Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome Jennifer Welsh, chief executive of the Belfast Health and Social Care Trust; Mr Alastair Campbell, director of performance at the trust; Ms Paula Cahalan, director of child health; and Ms Kerrylee Weatherall. You are very welcome. Apologies for the previous evidence session going on for longer than scheduled, but it was an important session. I am sure that we will cover some of the aspects that we covered in that session in this one. You sent us some information in advance. I will hand over to you for some brief introductory remarks, and then we will take questions.

Ms Jennifer Welsh (Belfast Health and Social Care Trust): Good afternoon, Chair and Committee members. Thank you for inviting us. As was reflected by Betty Carlisle in her welcoming remarks to the Committee, it is good to meet out in the community, where the majority of the Belfast Trust's care happens. Given that we are meeting at a women's centre, I asked to join me two director colleagues whose areas of work concern women's health or family health. Paula Cahalan's portfolio of responsibility includes child health, maternity and gynaecological and sexual health services. Kerrylee Weatherall is the interim executive director of social work and director of children's community services. Alongside them is Alastair Campbell, director of performance planning and informatics in the trust. In addition to the paper that we submitted, we hope, between the four of us, to be able to provide a flavour of the overarching work of the trust, the progress that we are making and where the challenges are. I am going to theme my opening comments across what we call the five Ps: our patients and service users; our population health and partners; our people — our staff, in other words — our performance; and our potential.

I will talk, first, about our patients and service users, and our population health and partners. Committee members know that Belfast Trust is the biggest trust in Northern Ireland. We deliver the majority of the regional specialties as well as providing local care to the people of Belfast. That is described in our paper as being "Belfast's Dual Personality". Given the range and reach of the services, the trust's patients and service users are eclectic. I have provided the Committee with high-level data that outlines, in broad terms, the health of the population of Belfast. Life expectancy varies across the city but is lowest in the most deprived areas, and, overall, Belfast has the lowest in Northern Ireland. Belfast also has the highest levels of social and economic deprivation, with more people facing health inequalities and more people, particularly women, living with long-term health conditions. In Belfast, there are high rates of cardiovascular disease, respiratory illnesses and mental health conditions. Hand in hand with those statistics, we included in our paper information about the scale of the challenges that a Belfast child faces, which I am sure members found sobering. You can see from that information that, for example, the number of looked-after children in the trust area accounts for more than a quarter of the entire number of looked-after children across Northern Ireland. The trust partners with the Belfast Outcomes Group to support children to realise their full potential and to help families to deliver the best possible outcomes for their children. I am pleased to tell the Committee that our health visiting team has been designated a UNICEF gold award baby-friendly service for excellent and sustained infant feeding support and parent/infant relationships. I do not need to tell you how important a good start is to the development of a child.

Members will understand that it is crucial that health and social care, through the neighbourhood model that the permanent secretary referred to in the Committee's previous evidence session, prioritises community services, particularly here in Belfast, and that it works in partnership with those in the community and voluntary sector, such as with our colleagues here in the Shankill Shared Women's Centre, to support, stabilise and innovate, and, ultimately, to deliver community services that make people's lives better. We have been engaging with the Shankill Shared Women's Centre for many years and have indirectly supported programmes, through things such as the Active Belfast Partnership. One of our team members is based in the Greater Shankill Partnership. She chairs the Greater Shankill health forum, in which the Shankill Shared Women's Centre is a partner. The Shared Women's Centre is also a core member of the Shankill family support hub and our neighbourhood renewal partnership, in which we also have a presence. We have also received PEACE PLUS funding towards targeting mental health services in the area of health inequalities, conflict, high mediation and so on. The Shankill Women's Centre has also been invited to participate, with funding, in an upcoming women's event for International Women's Day, on 8 March. We are always working to deliver more care in partnership with, and in, our communities, particularly what would once have been considered hospital care — a conversation that the Committee had in its previous session. We provide a glaucoma clinic, down the road from here, in the Shankill Wellbeing and Treatment Centre. That is a great example of something that used to be provided in a hospital that is now out in the community. That clinic receives excellent feedback from our patients.

I will move on to people. I am incredibly proud of colleagues in the trust, who deliver care under extraordinarily challenging circumstances. Reflecting the population that we serve, the 22,000 people whom we employ come from right across Northern Ireland. I acknowledge, as I have done previously to the Committee, that the past year has been particularly turbulent for the Belfast Trust — staff, patients, service users and families— with much hurt and anxiety. We have had intense scrutiny and pressure. Many issues need to be addressed, and confidence that needs restored. We have openly seized that opportunity and pushed ahead with change. The recommendations arising from the Hill/McBride report have been helpful in signposting a way forward, and I am pleased to report that, further to my attendance at Committee at the end of October, we have a well-established and well-supported programme, and we continue at pace across a number of areas. We have a newly established culture and governance group, which provides oversight of all that we do in that area. Currently, that group is led by Patricia Gordon, the acting chair of the Belfast Trust, and I anticipate that our new chair will take on that role. Work streams are in four pillars: cardiac surgery; people and culture; governance and assurance; and medical leadership. Those four work streams are values led — that approach is core to everything that we do in the trust — and reach down through the organisation. I am steadfast in my commitment to building a safe and supportive workplace and to rebuilding trust with colleagues, trade unions and the public. I assure the Committee that those work streams are not talking shops. My colleagues on trust board and the executive team and I are held to account — rightly so — by the Department of Health and the Minister, who, alongside our staff, want to see sustained progress. I look forward to building the confidence of the Department to demonstrate that we are making sustained progress to enable the trust to be de-escalated from level 5 of the support and intervention framework.

On performance, members know that the past few years have been particularly challenging for health and social care: the Committee reflected on that in its previous session. Our teams have weathered the pandemic. We introduced a transformational new system in Encompass, which requires all our staff to work in a completely new way. Demand has increased in line with demographic projections. We continue to deal with the twin problems of unacceptably long waiting times for planned care and extreme pressures in our urgent and emergency services and our community services. It is important that members know that, despite those issues, our teams are delivering more care than ever before. When we compare a recent four-month period with the same four-month period last year, and with the same period, pre pandemic, we see that we are now delivering approximately 10,000 more inpatient and day-case treatments and that we have delivered approximately 20,000 more outpatient appointments. That does not include the additional non-recurrent funding that the Executive have made available to target waiting times. Our teams have also been putting on additional clinics, running mega-clinics and carrying out clinical and administration validation of waiting lists to ensure that we have maximum impact. It goes without saying that our waiting lists are still far too long, and members will have seen that all trusts are struggling, but we definitely see a long-term trend of reductions in our total waiting lists. We continue to experience intense pressure across our unscheduled care services, where the environment remains very challenging for our staff and, of course, particularly for patients.

On top of role as providing the district general hospitals for Belfast, we are the major trauma centre for Northern Ireland, and we have seen increased demand and attendances in both those populations. On an average day, we operate at approximately 100 beds above our funded capacity. While that issue is particularly intense over the winter period, it is a year-long challenge. In spite of the pressures, however, our teams have made improvements such as reducing the number of patients who wait for more than 12 hours for admission; reducing the overall length of stay for patients who require simple and complex discharge; and enhancing the number of services that provide either direct admission or planned urgent care that does not, therefore, require attendance at the emergency department. We have reduced ambulance handover delays and have introduced new services such as our psychiatric treatment and assessment hub at the Mater Hospital, which some of you have visited.

We also face challenges in the community. As members heard in the previous session, every day, there are many people who are fit for discharge whose onward care is delayed, and they therefore remain in a hospital bed. That is not what patients want, and it puts additional pressure on our hospitals and restricts good flow through the system. When it comes to onward care into the community, adequate nursing home capacity is a challenge, specifically the right kind of nursing capacity and particularly in things such as dementia care and complex behaviours. In spite of those challenges, we are making sustained improvements in complex discharges for older people and for under-65s with complex needs. For example, on an average day in 2024, we saw 20 to 25 people with complex needs being discharged from our acute hospitals, and that could be up to 40 people on a good day. As of the end of 2025, as a result of unrelenting focus on that area from hospital social work teams, we have been able to discharge 40 people on average, which was previously the number on a good day. A good day for us, now, involves up to 60 complex discharges. We are making good progress. We have also established new pathways that help us to keep people better cared for at home, and therefore able to avoid coming into hospital. That is particularly important for the frail elderly and those who are at end of life. Some of the examples the Committee will be aware of are the Hospital at Home initiative, our community falls team and the community palliative care hub. We are about to begin a number of pilot schemes, which we hope will make a big difference to how we care for elderly people outside hospitals. That includes pilots for how the trust can enhance care in care homes and how we can schedule preventative home visits for the over-65s. We will reconfigure all our elderly care wards, which are currently dispersed across our hospitals, to a single unit on the City Hospital site with a direct assessment unit and a community referral service.

Much of what I have said confirms the potential to transform our services. They are not just a pipe dreams. It is a reality: we are actually transforming services, and the staff are up for that. Staff have shown that, given empowerment and a safe space, they have the ability and the wherewithal to make positive changes for patients and service users.

There are real opportunities to continue to transform our services, digitally. We have Encompass, the Northern Ireland picture archiving and communication system (NIPACS+) and the laboratory information management system (LIMS), which provide a strong digital foundation. We will continue to find new ways to use those systems to improve our services. The My Care app offers the possibility of creating a new way of communicating with patients, which could offer huge benefits in the future and should help to empower patients to own their life's journey in the health service. I will touch on points that the permanent secretary made in the Committee's previous session. We have strong relationships with our two local universities, and we are key players in two of the current city deal projects. We are working in partnership with Ulster University on the development of the new centre for digital health technology, and we have partnered with Queen's University to develop a clinical research innovation centre called iREACH Health, which will sit on the City Hospital side. Those are two hugely exciting projects that will, without doubt, deliver cutting-edge research that will benefit Northern Ireland's population and economy.

Finally, issues with the trust's capital builds have exercised us all for some time. I am pleased to report that the new children's hospital continues to progress well on site. I am aware that lessons learned from the maternity hospital, as well as changes made to the latest guidance, will impact on the cost and the building programme. As was previously reported to members, we have agreed a way forward for remediation works to the buildings for the acute mental health inpatient centre and the maternity hospital: design teams have been appointed for both sets of work, and design work has begun. I anticipate that I will have updated costs and a more detailed programme of work for both buildings at a later date, and I will be happy to keep the Committee across the detail on that.

For now, we hope to discuss the broad areas of interest across the Belfast Trust, in the vast and diverse services that we deliver, but we are, of course happy to take any questions that members might have.

The Chairperson (Mr McGuigan): Thank you very much. That was a pretty extensive overview. I commend you and your staff for the good work that you do. You indicated some of the positive work that has been carried out by staff in the Belfast Trust, particularly through engagement with the community. You also outlined some of the impacts of living in a big city with socially deprived areas. We take all that on board.

Unfortunately, on occasions such as this when we are under time constraints, we tend to focus on some of the challenges. I do not want you to think that we are not appreciative of your good work. I attended the launch of the Belfast community palliative care hub a couple of weeks ago in Stormont. From the work that it has done on palliative care, the Committee is aware that that is a really positive aspect of healthcare. We wish that project all possible success.

You finished by talking about capital projects. You are right to say that that issue has exercised the Committee a lot over the past year. You said that you expect the cost of the children's hospital to go up because of lessons learned. Do you have any indication of what the extent of the rise in cost will be?

Ms Welsh: No, I cannot give a definitive answer on that at this point, but I would be more than happy to come back to the Committee when we have that detail.

The Chairperson (Mr McGuigan): You said that you would come back to us with an update on the maternity hospital and the mental health hospital. We really appreciate that. Do you have any indication of the time frames for both of those, additional to what we might have already heard? We would like to get the maternity hospital open and patients and children benefiting from it.

Ms Welsh: We are looking at how we could phase that opening. Paula may want to comment on that. There are some aspects of the building that we believe could be opened relatively quickly. We are assessing what services we could potentially move into it.

Ms Paula Cahalan (Belfast Health and Social Care Trust): There are two phases to the work: remediation for the entire building, and focused work that needs to be done on the design of the water system for augmented care in neonatal. The hope is that all of the work on the broader remediation will mean that parts of the building can be occupied. In the earliest phase of the work, we are focusing on the use of that building for ambulatory services. We are working on risk assessments for that at the moment. We hope to be able to deliver early pregnancy support, antenatal care and more of those types of services from the building, but we are working with the teams on that at this point.

The Chairperson (Mr McGuigan): Can you give any indication of a time frame?

Ms Cahalan: We are bound by the scheme of work. I am not in the estates and capital design side; I am at the service delivery end. Apologies, but I have not been provided with a definitive time frame for that. We are waiting for the design team to give the final call on that.

Ms Welsh: We are waiting for them to give us the final go-ahead. I do not want to be definitive on that, Philip: we are waiting for final details.

The Chairperson (Mr McGuigan): OK. Going back to an issue that was discussed in the Committee's conversation with the permanent secretary in our previous evidence session, is there a trusted assessor working in the Belfast Trust, 24/7?

Ms Welsh: Yes. We have that in place. I cannot say that it is a 24/7 service, but that model is certainly in place there. That is part of the reason why we have been able to increase the number of complex discharges from 20 to 25 discharges a day, and 40 on a good day, in 2025, right up to 60 on a good day. That is all part of the package of works that we have put in place with the trusted assessor and the early review scheme of care packages and so on. A range of things in that space have allowed us to improve.

The Chairperson (Mr McGuigan): You have given some positive figures. If my figures are correct, however, the average length of stay in Belfast is still the longest across the North. Are there particular challenges in Belfast, compared with other trusts?

Ms Welsh: I will come back to you on that, because I did not think that the length of stay in Belfast was necessarily the longest. We need to look at individual specialties. It is also important to bear in mind that, given the dual personality that I referred to, we are not just a district general hospital; we also have the major trauma centre and regional specialties. We have a complexity of services, and some patients will, rightly, have a longer stay. It is important to look not just at an average. If we compare our general medicine or general surgery with how the other trusts are doing on that, I think that we are on a par with them.

Mr Alastair Campbell (Department of Health): That is definitely right. As a trust, we tend to take patients in from elsewhere. When patients are moved across trust boundaries, around 12 to 16 hours is generally added to the time that is spent in hospital, due to the complexity of the discharge. As we tend to be an importing trust, we tend to have slightly longer lengths of stay. That is not just our problem, by the way; other trusts have the same thing if they are repatriating: it is just that we have a higher proportion of patients coming from outside the area.

The Chairperson (Mr McGuigan): Jennifer, you said that you see more patients and have more clinics: you are doing more work, yet the numbers are going up. Why is that? If you are doing all that work, why are we not seeing reduced numbers?

Ms Welsh: We see reduced numbers of decisions to admit (DTA), for example. You will all be aware of the high numbers of decisions to admit in emergency departments. That is an indicator of the lack of flow and the pressure on the system. Belfast has done well in reducing the number of decisions to admit. When I last looked at the app, the Royal Victoria Hospital was sitting at 25 DTAs. Only a few months ago, it would more often have been sitting at 40 or 50 DTAs. The numbers of people who attend EDs is going up, while the number of discharges is getting better, and we can see the impact of the reduction in the number of decisions to admit. As a result, we have recently been able to reduce the escalation beds that we have had up. It is a bit of a complex picture, and it is constantly moving, but I am confident that it is going in the right direction. DTAs are one of the snapshots that you can look at to tell you that it is moving in the right direction.

Mr Campbell: The biggest improvement has been the steady downward trajectory in waits of 12 hours or longer, which has been sustained for the past 12 months. I am not saying that everything is perfect — there is a long way to go — but we are seeing improvements.

The Chairperson (Mr McGuigan): OK. You mentioned a number of other issues, such as reducing ambulance waits. Others will want to ask about that, so I do not intend to ask questions on it. I was struck when you said that you want the Belfast Trust to be a safe and supported workplace, as we all do. After the session, the Committee will discuss a written briefing on violence against staff. We would expect the figures for Belfast to be greater than those for other trusts, but the figures for other trusts are substantially better. From October to December 2025, there were 787 incidents of physical abuse and 292 incidents of verbal abuse: a total of 1,079 incidents. That is a stark figure for the violence that your staff have to put up with. Last week, we visited Antrim Area Hospital's A&E department and heard positive things about the impact that body-worn cameras could have, as you will be aware of from your previous role, Jennifer. We understand that they are not a silver bullet, but would the Belfast Trust work swiftly to implement body-worn cameras to add an extra level of safety for the staff?

Ms Welsh: Absolutely. We have gone to our trust board to embark on a consultation on body-worn cameras. We are required to do that consultation, at the moment. I would hope that, through the committees in common approach and with the Department's agreement, if one trust does it, we would all just get on with it. That would be my preference.

The Chairperson (Mr McGuigan): I am interested to hear of any other aspects of policy that you plan to introduce, or that you could introduce, to reduce those figures.

Ms Welsh: Awareness in the different emergency departments is a big part of it. It is true to say that, when services come under pressure, it is more likely that there will be that kind of challenge. Some of it is about trying to keep areas calm. The fact that we have been able to reduce the number of decisions to admit in emergency departments and have those EDs less crowded and more calm is one of the things that helps to address tension and a heightened environment. The body-worn cameras are activated only when they are required, but we find that, where they are in place, they are a deterrent in themselves. Those are the types of things that we are planning. I am not sure whether colleagues want to add to that.

Ms Kerrylee Weatherall (Children's Social Care Services Reform Programme): At our children's homes, we do have assaults on staff. However, that is do with the trauma that children face. We have brought in a therapeutic model that has reduced incidents, and that has been wholly embraced across our children's homes. It has supported how we de-escalate behaviours and how we wrap around young people. We do have policies; we are following the Northern Ireland framework for integrated therapeutic care. When we embrace such models and approaches, we see a big difference in how children and staff respond to de-escalation methods. We are not considering wearing body cameras in children's homes, but there are other ways of doing it. We have had positive outcomes and have seen a reduction in aggression and violence towards staff, for example in our social care.

The Chairperson (Mr McGuigan): This is the last question from me. You provided an update on the McBride/Hill report, and that is welcome. Can you give us a sense of where the cardiac unit is in particular? That was a major cause of concern and led to the introduction of the special level. Can you give us an overview of where things are with that unit? When do you expect, working with the Department, to reduce the special measures?

Ms Welsh: You will be aware that we appointed an interim cardiac clinical director, Mr Peter Braidley. We were fortunate to have him at our public trust board meeting in January along with other colleagues from cardiac surgery. We wanted to present in a public forum all the changes and the improvements that have been made. Peter and other colleagues made a thorough presentation on the work that he is progressing with the clinical team such as moving to a surgeon-of-the-week model and also creating three sub-specialty teams.

Those are all things that show good progress from a clinical perspective. There has been a huge amount of work on respect-and-civility training, and a very high percentage of the staff has now gone through that programme. A detailed newsletter regularly goes out to the team, so there is a quite a bit of engagement in and around that. We continue to work closely with that team.

Peter will be with us through to, at least, the end of March. I hope that we can persuade him to stay longer because he has been of great benefit to the unit. He has been through challenges in his own unit and is bringing that experience to us. It is a regional service, and there is nowhere that we can compare with in Northern Ireland, so it is important that we look outside. We continue to work closely with that team.

The other themes that I mentioned are in the overarching McBride/Hill report, and those themes also reach back to the DCO cardiac surgery report and other reports and things that I want to take forward in the organisation. One area is medical leadership. The McBride/Hill report talked about the tenure of medical leaders and how you get changeover and how clinical directors have access to the executive team, for example. We have done quite a bit of work on that. We have started a new training programme for our clinical directors and senior managers, bringing them together. That was launched in November, and there has been really positive feedback on it.

We have also looked at refreshing the cadre of clinical directors and chairs of divisions so that, at the five-year point, if you have not already been through a re-interview process, we will do it then to try to refresh jobs. We intend to create a clinical council or a clinical forum. I was used to having that in the Northern Trust, where clinical directors and chairs of divisions met regularly, usually monthly, with the chief executive and the executive team. We will put that in place.

The theme of governance and assurance looked at, from the trust board down, the governance and assurance mechanisms that are in place. We have developed a new assurance framework that we will probably be launching at the beginning of the new financial year in April. That will create of a number of new formal committees of the trust board. There will be a new patient and safety-quality committee that will replace our assurance committee. There will be a new people and culture committee and a new performance and transformation committee, and a new performance-management framework will go with that. There is a whole swathe of things in that regard.

Finally, I will say a bit about people and culture. I engaged an external adviser, as the report suggested, to do a review of the HR function.

That is well under way, and I anticipate receiving a report and recommendations from that in March. A huge amount of activity has gone on since the end of October.

The Chairperson (Mr McGuigan): That is welcome. I suppose the question that the public, and we as Committee members, asks is whether the activity is effective. What came to light in previous reports was described as "shocking", and why would it not be? If you looked at that unit now, how would you, as chief executive officer, describe it?

Ms Welsh: I looked to Peter, the clinical director, and he was clear on the assurances that he gave us on the safety and quality of services in that unit. We have been fortunate that the cardiac surgery service has always participated in national benchmarks and can stand on its record of safety and the quality of services that it provides. We continue to support the team in team-building aspects.

When would people feel a difference in the trust? When I was with you in October, I talked about culture change being a long-term game. I remember saying then that it is a three- to five-year journey. We focus on particular areas and give them support where needed, such as cardiac surgery. However, much of it is about engagement across the organisations, even on things such as the development of our performance management framework or the development of our corporate plan. A lot of the work is about the engagement that we have with clinical teams to develop the strategy. The same is true of the people and culture. It will change over time, and our staff will feel it first.

The report has been well received. We, the senior team, have accepted it and accepted all the recommendations, and we are moving forward in good faith to build a better Belfast Trust.

The Chairperson (Mr McGuigan): OK, we will leave it there.

Mrs Dodds: Thank you for the presentation. It is very important. I want to cover a few issues, so I will dive in as best I can.

You wrote to me recently with an update on the maternity hospital, indicating that the required works for option 2, which is the neonatal issue plus the wider works, would take another 28 months. Given that the maternity hospital was handed over to the Belfast Trust two years ago this month or next month — certainly, we are at the two-year mark — we are talking about four and a half years before the hospital can be operational in any way, shape or form, apart from some clinics. Most people listening will find that an incredible situation for us to be in: four and a half years after, and that is only if everything goes OK.

You also go on to say that should option 2 fail to deliver, option 3 will require a much more extensive piece of work, which would, potentially delay it even further. Are you sure that option 2, that is, replacing the pipework in the neonatal unit and flushing the rest of the hospital pipework, will be effective? According to the last information that I got, you are spending about £40,000 a month, literally flushing water down the drain at that hospital, and that water is still not safe to drink or use.

Ms Welsh: In relation to the options that were put forward, you will be aware that the trust had commissioned an independent report, which proposed option 2 as the solution. Subsequently, the Minister commissioned an independent report, which proposed option 2.

I believe that option 2 is the right one. I have no reason to believe that it would fail. If it is delivered correctly, it is the right thing, and it will be successful. There is an abundance of caution here: we are saying that, should it fail, we would have to escalate to option 3. That is the advice that we are getting from the independent reports.

Should it have taken this long? Absolutely not. A detailed investigation into how we got into the situation is under way, and it would not be appropriate for me to say anything more at this point. However, I am sure that I will come back to you in due course.

Mrs Dodds: Most people would think that having to wait four and a half years until we can use a hospital is nothing short of a scandal. I know that you will agree.

If I were to go into the hospital today, would the water be safe to drink?

Ms Welsh: My understanding is that, yes, it is safe to drink.

Mrs Dodds: You are confident that it is safe to drink. Can you explain why signs have gone up telling people not to drink the water?

Ms Welsh: The director of infrastructure is not here to comment on that — my apologies — but we can come back to you on that.

Mrs Dodds: We need to know. My understanding is that warnings have been put in place not to drink the water. It would be great if you could answer that question.

Will you continue the flushing of the pipes during the two-and-a-half-year period, or will that all be done in one go?

Ms Welsh: There have previously been detailed briefings on the capital infrastructure, and my understanding of today's meeting was that it was to be a trust overview covering a wide range of issues. I said in my opening remarks that I would be happy to come back and give a detailed briefing on infrastructure. We were hoping to focus on services today. I am happy to return, Chair, with the director of infrastructure, because I cannot provide an answer with all the detail on the question.

Mrs Dodds: An overview of the trust is also an overview of its buildings and its ongoing capital projects. It is poor that, again, we are not getting the full answers and have to wait.

I noticed in one of the trust's finance committee reports that it has an overspend. Will you be able to balance the books by the end of the financial year?

Ms Welsh: It is unlikely that we will balance the books this year. It is hugely challenging for all trusts. We are projecting a deficit position; that is known to the Department, and we work closely on that.

Mrs Dodds: OK. Do you know what the deficit position is? The information that I have gleaned suggests that there will potentially be an overspend of £139 million, with an overcommitment of £106 million.

Ms Welsh: We are projecting a deficit of about £9 million, excluding pay.

Mrs Dodds: Oh! Does the £139 million relate to pay?

Ms Welsh: No. It would not be as much as that. We present it in that way because the Department asked what the deficit position would be, excluding the pay

element. We are currently projecting it as £9 million.

Mrs Dodds: OK. Again, that would be an interesting one to come back to. It is important.

You talked briefly about the McBride/Hill report. I said when you previously came to the Committee, and again when the report was being talked about at the Committee, that some of the issues had been skirted around. Those were tidied up under the heading of legacy issues, yet we are still skirting around them today. Some really encouraging things have been going on. I hope that they work out; it is for everybody's good that that should happen. However, we are still not dealing with what we euphemistically call "legacy issues". There is one important question that, again, I want to ask about them. It comes from a note that you sent me.

The investigation and review of the maintaining high professional standards (MHPS) process are being carried out using random sampling. If a clinician wants their case reviewed, will it be included? Can they ask for that specifically, or would that upset the randomness of the sampling?

Mr Campbell: I met unions to explain that to them. That was our chair's original plan at the time. It has to be random to give us a sense of how the scheme was running; whether it was running as effectively as possible, where the issues were and whether it was taking too long. If we make it —.

Mrs Dodds: Well, it was taking an unearthly amount of time. Some consultants were in the process for years on end. In fact, they had accumulated about three of those by the time that one was finished. We know that it was not effective or efficient. I am trying to ask you this: if you want your case to be investigated, can it be investigated?

Mr Campbell: There are processes in place for people who want to revisit it. I do not think that this would be the appropriate place for the MHPS review because it is not intended to reopen the files: it is intended to look at how the process was applied to the files. That is looking at something —.

Mrs Dodds: This is slightly different.

Mr Campbell: Yes.

Mrs Dodds: OK. If a consultant or clinician — whoever it happens to be — wants access to the files, are those files openly available to them?

Mr Campbell: I do not know the answer to that, I am afraid. I would need to check.

Ms Welsh: I am aware that all the files were archived, so a sample will have to be retrieved from archives to enable the exercise that we have just talked about to be carried out. They are not —.

Mrs Dodds: Without the exercise; I am not talking about the exercise.

Mr Campbell: I am happy to come back to you on that.

Mrs Dodds: If x wants to find out what files were kept on them, are those files openly available to them? Have files been openly available to tribunals that have taken place?

Mr Campbell: May I check that and come back to you in writing? I am responsible for looking after the review. However, I do not look after that area on a day-to-day basis, so I do not know the detail of how accessible they are, I am afraid. I will come back to you on it.

Mrs Dodds: It is important to get answers, because those are the questions that I have been asked. It has been indicated to me that those files have not been openly available, even when there has been a legal process.

Mr Campbell: I am sure that we follow the correct legal process, but I would need to check what that is.

Mrs Dodds: OK.

I see that, from April to December, the waiting lists for scopes, for example, have gone down considerably for waits of up to nine weeks and waits of up to 52 weeks. That is good news. In particular, from what I can see on the graph, the number of people waiting up to 52 weeks has halved. That is good news. The overall number has come down from just over 2,000 to under 1,500. Therefore, between April and December, there has been a reduction of 500 or 600 in the number of people waiting for scopes. Has that been due to the elective care process or processes that you have instigated in the hospital yourselves?

Mr Campbell: It is a bit of both on scopes. The team has done some quite innovative things with regard to how they manage it, for one thing. Some quite old-fashioned performance management has also gone into it: they have really honed down on ensuring that they are making the absolute best use of everything that is available and the clinicians are all fully booked. Then there is the additionality that they are doing on top of that. All those together have really driven down waiting lists. The endoscopy team is a high-performing one. As well as the reduction in numbers, we have brought down the red-flag waiting time. It is well under two weeks now for red-flag endoscopies. The whole process has been streamlined.

Mrs Dodds: That is good news. There are still considerable numbers of people waiting —

Mr Campbell: Yes.

Mrs Dodds: — but it is good news that it is going in the right way.

Mr Campbell: Particularly on the red flags.

Mrs Dodds: Unfortunately, the inpatient —.

The Chairperson (Mr McGuigan): You can have a quick question. We need to move on.

Mrs Dodds: I do think that this is important, actually.

The inpatient and the new consultant outpatient lists have not changed in any shape or form.

Mr Campbell: The data does not tell the whole story, unfortunately. I did look at it myself. We had a steady improvement — a reduction— in the outpatient waiting list in either October or November. We had 9,000 patients added to the waiting list who had not been included in outpatients before but who are now. I think that that is for clinical physiology, so those 9,000 have taken it back up. You will notice that, before that, the outpatient list was heading in the right direction, but it has gone up again. It will continue to fall because we are doing more outpatients, new and review. It is a much bigger number as well, as you can see from the graph.

Mrs Dodds: The number for new consultant outpatient waiting lists is just over 160,000. It then goes up, as you say, in November and December. Those are huge numbers.

Mr Campbell: They are.

Mrs Dodds: Is there a plan to deal with that?

Mr Campbell: There are a lot of different plans. Outpatient modernisation is one of our big, key transformation projects. We already have about 4,000 patients who are on patient-initiated follow-ups. That means that, instead of being programmed for review, it is up to the patient: if they have a deterioration, they will contact, and they have a route to contact the clinician directly. A lot of our reviews were just checking up on patients, so we need to focus more on new, to make sure that those are new patients and reduce the number of reviews. That will allow us to do more capacity.

Moreover, we also have a fantastic example today from dermatology and how they are using My Care and photography to reduce waiting times. At one stage, the waiting time for a routine dermatology appointment was seven years. They have brought that right down, because now you can get access to the clinician quickly, so the GP can get access; they can refer you, get assessment of the photograph and get advice and guidance. If you do need to be retained on the waiting list, you will see someone, and if you do not need to be retained, you can be discharged. There is a lot of work that we can do, and a lot of it will be moving away from traditional models, which will take time, but the outpatient waiting list is our biggest challenge.

The Chairperson (Mr McGuigan): Moving on —.

Mrs Dodds: Will there be a specific review of women's health waiting lists?

The Chairperson (Mr McGuigan): We need to move on to other members, just to be fair. Colin?

Mrs Dodds: I think that that is also very important.

The Chairperson (Mr McGuigan): Colin?

Mr McGrath: Thanks very much, Chair. This will probably go one of two ways. [Inaudible.]

I was going to say, "Well done", because the number of complaints that I used to get about the Belfast Trust has reduced since you have taken over. There is a sense that people are taking a step back and letting the new leadership bed in. If people can see that there is change, that there are new systems in place and they feel that they can engage with that, that it is fair, open and transparent, that will help people. I say, "two ways". I could have an inbox tonight that says, "No, it is actually like this", but, hopefully, it will go in the right way.

You spoke about the changes to the culture that you are making at the top. One of the concerns that I had all along — I have interacted with you on it — is how the person at the bottom, who perhaps feels that they have been given a hard time and treated badly, interacts with a process that they feel is stacked against them. Have there been any changes in the process to give people a sense that they are getting a fair crack of the whip if things go wrong in their workplace or in their working environment?

Ms Welsh: There has been quite a bit of focus on that. First, we always want people to be able to raise something with their line manager. If they have a concern with that, they need to have somewhere else to go. Part of what we need to do is equip our managers to deal well with issues of concern. One of the things that we have introduced is a new leadership academy, but it is not just about leadership; it is about good, old-fashioned management as well. Some of the things that managers have to deal with now are very tough, and we need to support managers to cope with them.

If the line manager is deemed to be the problem, where does the person go? They go to the person above that. If they are not comfortable doing that, we have our whistle-blowing process. I have seen an increase in the number of people wanting to come forward in relation to whistle-blowing. Some of that is just about supporting an individual and supporting the manager. Sometimes, it is through mediation to come to a different solution. We have appointed a non-executive director to oversee that process, so if a staff member feels that they do not want to come anywhere near the executive team, the non-executive director can have oversight of everything. I do not say that we are there yet, but it is all part of the cultural change. We have a lot of focus on that and we are encouraging people in that direction.

Mr McGrath: That is positive to hear, because the word "nepotism" was often used, as people felt that if a manager was not able to help them and they bypassed that person, it was the manager's buddy or former colleague or former friend or former whatever. The workforce may be big, but Belfast is a small place. It is about people having the confidence to say, "If, in that immediate space around me, I do not have faith, I can come right somewhere else". If people have faith in the system, it will help the bed-in, and people will be happy with that.

To hark back to the issue of cardiac surgery, where a lot of this started, are you confident that everybody has undertaken their training? Are there any blocks in there, or do you feel 100% that that department is running well and does not have the same issues as it had before?

Ms Welsh: To be quite honest, I think that this is constant gardening. Those individuals are working in a high-pressure environment, given the nature of the service that they provide. Is everyone absolutely 100% happy all of the time? No. I am reluctant to say any more than that in case some of you get a text or a phone call to tell you otherwise. We continue to wrap around and support that team, and we will have to continue to do that for a period of support. However, I assure you of the safety and the quality of the service. I have no doubt about the commitment of individuals to make that service the best that it can be.

Mr McGrath: Do not mention gardening. You do not want to see the state of my garden. It brings bad memories for me.

Finally, we referenced earlier that the Department can use care home places as step-down and that you may have some available finance to use but that maybe you have had to cut back on it. Are you at the point of saying, "We just do not have the money to pay for those care home places in the independent sector", and therefore people have to stay in beds and it causes the back-up, or do you feel that you are constantly able to use all the beds available to you in the independent sector?

Ms Welsh: I did not recognise that, to be honest, and I am happy to engage with the independent sector. I do not know whether it was a particular care home group or in a particular geographical area. I do not recognise that. You might speak to Colin McMullan, the director of our community services. It may be that, as the needs of patients change, we require more dementia beds, for example, in a particular area.

One of the things that we suggested to the Regulation and Quality Improvement Authority (RQIA) is asking whether we can work with care home providers, because we need a shift from traditional residential beds to more nursing beds, and, particularly, more nursing beds for people with challenging behaviour and or very complex needs. Unless it is something in that space, it was not something that I recognised.

Miss McAllister: Thank you for your answers so far. I feel as if you have done your homework on the questions that I want to ask and brought social care and women's issues here today, so I will base most of my questions on that and cancer services, which I presume you will be able to answer anyway.

First, I will start with the last. Can you provide an update on the much needed upgrade to the regional haematology unit at the Belfast City Hospital? That issue has been raised time and again. My colleague Sorcha Eastwood has asked me to raise that again with you today. There has been some limited work done in the tower block, but it needs an overall refurbishment. Can we get an update on that?

Mr Campbell: I do not have an update on where it is. The business case has been approved and the work is ready to go, but I will need to come back to you on exactly what stage it is at and what the timescales are for completion.

Miss McAllister: What does "business case approved" actually mean for patients who need to use the haematology ward and their families?

Mr Campbell: It is a really big step for us. Basically, the work could not progress until the business case had been approved. The team is ready to go as soon as the work is complete, so everything is lined up. We just needed to get the go-ahead to proceed, so we just need to get the solid timescales for that.

Ms Welsh: It is about the funding being available to allow us to go ahead, and we as a trust board have approved that. It is getting it scheduled in now, along with all the other work that we will be doing. That is outside the very large-scale projects. It is what we deem as general capital.

Miss McAllister: That was my next question, so, we are not talking years and years? What kind of time frame are we talking?

Ms Welsh: No. Completely different teams will be doing the very large-scale investment. It should not be terribly long before we get that started. We were doing other work in the City Hospital tower on another floor, so I will come back to you with a specific date, but my understanding is that it is scheduled in for not too far away.

Miss McAllister: I look forward to that response.

My next question is about how the Belfast Trust's Da Vinci machine can help with gynae waiting lists. In its latest press release, the Royal College of Obstetricians and Gynaecologists said that the queue of women, standing shoulder to shoulder, waiting for gynae services, stretched for 15 miles. I have asked questions about robot-assisted surgery many times. It is carried out by trained clinicians and consultants and is predominantly used for men's health, rather than women's health. That may not have been a conscious decision when those clinicians were being trained, but it was a decision, nonetheless, that benefits men rather than women. In his answer to a recent question for written answer, the Minister said that the new robotic surgery, which could be used for gynae across the region, has only now been thrown into the review of general surgery. That made me wonder whether that is a step back from where we were. My understanding was that not only would we have a new machine for gynae but that the current machine would be utilised further.

Ms Cahalan: I will start with the good news. We had a bid to our charitable fund for new kit under the capital scheme. The fund was happy to approve that, but there are revenue consequences to initiating a new robot. From a consumables point of view, we needed to make sure that we were able to support the associated costs. That necessitated a bid on the revenue side to our colleagues in commissioning. They have since come back and approved that proposal. That led to us being able, at the trust board, to approve that the charitable fund be secured. That has gone ahead, and we are at the procurement stage. That will go into the City Hospital and it will be used, not just for gynaecology: it is a joint enterprise with colorectal surgery. I am pleased to say that the commission sessions for gynaecology have been agreed, and that that will commence.

Miss McAllister: I know that it is not solely for gynaecology, but I wanted to emphasise the fact that while it was predominantly used in men's health, we could see that it would have overwhelming benefits for women's health, and particularly on gynaecology waiting lists. When will we see that?

Ms Cahalan: We absolutely will. The original robot will remain in situ. We were using it episodically, and we had sessions available for gynaecology in order to maintain skills. Those gynaecologists who were trained were maintaining their skills in the use of the robot in the sessions that were available to them. We now have a more planned and programmed piece of work. The equipment will be used for gynaecology cases. We know that, with endometriosis, there is a significant benefit.

Do you want me to give you an update on our gynaecology waiting position?

Miss McAllister: Yes. That was going to be my next question.

Ms Cahalan: It is a good story to tell as well. There is still work to do, and I want to acknowledge that from the start. The gynaecology team has undertaken a multidisciplinary approach to outpatient modernisation, so I will start with the outpatient space. We started the year with a ministerial target of no one waiting longer than four years. Then, because of the provider collaborative, we set ourselves a more ambitious target of around three years. That is the target that we have been working to. For our outpatient gynae activity for urgent cases, we started in April 2025 with a waiting time of 36 months. By January 2026, we got that down to 14 months, and we are on target to have that down to 12 months by the end of March 2026, which is, obviously, very pleasing to see.

Our routine waits start of the year at 40 months, and again, we have achieved an improvement, with the waits down to 34 months in January 2026, with further improvements planned to get us to projected picture of 32 months. That brings us into the longest waiting time being less than three years. There is clearly more work to be done there.

Miss McAllister: Is that waiting times for first appointments?

Ms Cahalan: First appointments.

Miss McAllister: Do they go into another queue for surgery if that is required?

Ms Cahalan: Obviously, not everyone converts to needing surgery. Those who do will join the waiting list. I can give you an update on our inpatient and day case rates.

Miss McAllister: I am sorry.

Ms Cahalan: No, it is absolutely fine. I am happy to do that. You are right; more activity in outpatients can put more pressure on the inpatient waiting list, so I am giving you the position as it stands. Our regional mesh service, which we deliver on behalf of the region, started the year on 10-month waits at April 2025. That is now down to two months, and we are very confident that we are going to maintain that waiting time. It is pleasing that, across all the programmes, there has not been one area of focus, allowing others to drift out. That is very good to see. We deliver the gynae oncology service for the region as well. We consistently meet the 14-,31- and 62-day targets. We are on target and on track for any red-flag referrals there.

For inpatient and day cases, in general gynaecology, we started the year in April 2025 with 85-month waits. Those are now down to 64 months at January 2026, and we are projecting 35 months by the end of March 2026. A lot of progress has been made there. For endometriosis cases, we opened the year with 88-month waits. That is now down to 21 months, and we will sustain that going towards the end of the year. So, again, very good progress has been made. On regional mesh, for inpatient and day case appointments, we started with 72-month waits, and we are now at 12 months and will be at six months by the end of March. In all those parameters, we have made gains through the work of the team, rationalising all the treatment that they have done. They have done vast amounts of clinical validation, and they have also put on extra sessions and have been doing extra work. We have used the independent sector for displaced work in more general gynaecology so that we can do the regional work. We have focused on the work that only Belfast can do and that could not be displaced. Some of our work has gone to the independent sector so that we can take that much more targeted approach. In endometriosis, we opened the year with eight-month waiting times for urgent appointments, and that is down to zero. We have no wait for urgent endometriosis outpatient appointments. For routine cases, we started the year with 11-month waits, and that is now down to eight months. So, again, there are some improvements there.

Ms Welsh: At your earlier session today, you asked about the committee in common and about what trusts were doing together. That is one of the areas that we asked for focus on. Paula referred to a provider collaborative. We have a number of provider collaboratives that sit underneath the committee in common structure, which is made up of the chairs and chief executives. The team has worked incredibly hard on that, and the results speak for themselves.

Ms Cahalan: Absolutely. I have one last comment about menopause services. Often, in general gynaecology, that is an area that gets somewhat lost in the focus of trying to deal with the red-flag work. We started the year with waiting times of two years, and that is now at three months. So, we are in a much-improved position across all the parameters. There is still much to be done. I fully recognise that.

Miss McAllister: You must be congratulated on the improvements made. There is no wait on one of those, and that is fantastic. Was that for urgent endometriosis care?

Ms Welsh: Yes, for endometriosis.

Miss McAllister: The 35-month wait in general gynaecology still means a wait for a number of years.

Ms Welsh: It does.

Miss McAllister: So, there are still improvement to be made. Do you think that you can sustain those?

Ms Cahalan: Yes. Those have been done through very focused work around the patient-initiated follow-up. They are from having the idea of retaining reviews for those who absolutely need them and then encouraging and empowering people to come back to us when they need us and being ready to see them. The other piece where we have seen great traction is on the advice with guidance. Alastair referred to that as being such a success in dermatology, and it has been a success in this space as well. It is well received that we are giving earlier support to our GP colleagues to manage lower-risk work, and that has brought the provision of care much earlier in the journey for ladies when they need it. It has been a very encouraging sign. Yes, we would not want to go back. That is the point, and we are committed to continuing to go forward.

Miss McAllister: That is great. Hopefully, with the new machine, we can drive the waiting lists down.

Mr Campbell: The My Care app creates huge new opportunities for us in how we manage outpatients because the advice and guidance works for primary care and works for people when they can get advice quickly when they need it. Someone, rather than waiting on a long waiting list, can, if they get a blood test, be told what they need to do to follow up, whether it is negative or positive and what needs to be done. I mention that because My Care is such a fantastic resource for us and such a tool for transformation. I am not sure that that many people know about it yet in Northern Ireland. I think that about an eighth of the population in Northern Ireland is signed up to it so far. If we are going to prioritise things that will really transform, the My Care app is part of the solution.

Miss McAllister: Thank you. I had more questions regarding social care but I will just ask one because we are quite late. I can keep in touch with you, Kerrylee, for another update. You work with the South Eastern Trust on respite provision and Lindsay House. I am disappointed to hear the news around what that will facilitate. Can you provide any feedback on the work that you are doing? Also, there are other facilities that are currently not in use in the Belfast Trust. I have submitted a question for written answer on Chestnut Grove, for example, as money has gone into it, but I am not sure what for. Has any other scoping work been carried out for respite provision for Belfast Trust families?

Ms Weatherall: We have done extensive scoping, and the co-director has also engaged with estates and is looking at properties. Today, I was contacted and told that there may be other opportunities with a provider that we have. We continue to look at our short break opportunities, but we have made some improvements to offer short breaks in alternative ways. We have set up fostering short breaks. In the past six months, we have assessed and approved two carers, and they are taking children for respite. We are also assessing six foster carers at the moment, and we have had 21 enquiries from people who will go through the assessment process. Within six months, we have set up fostering short breaks, because not all short breaks have to be in a home.

We have also set up Forest Lodge as a temporary measure, but you will be aware of that. The RQIA has extended the registration to help with that. We went back to Barnardo's, which has had challenges with recruiting staff. We have looked at the families who receive respite short breaks and extended that for other families to come in, so that more families and children can get respite. We have set up an in-reach service, which goes into family homes for a few hours a day and extends over the weekends. The service has been inundated with referrals, and families are benefiting because they get some time to go shopping or to have a meal in a restaurant.

We are disappointed. We understand the South Eastern Trust's position and that it has been challenged by the Lindsay House situation, which has led to challenges for us. However, we are exhausting all opportunities at a great pace. There have been obstacles to finding suitable buildings for short breaks, but I can reassure the Committee that we have not stopped looking. The extension of the community and voluntary sector contracts has helped. For example, we previously had 13 children on the edge of care who were waiting for residential care, and that has been reduced to five because of the increase in short breaks, the provision of in-reach and the extension of the community and voluntary sector's input into the families. Some 46 families were waiting for short breaks, and that was reduced to 38 recently.

We can see improvements, but it is not at the speed that we would like because of the challenges that we have faced, but we are determined to keep driving forward to provide more short breaks.

Miss McAllister: OK. I am happy to take further questions.

The Chairperson (Mr McGuigan): It is 5.15 pm, are you happy to stay for another 15 minutes? [Laughter.]

I need to ask that question. There are three members left, and it will be five minutes per member. I apologise. We will have to resurrect this again next week.

Mrs Dillon: My question will not even take five minutes.

The Chairperson (Mr McGuigan): Danny, you have five minutes.

Mr Donnelly: Thank you, Chair.

Mrs Dillon: You don't have to use them. [Laughter.]

Mr Donnelly: I had quite a few questions, but quite a few of the topics have been picked up by other members. Colin mentioned the independent sector's briefing last week, at which representatives said that trusts have underspent on social care, particularly in the later months of the year. You said that you do not recognise that at all. Can you provide us with any figures to back that up, because it is quite a strong claim?

Ms Welsh: We will come back to you. Can you give us anything that you have about the areas where they believe that there is a concern? I am happy to go back to the director, Colin McMullan, and ask him to look into the matter in some detail.

Mr Donnelly: Thank you. You provided a DTA graphic for 79 days from 1 January to 20 March 2025. Why did you use that snapshot?

Mr Campbell: I did not have an updated graph to hand. The trajectory has been sustained, and we saw an increase in November and December, but not to the same levels as those months in the previous year. While it was very busy, and we expected the business to lead to an increase in DTAs, we have continued on a gradual downward trajectory. We are making progress.

Mr Donnelly: I am interested in seeing some more figures.

Mr Campbell: I can send an updated graph to show the past few months if that would be helpful.

Mr Donnelly: It seemed odd to get such a small snapshot. What are you doing to decrease DTAs? My understanding is that, within the population, a certain number will get certain illnesses and require hospital treatment at a certain time. How is that being reduced?

Mr Campbell: A survey of the ED last year showed that a large number of people go to the emergency department because they do not know or do not have alternatives. They think — they are probably right — that the ED is the fastest way to get treatment in certain circumstances.

What we have put in place in the Royal is ward 2F. It is like an acute medical unit, so people can come in and get a very quick assessment, and if they are able to go home with a plan, they can. That means that they do not have to stay in hospital, which is better for them, and avoids any lengthy stay in hospital or in ED. They also have a REACT model, although I cannot remember what that clever acronym stands for. That is a multidisciplinary team that identifies people who come through the front door. They see them quickly, and if they can direct them to a different service or make sure that they can be seen in a way that means that they will not have to spend time in the emergency department, they can get diverted into those steams.

In addition, we have a wide range of same-day emergency care pathways. If someone comes in, they get an appointment for maybe the next day or for two days' time into an urgent or rapid clinic, which, again, means that they do not have to be admitted or wait. There are cohorts of patients that that works for. In future, we can look at areas that are really exciting such as virtual wards where people can be monitored using devices at home or by a group in the hospital. People who we would currently admit almost as a precaution could be monitored safely at home. The model that they have is working phenomenally well. Our number of DTAs dropped overnight when we brought in 2F. It has worked really well, and although the drop has been sustained, there is still a lot more to do.

Mr Donnelly: I am glad to hear that. I want to pick up on the length of stays. You highlighted a couple of differences between yourselves and other trusts. Geriatric medicine, in particular, is significantly different from the Northern Trust.

Mr Campbell: Yes. I think that the data shows how long it usually takes us to repatriate, depending on the location that the patient comes from. I have to say up front that that is not targeted at the Western Trust or the Northern Trust because they have exactly the same problems when they repatriate patients to us. The difference becomes more obvious because we have a lot of patients to repatriate. Essentially, if someone comes in from Belfast and is repatriated to a Belfast care home or a Belfast home, they tend to be faster. It is just when we have to move across trust boundaries that there is an unavoidable delay. We work closely with the other trusts. With the Northern Trust, for example, we have a daily meeting about fractures patients to make sure that we can repatriate as quickly as possible. However, it is constant challenge.

Mr Donnelly: The difference compared with the Northern Trust is 10 days.

Mr Campbell: Yes. With all these, it could be that particularly long waiters drag up the length of time. Sometimes, it might be better to look at the median figure to see the average. We would get patients who stay for a long time in some of the regional specialties. Someone, say, staying for months in hospital could warp the figures.

Ms Welsh: With my previous hat on from the Northern Trust perspective, repatriating people from Belfast back into the Northern Trust was an incredibly big problem. If you look at the service there, particularly in Antrim where there are very high DTAs, it really does not have the infrastructure that it needs to deal with the size of the population. It is the same with getting complex people a care home package or to home care, so I have a lot of sympathy for the challenges there. The point about looking at a median position might be better.

Mr Donnelly: OK.

Mrs Dillon: Paula, with regard to your report, will you give me in writing a breakdown of which gynae services are regional and which are Belfast Trust-specific so that I can start looking at the other trusts to see where they are with women's health?

Ms Cahalan: Sure. The only true regional specialty is our gynae oncology.

Mrs Dillon: So, nothing for endo? What about the use of the new machine, for example? Is that going to be regional?

Ms Cahalan: I should say that endometriosis has not been a specifically funded and commissioned subspecialty service. We all run it through our general gynaecology services. We have, perhaps, been fortunate in some of our more recent appointments to our subspeciality teams and we have dedicated those to our endometriosis patients, which is why we are now in an improved position. Whether other trusts have the wherewithal to do that for a subspeciality, I really would not be able to comment. What I would say is that the intention of the strategic planning and performance group is to bring a more regional approach to endometriosis. It is our understanding that it will probably go for a two-trust model on that, with Belfast likely to be one because of the Da Vinci robot, and the expectation is that the Western will be the other trust. That is our working understanding at the moment, but it is a work in progress with our colleagues in commissioning.

Mrs Dillon: Perhaps that is a question that we can ask the Minister. It is good to have that information for that reason. I want to ask you about children's services. Unfortunately, we talk about Cinderella services all the time, but there is nothing like the Cinderella service that is offered to our children in care settings. There needs to be a focus on that. They never have anybody to speak up for them, because their families do not have the capacity to do so. The data from the Youth Justice Agency has identified that children in residential children's homes represent the majority — 80% – of statutory referrals for care-experienced children. There is a subgroup that is in the early stages of taking forward a specific project to consider practical actions to help to reduce that. Are you able to provide any detail on that now? If you cannot, I am happy to get that in writing. Earlier, you mentioned a specific programme to work with children who are, perhaps, aggressive in care homes, and the trauma-informed approach to that. Is that part of that?

Ms Weatherall: No. They are separate models. I will be happy to give you information on both. I do not have specifics to give you.

Mrs Dillon: I am happy to get that in writing. I would like to get as much detail as possible, even on how they are coming into contact with the Youth Justice Agency. Is it around aggression in residential settings? My understanding was that some really good work was happening there. It is their home, at the end of the day.

Ms Weatherall: We see it as a therapeutic home. That is why the Northern Ireland therapeutic model that we have all embraced in our residential homes has helped to de-escalate that and change mindsets as well. It is a behaviour response; it is not an assault on a member of staff. It is about how trauma and feelings are acted out. We have done a lot of work around that, and, as I said earlier, we have reduced those instances. The homes are better calibrated; there is a better feel, and better interpersonal relationships. I will send you a copy of the TIPSI model and our statistics on how we have improved. I will look into the matters around the youth justice group that is to be set up, and I will come back to you.

Mrs Dillon: That would be really good. We can come back to that at another time. Thank you.

Mr Robinson: I want to make one very quick comment, and I have one very quick question for you, Jennifer. First, Paula, well done. We will expect you to come here every week to tell us the good news, given all the bad news that we have to deal with every week. [Laughter.]

Ms Cahalan: No pressure.

Mr Robinson: Jennifer, I want to ask you about the maternity hospital. We got our most recent briefing back in October. I appreciate that you are not here to comment on the complexities of the maternity hospital. We were told at that briefing that the trust and the legal representatives were working with independent experts on issues of liability. Are you able to update us on liability? We are all keen to know.

Ms Welsh: As soon as I am able to give you a clear briefing on that, I will be happy to give it to you. We do not have the final information on that.

Mr Robinson: You still do not?

Ms Welsh: We still do not.

Mr Robinson: OK.

The Chairperson (Mr McGuigan): Very quickly, Paula — I do not want to prolong this — I join everyone in congratulating you on those figures, some of which are very dramatic. You said that the endometriosis waiting list has reduced to zero. Does that mean that the waiting list for treatment is down to zero?

Ms Cahalan: That is for outpatient referrals, in the urgent category. The routine category still has a lengthy wait attached to it at this time. We have tried to pull that out from the general gynaecology waits so that we are, at least, taking a more focused approach. That is why we have managed successfully to bring our urgent waiting time down, rather than everyone waiting globally for it.

The Chairperson (Mr McGuigan): We had a debate on that subject in the Assembly. That is why I am interested in the reduction in the number of urgent waits to zero. How many are we talking about?

Ms Cahalan: I do not have that written down in front of me, but I will be happy to provide that to you. I will get you the actual numbers in that category.

The Chairperson (Mr McGuigan): That would be helpful. It is definitely an issue of concern.

Ms Cahalan: Yes, absolutely; no problem at all.

The Chairperson (Mr McGuigan): OK, thank you. Thank you very much to all of you. I appreciate your staying longer. I was told mid-session that a music class was going to be starting, so I thought that we were going to be drowned out. [Laughter.]

I appreciate your spending the length of time that you did with us. Thank you.