Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome Robbie Butler, the Minister of Health, along with the following officials from his Department: Jim Wilkinson, deputy secretary of the healthcare and policy group; Tracey McCaig, chief operating officer of the strategic planning and performance group (SPPG); and Peter Toogood, deputy secretary of the social care and public health policy group. You are all very welcome.

Initially, this meeting was in the diary so that we could talk about winter preparations. Obviously, that has changed slightly. We will talk about winter preparations, but we have lots more to talk about. Given that this is your first formal engagement with the Committee, I congratulate you on your new role as Minister of Health. I wish you well. I say this all the time: leaving aside politics, I always want to see the Health Minister, whoever they are and whatever their political party, doing a great job, because Health is so important for all of us. We will ask you difficult questions today, but I will hand over to you, Minister, for some opening remarks before taking questions.

Mr Butler (The Minister of Health): Thank you so much, Chair, and thank you, colleagues. I have worked with most of you for some time now. I have said this a few times, including at the Hospice Alliance Northern Ireland event yesterday, which the Chair was at: I expect challenging and difficult questions, as any Minister should. Your experience of working with me means that you will know that, where those are of benefit, I will absolutely take them, but, if they need pushback, similarly, you will get that. I agree with the Chair that everything that we do in Health — the Committee has a very good reputation on this — has to be non-political and to have the interests of Northern Ireland at its heart. I have already witnessed the value of the Committee to my predecessor and his predecessor when it comes to prioritising Health. The role that you guys have is every bit as important as the role that I have in fashioning that. I was Chair of the AERA Committee previously — I am sitting in a very different seat now — and I do not see the Committee and the Minister being in conflict too many times, because, ultimately, we are here as legislators and scrutineers to deliver the very best. Thank you very much for that, Chair. It certainly feels different sitting on this side of the table.

This is my first time appearing in front of the Committee as Health Minister, so I want to set out clearly how I intend to approach the role, the immediate pressures facing the system and the action that I expect to see. I am joined by senior officials whom, I am sure, you all know and on whom I will probably lean very heavily today, because this marks just my fifth week as Minister. I am honest about the fact that — I have said it from day 1 — I will surround myself with people who have knowledge of the system and system users to make the right decisions. I fully expect that there will be the occasional curveball from the Committee, because I know some of you characters from the Chamber and from working with you for a number of years. In many ways, that often helps to solicit the very best.

From the outset, let me make it clear that my ambition is to have a health and social care system that provides safe, timely and high-quality care. However, I will not pretend that that can be achieved through another plan or a single intervention, because demand is rising, our workforce is under sustained pressure, and the financial position is exceptionally difficult. Reform is essential, but reform must translate into better access, better outcomes and a more sustainable service. Crucially, I want to repair the unwritten contract between service users and our health and social care system.

My approach is straightforward: I will listen to patients and staff; I will follow the evidence; and I will be accountable for everything that I do, because I want my time in office to be judged by delivery. I look forward to working with the Committee to achieve that. Having served across multiple Committees in this place, I know and genuinely value the role that they fulfil. You will, of course, scrutinise, but, as the purpose of a Committee, under Standing Orders, is also to formally "advise and assist", I hope to, in the short time that remains, see our relationship through the lens of constructive challenge and shared focus on solutions. Before I proceed further, I thank my predecessor Mike Nesbitt for the work that he undertook and the momentum that he created. I intend to build on that work while bringing my priorities and focus to the role, even in the short period that I have.

The health and social care reset plan remains the framework for reform, with its focus on prevention, neighbourhood care, workforce sustainability, digital enablement and reducing unwarranted variation. My priorities within that work are improving access to urgent, primary and elective care; strengthening mental health and social care; supporting our workforce; and ensuring that decisions about services are evidence-led and publicly accountable. However, of course, those priorities must be considered against the financial reality. For planning purposes, the Department has assumed funding of approximately £8·7 billion for 2026-27, and that is against identified pressures. The opening shortfall was approximately £0·8 billion, as you will be aware. Even after planned savings of around £300 million across the Department and its arm's-length bodies, a residual gap of approximately £0·5 billion remains today. Members will know about the savings requirement placed on trusts, but the previous red line of "no risk of harm to patients" remains. I rubber-stamped that in my early days. Nevertheless, difficult choices still lie ahead. Health cannot reach financial balance through efficiencies alone, and I will continue to make that case clearly in the Executive. I spent about two hours with the Executive this morning and made that very point. The health service cannot save its way out of a structural funding gap of that scale.

You will be aware that there is a legislative programme. That programme will require close engagement between my Department and the Committee. I am hopeful of the Adult Protection Bill's progressing through its remaining Assembly stages, with proper consideration also given to the relevant findings of the Muckamore Abbey Hospital inquiry. The safe staffing legislation has now been drafted, and I am hopeful that I can secure Executive clearance in the coming weeks. The control of data processing Bill remains before the Executive for approval, and I will be engaging with colleagues to try to secure movement on it. I also remain fully committed to introducing duty of candour legislation. That legislation is too important to rush, particularly at the expense of proper scrutiny by the Committee, but I can confirm that I have instructed officials to proceed at pace with its development and to start the necessary process to draft the Bill. However, time is really tight, and public accountability will not be strengthened by making promises that the remaining Assembly timetable may not realistically accommodate. We will know more shortly about what is deliverable, and I hope to bring something to the Committee.

I want to provide a brief update on the independent reconfiguration committee (IRC) that was announced earlier this month. I suspect that the Committee shares my belief that public confidence in major service change decisions badly needs to improve. The independent reconfiguration committee will, at my request, provide independent expert advice on major or contentious proposals. It will not replace the assessments that are undertaken by the trusts, the SPPG or the Public Health Agency (PHA). Despite what has been claimed, it is not another review of the health service. We are on a pathway, and we will stay on it.

The purpose of the committee is to test the evidence; examine whether reasonable alternatives have been properly considered; and provide an additional layer of assurance around the quality, transparency and impact of proposed changes. The committee will advise, not decide. Ministers should remain democratically accountable for decisions, and I will take responsibility for any major decisions during my tenure. I am pleased to confirm that Professor Clive Kay will chair the committee. His extensive NHS leadership experience will bring valuable expertise and independent oversight to its work. His appointment is in train. I met the professor, and I am very happy about his appointment.

I recognise that members will also expect me to raise inpatient maternity services at Daisy Hill Hospital. My statement in the Assembly on Monday set out the position, the immediate steps that are being taken and the contingency arrangements that are under examination. Discussions have continued throughout the week, and Tracey has been particularly closely involved with the issue. I will answer the Committee's questions as fully as possible today.

I turn to winter preparedness and urgent care. Winter planning is not an annual exercise that begins in the autumn. The pressures that face health and social care exist throughout the year, but winter magnifies them and reduces the margin for error. Whilst the precise levels of pressures may vary from year to year, their arrival should never come as a surprise to any of us. I know, even from my time as an MLA, that there is often great annual emphasis given to the Department's winter plan, even to the date on which it is published. However, we do not need a plan for its own sake. That is why, this year, we have decided to try something different.

In July, the Department issued winter surge planning guidance to Health and Social Care (HSC) chief executives. Trust plans were published on 18 September, giving the public and the Committee greater visibility of the arrangements that were being put in place. The priority is to prevent avoidable hospital attendance and admission, maintain safe critical care capacity and support timely discharge. That requires a whole-system response across primary care, the Ambulance Service, hospitals, community services, social care and, indeed, the voluntary sector. The plans must also provide credible staffing arrangements for holiday periods and high absence periods, strong vaccination delivery, alternative pathways to emergency departments and rapid escalation when demand exceeds capacity. A surge oversight programme board, chaired jointly by the PHA and the SPPG, is planned to begin in late October to support oversight, information-sharing and communication. That will ensure that we are agile and responsive.

I am acutely aware, too, that many patients, particularly older people, wait too long in emergency departments. We must improve the flow through hospitals, but we must also make it easier for people to receive the right care without attending an emergency department where it is not clinically necessary to do so. Hospital at Home, intermediate care, virtual wards, same-day emergency care, Pharmacy First and integrated neighbourhood teams all have a role to play, and no single initiative will solve the pressures. I will expect evidence that the different parts of the system are working together and that plans are delivering results for patients. The Committee will, no doubt, play an important role in that scrutiny function.

When it comes to domiciliary care, social care capacity is central to the safety and performance of the entire system. It supports people to remain independent, prevents avoidable admissions and allows patients who are medically fit to leave hospital without unnecessary delay. More than 23,000 people currently receive almost 300,000 hours of home care support each week. However, in July, 2,750 people were waiting for all or part of a care package, representing 9,415 hours of unmet need. That position is not acceptable, and it has consequences for individuals, families, carers and, indeed, hospital flow. Trusts are working to reduce unmet need, but the response must extend beyond providing additional hours through the existing model. Through adult social care reform, we are prioritising prevention; greater use of technology; expanded self-directed support; and new approaches to care at home and in care homes.
The objective, Chair, is practical: to help more people remain safe, independent and connected to their communities whilst building a social care system that is sustainable for those who use it and those who work in it.

Many of you are interested in an update on pay and workforce. I acknowledge, in this space, the professionalism and commitment of our Health and Social Care workforce. The staff continue to deliver care in extremely challenging circumstances, and the delay in implementing the 2026-27 pay award is adding to understandable frustration. In fact, I would go further and say that it is now palpable frustration, and I can understand why. My predecessor issued a ministerial direction to implement the recommendations of the NHS Pay Review Body and the Review Body on Doctors' and Dentists' Remuneration and to introduce a real living wage across health and social care and the independent social care sector. I fully support that decision.

The Department cannot implement the award without the required Executive approval. That approval has been sought, and I will continue to press for an urgent decision. The Executive met again this morning, and, whilst I will not breach any confidentiality, I can assure you that I raised my desire to move on pay. Staff should not be left waiting unnecessarily for clarity on pay that colleagues elsewhere have already received. Delay also carries wider risks for morale, retention and industrial relations as we enter this critical winter period. The pay award is an Executive responsibility, but one that I am hopeful can and will be resolved in the short time ahead.

In conclusion, the coming months will be difficult. There is no responsible basis on which to promise that winter pressures will disappear, but there is every reason to expect clear planning, strong oversight and honest accountability for that delivery. I look forward to working constructively with the Committee, and I am happy to take members' questions. Thank you.

The Chairperson (Mr McGuigan): Thank you, Minister. I will start with legislation. This is a legislative Assembly, of which I am a Member, and the Committee has important work to do with regard to legislation. I have to say that my eyes rolled a wee bit at some of your language around legislation. You said that you are "hopeful" about the Adult Protection Bill. We need to be more than "hopeful" about that Bill. We absolutely need to see progress on it and for it to be concluded before the end of this mandate. The Committee has been doing its due diligence. We have been writing to the previous Minister and the Department since as far back as March this year, asking when we would see specific pieces of legislation. The last update told us that we would see safe staffing in early September. We are now in late September, and we have not seen that. We were told that we would see a data processing Bill before the summer. We are now beyond the summer, and we have not seen that. Minister, I was particularly shocked that, while you said that you are "fully committed" to introducing a duty of candour Bill, you put caveats on that.

You praised our healthcare workers. Nobody will not praise our healthcare workers. They absolutely deserve our praise and thanks for their commitment and dedication. However, we also need to recognise that, sometimes, things go wrong. In the past week, the Committee has met families of patients of Dr Watt in the neurology scandal. We have, in the past, met the Ladies with Letters, who were traumatised and harmed as a result of the cervical screening scandal in the Southern Health and Social Care Trust. We had the hyponatraemia inquiry and, most recently, the Muckamore inquiry. Those are four scandals that I can name off the top of my head in which patients were harmed, traumatised and, in some cases, lost their lives as a result of failures in the system. All of those inquiries have specifically recommended that we should have duty of candour legislation to oversee failings in the system when they arise. That would protect staff and, ultimately, patients. With six months left in this mandate, Minister, I would like you to give us a firm date for when we will see a duty of candour Bill come before the Committee for us to scrutinise, so that we can protect our citizens out there.

Mr Butler: No problem. I appreciate your candour and forthrightness. You are absolutely right: what went before is unacceptable. I have apologised, as previous Ministers did, for the scandals that have beset people whose needs the social care system was set up not just to serve and meet but to protect. In some cases, that fell short: there is no argument about that, Chair. On taking up the post, I want to reflect upon the recommendations in those reviews. Some of the reviews are still ongoing in terms of the departmental response, particularly Muckamore. What that was is not in dispute, but there is a read across on the provisions of the legislation to ensure, first, that there is no duplication; and secondly, that it is fit for purpose. We are all working our way through that report. It is really important that legislation is correct and a fitting tribute to those who have suffered.

I will say, from a political point of view, that, before the Muckamore Abbey Hospital inquiry, there were scandals that should have led to the Executive introducing legislation. Unfortunately, for five years out of 10, we have not had an Assembly, which has meant that there has not been a Minister to bring things forward. That is not a cop-out from me because I am now in this role. I give you a commitment today. I have asked for the duty of candour Bill to be drafted. I am working with Executive colleagues — there is a challenging Executive legislative timetable, including in respect of private Members' Bills — but it absolutely needs to be right. I am fully committed to the previous commitments that were made to introduce legislation.

The Chairperson (Mr McGuigan): I forewarned all members that they can politely interject, because, although you have been generous with your time, we could keep you for four times the time available.

At the beginning, you said, among a lot of things, that you should be judged on deliverability and that you want to be held accountable. I have mentioned four pieces of potential legislation: I want a date for when we will get all four of them. Duty of candour legislation was a recommendation from the Muckamore inquiry, but all the other inquiries resulting from scandals also talked about having a duty of candour. Two years is a short mandate, sure, but it should be enough time. Six months from the end of the mandate, we should not be talking about drafting legislation. The Committee wants to know when we will see those four Bills come through. You have not given us a date for any of them.

Mr Butler: I cannot give you a date, and that is partly because the Committee will have to perform its scrutiny, and it might decide that it wants to reduce or extend its scrutiny period depending on what it sees in Bills and other significant legislation. I can say that I am committed to and have instructed —.

The Chairperson (Mr McGuigan): Has a duty of candour Bill been drafted yet?

Mr Butler: Chair, I said that I have instructed it to go for drafting.

The Chairperson (Mr McGuigan): How long is that process likely to take?

Mr Butler: It is impossible to say, because of the detail of the draft legislation. It depends on the length and detail of the Bill. I am happy to offer the question to some of the policy leads.

The Chairperson (Mr McGuigan): When it comes to accountability and deliverability, Minister, if we do not get a duty of candour Bill in this mandate, will you feel that you have failed the people who have suffered as a result of the hyponatraemia, neurology, cervical cancer screening and Muckamore scandals?

Mr Butler: I will do my absolute best. I made the promise on day 1 to do my absolute best in the time that remains to me. On Monday, I said in the House, where I also answered a question for oral answer on the Children's Hospice, that I would not overpromise and under-deliver. I will leave a legacy of things that offer value. Getting it right, and getting it right first time, is more important.

I will hand over to the policy lead. Other things are in train, including primary legislation in Westminster such as the Public Office (Accountability) Bill, known as the Hillsborough law. There are opportunities in that for us to look at efficiencies. On the back of that, we could introduce secondary legislation that might meet the need more quickly. That does not reduce my ambition to introduce a duty of candour Bill, but it has to be right.

Mr Jim Wilkinson (Department of Health): There are the straightforward procedural bits. We have completed the policy work and the preparation for instructions. We have not drafted the instructions yet; we will have them completed in about four weeks. We then have to have input from the Office of the Legislative Counsel (OLC), which has also committed to using its best endeavours to draft the Bill. There is a process to go through there to finalise it. Obviously, there is also a stage before that, when Executive approval is secured.

In the policy context, duty of candour has been a complex, controversial and, indeed, emotive issue. The policy proposals that we discussed at the Committee and that we are working on are for an organisational duty of candour, not an individual duty of candour. There has been a lot of discussion and debate about the inquiries that you mentioned and a general concern about the balance between those duties, but the policy for which we have developed proposals is an organisational duty of candour. We have gone through the policy process work to look at how that happens in England, Scotland and Wales, because that is where our comparators are. We should have —.

The Chairperson (Mr McGuigan): Yes, but the date for the end of the mandate and purdah is not a surprise to anybody in the Department. Assurances were given to the Committee on time frames that we are now well past. Commitments were given to families who have been through the horror of those inquiries. Those families were promised things. A duty of candour Bill is important to instil confidence in our health service.

Mr Wilkinson: It is, and, as I said, it is an organisational duty that we are drafting instructions on. We should have completed those instructions within the next four weeks. Those will go to the Office of the Legislative Council, and the council will go through —.

The Chairperson (Mr McGuigan): Will we have it to scrutinise before —?

Mr Wilkinson: When the Office of the Legislative Council's process is complete, that will come forward for scrutiny. We cannot make a guess about moving from a scrutiny process to a fully endorsed piece of legislation within the amount of time that is left in the Assembly mandate.

The other point —.

The Chairperson (Mr McGuigan): Minister, you were Chair of the AERA Committee. All these Bills and their time frames are important. The Committee wants to do its job of scrutinising as best it can, and we absolutely give our commitment to do that. Minister, as a previous Committee Chair, within what time frame in advance of the end of the mandate would you expect to see this Bill introduced?

Mr Butler: As somebody who has chaired a Committee and who understands that, when draft legislation comes through, the complexity and touchpoints of it have to be assessed, it would be absolutely foolish of me to say. My ambition is to do something within the mandate. As I have said from day 1, however, I will not make rushed decisions; I will make the right decisions. There is another opportunity. When the draft legislation is ready to go, there will be a new mandate and this place will be up and running again. We can leave legacies. We need to get it right, as opposed to rushing something through. My legacy will be getting things right.

The Chairperson (Mr McGuigan): Nobody is asking the Department to rush. Legislation, such as that on duty of candour, should not be rushed; it should be prepared diligently, well in advance —.

Mr Butler: You raise a good point, Chair. To be fair, there are only six months left in the mandate. With that in mind, I am not saying that it is impossible; I am saying that we do not know what OLC's workload is and what time it will take out of that for this work. Legal aspects will need to be examined. A statutory duty of candour is needed, because —.

The Chairperson (Mr McGuigan): It does need to happen. I need to move on. I think that everybody out there agrees that that needs to happen. I do not think that people will be confident, from listening to the answers that we have got, that it will happen, which is disappointing.

The Executive have prioritised waiting lists, as the previous Minister did. There was additional funding for that. Some really good work has been done on reducing waiting lists. What are your additional priorities in advancing that so that we can see further reductions in our waiting lists as we move into '27.

Mr Butler: Those figures are reported monthly, which is really useful, because we can see where there is cut-through and significant improvement. The agility of that monthly reporting also allows us to see, in real time, the areas on which we need to bring more focus. It is in the public domain that we have not seen that cut-through in scanning, for instance. When we look at the pressures in those areas, we need to have the agility, the momentum and the ability to flex, in red-flag cases in particular, to ensure that the people who are in the most acute need are seen in the right place and at the right time. I am grateful, as the previous Minister was, for the Executive's approval of that approach. This is an area in which I say robustly that our health service is working in some instances — where we get it right — but we have to learn from the opportunities that are there. That agility lends itself, in this process, to —.

The Chairperson (Mr McGuigan): What further improvements to waiting lists will we see over the next three months?

Mr Butler: If you do not mind, I will bring Tracey in on that detail.

Ms Tracey McCaig (Department of Health): The priorities-for-Government funding that came in for waiting lists was being used non-recurrently at first; we are starting to build capacity now. We are looking for shorter waits, and we have seen our overall outpatient waits reduce in the past two quarters and treatment waits fall over the past year. We are making inroads. We are looking at some of the other areas, such as fractures and hips, that have been challenging in terms of additional demand. It is not just about money going in. We are also putting efficiencies in place; looking at sensible medicine, on which the Committee has had a briefing; making sure that people get the right intervention at the right time to make that happen; and working on demand management. What you should see is overall waiting list numbers come down; the longest waits come down; and our improvements in red-flag and time-critical appointments stay in a sensible place.

The Chairperson (Mr McGuigan): I will come to red-flag cases. Before we get on to that, however, you talked about some of the money being used to build capacity.

Ms McCaig: Absolutely.

The Chairperson (Mr McGuigan): The Committee hopes that that money will continue into the Budget, should we get one, and that it will be possible to continue to build capacity so that we are not just reducing those numbers temporarily.

Can you assure us that that money will be used in a way that ensures that we continue to see reductions in our waiting lists month-on-month and year-on-year.

Ms McCaig: Absolutely. The balance of the funding started to become much more non-recurrent. We were just able to get through our activity at the same time as building capacity. That funding was invested in the workforce, in training places and in additional activity spaces. It looks at where we deliver at the moment. You have seen a lot of our regional centres, which are really pushing through. They are doing great work. The team in the South Eastern Health and Social Care Trust was this week, I think, the first in the UK to get Getting It Right First Time (GIRFT) accreditation. There is a massive amount of work being done in that regard. Our funding profile in the priorities in the Programme for Government (PFG) has changed significantly since we first started this. Much more of the funding is recurrently committed to our capacity internally, which we have to make sure is delivered as efficiently as possible. Our ambition is to continue to reduce waiting times and to make sure that patients on waiting lists are being cared for while they are on them.

The Chairperson (Mr McGuigan): Those subjects are really important, but, unfortunately, because of time, we have to go through them quickly.

You and the Minister mentioned red-flag cases: targets are not being met. Neither the 31-day target nor the 62-day target is being met. Will we have a Minister in front of us at some stage telling us that the health service, rather than improving or simply doing its best, is meeting the targets that need to be met?

Ms McCaig: There has been a full review of all the cancer pathways. We have received significant support from each of the clinical reference groups working their way through the pathways. We are working through a number of audits. We are also looking at demand. If we have a long waiting list, do we have more people coming through as red-flag cases, and is it the right number at the right time? There is a massive amount of activity going on in that regard. Jim and I are part of the cancer strategic advisory forum, along with a lot of our partners. To drive that, our focus is on what we can do with our partners in the community and voluntary sector, through our research and development and even through pharmacy interventions and so on. I cannot commit to a time for that now, but a multitude of work is going on in that area. We hope to see the same significant improvements as we saw in general elective care. Our team will be with you in the coming weeks so that the Committee can do a much deeper dive into those matters.

The Chairperson (Mr McGuigan): Fair enough.

Mr Butler: Something has just occurred to me. I do not want to be too specific about which cancers I am talking about, but, as we advance our research and development and do earlier screening and detection, pressure may then come about because of the numbers of patients increasing. Earlier detection means earlier intervention and better outcomes, but the challenge, which we will face with our eyes wide open, is that, as people are identified earlier, they will also come on to certain lists. They will not necessarily be on red-flag lists every time, but, sometimes, they will be, such as when someone develops cancer in an unusual way. Sometimes, the successes may look like an additional challenge, but it is really important that we have our eyes wide open and make sure that everything is connected.

The Chairperson (Mr McGuigan): I will move on to workforce and pay. The Executive do not have a Budget. We hope that that situation will be resolved very quickly. If there is a Budget, Minister, how quickly will you deal with the issue of pay? Our staff need more than our thanks and praise; they need to be paid properly. Peter is here, and he will know that I am going to ask about the minimum wage for social care staff, because it was talked about in the context of winter preparations, with 2,750 people waiting for a domiciliary care package. Our social care staff are not paid anywhere near enough, and nurses, doctors and consultants are also waiting for pay rises. Can you give a commitment today that staff will get their pay rises within the year and that social care staff will be paid appropriately for the work that they do and so that we are able to deal with the 2,750 people who are waiting for a domiciliary care package?

Mr Butler: Thank you, Chair, because we should never stop talking about that or working towards it. I fully support my predecessor's ministerial direction on Agenda for Change pay and the real living wage. As you rightly pointed out, everything is connected.

If we want to improve patient flow, reduce hospital stays and free up beds for those who need them, we need to ensure that those packages are in place. That means having the domiciliary care workers about whom you talked. There is an extant pressure that has been measured and is ongoing. Part of that absolutely will be about staff not feeling that they are being rewarded for the excellent work that they do. I agree with you and would like to hear it every time. We stood and clapped during COVID, but that now rings hollow for those staff.

To be fair to my Executive colleagues, none of them disagrees with me. Without breaching confidence, during the two Executive meetings that I have been at, that point has been reinforced; in fact, I had a meeting with the Minister of Finance this week. The issue is partially linked to the fact that we have not agreed a Budget, but, even if we were to do so, the Department of Health would be overspending. As I have said about my brief, even with the efficiencies that we have found in-year, we have still overspent by half a billion pounds. You will be aware of the negotiations taking place with the Secretary of State and the Treasury: the Treasury is, I hope, listening for this reason: the Department of Health is one of the highest-performing Departments in how ambitious it is about providing the best service that it can and in finding efficiencies and trying to be fiscally responsible.

I made the point to the Prime Minister a number of weeks ago that, given the plan that we have in the Department, particularly for integrated neighbourhood teams and the transformation and reset piece, we can, if we get it right, deliver tangible change and a sustainable service. An issue such as pay could see that unravel, however. As we face into the winter surge and winter preparedness, the plan is there on paper, but if we do not have the workforce to deliver that plan, we will be in trouble.

The Chairperson (Mr McGuigan): Workforce is the next issue, and you have taken me on to it. You talked about Daisy Hill Hospital: it is one of many examples that we have heard about in the Committee in recent months of failings to do with workforce. There has been a lack of a workforce strategy and, in some cases, a lack of workforce planning. What are you and your Department doing to identify the gaps in our workforce? I may not have the chance to get on to the matter of reform, on which I wanted to touch base, because I will need to move on, but, in the case of certain examples, we may be talking about transformation that is based on clinical evidence and good outcomes. Far too often, however, we are talking about the opposite. In most cases, transformation is forced on us because of workforce issues or shortages. That is not good for a health service, nor is it good for staff, particularly in rural areas. In a lot of cases, hospitals serve rural communities, be it Causeway Hospital in my constituency, Daisy Hill Hospital or the South West Acute Hospital (SWAH). People need an assurance that the Department will get to grips with the issue as best it can, produce a workforce strategy and deliver on it so that we are not constantly talking about failures in our health workforce that we should be able to foresee.

Mr Butler: Chair, I absolutely agree with you and will take any critique in that space, but I will allow Tracey to give some more detail. I have more than a passing interest in the topic. As I have said a million times — Danny will roll his eyes — one of the roles that I fulfilled in the Northern Ireland Fire and Rescue Service (NIFRS), where the picture was very different, was that of establishment officer. I had responsibility for people who were contracted, and I was able to move them around and ensure that stations had the staff and the resource to respond to need. Unfortunately, the health service is a very different beast. People are not contracted in the same way, and people have the ability to move.

At the highest level, my challenge — I have spoken to my officials about it — is to make the NHS in Northern Ireland the place where people want to work. It is also about giving staff a sense of identity and value in the places in which we need them to serve. That is a high-level challenge and therefore difficult to deliver, and it is certainly not deliverable in the short term. Having spoken to my officials — Tracey can speak to this — I believe that some of that work was already in train, so I cannot claim ownership of it, except to say that that will be a fundamental driver for me in my short time as Minister, and I hope that there will be a legacy from it. It is a significant priority, because we can deliver nothing if we do not have the right people in the right place.

Mr Wilkinson: As the Committee will be aware, a workforce strategy has been in place since 2018, but, like all strategies, it has it flaws, and there are concerns about it. Chair, you raised the issue of workforce and workforce growth in particular: there are three drivers for that, as you will be aware. The first is the change in how we work, with the move to multidisciplinary teams (MDTs) and the different skills mix that is needed there. The second is growth in demand. We go through a process of workforce reviews for each specialism. As a result of those reviews, we have seen our number of training places and, indeed, our medical and nursing workforces grow by 32% and 23% respectively since 2018. There has been considerable growth. The challenges that we face are around growth in demand; meeting that demand; retention of staff in areas in which there are service vulnerabilities, which you have highlighted; and getting more comprehensive, joined-up, front-line workforce planning, which the Minister has described, for what is needed to deliver operations — that must come from trusts — strategic forward planning and strategic planning from the Department on where we are going with advances in care. Despite those advances, we still see service vulnerabilities. A lot of them are, as you have said, down to workforce issues.

I will make the point — Tracey will have more detail on it — that some of the specific service vulnerabilities are the result of workforce pressures that exist not just in Northern Ireland or in rural communities but across specialisms throughout the UK and more widely. In order to focus again on workforce and to work collaboratively with the trusts, taking account of the new structure that is in place, including the committees in common, we are establishing a strategic workforce management group that is trying to bring, in a much more coordinated way, that strategic output to training, forward planning and operational delivery to better protect vulnerable services and get workforce planning right.

It would be wrong to say that we have got it right. It would, however, also be wrong to say that we have got it completely wrong. We have endeavoured. Some of the problems that we face are faced elsewhere, particularly in highly vulnerable specialisms. One of those specialisms is obstetrics, but we have others. We have already mentioned some of the challenges that everyone is facing with scanning and radiology. You will have heard from the committees in common. We are doing our best with the progression route by providing and trying to fill training places. There has been expansion. We are doing our best to work with trusts to see what we can do to retain the skills that we have. There is more work to be done — Tracey will be clearer on this — on how we collaborate effectively with the workforce that we have.

The Chairperson (Mr McGuigan): On the Committee, we meet a lot of groups. We could be discussing mental health and meet, for example, the Royal College of Psychiatrists (RCPsych). Almost all groups talk about the lack of available training places. I am not disagreeing with you, but I see no evidence of what you say when we engage with the sector, because that is its number-one complaint. I will leave it on that point. I will not ask you to come in again, because I want to move on to my final question.

Mr Wilkinson: It is not dissociated from budget, Chair.

The Chairperson (Mr McGuigan): OK.

Minister, you probably predicted this question, but, when he was here, I asked your predecessor about political interference from the leader of your party. It was obvious to anybody with two eyes and two ears that there was going to be political interference from the leader of your party. There were two examples of where he tried to interfere in decisions that the Minister of Health should be making on the basis of clinical evidence. Your predecessor gave a fairly decent commitment and then showed his integrity by following up on that commitment when the interference happened again. I will ask you the same question: do you expect there to be interference from the leader of your party? When you are making decisions, will we, as a Health Committee, as well as waiting for the outcome of ministerial processes and committee processes, have to wait to hear from outside influences, namely your party leader and his instruction? If he tries to give you an instruction that goes against clinical or medical advice, what will you do?

Mr Butler: I have committed to being a listening Minister. When I say that I will listen, I mean that I will listen with fascination. Everybody has a view. I am the Minister of Health, however. The decisions that I make will be based on the expert clinical advice and user voices that I hear. I will ensure that I am a public-facing Minister. I reject in its totality any intimation that anybody has whispered in my ear or said, "This is the way that things will be". That could not be further from the truth.

The Chairperson (Mr McGuigan): The previous Minister said —.

Mr Butler: I would hope that members, including you, Chair, have spent enough time working with me to know that, although I look like a good, sound guy, I am also a man of integrity. There are things that just do not happen in my sphere, be that my personal or professional sphere. I will be my own man.

The Chairperson (Mr McGuigan): The previous Minister said that he was given two red lines, puberty blockers being one and Causeway Hospital the other. A decision still has to be made on Causeway Hospital. When you were given the position of Health Minister, did your party leader give you any red lines?

Mr Butler: What was said between the previous Health Minister and the leader is a matter for the two of them. Only those two people know how that conversation went. I can state unequivocally that there are no red lines.

The Chairperson (Mr McGuigan): OK.

Mrs Dodds: That is perhaps a neat segue into my first question. I have been reliably told that the decision has been taken to lower the bowel screening age: that is a matter for congratulations. It is the right decision, and it will save lives in Northern Ireland. Were you going to make that announcement to the Committee today, in the House or at your party conference?

Mr Butler: The Member is fresh from her party conference. I am sorry that I did not get to see it. I was busy on Saturday.

It is slightly premature to say that there will be an announcement about bowel screening today. You can check this in Hansard, but it is something in which I, as an MLA, have been interested. It is a cancer that has affected my family. I am passionate about tackling it and have been driving the need for there to be the change to which you referred. There is no inaccuracy there, to be fair. I am sure that the Committee is well over the detail.

There are a couple of issues with the submission that I got. I am hopeful that the answers will be what I want to hear. Again, I make the point that I will look at the detail. I want to ensure that, if anything happens or I put my name to something, it does exactly what it says on the tin. There is absolutely no doubt — I know that you are committed, Diane, to pushing for the change that we need to make — that we need to be in the same space as the rest of the UK when it comes to the age range for screening and we then need to encourage people to partake in screening. That goes back to the point that I made about the challenges with waiting lists and red-flag cases. When we open up innovative screening programmes, there is the potential, rightly, to identify cases earlier, but they could still become red-flag cases, which means that we have to be honest about how we measure the effectiveness of our targets — they are shared targets — to reduce waiting times. If all the things that come to me are as I want them to be, there may be an announcement. Let us hope that, before the end of the mandate, there are more good-news stories.

Mrs Dodds: Will there be an announcement before the weekend or an announcement before the end of the mandate?

Mr Butler: The case has been well made, and there is a lot of good evidence. I need to make sure that that evidence stacks up, that it does not fail to deliver and that the resource is there to provide the care, because doing that does not come without resource, nor does it come without an impact on workload and on the relationships that are there. I want to see that there is confidence there, because I do not want to overpromise and then under-deliver.

Mrs Dodds: That really has not answered my question, but I will move on to the next one. When will you announce the 24/7 mechanical thrombectomy service?

Mr Butler: I hope that we will do so imminently. I have met many patients who have benefited from it; in fact, I have heard some personal stories about how effective it is.

Mrs Dodds: It is like a miracle.

Mr Butler: It is. That is a really good way of describing it.

Mrs Dodds: It is also really important. Can we expect an announcement about it this week?

Mr Butler: There will be an announcement about it very soon.

Mrs Dodds: This week?

Mr Butler: I hope so. Again, I will need to see the detail to ensure that I know —.

Mrs Dodds: There is a lot of detail that has to be decided between now and Saturday, but we will move on, which is important to do.

In July, representatives from the gender service at the Belfast Trust were here. I asked them this specific question: what is the age of the youngest person who has been treated with puberty blockers in Northern Ireland? They said that they did not have that information available but would write to the Committee. It is my understanding from the Committee Clerk that nothing has come back from the Belfast Trust. I also submitted a question for priority written answer that should have been answered by Tuesday of last week, and it still has not been answered either. Why are the Department and you, Minister, so reluctant to tell us the age of the youngest person in Northern Ireland to have been treated with puberty blockers?

Mr Butler: What I will say at the moment is what I believe that I know, because I have not been briefed on that issue, and it is not an issue in respect of which I was aware of any delay in response to you. My officials —.

Mrs Dodds: There clearly is a delay. There is a delay in the trust's response to the Committee. There is also a delay in answering my question for priority written answer, which should have been responded to within two working days.

Mr Butler: My officials will follow up on that in due course. They will correct me if I am wrong, but, from debates that have taken place, I believe that the numbers are so low that they are loath to give out exact information, so they tend to give the age range instead. If they were to give a distinct age, they would come close to identifying a person. What I suspect is —.

Mrs Dodds: We all understand that —.

Mr Butler: The answer will probably be an age range.

Mrs Dodds: I want an answer to that question.

Mr Butler: You will get an answer to that question, and I will ensure that an answer is given to you, but —.

Mrs Dodds: Thank you. That is massively important.

Mr Butler: — I need to be clear that it will be an age range that you will get. I do not imagine that my officials will be able to give the absolute youngest age; I suspect that they will give you a five-to-10-year age range. Peter, is —?

The Chairperson (Mr McGuigan): For clarity, the Department was to give us that answer via the trust.

Mrs Dodds: Right. The Department was to give us that answer, but we still have not received anything. I have outstanding questions for written answer from months ago. That is just part of the problem with the Department. It does not have a focus on answering specific questions, and that it does is important.

I have a range of important stuff that I want to ask you about. I studiously followed up with your predecessor on issues in the Belfast Trust to do with capital projects and its absolute squandering of tens of millions of pounds. To the best of my knowledge — I have tried to follow through on this, but, to be honest, I have so much information, so I hope this is right — there have been five reviews, but I have heard nothing much about the outcome of them. In April, the chief executive of the Belfast Trust came to the Committee and announced a review of the handover of the maternity hospital: she was very upset when I said that it all sounded like a bit of a ruse to get through the Committee meeting. In July, we got a response from the Belfast Trust saying that it still had not appointed someone to do the review but hoped that the review would be finished in October. All the other reviews have largely been carried out by the Belfast Trust. Where is the accountability? Will you ensure that there is accountability in the Belfast Trust for the absolute — I can use no other word for it — squandering of millions of pounds, which it continues to do?

Mr Butler: Nobody can defend what has happened, Diane, because not only has it been a colossal waste of taxpayers' money but, for the people who need and deserve those services, it has been an abject failure. That piece that you talk about is —.

Mrs Dodds: If it is an abject —.

Mr Butler: May I just finish?

Mrs Dodds: I have a lot of questions —

Mr Butler: Do you mind if —?

Mrs Dodds: — that we need to —

Mr Butler: May I just —

Mrs Dodds: — get answers to.

Mr Butler: I will get to the answer, if you do not mind. Thank you.

I accept where you are in that regard. You have not received a certain answer. Chris Matthews is my deputy secretary of the resource and corporate management group, and I will ensure that I get an update to answer your question in the fullest sense. We have lost enough time.

Mrs Dodds: That is really disappointing, because anybody would have known I was going to ask those important questions today.

The Belfast Trust is in the process of refurbishing a ward at Knockbracken Healthcare Park so that people can be decanted there from the acute mental health unit at the Belfast City Hospital site because of huge problems there. It will cost many more millions of pounds to fix those problems. Can you give us an update on the budget for that and indicate the exact overspend?

Mr Butler: I will turn to my officials in a moment for the detail. You will understand my absolute interest in mental health and learning disability, and it is not simply because of what happened in Muckamore, although, obviously, that has had an impact on the facilitation of accommodation. We already did not have appropriate and timely availability of accommodation.

In fact, yesterday, I was with the Northern Trust at Holywell. That is a slight detour, but I want to show my commitment to looking at the estate that we have and understanding the full picture to ensure that we have the right facilities in the right place at the right time. A lot of people have been —.

Mrs Dodds: I represent people who rely on the Southern Trust. Craigavon Area Hospital was built in the 1960s and 1970s. During a storm 18 months ago, the windows came in around the patients. It is appalling that we are squandering money in other areas, but neither you nor your predecessor have been able to give me a guarantee that there would be even a small amount of money to start to plan for a new hospital in Craigavon. I understand that the current overspend on Knockbracken is almost £1 million: can anybody verify that?

Mr Butler: I have to declare an interest in that one of my close colleagues — no, my wife — works in Knockbracken. She is not in that unit, but she works in Knockbracken.

Mrs Dodds: That is completely fine.

Ms McCaig: I do not have that information here for you, Diane. It is not any of our particular areas, but I will undertake to provide a clear update to the Committee on that, working with colleagues.

Mrs Dodds: That is disappointing. Anybody would have known that these are the questions that I would ask.

In terms of winter preparedness, your predecessor spent a lot of time talking about the "big conversation" and about how everything was going to move on and so on. He sounded a bit like David Cameron at times, but anyway. Look at the figures for the first quarter of this year, from January to March: we had the worst emergency department performance on record for four-hour and 12- hour waits. Some 69·5% of patients waited for four hours or more, and nearly a quarter of patients waited for 12 hours or more. Add those figures to the Royal College of Emergency Medicine's (RCEM) report published earlier this year, which indicated that we had over 1,000 excess deaths in emergency departments in 2024-25. What will be different this year? How will you prevent that kind of tragedy — it is a tragedy — from happening again?

Mr Butler: Thank you for that. I have family members who, even recently, have had to access an A&E on repeated occasions. What has happened has fallen short of what any of us would want. I recognise the benefits of earlier communication that, I believe, the Department and SPPG have achieved with the trusts with regard to winter preparedness and the allocation of their plans, but there is also a new way of working. Some of the things that are in train should prove beneficial, even though they may not be designed for winter preparedness. For instance, the Northern Ireland Ambulance Service's release to rescue initiative should help.

Mrs Dodds: May I ask you about that? I have spoken to consultants in emergency departments, many of whom are concerned that, while release to rescue improves ambulance times, it clogs up emergency departments.

Mr Butler: I will let Tracey take that one.

Ms McCaig: There are a number of points along the continuum of the care pathway for someone who needs emergency care that we need to resolve and improve. We are in the middle of that process. We said that the first thing that we needed to do, following some of the risks that we noted with ambulance turnaround and the availability of ambulance crews, was the release to rescue initiative. That has been really successful, and there will be further comms around that in the coming weeks. However, we have improved our average handover for within an hour to 73%, and we have decreased the number of handovers that have taken over two hours. We will, occasionally, have an over-two-hour handover, and we accept that in the system.

At the same time, we are not just fixing one part of the continuum; we are asking what is the other part that we need to do. You are right: if we only did that, we would clog up the ED. Indeed, if we project the numbers, we will have 11,000 more patients coming through our processes this year in our EDs than we would have done. You need to deliver the additional same-day emergency care or elective care; you need to deliver your Hospital at Home; and you need to look at virtual wards. Importantly, we have Getting it Right First Time with us on the acute medicine: that is absolutely the beating heart of what we need in that space. Getting It Right First Time has provided every one of our sites with written and verbal feedback on what also needs to happen. It has a set of 12 recommendations, and each of our hospital sites has taken on board what is being said to it. There is improvement ongoing, and we are looking at putting the same focus on all of those to make sure that they move the same way as we have in release to rescue. You cannot take just one piece, and we understand that it will take time.

Mrs Dodds: Can I ask you one question?

The Chairperson (Mr McGuigan): One quick question and one quick answer.

Mrs Dodds: It is really important. The RCEM report said that, in that year, our EDs were operating at 137% capacity: that is almost one and a third per cubicle, if you look at it that way. Can you guarantee that the winter preparedness plan — along with Getting It Right First Time and the other issues — will ensure that that does not happen again? It seems to me that, if you just offload a lot of people into EDs, that figure will increase.

Mr Wilkinson: That is the right question, Diane: you have to be judged by your outcomes and outputs. What we can say is that the winter plan is being designed for that not to happen. You mentioned the big discussion: some of the areas that came forth in the big discussion that we are majoring on — you will see it in our surge planning — was ED avoidance where possible, with a particular focus on managing frail elderly people as far as possible in the community or through virtual wards or direct admissions. Look at the populations of EDs, particularly when it is long waits: there is no avoiding the fact that the majority are frail elderly people. That is not necessarily the best place to care for them. While it is impossible to give a guarantee of whether it will happen, what we can say is all of the actions that we have asked trusts to plan for — all the priority areas from the big discussion — are designed to have an impact on those long waits and in particular that vulnerable population.

The Chairperson (Mr McGuigan): We need to move on to the next member.

Mr Donnelly: Thank you, Chair. I welcome Mr Butler to his new role. It is a huge role in an absolutely massive Department, and it affects everybody's lives in Northern Ireland in serious ways. I know that we have some shared interests in disabilities and learning disabilities, and I know that you are well briefed in those areas. You mentioned that you have been here for five weeks: are you up to speed yet?

Mr Butler: Absolutely not. I would not be up to speed in everything, because it is such a wide and vast field. Not only is it a wide and vast field but it is an ever-changing picture of new opportunities coming on board. Obviously, there are the unplanned events, and there have been one or two of those in my short tenure. If anyone says that they are an expert in health, they are not the right person for the Health Ministry. There are so many voices to listen to.

I look at it through the prism of integrated risk management planning. Even on the perfect day, something can be out by design. I would like to see an agility embedded in the health service. There are things that we know and things we can do and plan for, but we need to have that resilience in the service to respond to the unexpected moments. What I would say is — I pay tribute to my back-room team in this — that anybody who has performed the role of Minister will understand. I am very content with the briefings that I have got, and they are non-stop. They are absolutely non-stop. I rely on the expert people around me. The rubber hits the road when I have to make a decision, Danny. That is what we do in politics. We are there as elected reps of the people; we are not clinicians. We are there to represent the people who deserve the service. Hopefully, my 20 years in public service before I got into politics will stand me well in that decision-making space.

Mr Donnelly: I hope so. There are some big decisions that are coming and need to be made soon.

Given the circumstances of your appointment and how close we are to the end of the mandate, can you confirm to the Committee that your decision to set up the independent reconfiguration committee was entirely based on the best possible clinical outcomes for patients and that no political considerations — including the political interests of your party leader — played into that decision?

Mr Butler: You and the Committee will be aware that the IRC was not born out of Robbie Butler rocking up to be the Health Minister. You will likely have been aware of the over 30,000 consultation responses to the networking piece. That demonstrated to me that there was a bit of a disconnect; it is not what people want. Everybody wants to have a healthcare system that is fit for purpose and meets them at their point of need. However, it is how we match delivery with that public expectation. When I learnt of the IRC, which was developed before my tenure and was already an idea, a potential chair had been identified. That was before I became Health Minister. I would love to say that it was my idea, Danny, because it will be an effective body if it is used, and I mean "if it is used", because it should not be something that sits there with people being paid to do nothing. If a Minister decides that something is controversial or has not been tested enough, they have the right to bring in that body.

Mr Donnelly: Speaking of being paid, what is the cost of IRC, and what services did not happen because of the cost of that?

Mr Butler: I will supply you with the exact costs when they are known, but they are very low.

Mr Donnelly: We have a chair and the costs are not known?

Mr Butler: If the committee is not called, Danny, it costs nothing; that is how simple this is. If the committee is not called, it costs nothing. Looking at the model in terms of the people who will come into the function, what has been designed is that they will come from professional bodies on a voluntary basis. The chair, as and when, will be paid, and that figure will be determined and shared with the Committee.

Mr Donnelly: Will Causeway be seen by that committee? I imagine that that decision is quite —.

Mr Butler: I notice that the member —

Mr Donnelly: Sorry, but will you let me just finish the question?

Mr Butler: Well, you have been good at it on social media, so I know where you are on that.

Mr Donnelly: We are here today.

Mr Butler: Yes, OK.

Mr Donnelly: We have heard clearly from clinicians who work at Causeway that emergency general surgery (EGS) is under extreme pressure and has been for years, so they are waiting for the merger and are concerned that the service may collapse. You tell me that the committee is set up and will be called and paid only if you give it a decision: have you given the Causeway to the committee?

Mr Butler: I have met multiple clinicians at Causeway who have differing views, so it is not a settled view. There is a report on emergency general surgery, which I have not seen, by the way. What tends to happen — this is happening in the public space, unfortunately — is that people are claiming that they would make decisions on transformation without seeing a plan. At the moment, the plan is between the Northern Trust and SPPG. That is where it is, and there is a lot of policy development in that space. The reality, as I have said, is that, if a change is made in any part of a service, it will affect another part of that service. I want to be a critical friend to ensure that any change has better outcomes for everyone.

Mr Donnelly: Absolutely.

Mr Butler: That means ensuring that all of the voices have been heard. What is important for me in any reconfiguration is giving the public confidence. Reconfiguration will be needed in some places. There is absolutely no doubt about that, because even the respondents said they understood that change needed to happen, regardless of where it came from. However, people want to be part of that change, and they want to have confidence. I do not want to build in a medical anxiety, which is hard to remove from a population.

Mr Donnelly: The previous Minister said that he hoped to publish the hospital reconfiguration plan in autumn this year: can you commit to that as well?

Mr Wilkinson: It was to publish the responses to the reconfiguration consultation. I know a number of members —.

Mr Donnelly: October 2024.

Mr Wilkinson: I know that a number of Members attended those events, which I attended as well. We were clear that we were consulting on the development of a network, not the component parts of the network. We said that the component parts of the network would be the hospitals that we have. Any proposed changes that came from trusts would have to be judged against whether they added or detracted from the network and a number of regional service reviews that are ongoing. We published a consultation on the actions and identified a priority action, which was how to bring another level of public confidence to decisions.

What came across in a lot of those consultations was strong support for the need for reform and strong scepticism about individual reforms as they are proposed. That was part of the consultation. Our action plans from the consultation are, first, the committee and looking at how we engage with the public, to review our guidance on change and review of services and to work internally and externally on regional transport, which was identified as a major issue. Progress in other areas is well afoot. One of those is greater collaboration. We need to see how the committee in common is working. Another area was increased activity closer to individuals that did not need to be delivered in the acute sector, and that is at the heart of the neighbourhood model. The idea that there would be a plan that would show every hospital and every service in it was not part of the consultation; it was describing what was. However, in the future, every change will be seen as a network change as well as an individual change.

Mr Donnelly: Thanks for that. I will move on to winter planning. Diane has already asked a couple of questions on that. We have had high pressures in our hospitals throughout the summer. We have had ambulance waits; we have had people waiting in A&E, sometimes for days; and we have had corridor beds across the system all summer. Staff and patients are concerned about the increased pressures that we will face coming into the winter, when pressures go up annually. You said that you expect the trusts to have published their winter preparedness plans. You are not doing one this year, but the trusts are doing them by 18 September. Have all of the trusts published their winter preparedness plans?

Ms McCaig: Yes, all of the trusts and SPPG and the PHA should have a plan. Some of them may have a summary, but they have all been advised that those should include a link to their detailed plan so that you can see that.

Mr Donnelly: My understanding is that those were not available today.

Ms McCaig: My team have been able to find them for me today. If the links are not there, I will happily share the links. We have been using them today, and they should all be online as of last Friday.

Mr Butler: I am interested in that, Danny, because, again, I do not want to say things and put dates out and them not be there. If there is anything missing —.

Ms McCaig: They are there.

Mr Butler: The other thing that you will be interested in is that I have been pushing for Easy Read. It has to be accessible, and, to be fair, we legitimately share a passion on that. I want to ensure that, in my tenure, a culture is developed for people with disabilities, including learning disabilities, so that they get the information that they are entitled to and are included in every aspect, including this.

Mr Donnelly: You talked about domiciliary care: increased domiciliary care and care in the community is the only way that we will increase patient flow. What are you doing this winter to increase domiciliary care and nursing home placements to get medically fit patients out of hospital? A couple of weeks ago, I asked you about the number of medically fit patients who were in hospital and:

You told me:

It did in October, because I asked the same question then and got figures. Have you stopped holding that information?

Mr Butler: I will hand over to officials, because I would not like to have given you an answer that was not —. If there has been a change, I am not aware of it.

I absolutely share your awareness of the need for domiciliary care. The first change that will help is if we get the real living wage paid to those who need it in that space. It is a complex picture, because there are different rates of pay depending on whether it is trust-provided or through another agency. From my previous role as Chair of the AERA Committee, I have carried over the knowledge that people in rural areas are difficult to reach with dual packages. There is an ongoing conversation that started in my early interactions with senior directors to ensure that this is a live topic of debate.

It is not just about the money: you see that when you meet domiciliary care workers. Within a week of becoming Health Minister, I talked to a lady who stopped me on the forecourt of a garage in Lisburn. She had done about 60 hours that week and was still working. She was passionate about her job and is someone whom I absolutely want to keep and do not want to see burnt out and want to see rewarded. For me, the first thing is to achieve the real living wage, Danny. After that, it is to develop that further.

This is not written down, but a point of interest for me is that we see efficient use of domiciliary care and listen to those who receive the service to understand that what they get is fit for purpose and meets their needs and is not something that is not what it was designed to be. It needs to be efficient and agile as well, to ensure that we spend our limited resources in the right way for the maximum outcome for those who use the service.

Have you anything to add on that?

Ms McCaig: There is some challenge on some of the numbers in the way that the question was asked, but I can tell you about the unmet need.

Mr Donnelly: It was similar to how I phrased it previously.

Ms McCaig: I am happy to take that up and understand the answer.

Mr Donnelly: I hope that the Department counts the number of medically fit patients in our hospitals.

Ms McCaig: We do.

Mr Donnelly: If you do not count, you do not know the need —

Mr Butler: The baseline.

Mr Donnelly: — and you do not know the size of the problem.

Ms McCaig: We do.

Mr Donnelly: So you know the size of it?

Ms McCaig: We know information on a periodic basis on that, so I will need to understand why that answer was provided. I will pick that up when I leave the room.

Mr Donnelly: OK.

The Chairperson (Mr McGuigan): One quick question and one answer.

Mr Donnelly: One quick question; OK. When is the Department's scoping exercise on palliative care due? You will be aware that the Committee did a report on palliative care and made recommendations associated with that. Palliative care is a vital service that provides specialised care for terminally ill and life-limited patients and is a source of huge support. When will the results of the scoping exercise be available? It started in January 2025. We have done our report and made recommendations, and the Department has accepted those recommendations. Which recommendations can you action before the end of the mandate? I think of the likes of the recommended summary plan for emergency care and treatment (ReSPECT) documentation and advance care planning. Which recommendations on palliative care can you action before the end of the mandate?

Mr Butler: I will hand over to Jim for some detail in that space. I commend the Committee for its report on that. When I first took up office, I spent a bit of time looking at the work that you guys had completed. I certainly share your ambitions. I know that the Department accepted the recommendations in full or in part. It goes back to what I said at the start.

Mr Donnelly: I think that they were accepted in full.

Mr Butler: Jim will talk through some of the detail. Nothing was rejected, but there are complexities in the delivery models and those types of things in terms of how you design the response. Nothing has been rejected.

Mr Wilkinson: There was one recommendation on understanding the support that the Department would give to a proposed capital project in Newry. We do not have the detail here, but I know that one of the recommendations was that the Department establish a specific palliative care unit focusing purely on palliative care but also the ancillary critical areas such as the ReSPECT programme and advance care planning. That team has been established and is working. We gave a commitment that we would come back to the Committee with a detailed action plan with detailed dates. Part of the action plan that is under development is about what we can do this year. I know that winter planning and some of the focus of the neighbourhood teams, as they work towards some of the surge planning, is around the advance care planning element. "ReSPECT" is a term that we use, but it was not unilaterally approached as a single planning tool. Work is ongoing on it. In particular, I know that they are committed to giving an update on the scoping exercise and giving some information on what is being done this year to stabilise services and what is the plan, because the scoping exercise is about a future funding model.

Mr Donnelly: When will that be out?

Mr Wilkinson: As I said, I do not have the detail of that, because it was not something that was —.

Mr Donnelly: We are nearly two years in now. January 2025 was 20 months ago.

Mr Wilkinson: As you know, we are taking forward the scoping exercise in collaboration with the system. I will come back to you with the detail on that and a firm deadline.

Mr Donnelly: We were told three to six months.

Mr Wilkinson: I will follow that up.

Ms McCaig: I believe that that is the plan. Our officials were here with you not so long ago. We have progressed the recruitment of a permanent clinical lead for palliative care, but we have an interim clinical lead at the minute. The scoping work is under way, and my team is heavily involved in that to baseline the information — what is the range of palliative activity? — and to understand that the ambition for the integrated neighbourhood teams is also in that space. There is a lot of activity that is not labelled "palliative" but works in that space. There is a lot of work ongoing at the minute, and the commitments that were given recently to the Committee should stand.

Miss McAllister: Welcome to the role, Minister, and welcome to your first Committee session. I have a lot of questions. First, I will start with two supplementaries: without asking Diane, I knew what questions she was going to ask. I appreciate that I sit on the Health Committee every week, but I knew — everybody would have known — that she would ask questions about capital. I hope that you will recognise the questions that I will ask so that we have answers.

Mr Butler: Just to be clear, I have not watched any recordings of the Health Committee in my time. I have not had time to do it even since I became Health Minister.

Miss McAllister: Aye, but how big is your Department, Minister? How many people do you have sitting behind you who advise you?

Mr McGrath: I do not blame you, Minister.

Miss McAllister: I have a supplementary on the duty of candour legislation. With all due respect, we understand that it is organisational and have done for many years. Both your predecessors committed to it in some form. Your most recent predecessor agreed to bring forward organisational duty of candour legislation, and his predecessor agreed in response to GIRFT. It beggars belief that you are saying today that you have just instructed the drafting of that legislation. Both your predecessors, who are from your party, did not instruct drafting, despite our having inquiries during both their tenures.

Mr Wilkinson: The Minister has instructed that we complete drafting as quickly as possible, to be specific.

Mr Butler: Anything that you said may well be accurate, but I will not sit here and say that I do not act, because I have acted. I am the Minister who has asked for the work to be done and for the detail to be provided. I do not mind hearing that, Nuala, because I am now taking action, and I said that I would be a person of action.

Miss McAllister: I cannot speak for everyone on the Health Committee, but my Alliance Party colleagues and I will commit to any additional sessions needed to get it across the line. I know that it may be difficult; we are also looking at the Muckamore families, the hyponatraemia families and the cervical screening scandal. It is not about just one individual but about many people.

I want to ask a question that my colleague has already asked. You are in the ministerial role because of the scandal around emergency general surgery at the Causeway Hospital. I understand that you have been put in a difficult position, but we are where we are. You did not answer the question about whether that would be referred to the new committee. A few weeks ago, the official who is sitting beside you said that the decision could be imminent, because everything had been gathered that needed to be gathered and there were just a few things to tidy up. Those are not the official's exact words, but, if we were to look at Hansard, we would see that we were given an assurance that it could be imminent. Are you referring that to the new review committee?

Mr Butler: I have an answer— go ahead, Tracey.

Ms McCaig: To follow on from the previous session, what I said was that I have not yet made a recommendation to the Minister. I have not done that. It is at its final stage. We have received information from the trust, and queries are ongoing. I do not expect that it will take much longer. When I was before the Committee previously, I was asked when I expected to get that from the trust: it is with my team; my team has gone through due diligence; and there are queries. I am not in a position to provide that information to the Minister today, but, at that point, the Minister will see the detail behind what we have considered and the recommendation that we have made for the Minister to consider.

Miss McAllister: Do you expect to refer it to the committee? If not, you expect to make a decision yourself.

Mr Butler: To be absolutely clear, I have no fear about getting any report; I will read it forensically. My ambition in life is to protect life and to give people the best possible service. I look forward to getting the report. I am not hiding behind anything. I will look at the report, and, if it is the right thing to do, if it stacks up in every question that is asked and every pressure that is put on it and if there is a sustainable service with better outcomes for the people who live in that area, I will certainly make the case for it and bring the public with me on that. To be absolutely clear, however, there is no provision in front of me. If it does not stack up, I will sit before the Committee and say that it does not stack up because it fails a test. Before I do that, however, if I think that it is so controversial and does not pass the test, the IRC will look at it and make their assessment, and you guys will absolutely have sight of that.

Miss McAllister: Will you meet the surgeons who, in an unprecedented move, sent that letter, along with the royal colleges and the Northern Trust, about what they see as service collapse? If the decision is not proactive, will we have service collapse in emergency general surgery at Causeway Hospital?

Mr Butler: You are absolutely right to ask those questions. The last thing that we want is service collapse, because, at that point, we would have failed. However, I have nothing in my inbox from anybody working in that space telling me that service collapse is imminent. I have nothing like that in my inbox. I have anecdotal —

Miss McAllister: It is literally out there, Minister. You do not have to have anything in your inbox to see.

Mr Butler: I am talking about a scenario in which there was something like there was in the case of Daisy Hill. Nobody is suggesting that anything is imminent; they are saying that a better service can be provided if services are amalgamated on a single site. That is not the reason for the move; the move comes out of a bigger report on EGS.

We need to remember that the reason for a move of the service would not necessarily be to prevent service collapse: that would be a temporary rather than a substantive move. The case that is being created by the Northern Trust is for a permanent move, and that is based on the assessment that it would be a better service. That is the prism through which this will be looked at. I will assess whether the IRC is required to play a role, but I am not hiding behind anything, Nuala.

Miss McAllister: We will have to agree to disagree. In order to prevent service collapse, some things can be permanently moved, but that has to be done right and transparently, and that is what is important here.

Mr Butler: You will also be aware that there are developments in clinical practice whereby surgeons across many fields are specialising and are no longer general surgeons. That is a good move, but, when those specialists move, the system has to be able to flex at the same time. In some of the conversations that I have had about how the plan was communicated, there has been acceptance that the communication of the plan has been a significant barrier to change.

It is not just about system collapse; it is about specialisms in a clinical field that may provide better patient outcomes. If that is the case, the system needs to be able to flex safely and ensure that that care is better than it was before.

Miss McAllister: You are absolutely right about surgeons making their moves and moving to a specialty; that is so important. It also relates to the questions from all three Committee members about the workforce strategies and the increased training places. The increased training places — 28%, 32% — are fantastic, but where do those people go? Not all of them are staying here. We are haemorrhaging people to the Republic of Ireland, so we cannot say that an increase in training places will solve the problem; I know that you did not say that. It is about the long term and the whole line, so, while I agree with you, unless you sort the problem at the bottom and the whole way up, it will not fix the problem in the long term.

Mr Butler: I will make a quick point on that. I totally agree with you; in fact — again, I am not breaching confidence by saying this — I am talking to Executive colleagues about that. I am not sure that we haemorrhage as many people as we think we haemorrhage. There are a couple of misconceptions out there that people go away and we lose more than we do. I do not think that that is the case.

There are things that we can do better to make this an attractive place to stay and work, and, for me, there is a particular emphasis on hospitals such as the SWAH, Daisy Hill and the Causeway because we have different populations in those areas. For instance, in the Northern Trust area, we have more older people. That is just one of the demographic things that we need to factor into the configuration of our hospital network. That is a live issue.

Miss McAllister: We are agreed on that point for sure.

Mr Butler: We can bank that one.

Miss McAllister: This is a side point, and you do not have to answer me now. If bowel screening moves to age 50 or 55 — I imagine that it will not go straight down to 50 — that reduction will be welcome. Can you also make a commitment to push for genetic screening to be offered to those who have bowel cancer? If it has been in your family, as it is in mine, you will know that everyone who is diagnosed with bowel cancer is not offered that genetic screening, even though that is possible. You do not have to answer me now, but, if you can push for that, that would be great.

Mr Butler: Like you, as I declared, bowel cancer is in my family, and I am acutely aware of that. That is a declaration of interest. I will certainly find out more about that, Nuala, and give you an accurate position.

Miss McAllister: I have another quick question.

Tracey, we have asked many questions about capital and resource in trusts, specifically when it comes to large machinery like the da Vinci robot, MRI machines etc. Do they come under the trust's capital projects, or is that resource? It is a bit of a mix, so it can be difficult to understand.

Ms McCaig: It is. Some of the funding might also be with charitable funds that have been donated to the trust for innovative changes that will support patient care. There is a mix. A standard MRI machine will be in your normal capital. That might be the capital that is already given to the trust, or, where we are doing something region-wide, it will be a decision for the Department. It may be that others use other funds to bring that in. It is not resource funding, but there will potentially be a resource implication, so we have to be careful that, when we bring in a robot, we have assessed all the other pieces of the jigsaw. Again, I expect my colleagues who will come to the Committee to discuss elective care in the next weeks to give you an update on that.

Miss McAllister: I ask that question to follow on from Diane's question about capital spend and waste. We have the maternity building sitting there, and so much money has been wasted on capital projects that need to be redone. How many more machines could we have had? I was fighting for robotics in gynaecology, and I am so delighted to see that that is being rolled out in other trust areas. However, when it comes to the waste of capital, we see consultants saying to politicians, "We need new machines". The Audit Office report in 2023 said that 16% of machines were obsolete: how many could we have fixed if we had stopped the waste in capital projects? I know that it is not really a question, but it is important that there is always a context when clinicians see that money being wasted and think, "What am I working with here? I could be saving more lives with better machinery".

I also want to ask about breast cancer. We are consistently missing our targets. It is 7·9% being seen within 14 days. Yes, that might be better than 5%, but it is simply not good enough. I know that a 95% target is extremely high, but when will women be seen in an appropriate time? A constituent has reached out to me to say that she has received her first Enhertu treatment, which is welcome. However, in your response to me today, you said that it will still be done on a cost-by-case basis. I was under the impression that the National Institute for Health and Care Excellence (NICE) had carried out the cost-benefit analysis of the drug. Will it be available for everyone who is eligible? It is the same for prostate treatment. Could you answer on those two points? Breast cancer and other women's cancer issues are massive.

Mr Butler: For full transparency, I have asked that question myself, because I want to get to a solid position on it. I understand the answer that is there, and I have asked for further detail to get the full picture. That was a great day: just about everyone in the room has contacted me about it, and you, Nuala, were foremost in doing that. For some people whom I have been dealing with, it was good news, but we need to move towards getting certainty about what that will look like and, again, not overpromise and under-deliver. There are great opportunities, and you are absolutely right that there has been movement on breast screening, but it is not good enough.

I will expand that to the women's health action plan, which I asked about on my first or second day, and all things with regard to women's health. I have sat on the all-party group (APG) on women's health and on many APGs with you guys, as you know. I have asked officials to work at pace, not specifically on breast cancer but on women's health in the round. For years in this place, I have heard that it is a significant topic of priority for MLAs across the sphere, so I have asked for more than an injection of energy into reporting on the women's health action plan. Will that be a silver bullet? Absolutely not, but I hope that it gets us on the right trajectory, given the other pressures that we have, and gives us some confidence. I was not party to its development, but I am keen to learn that the voices have been captured on the need and the expectation.

Miss McAllister: On that point, voices have already been shouting from the rooftops. Research has been commissioned, whether by academic institutions or by the community and voluntary sector. Female — and male — politicians have been shouting about a women's health action plan for years. It was the first motion that Alliance tabled in the House when the Assembly was re-established. We need to see action on it, because women's health cannot be secondary to other health matters. Health inequalities affect women in many ways from birth until death, so there needs to be a plan just for women. We need to see that.

The Chair is giving me a look, so I will ask my final question. You are or were a foster carer, so I believe that you have a passion for children's social care. What are your priorities for implementing the recommendations? Also, will you take a closer look at respite and the trusts' response or lack of response to that issue? We still see a response that is simply not good enough not just in provision but in attitude. Something needs to change.

Mr Butler: No problem. I do not want to blindside officials in that regard. The Ray Jones report was written when Robin Swann was Minister, and, evidently, there is crossover, particularly with the Department of Justice and your party's Minister. The previous Health Minister looked at doing work on that, but I want to look at the report again.

I have significant ambitions for what we can do, but good things are happening as well. I do not know whether you are aware of something that happened in the space of looked-after children just two weeks ago. It was a significant investment: £30 million from the National Lottery community lottery fund and £30 million of government money for Together for Families. I attended the launch with the First Minister, deputy First Minister and Justice Minister. That is the type of approach that will really change the space for looked-after children, because the energy there is this: how do we prevent children from needing foster care? I often asked that question as a foster dad for many years. How do we prevent children from needing adopters? It is by getting into the preventative stage of keeping families together, which is the best outcome for children in most cases. We have record numbers of children in care at the moment — about 4,500, which is almost 1,000 more than we had during COVID. Something is just not right in that space. There are lots of good people, and you can rest assured that my shoulder is to the wheel on what we can do in that space. It is about being realistic in the space that we are working in, because there are partner bodies and charities that do great work for the trusts, and there are trusts that do good work.

On respite, I think that you were talking about respite for young people with learning disabilities as opposed to children's respite care. I will turn to my colleagues on that because I have been reading papers on that literally in the past couple of days.

Miss McAllister: I encourage you to get across it, because it comes up in Committee a lot.

Mr Butler: Yes. To be clear, it is not something that I have no knowledge about. As an MLA, I have written emails to my party colleagues who have held this role. I understand the issue, but I am not prepared to answer a question in that space.

Peter, do you want to come in?

Mr Peter Toogood (Department of Health): We know that it is important to the Committee. It is important to us, to the Minister, to all of the Department and the trusts. I assure you that we are closely scrutinising the trusts' activity in that regard. We are seeking updates at the moment on their progress, because we want to make sure that we achieve the ambition of spending that £13·1 million. Rest assured, however, that it is always at the top of the pile for me and those who work with me. I work closely with Tracey and her team to make sure that that money is fully utilised for the purpose for which the previous Minister set it aside.

The Chairperson (Mr McGuigan): We need to move on.

Mr Robinson: Thank you, Minister. It is good to see you.

Mr Butler: You are polishing your glasses; that is not a good sign.

Mr Robinson: It is so that I can see what I have written down.

I have a couple of easy questions to begin with. I met the previous Minister about Changing Places facilities throughout the Health estate. He kindly met me and a number of disability advocates from the Province. Some commitments were given. I have since followed that up with a request to meet you along with disability advocates. I hope that you agree to that request. Officials, on that day, tried to imply that delivering those facilities across the whole estate would have huge costs. I have seen examples, even one in Parliament Buildings, of retrofitted Changing Places facilities. The equipment can easily be fitted to walls in the Health estate. I hope that you accept that invitation and take on board those concerns, because an individual has a basic right to be able to use a Changing Places facility and not have to be changed on a hospital floor, because that is incredibly degrading for them and their family. Those advocates asked me to make that appeal to you today. Please open your door. The email is with you, and I hope that you accept that invitation. That point does not require any answer from you today.

Mr Butler: If you do not mind, I will answer you candidly. Members will be aware that I have chaired the all-party group on disability for a number of years. Danny, you and I seem to have a crossover on a lot of APGs; you are like my shadow. On your request, I signed a letter this morning agreeing to a meeting. Before your ears prick up, there is a caveat: I have accepted so many requests that the trajectory for upcoming meetings is becoming genuinely —. I said at the start that I would make myself available, but I am looking at my inbox now and saying, "Oh my goodness". I have to balance meetings, delivery and actually doing work, because you guys will hold my feet to the fire if all I do is have meetings. That request was on my desk today, however — that is the truth — and I signed the letter today. The response will say something like, "Contact the diary secretary". I know whom you will bring to that meeting.

Mr Robinson: You have got off to a good start.

You will be aware, as other members are, that guidance has been issued to unions in the education sector advising that classroom assistants do not carry out tracheotomy procedures. That advice has put some principals on the back foot. I am aware of one case in my constituency where a principal had to tell the parents of a child who has complex needs that she can no longer take that risk, meaning that that child will now be removed from the school. To me, that is an outrage. No child should lose their education as a result of what appears to be a logjam between the Education Authority (EA) and the Department of Health. I am open to hearing some clarification on that, but that issue will be coming down the tracks, if it is not live already. Other members who have not yet spoken may highlight the issue too, but it is an outrage. It is a bad news story that is coming down the tracks.

Mr Butler: There are a number of things to say about that — Peter will probably kick me in a second or two — and we are developing a discussion on the wider piece. I have experienced that myself, not so much with education but with the at-home care aspect of directed care for a young person in my constituency who had had a tracheotomy and had run into the same issues, so I am aware of it. We need only look back to the summer to see the issues that there were with summer scheme provision, with the chats about that and a solution being found. I will go back further —

Mr Robinson: Not for all pupils.

Mr Butler: Not for all pupils. It is those with the more complex medical conditions who require specialist care. Some of the procedures are incredibly clinically involved and delicate, and they involve risk that has to be managed.

A wider issue that relates to children with additional needs that I have not addressed yet — I am trying to get my head around it — is specialist provision in mainstream schools (SPiMS). It is about looking at the adequacy of the work that went into seeing whether we had the resource to support the SPiMS when they were created. I am absolutely wedded to ensuring that young people with a learning disability or a disability are —. It is especially important, when multi-departmental work is needed, that we do our best to get it right first time.

I know that the piece about the pressures that are being faced is in the public domain, and I am alive to that. I do not have the solution today, but I will bring Peter in to give some detail on the context of that issue. You and I probably have the same concerns about dealing with that and finding the solution.

Mr Robinson: Particularly when there are classroom assistants who are appropriately trained to carry out the procedure.

Mr Toogood: I was made aware of the issue, Alan, late last week or early this week, when the Education Authority notified us of the challenge. We are looking at it urgently because we share your concern that no child should be excluded from school for that reason. Our Chief Nursing Officer, who is responsible for the provision and oversight of healthcare in schools and special schools, is looking at it. We will meet the Department of Education and the Education Authority on Monday. That forms part of our overall engagement with the Department of Education and the Education Authority on healthcare for pupils with special educational needs. That is the update: we are aware of it; we are dealing with it. I do not have a resolution or an outcome, but it is an active delivery action point.

Mr Robinson: Given that you were aware of it for some time, why are the meetings being held on Monday?

Mr Toogood: Sorry. We were made aware of it at the beginning of this week, I think, when we received the formal letter, and we have been working on it this week. It is not that there have been no meetings — we have been looking at it — but we do not have a resolved position yet. We need to work through that in order to clarify exactly what was said to whom and even to establish some of the facts.

Mr Robinson: I really hope that there is a solution. There has to be.

Mr Butler: It is a joint —

Mr Robinson: There has to be a solution.

Mr Toogood: Absolutely.

Mr Butler: Absolutely. I totally agree. It is an area of extreme interest for me, and I will work with my —

Mr Robinson: I understand that there is more than one such case in my constituency, and I imagine that there will be cases elsewhere on which parents will contact other elected representatives.

Mr Butler: Our special schools have provided a fantastic arena for the pupils who have needed them over the years. Unfortunately, as with a lot of the school estate, there has been underinvestment in many facets of them. The complication arises when there are medical complexities, with two agencies being involved, new clinical guidance or improvements in service and so on. We need to ensure that that is seamless. If changes are required, the resource to make them needs to be there. You cannot make changes if you do not have the resource to back them up.

Mr Robinson: Yes.

Causeway.

Mr Butler: I did not know that you would mention that.

Mr Robinson: Your officials briefed you.

The Northern Health and Social Care Trust made its recommendation in May 2025, which is almost a year and a half ago. How long does it take to make a decision on a recommendation that was made a year and a half ago? Is it too hot a potato for your Department to deal with?

Mr Butler: I will pass that to Tracey, because she has the experience of that.

Ms McCaig: I can certainly give you that. The consultation ended at that point, but the element that we have been looking at is how we make sure that each hospital has the capacity to deal with it and to make sure that Causeway Hospital is still provided with sufficient resource and activity to maintain it as a hospital. At the same time, there are conversations with the Northern Ireland Ambulance Service (NIAS) and the Western Trust. Each of those elements has been moving through over that time.

As I said at the previous Committee meeting, we have to see this as a network, so it is moving one part of the network. The unplanned position between SWAH and Altnagelvin makes it more complicated because we have to make sure that the network can function properly. It has taken some time for the Northern Trust to put in the detailed position. In the past fortnight, our teams have been working together up to that stage. It is not that it is a hot potato; it just took time. It is not without significant cost, so we also needed to find funding to make it work. Some of the elective care funding that was made available has been diverted to support the move, should a decision be made to take it forward.

Mr Robinson: How much?

Ms McCaig: I cannot give you the exact figure today — I do not have it with me — but it is not insignificant. It includes investment in the new deal, investment in elective in the Causeway area and support for other senior decision-makers and surgeons in that space. When we conclude, it might include the Antrim service and support in the Western Trust. Therefore, it is not without a cost, which also had to be worked through.

Mr Robinson: Why is it that the loudest voices are being heard, particularly on Twitter? Why is it that the voices of staff members, including senior staff and some surgeons who are unhappy with the decision, are not being heard?

I say this with the greatest respect to clinicians, but some of them are acting like politicians on Twitter. I would expect those not remaining silent but speaking out, particularly those who have concerns about the decision, to be reined in.

Ms McCaig: To be clear, the process that we went through involved looking at all the consultation responses, and there is a wide range from political representatives and the population in the Causeway area in particular. All those responses have been taken into account. I am aware of the discourse on Twitter and other places, but the work that we are doing at the minute is to look at it without that.

I do not need to read Twitter to understand the component parts. There are voices, and some of the positions that have been put forward are in the consultation. Some of the voices have become louder over time, but it is really important that we have due regard to what was in the consultation, unencumbered by some of those other elements, and do what we need to do in a fair and reasonable way. That is where we are.

Mr Butler: I will address that. You raise a good point. Unfortunately, X has developed into a space where the media pick up the news and take those loudest voices. To be clear, from my perspective, I will not be taking any information from Twitter, no matter whom it is from. I do not care what level of clinician they are; I will not take my advice from that space. Neither would you, but you can see how that gets into the public psyche and feeds the media narrative.

I assure you that I have heard contesting voices from clinicians about the plan: that is absolutely true. Without mentioning names, there are clinicians in that hospital who have spoken in public meetings, and I understand that it is delicate and difficult for them to speak in that space. Equally, it does not make them absolutely right and nor does it make them wrong.

On the development of the plan, it is absolutely vital that I encourage all voices to be heard. In the past week, you guys will have seen the Regulation and Quality Improvement Authority (RQIA) response to the paramedic and ambulance situation because of what happened in SWAH. That was not an anticipated result of the removal of that service, but it was very much in my consciousness that, when you squeeze or move something at one point, something else will happen elsewhere. Before you move anything, you have to know that you can guarantee that you know where it will move to and that you have the resource in place not just to provide a service but to make it sustainable.

All the conversations are useful, but you make a really good point. I accept that there are people who are not doing it publicly but are sharing through the appropriate channels.

Mr Robinson: Why is it Causeway Hospital, Minister? I asked that question at the emergency meeting that we had in the summer. Why, whenever a service has to be centralised, the perception, rightly or wrongly — the evidence tells me that the perception is the right one — is it that services are removed or recommended for removal from Causeway Hospital, rather than pathways being created elsewhere? Why is it that the people whom your party leader and I represent are the losers?

Mr Butler: Ultimately, if a report led to —.

Mr Robinson: Why do we see a pattern of behaviour similar to what happened at Roe Valley Hospital in Limavady in 1997, with service after service being removed under the guise of centralisation and threats to stability, leading ultimately to that hospital having to close? That is the fear: 13 miles away, we saw a hospital close. That is a fear that you, as Minister, and the Department need to get your heads around.

Mr Butler: There are two aspects to that, Alan. The first is what I referred to at the start, which is public confidence. There has been a history and a trajectory in which the public and service users have not been informed. They have been told what will happen to them as opposed to being a part of the solution. I trust the public to be a part of any solution that delivers better outcomes for them, but the solution has to be robust in providing better outcomes.

The one thing that I will push back on is this: there has been and will continue to be significant investment in Causeway Hospital. That is the absolute truth. I was up there recently, and I had a walk around and saw some of that investment at first hand. However, if you do not need the care, you do not know that it is there. That goes back to the point that I made about communication: there are some good things happening.

We lost the 24-hour A&E in Lagan Valley Hospital, and I still wrestle with that today, 20 years after it happened. I was left with the feeling, "Why did it go?". I live in the Lagan Valley constituency and regret that that happened, but I also know that we have the comfort of living 10 miles away from the Royal Victoria Hospital, the City Hospital and the Mater Hospital and 12 miles away from Craigavon Area Hospital.

When I look at those issues, I will look at every case as a case in point. Causeway is not 10 miles away from any of the other acute hospitals. However, if patient outcomes are better, people are convinced and the business case stacks up, it is never wrong to do the right thing. You have raised some good points, and they are the very questions that I am asking. I want to have absolute confidence before I make a decision.

The Chairperson (Mr McGuigan): That is a good place to stop. We need to move on.

Mr McGrath: Thank you, Minister. You have been hit with a lot today, not least that, if you need a template for making announcements at your party conference, should you be going to do that, you can look at any of the other parties. I am sure that every other party has made announcements at their party conferences over the years. There are plenty of templates out there for you to pick from.

The health service has severe staff shortages. The entire system needs to be transformed. Waiting lists are not being dealt with; our emergency departments are overflowing; and you cannot afford to pay your staff. Cancer care times are getting longer, and neurodivergent people are not getting access to the services that they need. Given all of that, your party is the smallest cog in a four-party Executive who will not give you the money that you need. The other parties will vote through a Budget that will not give you the amount that you need to deliver all of those services. Why did you take the job on?

Mr Butler: Wow. I analysed it and made a speedy decision; I did not have a lot of time to think about it. It was not a personal ambition, because it is a difficult job. I wake up most mornings with a knot of fear in my tummy. Having worked where I worked before, I understand that things go wrong, not deliberately or by design.

Health impacts on all of us, and it is probably a portfolio that everyone around the table could take on and bring something to, because health and social care impacts on every one of us from the moment that we are in our mum's womb until the day that we die. That care is not linear; it goes in a slight U-shape. I have been looking at that over the past couple of weeks. People who use hospitals and primary care are predominantly older or pregnant, and there is a slightly different bit in the middle. When I listened to some of the voices over those 24 hours, some of it was about health, and some of it was about what was happening and how it came about, but people spoke on the radio with genuine fear about what was coming next and about this becoming slightly political.

I am humble enough to say that, when I looked at my skill set, limited as it is, I felt that I could bring something that would inject something slightly different, albeit for seven months, as it was at the time. I will face a barrage of hard questions in the Chamber and rightly so, but I have built up a reputation with all MLAs and parties as a character who wants to do business and will do it without any politics attached to it. As the Chair picked up at the start, there is no politics in health. If any of you were to get the opportunity to be Health Minister, I am sure that you would not shirk it, and I did not shirk it.

Mr McGrath: I would like to think that there is no politics in health, but there is an associated issue, and that is the politics of where the Budget goes. Other Ministers will make sure that their pet projects, which do not mean life or death to people, are funded, while you will not get the funding that you need, which is about life or death. I worry about the Executive's approach to the funding.

You have been in post for only five or six weeks, but have you been able to work out why there is a culture in the Department that is against rural communities? I say that because I have watched services being stripped from the Downe Hospital; I am watching services being stripped from the South West Acute Hospital; we are watching services being stripped from Daisy Hill; and we are watching services being stripped from the Causeway. I do not see Craigavon, Antrim, the Royal and Altnagelvin being stripped of services. Is there a palpable sense of bias against rural communities in the Department, or is it just the way that things have developed?

Mr Butler: I have been there for only five weeks and can honestly say that I have not received a piece of paper or briefing or heard a murmur or a whisper in that regard, Colin. However, I have also been Chair of the AERA Committee, which covered not just agriculture but environment and rural affairs, and we can see the same issue play out in our schools, our road infrastructure, public transport and every facet of public service provision where it is much more difficult to find a solution in rural areas.

All that I can do, in the short time that I have, is hope that people will trust me. I am wedded to my last year and a half as Chair of the AERA Committee, and we have to recognise the demographics. We have an ageing population and plummeting birth rates, and the Department is looking not just at today but at the situation in five years, 10 years, 20 years and 30 years. The difficulties that we face today could become even more difficult because of the shrinking and ageing population and comorbidities. When you add the layer of rurality, what are the outcomes? It goes back to my earlier point. When I make a decision, it will not be for today or for the workforce that we have today; it will be with an eye on what will happen in 10 years' or 20 years' time and what will help to sustain that.

Tracey talked about the ongoing move to a neighbourhood model. Hospitals should be used only when you absolutely need them. There is an adage — being of a similar vintage, we will all have grown up hearing it — that you should not stay in hospital too long because it may not be good for you. The Department is alive to that, because it is not an inaccurate saying. If an older person spends too long in hospital, they get muscle fatigue and wasting; it reduces their mobility; and they need a physiotherapist for a longer time. If we can deliver care closer to home —.

Mr McGrath: We are straying off the point that I was making.

Mr Butler: We are, and we are not. The neighbourhood model is part of it. The approach is to turbocharge the neighbourhood model that will bring care closer to home, but to ensure that rural dwellers are part of that and are not neglected.

Mr McGrath: Absolutely, but I think that you can get the difference. When we talk about rural things, we are talking about urgent care and not necessarily hospital care. The Hospital at Home scheme is grand if you can wait for two or three hours for somebody to come in: this is about constituents who are waiting two or three hours in an ambulance. Urgent surgery or maternity services can be accessed easily. You mentioned Lagan Valley, and I thought the same about it. A blue-light ambulance going 10 miles down a motorway to get to the next hospital is great, but it is not so good if you live in some areas that I represent, from where it would take about an hour to go by blue light, and that is on top of waiting for the ambulance to arrive.

You mentioned staff shortages and said that the decisions that you take today will not be for today but looking to the future. I am rattling through this because we have only 15 minutes each. We hear of difficulties with maternity services because of a lack of staff at Daisy Hill and Causeway hospitals, for example. We are five, six or seven years down the road since those staff shortages started, and we are getting to the critical point when services are collapsing as a result. What sectors are your officials telling you are short of staff now and will collapse four or five years down the road? You must know the trajectory. You know how many people are training to be doctors, how many are in position and their ages. You could probably throw the figures through ChatGPT, and it would tell you exactly where the problems are. Have you done an assessment of where the difficulties will be, and is there something that we can do about it now?

Mr Butler: I will bring Jim in on that. It is a bit of a busman's one for me. I know that work is ongoing, and Jim will maybe speak to some of the details of that. I met the Royal College of Psychiatrists, for example, and was told about its specific difficulties. Some of the fixes here are about attracting people to certain areas of clinical practice. Medical friends tell me that people going into medicine may not know exactly where they are going to pop out, and they may change their minds on that journey. Some of this is not even about the early gifting, but we have to create the space and the places. What excites me is that, in the near future, we will be trying to make this an attractive place to work and serve.

The other moveable feast is the fact that there is clinical practice specialising, which moves at a different pace, meaning that service delivery has to be able to flex in that space. Take Daisy Hill as an example. What happened there is that a number of people who were entitled to move decided to move at the same time. The good news is that the shortage of midwives there a number of years ago has been almost wiped out. There is only a small shortage of midwives at Daisy Hill.

Ms McCaig: It is 2.9 or something like that.

Mr Butler: You are talking single digits now. If we could get to no vacancies, it would be better. That is evidence that the workforce plan is working.

With regard to contracts, consultants can and do move. What we need is resilience in the system to reflect that. I am having conversations not just about recruitment but about agility across the region. Those are at a very early stage. I have not yet had discussions with the trusts, but I spoke about that in the Department. Where is the agility? This is a health service, not a trust.

Mr McGrath: If it gets too tense in here and you need to crack a joke, tell us that the Department has a workforce strategy and that it is succeeding. We deal daily with the outcomes of that.

My last question is landing on you, Minister, because you are here. This is the fifth time that I have asked this question, — I have asked it twice in letters and in two questions for urgent written answer — and I cannot get an answer: does Encompass reboot every month?

Mr Butler: I cannot answer that. What do you mean by "reboot"? Do you mean absolutely reset?

Mr McGrath: I have been told that it reboots once a month and that that has an implication for test results being accessed and an effect on appointments. I asked that of your predecessor on four occasions, and I cannot get an answer.

Mr Butler: Encompass is a magnificent system. I am aware, however, that there have been significant teething problems regarding access and the glass ceiling, but I have not heard about what you describe, Colin. I will ensure that that is followed up. You raise a significant issue, and I can see that Danny also knows something about that, so I appreciate that. Thank you. I am sorry that I cannot answer.

Mr McGrath: I have concluded my 15 minutes in 12 minutes, so there you go. I will pass back to the Chair.

The Chairperson (Mr McGuigan): I was expecting a longer answer. [Laughter.]

Mr Butler: I have nothing to add, Chair.

Ms Flynn: Congratulations, Minister. This is my first opportunity to say that to you since you took up your post. You are taking on a massive role, and I am sure that all members of the Health Committee wish you all the best in the months ahead.

You mentioned that one of your priorities — I was glad to hear it — is strengthening mental health provision. You will not be surprised that that is my focus today when it comes winter preparedness and waiting lists. Has the Department made any assessment of expected additional mental health demand as part of the winter preparedness plans?

Mr Butler: I will hand over to Tracey to answer that and come back to you. I want to talk about my plans in that regard.

Ms McCaig: Our colleagues are still working on those winter plans. I do not have figures today for what we might expect. You may expect an upturn, but we are mostly talking about winter illnesses, including COVID, flu and all the other things. We have to make sure that we do the right thing all year round for those who may be in mental health crisis. I am not sure whether the Committee has an upcoming session on that; I assume that you may have. Colleagues across the piece will be able to give you a little more information about some of their plans: for instance, is an emergency department the right place for someone in mental health crisis?

We need to set that in the context of our ambitions to do a lot more. However, the funding that we have at the moment and the savings plans that we have to enact mean that this winter will be about how we use what we have to best effect, rather than necessarily having anything additional. Conversations are ongoing about that very thing but not just in the winter context.

Ms Flynn: OK. You may not have the detail, but are there any contingencies in your winter preparedness plans for mental health beds? We are already well over capacity, but is there any breakdown across the trusts of contingency mental health beds for the winter? Are there arrangements in place if you run out of beds?

Mr Wilkinson: As Tracey indicated, those are being assessed. However, when we wrote to the trusts to ask for their winter surge plans, we asked them to identify their short-term bed capacity, their rehab and acute patients and alternative pathways in ED, as well as to agree an escalation process. The escalation process is featured in every element. We are saying that, in the event of a surge, we need to know when and how to escalate. That is the process, particularly in mental health, that Tracey's teams are looking at now. Trusts will have produced those plans, and we are testing their accuracy and assessing their impact.

Ms Flynn: OK. Will we get a breakdown of that information once the trusts come back to you with more details?

Ms McCaig: Significant work has been undertaken with the Northern Ireland Ambulance Service on what it might do when someone first makes contact. There are a lot of plans in place in that regard. It is also about how quickly those integrated pathways work from the minute that we get a call through to the right place to direct access. Quite a lot of work on that is ongoing, and our colleagues will be able to update you on that.

Ms Flynn: That is great. I will follow that up with you after today.

Again in a mental health context, I turn to hospital discharges, which a couple of members, perhaps including Danny, touched on. Are you aware of how many patient discharges from hospital mental health beds are delayed currently? I have been made aware that there are delays because of trying to get suitable support packages to get people back out into the community. We often talk about domiciliary care for older people, but have you put together any plans for over the winter to find suitable community support packages for mental health patients whose hospital discharge has been delayed?

Ms McCaig: That is a significant focus for the mental health team, including from the Department side and right down into the trusts. We are experiencing delayed discharges; I do not have the numbers with me today, but I will be happy to send those to you afterwards. It is a real challenge to find suitable alternative placements, and, at times, people's discharges are delayed. The best place for them at that point is being supported by the hospital network. We need to make sure that they move as well. There are delayed mental health discharges, and that is also the case in our acute hospitals. There is a focus on both of those situations, but I cannot say that we will crack it over the winter.

It is an ongoing process to make sure that we have sufficient placements. There is insufficient additional money to go out and generate a lot of additional packages, so we have to ensure that we work with what we have through crisis response and other things — again, a bit like what we do in our EDs and other places — to ensure that all the care that we have is provided at the earliest point to prevent people needing to be in hospital and then to prevent delayed discharge. That pathway is also being worked through. As with EDs, it is not easy in that space. I can get you some information on that.

Ms Flynn: That is great, Tracey. It is obviously an issue for the Department of Health and the Department for Communities. In the Chamber the other day, I raised the issue of available properties for supported living for people who are going through mental illness and coming out of hospital. Over the past four or five years, about 8,500 new homes were built, but only eight of that number were supported accommodation for people with mental health issues. That is a bigger piece of work for Health and Communities. I will come back to that with you.

Just this week, I picked up a case in West Belfast that has really worried me. It is not groundbreaking; we have all picked up such cases. We are aware of the waiting lists: this is about waiting lists in the context of mental health. The case is of a primary-school child who has, basically, reached crisis point. We are talking about a very young child at primary school. The child was going through crisis and was at crisis point. The family and school reached out to get the child the support and help that they needed. The family heard nothing for a number of weeks. When it was followed up by the school, they were informed that the child had been put on a waiting list for an urgent mental health assessment. The family was told that the child had to wait for nine months. They were also told that, once the child gets the urgent mental health assessment after nine months, they will have to wait for over a year before they can start ongoing treatment. I just despair when I come across such cases.

We deal with so many pressure points in our health system at the minute. I am not sure whether you are aware of it, Minister, but, earlier in the month, the Royal College of Paediatrics and Child Health in Ireland released a report that talks about the fact that the mental health of our children in the North is worsening. When I picked up that case earlier in the week, it really frightened me. I thought, "How does any family deal with that?". You have a child of primary-school age in urgent mental health crisis, and you are told that you have to wait nine months. I could not live like that if it were a family member or child of mine. I do not know how we expect families to wait and to cope with those delays. I know that you are stuck where you are at the minute with budgets and all the rest, but, please, if there is anything on that — any breakthrough on child and adolescent mental health services (CAMHS) for our kids — I would really appreciate an update.

Diane raised the issue of bowel screening: the stuff being done on that is brilliant. I would really welcome any forthcoming announcement on that being extended, Minister. Are there any plans to introduce screening for lung cancer? We have touched on it before. We know that, next to breast cancer, it is the biggest killer of women. It is the biggest killer of men. Scotland, England and Wales are all rolling out some form of screening programme, and the South of Ireland is developing flagship pilots. We are becoming the outlier. It would be a very important screening tool.

Mr Butler: Órlaithí, I thank you for your work on the all-party group on suicide prevention. You have chaired it for some time. This week's event was really good. I just want to mention that I followed through on my promise that day to speak to my Executive colleagues today. There is a cross-Executive strategy on mental health and well-being and suicide prevention. I think that it was set up under New Decade, New Approach. I reaffirmed that today. I have asked them to consider looking at that report, because I thought that it was useful and the issue needs an all-Executive response.

Would you mind firing through the details of the mental health case that you mentioned? I am particularly interested because, obviously, there is a clinical manifestation there. I imagine that the response to it has been a matter of triage. We need to ensure that the right response is given.

On the second part — Tracey, you can kick me under the table if I get this wrong — at the point of assessment, they will be told what treatment is needed, and then there will be a determination. That does not happen until they have had that assessment and have found out how that happened.

On lung screening, I will hand over to Peter Toogood. The long-term trajectory for that is slightly better because of the Tobacco and Vapes Act 2026 and the changing legislation. The number-one contributor to lung cancer is, evidently, smoking. We still do not understand the impact of vapes and so on. As a lifelong non-smoker — I should not do that — I am glad to see that in that space. Screening is absolutely important, and I am sick of Northern Ireland being an outlier in anything in that regard. That is the truth.

Peter will give us a better update on that space.

Mr Toogood: England, Scotland and Wales are following the National Screening Committee's recommendation to screen current and past smokers aged 55 to 74. The thing about screening is that it is not just about the screening itself; it is about the infrastructure behind it, such as the people, the diagnostics, the treatment and the various pathways that need to be put in place. Anything like that is a significant piece of work. That may be the method by which it is identified, but there is a lot more work behind it. The Minister recently approved some funding for the PHA to start the plan on how we introduce that lung screening pathway here. It is a plan to a plan. We are not saying to introduce it; we need to start work to see what that means in a Northern Ireland context, because we do not have it. That is in the process of being put together.

Ms Flynn: On that, Peter, sorry to interrupt you, but, given that we know that it is the number-one cancer that is killing men and the number-two cancer killing women, why — I know that it is hard without money — are we not prioritising that work a bit more to introduce that screening when we know that it will save all the lives that are being lost through cancer?

Mr Toogood: This is the first step, Órlaithí, that we have to do. We are starting that, and the Minister has agreed that it is important to do that. There is a constant balance between bowel screening, cervical screening, breast screening and all the other stuff.

Ms McCaig: I will add to that. At the most recent meeting of our strategic cancer advisory forum, which involves a lot of other stakeholders — I forget the date, but Jim and I were there — the two pieces of advice to the Minister were about bowel screening and lung cancer. I give an assurance that, while the Public Health Agency is working on screening because it holds that portfolio, the additional element of the plan about what we need to do for the infrastructure in acute hospitals and others and the impact of that falls to my team. I have re-prioritised some other work that I have seen as less — could fall a little bit behind. With everything that we do, it is hard to make a call to prioritise resource to be able to work alongside the Public Health Agency at the same time. We agree with you: it is an important piece of that.

The Chairperson (Mr McGuigan): They are all important issues, but I will have to move on.

Mrs Dillon: Thank you, Minister and officials, for coming. You will be glad to hear that some of my questions require a yes or no answer.

Mr Butler: I cannot promise that, Linda.

Mrs Dillon: Well, I want a yes or no; that is genuinely what I am asking for.

You talked about looking at the Ray Jones report: have you met or do you intend to meet the Reimagine Children's Collective? That is a collective of groups and organisations such as Barnardo's, Action for Children and others that represents children. That group has a really good report with recommendations on how to move forward with the Ray Jones report. Obviously, we are three years down the line after that report. Have you met or do you intend to meet that collective? That is a yes or no answer, almost.

Mr Butler: I do not recognise that I have had an invitation in that space — I might well have done — but it certainly sounds like the type of meeting that I want to have, Linda. I will hand over to Peter, but I certainly want to be well informed in that space.

Mr Toogood: Linda, we have worked closely with the Reimagine Children's Collective, and I really admire what it has done. We are working on the Ray Jones report, which made 53 recommendations. The previous Minister accepted 34 of those, and there was then a big chunk related to the authority. A key element of working on children's social care is about what the Minister said earlier: we are not just doing that ourselves; we are working with the community and voluntary sector and every other wider provider because that is what is needed to fix the issues and the challenges. We will check whether there was an invitation, but we want to engage in that regard. The collective has been invaluable in getting us to where we are. As you are aware, a programme of work is taking place on the reform of children's social care in which that collective has been instrumental.

Mrs Dillon: You referenced the women's health action plan on a number of occasions: do we have a date for the publishing of that? That is a yes or no answer: either we have a date, or we do not.

Mr Wilkinson: The Minister has definitely requested a date by which we should come forward with proposals. I do not have that to hand, but I know that we are working towards a deadline.

Mr Butler: I definitely requested a date.

Mrs Dillon: The Committee would like that date —.

Mr Wilkinson: The Minister has requested that, and we will bring it forward as quickly as possible.

Mrs Dillon: As soon as that date is available, the Committee would like to have it.

Mr Wilkinson: We will let you know that.

Mrs Dillon: OK.

Does the Minister have any intention of doing an awareness-raising campaign around the symptoms of ovarian cancer? Is that something that you plan to do? Again, that is a yes or no answer. I understand all the reasoning as to why you may not be able to do any of that.

Mr Butler: I am looking at awareness campaigns as a whole because people outside the Department have asked me about what they look like at the moment. Ovarian cancer is one of the ones about which I am interested in seeing exactly what we are doing. I am interested in awareness-raising campaigns; I saw great benefits during my previous employment from public information and that type of stuff. I am trying to get a better picture of where all of those are, one of which is ovarian cancer.

Mrs Dillon: OK. There are opportunities to think outside the box when it comes to such things. There are cheaper ways in which to do awareness-raising campaigns than would have been the case in the past.

Do we have a date for when the learning disability support model will be published?

Mr Butler: I am looking at Peter to give an update on that.

Mr Toogood: We do not have a date for the publication of the model. There are two things that will go to the Minister shortly. One is the qualitative report on the consultation that we did. As you will recall, we published the quantitative report back in January. The qualitative data from the consultation will go to the Minister shortly. Closely after that, certainly in the next month or two at the most, will be the delivery plan that underpins the model, which will say, "OK, this is what we're actually going to tackle in the first instance" and identify the commitments that we will look at next year in particular. There are two publications coming shortly, Linda, that will, hopefully, give you some flavour and colour in that regard.

Mrs Dillon: OK.

Minister, you said that the issue with Daisy Hill was the fact that two consultants moved, which they were well within their rights to do. You said that you have started a conversation about having agility in the system to allow for such things: when will we get an update on those discussions? We do not want to wait until we have an outcome; we want to get an update on where that is. That is a consistent problem, so we need to look at how we address it as a region-wide issue, rather than having consultants attached to hospitals. The Belfast Trust is benefiting from Daisy Hill's loss.

The point was made in response to Colin McGrath's question, to be fair, about Craigavon not losing services. Services in Craigavon are at risk for the same reason as they are at risk in every other hospital: workforce issues.

Mr McGrath: It will be protected.

Mrs Dillon: Craigavon, frankly, could not cope with the babies who would have been born in Daisy Hill. Let us face it: we are talking about increasing the number of babies whom Craigavon would have to deal with by 50%. Craigavon could not cope with that, particularly given some of the issues with the facilities in Craigavon, which were outlined by Diane Dodds.

Mr Butler: If the move were required, that would very much form part of the development of any plan. The primary piece is about ensuring that those pregnant mums are as safe as possible, no matter what. It is about ensuring that the best outcome is achieved with whatever limited resources there are. Nothing is being closed down at the moment when it comes to the regional reach-out. It has not come back with anything yet. Tracey will give you a further update on that. We have not stopped at just regional outreach; we have reached out across the water and into the Republic on that requirement.

My preference is that we secure suitably qualified and experienced obstetricians for Daisy Hill, even on an interim basis. To be absolutely clear, that is not the precursor to the removal of maternity services from Daisy Hill. That is not the case. Demonstrating that it could be achieved through a temporary fix would be preferable, but I will not put the safety of women in that area at risk if we cannot safely staff those services at Daisy Hill. We also need to ensure that we have the confidence of those people. For me, the primary concern, which the trust will back up, is this: what do the comms look like for those who are on that pregnancy journey at the moment? Do those who are ready to deliver imminently know that a safe system is in place at Daisy Hill for them? If that situation changes, it needs to be communicated in a timely manner.

The assessment in and around Craigavon is a live part of that discussion. The trust is working with SPPG in that regard. Any change that has to happen will be based on that risk assessment to ensure that we provide the highest level of safe, quality care.

Ms McCaig: When it comes to the numbers, we should also note that the Southern Trust has appointed someone from the Belfast Trust. That backwards and forwards happens, but it is not sufficient.

It is also important to note that there is a national shortage of obstetricians. We have seen the impact of that on the Royal Devon trust and other places. It is really challenging. There has been reach-out to NHS Grampian to look at other models of care for obstetrics to see whether those would work. We have reached out to our colleagues in the South to see whether any support could be provided from there. A lot of work is going on, as it was even before this situation, to stabilise our maternity services in Daisy Hill.

The Minister spoke about the really successful process to do with midwifery, which was fantastic. We knew that there were tight numbers, but to have two staff move on at one time was really difficult. The Southern Trust has done a really good job of trying to find other staff since we first heard of movement in those posts. It has been a significant challenge, involving reaching out across the UK and Southern Ireland as well as internationally. It is a really difficult time, and we need to be able to support the trust in that space. It is important that we do the contingency planning —.

Mrs Dillon: Sorry, I do not mean to cut across you, but our time is limited. Obviously, we want continual updates on the Daisy Hill issue —

Ms McCaig: Absolutely.

Mrs Dillon: — not least because we already have the highest infant mortality rate across these islands. That is not specific to Daisy Hill — I want to be clear about that, because I do not want to put any fear into the community — but that is not good enough. In 2024, the figure was 4·5 deaths per 1,000 live births: that is absolutely disgusting. We have Mary Renfrew's recommendations. Let us seriously look at prioritising women's health, as the Minister said. In doing that, we will prioritise children. I accept all the challenges around obstetrics, but let us look at Mary Renfrew's recommendations and see how we can improve the outcomes for women and children.

Finally, I will raise two things. We need to be more dynamic. I know that you are looking at all those things, and I accept the pressure that you are all under. I have a lot of sympathy with you, to be honest. However, we need to start being more dynamic and looking outside the box more in a way that is safe when it comes to how we deliver care. That goes back to the domiciliary issue that was raised earlier and the constant request and need for more money. We need to change how we spend money.

First, we need to seriously look at how we spend what we have. We know that it is more expensive. Everyone — all the trusts and all the officials, the previous Minister and the current Minister — has said that it is more costly to keep people in hospital. How are we seriously going to change how we invest that money in care packages? We know that we will lose care workers because of the cost of diesel. Again, that will affect rural communities.

Secondly, I want to get confirmation on a point that was raised by Colin. Am I right in saying that, in all monitoring rounds and in allocating any additional money that we have got from the British Government, the Finance Minister has prioritised Health every time? I want to get clarity on that.

Mr Butler: I do not have the detailed picture on that. I know that I have to speak as Health Minister, but I do not have the answer, except to say that everything that comes across here goes into one pot. As far as I know, we make our bids on the basis of our business cases.

The Department has done incredible work on that. It has reduced the budget requirement from around 52·5% to, if we achieve the savings, around 50·5% to 51%. As a Department, we are on the right trajectory. I agree with you, Linda, that we have to do things differently. I have to work within a finite budget, and I have to find ways and better ways of keeping people safe in every aspect of life, whether that is at birth or at death with dignity in dying. The challenge is there.

I used the word "agility", which is what I would like to see more of across the piece. We have become risk-averse, possibly with good reason in some instances. We need to drive innovation. In my first-day brief with my senior leadership team, I asked officials how we are capturing the voices of professionals who work every day, including cleaners, domiciliary care workers, transport staff, nurses and doctors, to identify good practice and to ensure that people are recognised for it and that it is tracked through as if we have one trust so that that is not isolated in one trust or one discipline. Work is happening in that space, and I would like to see that accelerated.

The Chairperson (Mr McGuigan): Minister, we have reached your time limit, but you will not mind, I am sure —

Mr Butler: I am going. [Laughter.]

The Chairperson (Mr McGuigan): — staying on to face the tough questions of your party colleague. [Laughter.]

Mr Chambers: Thank you to the Minister and his officials for their attendance today.

Minister, in your opening remarks, you alluded to the staff pay awards and the difficulties surrounding that: how concerned are you about the prospect of industrial action down the line? Is it fully appreciated across the Executive just how precarious the position now is and how close we are to significant disruption across Health and Social Care? I am sure that you will agree that that is not a place in which staff want to be.

Mr Butler: On your last point, Alan, you guys will have heard this before, but it is important to say it for the public record. As a firefighter, I voted for strike action in the early 2000s with a really heavy heart, because I knew, when I did that, that I was removing myself from the position where I would provide a response. We included a derogation, which was that we would respond to life-risk calls. We stood at the brazier day after day and night after night, and I see the deduction on my pension statement and saw it on my pay statement at the time. When people take strike action, they do not take it lightly. It is taken maybe not just on a specific point because they are not paid when they strike, unfortunately. I do not think that there is anybody in this room who is not part of a shared frustration that, with Agenda for Change and the commitment that has been made around the real living wage, we have not been in a position to move on pay.

To give you an accurate update, I say that doctors and dentists are already in that space. RCN will be balloting in the next couple of weeks, and I have been told that there will be no derogations in its action. It is absolutely, totally and utterly frustrated with the inability to move on pay. With any union, I want to ensure that I keep the door open, and Executive colleagues will do that with their own public-sector workers.

My fear is that strike action will impact on any of the good work that we have done on winter preparedness, on the waiting list initiatives and on the multiplicity of questions that have been asked today. Meetings that I have had with unions have not been like this meeting; they have been even more serious because the unions understand the position that they are in. They have watched their colleagues across the water. They have seen the commitment that we gave on pay parity and that we are not doing it. We need to move on that. I have had a couple of meetings with my Executive colleagues where I have made that point, and I have had no pushback. Some of my colleagues are in a similar position with the portfolios that they hold. My risk and our risk is that the outcomes of that lead to poorer outcomes, so I want to avoid that at all costs. I hope that my Executive colleagues and I will be able to move at pace to enact that.

Mr Chambers: I am sure that we all agree that we hope for a satisfactory outcome to that issue.

Minister, the news about Daisy Hill this week was deeply concerning, not least for the communities that it serves. Can you confirm once again that it was not the result of planned reform or a ministerial decision but, rather, came from an unplanned workforce challenge in a discipline that already faces a UK-wide challenge? Does the Minister agree that it would be wrong and potentially damaging to conflate the immediate operational problem with the wider debate about reform?

Mr Butler: I absolutely agree with your point. It goes back to Alan's point about some of the narrative on social media. We are in a Trumpian world where people seem to be at a loss if they do not have something to be contentious about and to spread fear on. The only way to effect real change is to have an honest baseline of the issue: the honest baseline in this case is that it was an unplanned workforce issue. Even the best workforce plan in the world could not guarantee that it would not happen. I would like to see more resilience and agility in the system to react to such matters, but I do not want to constrain a workforce from further professional development or moving into specialisms. If moving is the right thing to do, it is the right thing to do.

We exist to provide and manage a system of care. I will be absolutely honest in all cases. Sometimes, it will not be the case as it was here, and it will be part of a wider plan. That goes back to the point about communication with service users needing to be much better: people need to be part of the solution, not told what the solution is.

Mr Chambers: Minister, I am sure that we all welcomed the good news about the reduction in waiting times, and the credit has to go to the staff. They have not just gone the extra mile; they have gone the extra two or three miles to achieve those results. You have been out and about a lot to meet staff at the coalface: is it your impression that the staff still have the appetite and the ambition to go further? Are you committed to tapping into that enthusiasm in order to continue to improve waiting times?

Mr Butler: I will put some of the improvements on the record to make sure that we understand what we are talking about. The improvements in the baseline are already evident in 2026-27. There has been a 16% reduction across all named procedures, with reductions of over 20% in primary hip procedures, primary knee procedures, tonsillectomy, paediatrics and scopes and a 13% reduction in the number of outpatients who are projected to wait for more than four years by 2027. There has been a 13% reduction in the number of outpatients projected to wait for more than three and a half years for the selected specialties. Those figures are real people.

The Member's point is important. We all stand in photographs with bigwigs, clinicians and all the great and the good, when the reality is that the delivery is carried out by the man and woman on the ward, the cleaner, the porter and the transport provider. We often forget about the people who turn up every day. In my first meeting with my senior management team, I asked what we were doing for the people who turn up from Monday to Friday. If you are a manager who is doing a rota and you know exactly who will turn up next week — they are the first names on your list — what are we doing to recognise that? What are we doing to go further than that and to drive it as the culture in our health service?

They are beleaguered, Alan. They are sick of people such as me standing up and taking credit for something that I have not actually delivered. There is a lesson in that for all of us. We rely on the people who turn up every day. We need initiatives that see that, respect it, reward it, platform it and drive it as a culture throughout the service.

Mr Chambers: There has been much speculation today about what you might or might not say at the conference on Saturday: I extend a warm invitation to any colleagues who would like to come along to hear what you say.

Mr Butler: Hear, hear.

The Chairperson (Mr McGuigan): after the meeting here before the conference.

Mr McGrath: I can guarantee what you will not be announcing on Saturday at the conference; it will be Monday morning.

Mrs Dodds: Just tell us now.

The Chairperson (Mr McGuigan): Thank you very much, Minister. It was a long session, and we appreciate it. We are scheduled to see you again in January, but, as it is Health, we could see you well before that. Thank you.

Mr Butler: I will be agile. As I said to you privately, Chair, and in session, whilst my diary is filling up, the Committee's role is as important as that of the Minister at times, as is that relationship. I will not duck the difficult questions, and I will give you honest answers. It may be difficult, but we are trying to improve things together. Thank you for your time today.

The Chairperson (Mr McGuigan): I also thank Peter, Tracey and Jim. Thank you all.