with us as TAB members and to hear our points of view on particular issues that they raised with us. We also had the opportunity to ask them about specific issues and raise specific agenda items.

As regards TAB and the transformation programme more generally, the transformation programme was split into a wide number of work streams. There were certainly well over 30, I believe. Some of that was being funded through the DUP-Conservative confidence and supply money. For two years, £100 million a year for two years was being used specifically to fund transformation. There were many work streams coming off that, some to which we had the opportunity to contribute and where our views were sought as trade unions, and others where they were not. Generally, we sought the opportunity to intervene, where we felt that we wanted to or needed to, in those work streams.

In the absence of a Minister, TAB has been a very useful structure. It has provided an opportunity to raise general issues of concern and seek clarity on the general policy direction under transformation. With a Minister in post, it could play a very constructive role, in that it would be an opportunity to advise the Minister directly and to scrutinise some of the major policy initiatives that were coming forward. It could operate alongside the partnership forum that we referred to initially, which includes the Minister, trade unions and employers.

TAB has not met for several months. It has not met Minister Swann. That meeting was postponed. Certainly, from my perspective as someone who is on TAB, there is a need for clarity on how we move forward from here. On Tuesday, in the Assembly, the Minister made some reference to how that structure is being reviewed. There is an opportunity for TAB to play a constructive role. Certainly, what colleagues and I have tried to do when engaging with the Department is to encourage it to have a much more consistent method of engagement with trade unions and the workforce on transformation issues. That has worked quite well in some instances. As you know, there is an ongoing situation with the emergency department at Daisy Hill Hospital. COVID-19 has, of course, lent itself to that. Prior to that, a pathfinder project that was established locally had trade union representation on it. That was a constructive process with regard to what was being planned for Daisy Hill and what the way forward needed to be for the area. There are models for engagement with trade unions that we would try to promote to the Department. Anne, do you or colleagues want to come in on the wider point about engagement?

Ms Speed: I would like to ask Claire to contribute, but I will say for the record that we have engagement on what we call the "bargaining issues", such as terms and conditions for the workforce and workforce planning, through the workforce directorate in the Department of Health. I think that they have problems getting responses from the policy leads and other parts of the Department of Health. I would like Claire to respond to that [Interruption.]

The Chairperson (Mr Gildernew): We have someone on the line. Maybe it is Claire who is not on mute, but we certainly are picking up on some of the childcare issues. We are all juggling with those.

Ms Ronald: There is someone else who needs to be on mute.

The Chairperson (Mr Gildernew): Absolutely. Go ahead, Claire.

Ms Ronald: To pick up briefly the issue of PPE and testing [Interruption.]

I will wait while others mute themselves.

The Chairperson (Mr Gildernew): We have a dog barking in the background. We are picking up on that. I am not sure that it is on Claire's line. If everyone presses hashtag 6, it will put your phone on mute. Sorry, it is star 6. That will put your phone on mute. Can everyone just check that your phone is on mute by pressing star 6? That sounds better now. Go again, Claire, please.

Ms Ronald: Can you hear me?

The Chairperson (Mr Gildernew): Yes, we can hear you OK.

Ms Ronald: When it comes to some of the PPE and testing, as Anne says, we have regular meetings as the negotiating group with the workforce department and with HRD. We have to be fair to them, because sometimes their answers are delayed because of the systems that we are working in. Some things are outwith our control. Take, for example, quarantine, which Westminster suddenly introduced. That will have an impact on us, and we are still trying to work through some of that. On the workforce side of things, we are building on those relationships and working through that.

As John Patrick was saying, it is wider as we transform, and that brings us back to the announcement on Tuesday. We ask where staff side sits within that, and we are still having to work through it. As we rebuild and transform services, where is the strategic voice — our members' voice — for the trades unions in that? That sometimes seems to be lacking. Then there is the tying up and integrating of workforce planning into any of those transformations that they are bringing through.

Hopefully, that answers the question.

Mr Chambers: I would like to pay tribute to the contribution of the workforce that you represent in dealing with this pandemic. It has certainly demonstrated your dedication to ensuring the health and well-being of the public.

In the paper presented to us, I note that you say:

You also say:

I asked the Chief Medical Officer about this frequency as recently as a fortnight ago, and I do not think that a final decision had been made.

What is your preferred frequency of such testing of all residents and staff in the care home sector?

Ms Speed: We could give an answer to that based on what has happened to date in care homes. We have a thorough report on the testing strategy, and we have asked for a presentation to be made to us. We do not have data to hand on the exact situation in care homes now, yet we need to be involved at the level of policy development around what is going to happen with care homes in the future. We need access to that data. The RQIA is collecting data on what is happening for the PHA, but it has not shared that information with us. We have a right to that information because it is our workforce, and our members, and, indeed, our families and communities, who are in those care homes. It is an important question, and all of us will need the data to make the right judgement about what is required.

I was glad to see an increased emphasis on testing. I was involved in discussions with the RQIA a number of weeks ago and made various interventions about patients going from hospital to home and about the delay in test results for care home staff. Test results for staff were being returned in the trusts within 24 hours, but it was 72 hours for care home staff. Over time, all of that has improved. I acknowledge that. They were initial problems. If we are planning for the next phase, all of us need to see the data and the analysis.

Mr Chambers: The Commissioner for Older People is calling for a frequency of twice a week. Bearing in mind that the test is unpleasant and invasive, would you protect the right of the workers you represent if they were not happy to present themselves twice a week for such a test?

Ms Speed: Obviously, we would have to consult those in the workforce who are our members; we cannot ignore their concerns. We would also need to have access to the staff to have that conversation. That is where the issue of the closed doors and the care home owners comes into play. We will consult where we can, but some doors are closed, and they need to be opened.

The Chairperson (Mr Gildernew): Thank you, panel, for that session. It has been interesting, informative and useful.

There has been a suggestion that we write to the Minister in relation to gaps in engagement between the management group and some allied health professionals. Members are agreed that we do that. We will also engage on the responsiveness to issues that you raised and consider how they can be improved upon.

Members, I thank those of you who are leaving. We will take a short break in order to get the additional two members on to the line. We will return at noon.