Official Report: Tuesday 21 January 2025

Ms Ennis: I will talk this morning about the continued lack of paediatric pathology services in the North and the implications that that has for our health service and, more importantly, the impact that it has on bereaved families.

We have been without a paediatric pathologist in the North since 2019. In that time, hundreds of families have had to travel to Alder Hey Children's Hospital in Liverpool to access important post-mortem analyses. Some parents are unable to travel with their child, perhaps for a health reason. For some families, the thought of having to travel after just losing their child is simply too much to bear, so they decide to forgo that post-mortem analysis. That is their right, and every family will make whatever decision is right for them at the time. If, however, we do not have that necessary health information, if we do not know what caused a stillbirth or miscarriage and whether that will have implications for a second pregnancy, and if we do not know whether there are unique health challenges facing the population here in the North, that represents a gap in our health service, meaning that we are not equipping parents with the information that they need in order to make a decision about whether to undergo a second pregnancy.

I know the impact that that is having on families. I sat with a family in my constituency who lost a baby during childbirth, and they explained to me the anguish that that caused them, the shock at their finding out that they would have to travel to Liverpool to find out the reason and the trauma that they still experience to this day from having gone through that. All that they ask is that we make sure that no other families have to endure that. That is something that we can do. We are a relatively small island with a relatively small population. We have approximately 100,000 births every year, and there is no reason that we cannot offer paediatric pathology services at home and therefore not add to the anguish that bereaved parents face when they lose a child.

I know that the Minister of Health agrees with me. In the Chamber not that long ago, he alluded to some progress having been made on the issue. I know that he had been working with the previous Health Minister in the South on it. With an incoming Government there and a new Health Minister being appointed, I urge the Health Minister here to resume that conversation with the new Health Minister to make sure that such services are in place for families here at home so that we do not re-traumatise parents and families by making them have to travel to Liverpool. The service and care that they receive at Alder Hey is second to none, but this is about the fact that families have to travel, which adds to the trauma and anguish that they are already experiencing.

I urge the Health Minister to take up those conversations with the incoming Health Minister in the South and look to implement such services here at home to make sure that families have access to them and do not have to travel following a child's death.

Ms Forsythe: Get your haggis, bagpipes and tartan ready: it is time to celebrate Burns Night. For more than 200 years, Burns Night has been celebrated every year on 25 January in honour of Scotland's national poet, Robert Burns, who is known all over the world. The story of Robert Burns and Ulster is one of an auld acquaintance that should never be forgotten. It is just one of our many historical connections with Scotland and expresses our shared heritage of the Scots language and literature. The Ayrshire poet and lyricist died in 1796, but he is still regarded as the most prominent poet to have written in the Scots dialect. His best-known poems include 'To a Mouse', 'Address to a Haggis', 'Tam o'Shanter', 'A Red, Red Rose', and 'The Selkirk Grace'.

Burns Night, sometimes called "Burns Supper", is traditionally celebrated with a dinner consisting of haggis, neeps and tatties — more commonly known as turnips and potatoes — along with food, poetry, music and dance. This weekend, we will see people gathering to celebrate Burns Night all over the world. It is fantastic to see the best of our Scots and Ulster-Scots history and culture being celebrated across the globe. With the new American vice president, JD Vance, having strong Ulster-Scots links, we look forward to sharing our culture with the White House in the future. In my constituency of South Down, Burns Night will be well celebrated, with really big events in Kilkeel, involving the Schomberg Society, and Lisnamulligan and with many other events where people will join each other to celebrate.

Mr Speaker, thank you for hosting a celebration of Robert Burns and Ulster Scots in the Great Hall today. It is most welcome, and I will be there, proudly donning my Hanna family tartan, which was beautifully crafted by the Harris Kilt Company in your constituency of South Belfast.

I will share a wee extract from a favourite Robert Burns poem of mine, 'The Rights of Woman':

I encourage you all to learn a bit more about Robert Burns and enjoy his poetry, and I wish everyone a happy and enjoyable Burns Night, wherever they are celebrating.

Ms K Armstrong: I congratulate Carers UK on its 60th anniversary. In 1965, Reverend Mary Webster, a carer herself, founded the first carers' organisation, the National Council for the Single Woman and her Dependants, and the carers movement was formed. Later, in 1988, it became Carers UK. In the intervening 60 years, there have been significant changes. Many steps have been taken in policy and legislation, but there remains a gender imbalance in caring along with a lack of understanding of unpaid carers and their value and substantial gaps in service provision and support.

The number of unpaid carers in Northern Ireland has grown to over 220,000 — one in eight of our population — over recent decades. That trend is likely to continue as our population ages and people live longer and with more complex illnesses. That, coupled with a social care system that is on its knees, has increased pressure on unpaid carers. I agree with Helen Walker, chief executive of Carers UK, who said:

— and Carers NI —

She also says:

To that end, I invite all MLAs to come to the Long Gallery tomorrow afternoon to join Carers NI and to hear from carers from Northern Ireland.

Mr McGrath: I will talk about the corridor care that is taking place in hospitals. Unfortunately, the term is increasingly being used and accepted as a relevant form of care. That should cause us major concern. We hear more about corridor care. I understand that a hospital trust in London has advertised for staff specifically to work in corridors: that gives a sense of how widely the issue goes. "Corridor care" means treatment in places other than wards and can include any inappropriate setting such as cars, taxis, visiting rooms, toilets and even storage cupboards. It is not a normal situation when any person who presents at our hospitals faces the indignity, injustice and lack of safety resulting from receiving treatment somewhere other than in a clinical space.

The frequency with which this type of care occurs is truly shocking. The Royal College of Nursing has detailed that almost 67% of its membership report that corridor care takes place in our hospitals daily and that 90% feel that patient care has been compromised as a result. That is not just relevant to the safety of those who receive the care in the inappropriate settings; the fact that people are getting treatment in inappropriate settings impacts on the care that takes place in the normal clinical setting of a ward. The impact is also being felt by our nurses and physicians, who feel that they are not offering the best possible care to somebody if they have to deliver it in a cupboard or a corridor. Recently, one physician highlighted that the majority of their time in emergency departments is spent administering care in corridors. That should not be normal practice, and we should not accept it as normal. It is not safe, and it is not fair to our healthcare workers to have to deliver care in that way.

Despite all that, we do not know the true extent of corridor care, because it is not recorded. We do not know for a fact how often it takes place. That is why I call on the Department to start recording the figures so that we know exactly what is taking place in our hospitals and do not have to rely on feedback from our doctors, nurses and patients about its extent. The reality is that corridor care has reached crisis point. It is time for the Minister and the Executive to get to work to address the imbalance for the sake of patients, staff and the wider public.

Mr Delargy: I intend to deliver elements of my speech as Gaeilge

Ba lá stairiúil é an Luan seo caite: osclaíodh Naíscoil an Phiarsaigh, Doire Trasna, den chéad uair, agus anois tá an Gaeloideachas ar fáil i gCluain Í.

That is fantastic news not just for pupils and their families but for our city as we witness the growing demand for Irish-medium education. That achievement is testament to the tireless efforts of so many teachers, parents and gaeilgeoirí

who have worked for years to make that dream a reality. Their dedication to promoting and sustaining the Irish language has borne fruit in that historic milestone.

Last week, a BBC report highlighted the growth of the language in the north-west. The Education Authority has also noted the need for two additional Irish-medium post-primary schools in the North. What an achievement to now have four Irish-medium education settings in Derry. What an opportunity to have a meánscoil

Beatha teanga í a labhairt

Mr Harvey: The Ulster-Scots sector has a rich cultural tapestry, which is celebrated in communities across Northern Ireland throughout the year. Its language, music, poetry and folklore are intrinsic to this place.

Robbie Burns, poet, lyricist and cultural icon, is celebrated across the globe on 25 January every year. He is known to be one of Scotland's most notable figures. In Northern Ireland, Burns Night is marked across many of our Ulster-Scots communities, with traditional suppers and ceilidhs. My party colleague from South Down has already highlighted some of the fantastic events planned for this weekend. I am delighted that you, Mr Speaker, will host an event this afternoon in the Great Hall to celebrate the life and work of Robbie Burns. It is wonderful that Derryboy Primary School, in my constituency, has been invited to participate in the event, and I look forward to attending.

The Derryboy Primary School community takes immense pride in its cultural heritage and often marks significant events, such as Burns Night, in the school calendar. Dr Harper, the school's principal, is passionate about the school's ethos and its place within the wider community. I take this opportunity to pay tribute to her vision for the school and its pupils. Many hundreds of schools across Northern Ireland are now engaging with the educational and cultural provisions supplied by the Ulster-Scots Agency. Derryboy Primary School is campaigning to become a recognised Ulster-Scots school. Unfortunately, there is currently no official route to achieve such a status or accreditation. I look forward to engaging with the Ulster-Scots Agency and the Department of Education on how that can be achieved, as we continue to celebrate our shared history and heritage.

Ms Bradshaw: On behalf of the victims and survivors of historical institutional abuse (HIA), I appeal for an extension of the deadline for applications to the redress board past 2 April 2025. There are a number of arguments for that extension.

First, I acknowledge the work of the HIA implementation unit in the Executive Office in using its contacts around the world to share leaflets and posters to try to raise awareness of the redress scheme and its efforts, over the years, to promote the scheme. We also appreciate the efforts of the Commissioner for Survivors of Institutional and Childhood Abuse and others in supporting the victims and survivors in making their applications. However, it has become increasingly evident that we have not located all the victims and survivors. In evidence to the Executive Office Committee this year, we heard of a gentleman in Fermanagh who had not heard about the opportunity to seek redress. We have heard countless other stories from people who are not resident in Northern Ireland and who had no idea about it.

Secondly, the deadline is already very tight — 71 days from now — and refers specifically to the receipt of applications. In practice, that means that someone still considering applying, for whatever reason, is already close to running out of time to do so. In reality, they would have to access the relevant evidence that they need, get the documentation together, engage a solicitor and send it to the redress board well in advance of the deadline. As an important side note to that, last week, we heard at the Committee that some solicitors' firms have already stopped taking new cases. Although we are chasing that up with the Law Society, it compounds the issue as regards the appropriate support that the victims and survivors require. I do not think that it is appropriate, given that people may still be considering, for legitimate reasons, whether or not to proceed. Added to that is the reality that, for some of the years during which the scheme has been open, the world was grappling with the COVID-19 pandemic. Interactions between people were, obviously, very curtailed, and we saw a huge reduction in people travelling home to Northern Ireland during a significant period in which the scheme has been open.

That leads me to the third reason: the presence of such a sharp deadline. That does not strike me as adequately trauma-informed. It puts significant pressure, not on the institutions responsible, which have never faced deadlines, but on the victims and survivors. Many of them, as I said, may still be considering whether to make an application. However, they must be given the choice, and they must be enabled to make that choice at the appropriate time, not under pressure because of an arbitrary deadline. I recognise that the ability to change the deadline is not straightforward, as it is defined in the Historical Institutional Abuse Act 2019, which was passed in Westminster. However, we in this legislative Chamber know that legislation can be amended where there are particular circumstances.

Ms Reilly: I want to highlight an issue that needs urgent attention, particularly from the Housing Executive and the Department for Communities: the failure to properly support women and children who are fleeing from domestic violence and need suitable accommodation.

I am working with a young woman from my constituency, West Belfast, who is a victim of domestic abuse. She is being supported by Women's Aid and other community counselling and trauma services, and I thank them for all the hard work that they do in our communities. Despite accepting that that woman is a victim of domestic violence and is in desperate need of appropriate accommodation, the Housing Executive has refused to allocate her primary social needs points because, when she first presented as homeless, she did not make it aware that she was fleeing a violent relationship.

For an organisation that is at the forefront of supporting vulnerable people, that approach is inexplicable. It ignores the fact that many women in that position are living in fear. Escaping an abusive relationship is the most difficult thing that they will ever do. Many will be too terrified or traumatised to put into words what they have been through. When they later find the strength to do so, their circumstances should be recognised and responded to. They should not be penalised for not speaking up straight away. However, because of the bureaucratic and inflexible approach that is currently being adopted by the Housing Executive, that is exactly what is happening. Victims are being denied points because of procedure, not because of their circumstances.

My constituent is currently living in a mixed-sex hostel. She has told me that male residents have been banging on her door in the middle of the night, retraumatising her over and over again. The bathroom facilities are shared. She has no toilet in her room. She is so afraid in the middle of the night that she cannot use those facilities. That is an intolerable situation. Given that that has been caused by the Housing Executive's policy, there will, unfortunately, be many other women and children enduring similar traumatic circumstances.

The Assembly has, rightly, committed itself to a strategy to end violence against women and girls. We have made clear that violence and abuse in relationships is never acceptable and that we want to change society into one in which women and girls no longer live under that underlying threat and very real risk of harm and abuse and to create a place where everyone can thrive and be safe. That cannot be delivered by one Department, group or organisation, so I am by no means singling out the Housing Executive for criticism. However, in that instance, it has a particular responsibility.

I understand that the Communities Minister is now in possession of the independent assessment of the fundamental review of allocations, which explored the housing selection scheme and the allocation process. Surely that is an opportunity to deal with this pressing issue. I hope that Members join me in calling for the current points system, particularly how it relates to domestic violence, to be reformed so that we can ensure that victims of that heinous crime are properly and compassionately supported whenever and wherever they ask for help.

Mr Bradley: I rise to highlight the need for a properly funded veterinary college for Northern Ireland. I first raised the matter when I was a member of the AERA Committee and secured cross-party support. I see here Patsy, Declan and Philip, who were members of the Committee at that time. However, securing the funding for such a veterinary college has been problematic, to say the least. Northern Ireland faces a shortage of veterinary professionals, particularly in large animal practices. A local college would bridge that gap and contribute to the region's agriculture and food safety sectors by producing highly skilled graduates. Economic benefits would include the creation of jobs during construction and operation. Such a college would have the ability to attract international as well as local students and would boost the local economy.

The establishment of a veterinary college could enhance Ulster University's academic standing, attracting additional funding and partnerships. Allied to the already excellent research facilities at Ulster University's Coleraine campus, it would have the potential to advance veterinary research, particularly in areas relevant to Northern Ireland, such as livestock diseases, public health and rural sustainability, while strengthening ties with our local agriculture and industry stakeholders, promoting innovation and economic growth.

Establishing a veterinary college at Ulster University would bring long-term benefits to the region's agriculture economy, academic landscape and professional workforce. I know from recent conversations with the university's vice chancellor that it stands ready to provide a veterinary college, but it needs the financial backing of the Executive to make that a reality. I call for the Executive to add a veterinary college for Northern Ireland to their Programme for Government and provide the necessary funding to ensure that the current shortage of veterinary professionals in Northern Ireland is addressed properly.

Mr McAleer: The proposed changes to inheritance tax on agriculture and business property relief are a direct attack on family farms, which are the backbone of our rural communities, economy and food security. Farming is not just a business but is a way of life passed down through generations. These changes would force many families to sell off farmland to meet tax bills, dismantling family farms and eroding the heritage that has sustained rural communities for decades. DAERA's updated analysis shows the devastating impact that these proposals could have, making it harder for farm families to pass on the land. This would jeopardise not only the future of farming but the long-term sustainability of agriculture here in the North.

In the South of Ireland, we see a better approach. Mitigations such as agricultural relief reduce the taxable value of farmland by up to 90%, protecting family farms and ensuring their survival. The British Government must adopt similar measures to safeguard the future of farming here. This Saturday, 25 January, the Ulster Farmers’ Union is holding seven tractor runs across the North in Armagh, Fermanagh, Tyrone, Derry, Antrim and Down. Registration starts at 12.30 pm, and I urge everyone who values farming to join in. These events send a united message that the British Government must rethink these flawed proposals before they devastate family farms, rural communities and food production.

Mrs Erskine: I am calling on the AERA Minister to act quickly to support the Fermanagh Classic and Erne Pike Classic fishing festivals. These fishing festivals are hugely popular and attract tourism to County Fermanagh during months that can be difficult for the hospitality sector. It came to my attention over the weekend that DAERA has stopped financial and logistical support to the organisers of these competitions, which could put them in jeopardy. The overtime cost of the Department's fisheries staff is thought to be in the region of £3,000, yet Fermanagh and Omagh District Council recently conducted an external survey of the fishing festivals and indicated that the Fermanagh Classic in May generates local spending of approximately £300,000 as anglers typically stay, on average, for two weeks in the county. The Erne Pike Classic in October contributes around £100,000 to the local economy. That is huge investment for my constituency. If those fishing festivals are lost, our local businesses will suffer and our economy will take a massive hit locally.

The Fermanagh Classic competition has been held for nearly five decades and its loss would mean not only a financial loss but a heritage and culture loss in the area. It is imperative that the Executive have a bit of joined-up thinking when it comes to these types of events. We cannot speak out of both sides of our mouths when it comes to increasing our tourism offering and, on the other hand, have a situation in which a Department is a cornerstone to whether or not an event takes place, but we turn our backs from supporting it. There is a broader problem within the Agriculture Department with the funding that is provided, because we have seen the loss of funding to agricultural shows as well. In Fermanagh, we lost the Fermanagh county show last summer, the first year that it had not gone ahead in over 150 years. That was also a huge loss to my area, and we cannot afford to see the fishing events lost. Yesterday, I spoke with the Agriculture Minister directly on this, and I have written to him as well. These events are so important to my constituency and for Northern Ireland overall.

Mr McCrossan: I rise to raise the issue of pseudomonas aeruginosa in our hospitals. Within the past two years, 58 people in Northern Ireland have died from that very serious infection, and 54 of those 58 people died in a hospital setting. It is the same type of bacteria that was found in the new Belfast maternity hospital last March, which delayed its opening, and it is something of grave concern, particularly within the hospital environment, that adds significant risks to those with weakened immune systems and more vulnerable people in our hospital settings.

I asked the Minister of Health for the most recent figures on people who have been affected. He has provided me with some clarity on those figures, but I fear that the number is actually much higher. In fact, just a few weeks before I, sadly, lost my mother in August, it was revealed that she too had contracted that bacterial infection. She was subjected to two long weeks of IV treatment three times a day: she had to travel to Derry three times a day in those two weeks. It was during that time that I saw the worst effects of that bacterial infection, because, with her weakened immune system, she struggled to fight off the infection.

The infection has affected many people across Northern Ireland, and the more questions that I ask and answers that I receive, the more questions that I have. I know that Mrs Dodds, a colleague from the DUP, has also raised questions about the matter and the presence of the bacteria in the hospital setting. Indeed, the Public Health Agency (PHA) said that the bacteria is highly likely to be found in healthcare settings. We cannot afford to overlook that. Our trusts, even with the severe pressure that they are under, need to ensure that hygiene and cleanliness are maintained at the highest possible standards in order to protect and ensure the safety of the vulnerable people who are being treated in healthcare settings.

I have further questions for the Health Minister and will seek clarification about hospital sites in Northern Ireland. I fear that we have not got our heads around the issue yet, and many people, unfortunately, have died as a result of contracting the infection in an environment in which they should have been safe.

Mr Speaker: I call Andrew McMurray. You have a couple of minutes, Andrew.

Mr McMurray: Thank you very much, Mr Speaker. I rise to acknowledge the 10th anniversary of the Feel Good Factor, which is a multisport outdoor pursuits club for women. The club has its origins in South Down, but it has now reached all across Northern Ireland. I was humbled to be invited to its anniversary dinner, which took place last Saturday evening at the Tollymore National Outdoor Centre. The 60 members who attended had taken part in a day of upskilling themselves in the mountains and on mountain bikes.

There can be barriers to entering sports, not least outdoor sports, that require people to have a certain number of technical skills before they can be safely practised either on one's own or as part of a proficient group. The Feel Good Factor aims to create a safe space for women to come to so that they can be upskilled and actively participate in an outdoor activity and get all the physical and mental health benefits that come with it. Those skills range from being trained in first aid, should an accident happen, all the way through to being comfortable on the summit of Slieve Donard in temperatures of -11°C, although "comfortable" is perhaps the wrong word in that context. The club, which is comprised of complete beginners all the way through to instructors of the highest standards, prides itself, through its nature, on creating not only participants but instructors and coaches. It continues to be a pathway for others to engage in those sports. The club teaches competence, which engenders confidence. As is the way with these things, it is not only about sport. It is an inviting club that, in its own words, has become:

In conclusion, I congratulate the founding members of the club as well as those who have contributed to its ongoing success and growth. Here's to another 10 years.

Mr Speaker: I ask Members to take their ease for a moment while we change the Chair.

Mr Carroll: On a point of order, Mr Speaker. It was indicated to me yesterday that Members who were not called yesterday for Members' statements would probably be called today. What are the criteria for selecting Members for Members' statements?

Mr Speaker: Essentially, the criterion that I have been using today has been to call Members who have previously not been called or who have been called on fewer occasions than others. For example, Pádraig Delargy has been called only once; Aisling Reilly and Declan McAleer have been called three times; Colin McGrath has been called five times; Paula Bradshaw has been called four times; and you, Mr Carroll, have been called seven times. You will soon be back on the train again. We try to facilitate Members as much as possible. I apologise for not calling you today, but Andrew McMurray, for example, has been called five times previously. We try to accommodate as many Members as possible. Members' statements are very popular. If you want to extend the time that is allowed for them, that is a matter for the Committee on Procedures. I think that Members' statements are fantastic. I learn so much about what is going on around the country and get a bit of an international flavour on occasion. I think that they are really good, and if the Committee on Procedures wishes to look at them, that is a matter for its members. I am sorry that I did not get you in today, Mr Carroll, but I will seek to facilitate you in the not-too-distant future.

Members may take their ease for a moment.

Ms Forsythe: I beg to move

Madam Principal Deputy Speaker: The Business Committee has agreed to allow up to one hour and 45 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. As an amendment has been selected and is published on the Marshalled List, the Business Committee has agreed that 15 minutes will be added to the total time for the debate. Diane, please open the debate on the motion.

Ms Forsythe: Thank you, Madam Principal Deputy Speaker. Childcare and early years education are key priorities for the Assembly and Executive. Every child deserves the best start in life. Access to quality, affordable childcare for working families is essential to our local economy. Childcare is such a priority that, in the face of extreme budgetary pressures, the Executive agreed to ring-fence some £25 million to progress it in 2024-25, the most significant enhancement of early years investment in Northern Ireland in decades. On 23 May 2024, Education Minister, Paul Givan, set out a package of measures for early learning and childcare that the Executive agreed would be implemented in the 2024-25 year. It included a portfolio approach, as so many of the objectives that were included were interconnecting. That included £7 million on measures to expand and stabilise existing early years provision and childcare; £5 million to begin the transition of all funded preschool education places to 22·5 hours; £9 million for the Northern Ireland childcare subsidy scheme; £2·5 million for the data collection exercise to evaluate measures and inform the early learning and childcare strategy; and, finally, £2 million that was earmarked for a targeted business support scheme for childcare providers to assist those in need of financial support. As detailed in the Minister's statement in May 2024, the Department for Economy and Invest NI would assist with the design of the scheme.

In January 2025, eight months on, where are we with that? The Education Minister has already implemented the Northern Ireland childcare subsidy scheme, with the parents of over 14,000 children receiving a 15% reduction on their childcare bills. That was up and running in under four months, putting money back into the pockets of working families. To date, the subsidy scheme has provided over £4 million in savings for working families. When combined with savings from the tax-free childcare scheme, it is estimated that those parents will have benefited from a share of nearly £9 million to date.

The Education Minister has already invested an additional £7·6 million in existing early years programmes such as Sure Start and the pathway fund and some that are administered by other Departments, such as the Department of Health's Fair Play grant scheme. He has initiated a major expansion of preschool education, so we will see an additional 2,503 children get a full-time place in preschool in September 2025, with more to follow in successive years. Furthermore, he has commissioned the Northern Ireland Statistics and Research Agency (NISRA) to undertake a major household survey of parents' childcare requirements. That and the administrative data collected from the Northern Ireland childcare subsidy scheme will inform the next steps. On all measures set out in the plans for the £25 million within his control, the Minister of Education has delivered.

The £2 million, however, that was allocated to the Department for the Economy to carry out an in-depth assessment of the sustainability challenges faced by many childcare providers in order to determine the support that they need and how government should respond to provide targeted business support has not been delivered. The motion calls on the Minister for the Economy to take action to unlock that funding for childcare providers in Northern Ireland. The sector needs support.

When the announcement was made last May, providers looked forward to seeing something, whether a scheme like that which was rolled out during COVID, temporary rate relief or something else, and welcomed the recognition that their industry was under pressure. It is therefore incredibly disappointing that the Minister did not expedite the scoping exercise that was necessary to inform the design of the scheme. That comes at a time when many childcare providers are already facing recruitment and retention challenges, including grappling with the National Insurance cost rises that face them in April. I ask the Minister for the Economy to explain the cause of the delay and to work alongside his Executive colleagues to expedite the delivery of that financial support to providers in financial difficulty in order to give them some hope, as well as to put some effort into delivering for those areas where the demand for childcare exceeds supply, which are in pockets across Northern Ireland, as soon as possible in advance of the end of the financial year so that the funding earmarked for childcare providers for 2024-25 can be unlocked.

The childcare sector is a full section of our economy in itself. If there were a crisis in any other industry in Northern Ireland, the Economy Minister would have intervened long ago. Alongside calling for him to unlock the funding allocated in the package for 2024-25, I ask him please to take urgent action to review, support and save the sector. There is little point in Members fighting to expand childcare schemes if there are no childcare provider settings or staff to deliver them. Having effective childcare in place is critical infrastructure for the Northern Ireland economy, and we need businesses to remain in place and be better supported.

Staffing in the childcare sector is a huge pressure. In February 2024, I asked the Minister for the Economy in a question for written answer whether he had plans to invest in staff training and qualifications for the childcare sector. He responded that he had asked officials to carry out an audit of what the Department must offer in that area and that the audit would:

I ask the Minister for an update on the audit. A significant barrier to accessing childcare courses in further education in order to train in the field is the need for GP sign-off to enable a student to be accepted on to a childcare course. A combination of challenges, such as access to GP appointments and the reluctance of some GPs to sign off, has prevented and discouraged many from studying such a course, reducing the potential workforce. In September 2024, 30 students were unable to take up places on childcare courses at the Northern Regional College (NRC). That means that potentially 30 new childcare workers every year are blocked from taking up their place.

We need to recognise the value of our childcare workers as early years practitioners and take steps to ensure that they are paid what they are worth. There is nothing more precious to parents than their children. Being able to hand over their child into the care of someone whom they trust is worth so much. I know that the childcare staff in Toddlers Cove and Little Treasures and a home-based childminder, Nicola, were worth their weight in gold to me. We need to see efforts made to keep those staff in the childcare sector.

It is disappointing to see the narrative presented by some that childcare businesses have done something wrong by increasing their fees, as though they have done so to neutralise the 15% discount given by the Education Minister. That narrative is unfair. Childcare settings are businesses that, like many others, have faced significant increases in running costs — electricity, heat, food for the children, insurance — and they will take a huge hit from the increase in employers' National Insurance contributions from April.

Every business has needed to increase its costs, unfortunately, and childcare businesses should not be vilified for doing so. However, that hurts parents, because those costs are passed on to them through increased fees. We need to seek solutions to that.

Whilst I am disappointed that the Opposition have not focused on the allocated funding, which has not been distributed to providers, and on holding the Economy Minister to account, I agree with the principle of aiming to do more on childcare as a whole. The Education Minister would do more if he could and if he had the budget allocated. We welcome the £50 million that has been earmarked for early learning and childcare in the draft Budget for 2025-26. A priority in the interim will be to continue and expand the measures put in place for this year. Over the coming weeks, the Minister will consider what else he can afford to do with the £50 million of funding that has been allocated for next year and will bring forward a plan in due course. The Education Minister will bring forward a comprehensive and ambitious early learning and childcare strategy for Executive consideration and public consultation by autumn 2025, but today let us focus on delivery.

We in the DUP made a commitment to deliver on childcare in our 2022 election manifesto. The DUP Education Minister took that on and has delivered with the limited budget that he was allocated. He has delivered a childcare subsidy scheme that has put £4·2 million back in the pockets of working families in Northern Ireland; 2,503 additional full-time preschool places from September 2025, which is 300 over the target; and £7·6 million to secure existing early years programmes, such as Sure Start, Pathway and the Department of Health's Fair Play small grant scheme. The DUP has delivered for working families on childcare and continues to be committed to doing more. It is time for the Economy Minister to deliver for the childcare sector, unlock the funding for this year and make sure that there continues to be a sector to deliver childcare. We need to secure the childcare infrastructure in Northern Ireland. There is no point in fighting to expand schemes if we do not have childcare settings and the workforce to deliver them.

Madam Principal Deputy Speaker: Thank you, Diane. I call Sinéad McLaughlin to move the amendment.

Ms McLaughlin: I beg to move

Madam Principal Deputy Speaker: You have 10 minutes to propose the amendment and five minutes to make a winding-up speech. All other Members will have five minutes.

Ms McLaughlin: Thank you, Madam Principal Deputy Speaker. As we approach the first anniversary of the restoration of the Assembly, I am glad to see that childcare is still regarded as a priority by all parties in the House. Throughout the past year, we have debated the issue many times, and, in February, all parties agreed that we needed to do more to support the childcare sector.

Progress has been made. For the first time, childcare is a stand-alone priority in the draft Programme for Government (PFG). The Northern Ireland childcare subsidy scheme has delivered savings to parents, and I welcome the allocation of £50 million of funding for childcare. Those victories are in no small part thanks to the hard work of stakeholders and parents who have campaigned passionately on the issue. Whilst all those measures are rightly welcomed in the motion, the DUP merely patting itself on the back for the work of its Minister will do little to support the families who still struggle to stay afloat. The Minister must surely recognise that the scale of delivery on childcare by his Department falls short of the expectations of parents across our communities.

Whilst I agree that it is unfortunate that the Department for the Economy and Invest NI have not finished the scoping exercise necessary to inform the design of the targeted business scheme for childcare providers, using a motion to score political points across the Chamber, while sitting around the same Executive table, is not the best way to go about that. I was tempted to leave the DUP motion unamended so that the public could see the special type of arrogance that it takes to blame another Executive Minister for the DUP's lack of delivery. It was really tempting to let the mud-slinging commence, but I could not do that because childcare is so important and our families are experiencing such hardship because of the lack of urgency on delivery. The ink is barely dry on the draft Programme for Government, and the infighting and finger-pointing is under way between Ministers. The blame game is on, and it is the fault of everyone except, of course, the Minister in charge of childcare. Failing to take responsibility for the issue at hand is by no means an adequate answer.

Parents and providers are not interested in the political games; they have no time for them. In fact, yesterday evening, Melted Parents NI took to social media and said:

They said that, despite promises and priorities from the Northern Ireland Executive, the childcare crisis is getting worse. They said that they are tired of party politics and blame and that they wanted their politicians to get together and fix the problem. Parents and families across the Province are interested in their bills going down and their children getting the best start in life. That is why we propose the amendment, which calls out the current failings of the Education Minister. The reality that parents and providers face is one that the Assembly should be ashamed of.

I am told time and again by constituents that they still struggle to cope with the rise in childcare costs. Whilst the Northern Ireland childcare subsidy scheme (NICSS) was a welcome intervention and has achieved some tangible successes, it is by no means the answer to the childcare crisis. The reduction in childcare fees through the NICSS has practically become null and void — redundant — as providers have been forced to increase their fees in order to deal with rising external costs and the lack of targeted support. Furthermore, the scheme is not available to all parents, which means that those who need support most are often those who cannot access it at all.

The Department must undertake a serious, comprehensive and ongoing assessment of the scheme to ensure that it delivers the changes that are needed and reduces bills for parents. The responsibility for that assessment falls squarely on the shoulders of the Education Minister, and it would be wrong to try to shift the Chamber's focus to the Economy Minister on that issue.

The business support scheme taken forward by the Minister is not a silver bullet that can meet the needs of all providers. We need to be much more ambitious and to stay focused on the priority in hand; namely, the delivery of a 10-year early learning and childcare strategy. Our ambition with the strategy must not be limited, and we must be transformational in our approach. Parents must be free of the burden of those awful costs. Businesses need greater support, and registered childminders must be allowed to expand their services.

In October, the SDLP launched our childcare policy, 'A Childcare Guarantee', which set out how, we believe, the childcare strategy can best support parents and providers. We call for affordability for parents through the halving of costs, ensuring that nobody pays more than they can afford; sustainability for providers through a new funding scheme that allows businesses to provide childcare in a sustainable manner; and the best start in life for children through a new independent body that will be tasked with the development and oversight of a 10-year childcare strategy.

Almost a year has passed in the mandate, and the strategy has still not been produced. It has been worked on for years. Parents and providers really cannot afford to wait any longer. I invite the Minister, through the amendment, to set a clear deadline for the publication of the strategy along with a transparent, long-term funding plan. The funding plan must meet the scale of the challenge that we face and provide the opportunity that we need to transform and make life changes. For too long, the Executive have considered the funding of childcare as merely an expenditure. It is long past time to change our approach and consider investing in our childcare sector as an investment in our social and economic infrastructure.

We have said many times that we should look towards countries that lead the way in that approach, including Sweden, Finland, Denmark and Norway; indeed, if we look closer to home, we find that the incoming Irish Government are committing to progressively reducing the costs of childcare to €200 per child per month. That approach to childcare has created a double dividend: it has kept childcare fees low whilst growing the economy.

We appreciate that public finances are tight, but, as a start, the Minister of Finance must ring-fence the Barnett consequentials received from increased spending on childcare in Britain. Doing so will provide the sector with a further £61 million-plus of funding. Transforming our childcare sector will not be easy, but it is paramount not only for the future of our children but for our economic development.

I urge the Assembly to support our amendment, which recognises the work that is still left to be done by the Minister of Education and the Minister for the Economy. It is a whole-Executive policy, and it must be met by the whole of the Executive, including through publication of the strategy. As we go forward, let us seize the opportunity to invest in our future generations and support their education and development. Our children are definitely our future, and, by taking this bold action now, we can ensure that they will continue to have the best start in life for generations to come.

Mrs Mason: The sum of £25 million, which was delivered by the Finance Minister, Caoimhe Archibald, went straight into the Department of Education to start delivery of the childcare and early years strategy. The subsequent introduction of the childcare subsidy scheme was, indeed, a welcome first step towards making childcare more affordable for families. That move acknowledged the vital role that high-quality, affordable childcare plays as the foundation for a child's early learning and development, whilst supporting families who are balancing the demands of work and home life. Sinn Féin was then instrumental in securing an additional £25 million, which doubled the childcare budget to £50 million. I am, therefore, bewildered as to why the motion has been tabled. Why are we using precious time to debate this issue when we are still waiting for the delivery of a childcare and early years strategy by the Education Minister? Surely time would be better spent on that.

The high cost of childcare remains a significant pressure for many families, and, while the subsidy marks progress, much more needs to be done to ensure that parents, children and providers are fully supported. Our childcare providers and childminders are under immense pressure to keep costs low, and it is critical that they are given the recognition and support that they need to continue to deliver the highest level of care. We need the Department of Education, with support from the Department for the Economy, to continue to work at pace to ensure that the targeted business support scheme gets off the ground and that emergency money can go into the pockets of hard-pressed providers. We eagerly await the childcare and early years strategy from the Education Minister. That strategy is long overdue and is urgently needed not just by providers and childminders but by families across the North. The strategy must tackle the mounting pressure that faces the sector and lay the groundwork for a system that is accessible, affordable and sustainable.

Every child must have access to the care and support that they need to thrive. That means prioritising provisions for children with special educational needs (SEN) and physical disabilities. It must also focus on the use of early intervention practices in order to raise educational outcomes and address educational challenges at the earliest possible stage. Our childcare and early years staff must have the resources, training and support to ensure that those children have the same opportunities to grow and learn. I urge the Education Minister to recognise and bolster the community and voluntary childcare sector. Those providers are often the lifeline of local communities. They are tackling disadvantage, breaking cycles of poverty and giving every child the opportunity to succeed.

We need targeted support for the Irish-medium childcare sector. Families who choose to immerse their children in the medium of Irish must not be disadvantaged and must have access to high-quality, well-resourced and accessible childcare. That is necessary to ensure that Irish-medium childcare thrives as part of a vibrant and diverse education system.

While we welcome the progress that has been made in making childcare more affordable, we cannot lose sight of the broader vision. All parties must work together to ensure that all families can access the childcare that they need. It is not just an investment in children; it is an investment in our future.

Mrs Guy: I am happy to take any opportunity to talk about high-quality, affordable childcare. It is such a vital issue for families, our wider economy and parents. Affordable childcare gives back to parents, particularly women, a level of freedom: the freedom to choose to remain in paid employment, when they become a mother, or to return to the workplace.

I will make a point that is perhaps not said often enough in debates when the framing is about parents going back to work. Stay-at-home parents are still working. In fact, they are doing a very tough, demanding and, often, lonely job. As a mother who was in a part-time role for a number of years, I assure you that I was still very much working during those years; I was just being paid part-time. I underscore that point in relation to other caring roles more generally: unpaid work is still work.

The critical point in relation to childcare is that, for many parents, having a job simply does not pay, because childcare costs consume their wages. In Northern Ireland, the childcare subsidy scheme has been a welcome first step to making childcare more affordable. The approach is right, but the scale is not yet sufficient. I underscore to the Minister the fact that supporting and incentivising flexible working, along with career support for women who re-enter the workplace, is vital in order to complement initiatives such as the childcare subsidy scheme and the expansion of the number of full-time preschool places.

The £50 million that was allocated to childcare through the Executive's draft Budget is a welcome and necessary investment, because, for too long, inaction and the collapses of these institutions have held back delivery on childcare, with support for our parents in Northern Ireland falling far behind that in other parts of these islands. Since our Government were restored, it is welcome to see support for investment in high-quality early learning and childcare policy. That policy area unites us across the Chamber. We endorse the model that was adopted for the subsidy scheme, and it reflects our policy proposals. We are hopeful that we will see that model of support being expanded to include school-age children as a minimum.

As the proposer of the motion highlighted, childcare is an ecosystem, and our childcare providers are a vital part of it. The motion rightly draws attention to the business support scheme for childcare providers that forms part of the package of measures that the Education Minister announced last year, which, disappointingly, has not been progressed. The Economy Minister has been asked to account for that, and I am eager to hear that update, because, if providers increase their fees to cover the rise in National Insurance contributions that is due in April this year, we are at risk of negating the financial relief that some parents are finally feeling. An intervention that is similar to the model that was used to support parents should be looked at for providers, but it should be conditional on improving staff pay and ensuring quality provision.

I pay tribute to all our childcare workers. They are an undervalued workforce of highly skilled and dedicated, caring professionals. However, remedies to meet recruitment challenges such as pay and conditions, training and investment in special educational needs and disability (SEND) support belong in a comprehensive early years childcare strategy, which we are still waiting for the Education Minister to publish. Successful delivery of that strategy will require cooperation between Ministers, particularly the Education, Economy and Health Ministers. I hope that the motion does not signal a breakdown in the working relationship between the Education Minister and the Economy Minister, because, in addition to the business support scheme, we need those two Ministers to work together to deliver on other objectives, such as, for example, post-19 provision and SEN provision, which is of particular urgency. If the Minister could offer an update on that work in his remarks to allay any concerns about undue delay due to ministerial friction, that would be welcome.

The Executive's package of interim support for early years and childcare prioritises specific interventions to ease acute pressures. Childcare is part of our social and economic infrastructure. Delays in delivering the business support scheme must be addressed urgently to stabilise the sector and ensure that we do not risk jobs and provision in our childcare sector.

Ms D Armstrong: The essence of the motion is about delivery and the recognition of the fact that early childhood development and learning is the foundation stone to building a society that values and supports every child through their formative early years, subsequent development and future life chances. It is also the foundation stone to building a fair society in which parents, particularly women, have the ability to stay in work or return to the workplace. I welcome the £50 million that was earmarked for early years and childcare in the Executive's draft Budget for 2025-26. This has the potential to be a watershed moment to deliver for our children and the prosperity of our people.

I sense the frustration in the motion that the scoping exercise has not yet yielded the body of work that is required to frame a childcare support scheme that would be a blueprint for the way forward. Analysis shows that the lack of childcare provision and affordability are major stumbling blocks for those who wish to return to work. Economic inactivity in Northern Ireland stands at 26·1%, which is the highest in the UK. In many cases, that is due to parenting or caring responsibilities, which are primarily undertaken by women. Affordable childcare has an important role in facilitating parental employment, which, in return, can reduce child poverty. In 2023, a major review by the Department of Education found that the majority of parents on low and middle incomes consider childcare to be unaffordable. Figures from Employers for Childcare show that the average cost of full-time childcare in Northern Ireland was more than £10,000 a year for one child. Therefore, there is an urgency to deliver the scheme in order to grow the economic outlook for all across Northern Ireland and help deliver a more equitable society.

When I speak to nursery owners, it is evident that the fees are unaffordable for parents, and many daycare nurseries cannot charge the appropriate amount to ensure that they are sustainable. That critical situation cannot last. The failure to instigate the business support scheme to help childcare providers represents another hammer blow at this time, on top of other wage and National Insurance rises that they face. In agreement with many of the contributors today, I recognise the need to push on with the scoping exercise that is being done in conjunction with the Department for the Economy and Invest NI, because that is essential for the adoption of a sustainable blueprint. Therefore, why was it not finalised by the Department in, as stated, December 2024?

It is imperative that we provide immediate assistance —.

Mr Mathison: Thank you for giving way. I acknowledge the frustrations with the lack of delivery on that scheme, but do you agree that childcare providers and parents do not want to see those issues being aired across the Assembly Chamber? They want to see Ministers working together to deliver.

Madam Principal Deputy Speaker: The Member has an extra minute.

Ms D Armstrong: Thank you.

Thank you for your intervention. Yes, it is the responsibility of all Members in the Chamber to show — my colleague across the Chamber also referenced this — that this is not an opportunity to score party political points. We are dealing with a cross-departmental topic that has fundamental consequences. Thank you for that intervention.

It is imperative that we provide immediate assistance to childcare providers in financial difficulty sooner rather than later. While I commend the substantial investments and positive steps taken thus far in the development of a childcare scheme, I join others in calling for the publication of the early years childcare strategy so that cross-departmental work can proceed. We must remain vigilant and proactive in addressing the ongoing needs of the childcare sector. By doing so, we will ensure that every child in Northern Ireland has the opportunity to thrive and every family has the support that it needs to succeed.

Mr McGuigan: The Executive have, in the past year, quite rightly identified childcare as a priority issue, and commitments in the Budget and the Programme for Government have demonstrated the desire to work collaboratively in the best interests of children, parents and our economy. Whilst it is clear that the Department and Minister of Education have responsibility for delivery on the issue of childcare, I say as a member of the Economy Committee that Sinn Féin also recognises the key role that childcare has in supporting families and workers and underpinning future economic growth here in the North.

We are all aware of the barriers presented by the high costs associated with childcare and the importance of ensuring that it is not only affordable but accessible and of high quality. It is welcome that investing in that area is a key Executive priority. I take this opportunity to acknowledge the £25 million that was initially secured by my party colleague the Minister of Finance, Caoimhe Archibald, and that, as indicated, was later doubled to £50 million. That is a significant commitment, and it is a chance for this institution to make meaningful progress and change for parents, children and those in the childcare sector.

We are already seeing some positive progress on the childcare subsidy scheme, but we are still awaiting the longer-term early learning and childcare strategy from the Education Minister. Like others, it was with some surprise that I read the motion, given that its authors focused their attention on the scoping exercise that is being carried out by the Department for the Economy and Invest NI to help inform the design of the Minister of Education's targeted business support scheme for childcare providers. As far as I am aware, the anticipated date for the completion of that work is March of this year, and it is a part of a cross-departmental collaborative approach to that specific aspect of the wider strategy. That approach is welcome and is absolutely necessary. We need to ensure that the best outcomes are achieved and recognise that childcare providers must be supported as part of the strategy. Most are small businesses and are impacted on by the rising cost of doing business and, more recently, by the rise in employer National Insurance contributions that were brought in by the Labour Government in Westminster.

I welcome the fact that the Minister for the Economy has committed to working with the Minister of Education on the scheme as well as the funding that he has allocated to the recently announced Assured Skills academy in early learning and childcare collaboration. Having the resources and opportunities to develop and continuously upskill current and future employees will help to ensure that children receive the highest level of care and support. Having targeted business support will help to ensure that businesses can remain viable and that parents can access affordable, quality childcare that will help them to return to or remain in employment. Delivering on childcare is crucial; we are all agreed on that. As we have seen in this place before, when we speak with one voice, we can achieve much more.

Mr Martin: I commend the motion to the House, and, in my speech, I want to reflect on some of what has been achieved in childcare and preschool support over the past year and comment on what needs to happen in future. Before I do, I want to pick up on a point that the Member for South Down and who is on the opposite Benches made. I do not think that the debate is pointless. People out there think that this is an incredibly important issue and that it is certainly worth spending some time on. The debate is really important, and it has been respectful so far.

I am a parent who uses childcare, and we need childcare for our daily life. I want to see speedy progress on the issue. Furthermore, I recognise that there are plenty of people who are watching the debate who are reliant on childcare for some of the reasons that have been cited. Our DUP Education Minister, Paul Givan, has delivered significant progress in this area over the past 11 months, and I want to pick up on a couple of those measures. It has been mentioned that, under the Northern Ireland childcare subsidy scheme, the parents of 14,000 children are receiving a 15% reduction in their childcare bills. That is money that is going back into those parents' pockets to use for something else. It is perhaps worth touching on the individual nature of what that actually means. In my constituency, over 890 families have benefited from the scheme and have saved a quarter of a million pounds. Those are real families, living real lives, who are benefiting from something that the Minister of Education has brought in.

As has been mentioned, the Minister has initiated, to my knowledge, the single largest expansion in preschool education in the history of Stormont, resulting in an additional 2,500 children now getting full-time places. That is significant, but it is not about patting ourselves on the back; it is about recognising that progress has been made. Some people in the Chamber may perhaps not want to admit that progress has been made, but it has. The Minister has invested £7·6 million in early years programmes. We know the names of those early intervention programmes — Sure Start, Pathway and Toybox — and we hear plenty about them in the Chamber. The DUP is delivering on those programmes and supporting and expanding them.

Mr Mathison: I thank the Member for giving way. There is not a party in the Chamber that has not acknowledged and welcomed all the investment that you outlined. It is important to put that on record. The question is this: why, on this specific issue, are Ministers not engaging and delivering on it rather than airing it in a non-binding motion? Surely Ministers' time would be better spent engaging together to get it delivered.

Madam Principal Deputy Speaker: The Member has an extra minute.

Mr Martin: I thank the Member for Strangford for his question. I agree with him. This is something that we want to see moving forward, and no one would debate that. The Member made the point about the time that we are using in the Chamber and so forth and whether that has been negative. I would reflect that the Member for Foyle was, possibly, rather negative in her comments, and I will come to those later. I agree with the Member that we all want to see good progress on this measure.

I counsel those who say that delivery is not fast enough or wide enough against such claims. To make this breakthrough, three key criteria are required: funding — Members mentioned that funding has already been provided; human resources; and capital. The sector gets that, but I am not sure that every politician in here understands it, so I have a very simple example. As parents, we got 12·5 hours in a local Presbyterian church hall. For that preschool to uplift to 22·5 hours, it needs those premises to be free and staff to work the extra hours. If the premises are not available and they are asked to provide additional hours, new premises must be found. Also, the staff must be willing to work the afternoon session or that extra time.

Some politicians believe that change can happen with a simple click of a finger, but that is not the case. We are always best to be open and honest with people about where we are and how we are progressing. I am fully assured that the Education Minister has done all that he could with the funding that has been mentioned, and it is disingenuous, I think, for anyone to claim otherwise.

I turn to the comments from the Member for Foyle. I do not mud-sling in the Chamber

or, for that matter, pat people on the back. She listed a number of Nordic countries. I remind her that those countries have extremely high tax rates not just for wealthy families but for middle-income families. I further say to her that the Executive do not have the vires to increase tax.

The final piece of the jigsaw is a scoping exercise, as referenced by various Members, and the Minister for the Economy is tasked with carrying that out. The minutes of a meeting of the all-party group (APG) on early education and childcare in September state:

Obviously, we know that it is not complete, and the aim is now to complete by March 2025. My hope is that the Economy Minister will deliver that as soon as possible. I am sure that he realises that it is a mission-critical element.

Madam Principal Deputy Speaker: The Member's time is up.

Ms Nicholl: I should start by declaring an interest. I will soon require further childcare

and will avail myself of the NICSS, which I was very happy to see.

I ran for election because of childcare. In my constituency, I saw how parents and families were struggling. I saw how some people who do some of the most precious work in our economy are paid poverty wages. I saw the lack of standardised childcare across the board, the need for investment in it and the need to recognise childcare as the social and economic infrastructure that it is.

I want to pick up on a number of things. I welcome Diane Forsythe's tabling the motion. From the all-party group, I know that she is passionate about childcare and has done a lot of work on it. I will pick up on a couple of points that Peter Martin made, particularly about people wanting to hear us talking about this and the fact that it is an important issue, which it is. What people want to hear us talking about, though, is the content of the childcare strategy and its delivery.

I echo what my colleague Michelle Guy said, which is that it is a sign of some concern to us that this issue is being brought to the Assembly as a motion. When the Assembly was restored, every single party leader stood up in the House and said that childcare was an Executive priority and that they were going to work together. I understand that a task force with officials from each Department is working on this, given that it is across the board. Obviously, the majority of it lies with the Minister of Education, but it also involves other Departments. It will be interesting to hear how the task force is going and what work is being undertaken. The setting up of the scheme should not be the height of our ambition. Having the audit done is not the final piece of the jigsaw; significant work is still required. I would like an update on what is happening with the task force. That is where this discussion should be happening, and the public discussion and debate should really be on the content of the early years and childcare strategy.

Preschool is not childcare, it is early education, and the two have been conflated in the Chamber today. That is partly because some parties, with the exception of Alliance and, to be fair, Sinn Féin, which has championed the subsidised supply-side scheme and has never had a position on free hours, have had to manoeuvre things to make this a little more palatable. Yes, expansion of preschool provision is very important, but let us be honest: the main reason that there has been so much of a focus on free hours is to make it easier for the DUP to change its policy position.

Alliance published its paper 'Children First' in October 2023, and that was done off the back of engagement with the sector, families, academics and business. It was very clear to us that, if we were building a childcare scheme from scratch, it would look very different but that, given where we are now, the best and most practical way of moving forward and ensuring that people can access affordable, accessible, flexible, high-quality childcare is to have a supply-side scheme. That is wonderful to have in place, but it is not the height of our ambition. My colleague Michelle Guy has articulated the need for school-age childcare. It is so important.

There are some things that it would be worth seeing and hearing a bit more about. I sit on the Economy Committee, and the 'good jobs' Bill will soon be introduced. There is no specific reference to childcare in that Bill. People could work in the best place in the world and have the best rights, but if they cannot afford their childcare, that will not help. We have to look at the ecosystem in which we are operating.

There is also a need for minimum standards. That was mentioned earlier when ratios, signing off students and students' ability to get places were spoken about. That sits with the Minister of Health. It does not sit with the Minister for the Economy or the Minister of Education. It is therefore another example of how it is a cross-departmental issue and of how there is a need for the task force to drive the work.

There are still a couple of issues with the scheme. People who use childcare vouchers cannot avail themselves of it. There is also a need to focus on parents' ability to have support so that they can stay in work. Those voices are sometimes the loudest, so it is really important that we listen to them. Childcare is an anti-poverty tool as well, however. It is therefore so important that we expand Sure Start and look at how we can help people who are struggling. Providers are having so much difficulty recruiting and retaining staff.

Madam Principal Deputy Speaker: Kate, your time is up.

Ms Nicholl: Thank you. We will be supporting the motion and the amendment.

Madam Principal Deputy Speaker: OK. I appreciate that.

I now call Conor Murphy, the Minister for the Economy. Minister, you have up to 15 minutes to respond to the debate.

Mr C Murphy (The Minister for the Economy): Go raibh maith agat, a Phríomh-Leas-Cheann Comhairle.

I welcome the opportunity to speak to the motion.

Although the Department of Education leads on childcare, it is a priority for the Executive as a whole. When setting the Budget for this financial year, the Executive earmarked an additional £25 million for childcare. As part of June monitoring, £25 million was allocated in full to the Department of Education. The claim that my Department was allocated £2 million is absolutely false. Although the Education Minister was in receipt of the full £25 million to fund childcare, I prioritised childcare in my Department and allocated £740,000 from my existing baseline to support pathways into the childcare sector. If the Member who proposed the motion had asked for an update since February, she would have been aware of that. As a matter of fact, I publicly launched the scheme and the courses in the Met last summer. My officials are also working with our six further education colleges to develop childcare microcourses for future delivery.

I also offered to assist Minister Givan's Department as required. On 22 July, he wrote to me and the Health Minister asking us to assist with his Department's targeted business support scheme for childcare providers. On 1 August, I responded to Minister Givan and offered the assistance of a number of officials from my Department and Invest NI. Minister Nesbitt also provided a supportive response.

The working group, comprising the Department of Education, the Department for the Economy and the Department of Health, first met on 30 August. The group identified the need to better understand the business models for childcare, what type of support is needed to ensure the sector's financial viability and how support should be targeted. Given my Department's business expertise, we volunteered to take that work forward. The research was scoped out and agreed by the group on 9 October, and, as part of the October monitoring round, the Department of Education transferred £153,000 to my Department to fund that research. The Department of Finance's innovation and consultancy services (ICS) was appointed to take forward the research, which got under way on 21 October. Consultations have taken place with a cross section of stakeholder organisations and 15 representative organisations in the childcare and wider sectors. More detailed consultations with individual childcare providers and parents are taking place this month and into February. The group agreed that the research would conclude in March 2025. The work is on schedule; there has been no delay. Childcare is an excellent example of various Departments coming together to deliver for our people. Officials in Invest NI, the Department of Education, the Department of Health, the Department for the Economy and the Department of Finance have done a terrific job, and I commend them all.

It would be understandable and, perhaps, acceptable for the Executive to be subject to criticism when we are not cohesive or are not working collaboratively, particularly on priorities that we have announced and set ourselves and for which we have secured support from all the parties in the Assembly. In this case, we are working collaboratively and very well together. I have no idea as to why the DUP wants to suggest otherwise. I will continue to support Minister Givan in that important work.

A number of points were made in contributions. Both the Alliance Members who spoke referenced the 'good jobs' Bill and flexible working. The 'good jobs' Bill is open to further suggestions from, and consideration by, Committee members in particular and other Members. The Bill looks at the issue of flexible working, but at every meeting that we have had with employers, we have made a point of talking to them about the need for them to be flexible, particularly in relation to women who are returning to the workforce, and to offer people arrangements that entice them back to the workforce and give them the support that they need to continue with their caring responsibilities, be they mothers or other people with caring responsibilities. I assure Michelle Guy that there are no issues with that. Most people are a bit bewildered as to why the Members across the way tabled the motion, but there are certainly no issues with that or with our work on the post-19 issue, with the Department of Education on the careers issue or with other Departments on a range of issues. No tensions or obstacles have been placed in the way of any of that work, and I hope that that continues to be the case, because the issues are much more important than party political exchanges across the Chamber. We will continue to work in that manner.

I very much welcome, first, the prioritisation that the Executive gave to this important area and the fact that officials, Departments and Ministers have got down to working together to deliver. We must do more, we must do it quicker and we must do it better. We are all committed to doing so, but there are many points to be debated on the issue. When Mr Martin responded to Cathy Mason, he missed the point completely.

Madam Principal Deputy Speaker: The next Member to speak will be Cara Hunter to make a winding-up speech on the amendment. Cara, you have five minutes.

Ms Hunter: Thank you very much, Madam Principal Deputy Speaker. I welcome the opportunity to make a winding-up speech on the amendment in this important debate.

Our amendment calls for a political commitment from both the Minister for the Economy and the Minister of Education to drive forward affordable childcare. I welcomed the launch, in October, of the SDLP's policy document, 'A Childcare Guarantee', which was led by our SDLP economy spokesperson, Sinéad McLaughlin. That aims to support parents, the sector and Employers For Childcare and is, ultimately, focused on getting the best outcomes for our children in Northern Ireland.

Nothing is more important than seeking affordability for parents here who are burdened every day with overwhelming costs. It is crucial that we seek sustainability for providers through a new funding scheme to ensure that providers are sustainable and that workers are paid properly. In my constituency, I have seen that Employers For Childcare does not want to burden parents with additional costs, but overhead costs, such as for electricity and heating, are rising every day due to inflation. It is a really difficult situation, and the sector is really struggling.

Ultimately, the key focus should be on our young people and on ensuring that they have the best possible start in life. That should be done through a new, expert-led independent body to oversee childcare and early education policy. After listening to the debate, I echo many of the statements that Melted Parents NI has made about childcare costs in Northern Ireland. Many motions on childcare have been tabled in the House, but, sadly, parents are still in crisis. Many feel that the NICSS savings have been made redundant by the rise in provider costs. Only eligible parents of preschool-aged children are being helped, and many feel that this is not the time for silo working or party politics.

I have spoken to countless parents in my constituency who are absolutely devastated by the fact that they are forced to leave work and to walk away from years of building a career, building skills and getting degrees. They have had to walk away from a job that they love and that provides them with an income and have had to do so, undeniably, because of the rising costs of childcare. They do not find it valuable to go to work any more, and that is grossly unfair. Despite the promises and priorities of the Executive, the childcare crisis worsens.

I move to Members' comments. Diane Forsythe raised an important point about access to childcare courses and the challenges of accessing a GP and with sign-off. She was absolutely right to mention the potential for 30 new childcare workers, because we need as many people as possible in the sector, and that is definitely an issue. Cathy Mason mentioned the need for urgency, the need to work at pace. That is undeniable. We need to serve our communities and parents when it comes to rising childcare costs. Diana Armstrong reiterated that there is no need for party political points on the issue: I fundamentally agree. She also said that it is an issue across Northern Ireland, so we need the answer — the solution — to come from across our Executive. Parents cannot cope with the stress of rising childcare bills married with rising electricity bills, gas bills, rent and mortgages: they are undeniably in crisis. Importantly, Kate Nicholl spoke about the need for an update on the task force: I, too, would like to hear more about that.

It is important to raise and reiterate the fact that progress has been made, as Peter Martin said. That is welcome, but my party and I feel strongly that it is not enough. Language was used that suggested that the Education Minister's work on childcare has been transformational. That is an opinion, but one that I would argue is not shared by the many parents across the North who still struggle every day and are walking away from their careers. We want to see our people in Northern Ireland being excited to have children, but, if you speak to people who do not have kids and are considering having them about the rising cost of childcare and of bills, it is apparent that we, as an Executive and a Government, really need to step in. We want to see leadership and collective action on the issue.

Madam Principal Deputy Speaker: Thank you, Cara. I call Phillip Brett to conclude and make a winding-up speech. Phillip, you have 10 minutes.

Mr Brett: Thank you, Madam Principal Deputy Speaker. At the outset, I want to set the record straight: my colleagues Diane Forsythe and Peter Martin and I are not members of the Executive. We are Back-Bench MLAs and are perfectly entitled to raise issues of importance to our constituents, the people who contact our offices daily and who put their trust in us at the ballot box. I will not take lectures from any Members on what I or my party's other Back-Benchers can or cannot use the time that we are allocated in the House to speak on. If I got up and said that, because the Alliance Party holds the portfolios of justice and agriculture, its Members dare not bring any issue to the Chamber through its Back-Benchers but that its party leader or its Ministers should raise it at the Executive, I would rightly be attacked and told that I was talking nonsense, yet it seems that it is OK for others to dictate what we bring to the House. Let me be clear: I will continue to bring to the House issues that are important to my constituents and the people who vote for me, and I assure you that my party colleagues will continue to do exactly the same.

This issue is vital. Ms Hunter has left the Chamber, but I will pick up on her saying that what has been achieved to date has not been transformational. Last week, I was at Currie Primary School with the Education Minister. As you know, Madam Principal Deputy Speaker, that school is located in one of the most socio-economically challenged parts of our city. From 1 September, those children will, for the first time, have access to full-time preschool education. For many of those young people, that school is the only sanctuary that they have. Regrettably, that is the only time in the day that some of those young people will get a hot meal. Unfortunately, for some that is one of only few chances for stability in their life. For those young people, the action taken by the Education Minister has been transformative.

I represent North Belfast, which, as you know, Madam Principal Deputy Speaker, is one of the poorest constituencies in our Province. The 487 families who have signed up to and received hundreds of thousands of pounds in support through the childcare subsidy scheme describe that as "transformational". For many, that 15% discount on their bills each month is the difference between eating or heating their homes. For Ms Hunter's constituents, it may not be transformative, but, for the people whom I represent in North Belfast, it certainly has been.

The Minister for the Economy rightly set out and articulated his points. However, it was clear, when the £25 million was allocated by the Executive, that £2 million of that funding was allocated to support childcare providers. The representations that we have received to our Committee are clear, Minister: they want to see action on that. You have highlighted that the research will be in place by 31 March, but you have not articulated this, Minister: what did you bid for in this Budget round to support that sector? What targeted support has your Department looked at introducing? I know that the Member from South Down said that we had precious parliamentary time here and that, from her perspective, this was a waste of that time. However, in her five-minute contribution, she gave no outline of what Sinn Féin's commitment, through the Department for the Economy, is to deliver the support that families need.

I turn to some of the other contributions. We will support the SDLP amendment. Ms McLaughlin said that she had thought about not tabling an amendment, but that would have denied her and us the 10-minute lecture that she gave on how we have not delivered on the issue. I am proud of the record of Minister Givan and of what he has delivered to date. In four months, the scheme that was set up in September has delivered £4 million. Is there more to do? Of course there is. We say in the Chamber that we should not be party political and should not snipe, yet we then dedicate entire speeches to making attacks saying that the Minister for Education has delivered nothing. We rightly say that there needs to be a partnership approach, but it seems that, when a DUP Minister delivers on anything, it is still simply not good enough. The public watching know that it is not the content of what is being delivered that Members find objectionable; it is the fact that this party is delivering for the people of Northern Ireland.

Ms Armstrong, who has been a welcome addition to the Economy Committee, rightly set out the importance of the childcare sector, particularly in County Fermanagh, which, I know, she is proud to represent. She welcomed, in particular, the £50 million that has been allocated in the draft Budget. I hope that she and her party will vote for the draft Budget when it comes before the House in the coming weeks.

The Member for Strangford, Michelle Guy, hit on an important point. It is not recognised enough that parents who are not in full-time, formal employment play a vital role in the development of our young people. Whilst they may not get a salary at the end of every month, the contribution that they make to our economy and to the growth of our young people needs to be recognised, so I thank her for making that important remark.

What is the debate about? It is simply about saying that our childcare providers need to be given support. In the comments made from the Benches opposite, I did not hear anyone disagree with that. However, I also did not hear an explanation of why that £2 million has not been drawn down and when the research will be available to the Committee and Members so that we can support those most in need.

The changes to National Insurance contributions, which will come into force on 1 April, will be a major issue of concern for childcare providers. We will see continued rising costs. Evidence given to our Committee showed that, on average, each childcare setting will face an increase of around £18,500 as a result of the decision taken by the Labour Government.

The onus is on all Members. The funding is there: let us get it out the door and support our hard-working childcare providers to ensure that all people, in all parts of Northern Ireland, have access to the support that they so richly deserve.

Madam Principal Deputy Speaker: Members should take their ease while we change the top Table.

Ms Flynn: I beg to move

Mr Deputy Speaker (Mr Blair): The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer will have 10 minutes in which to propose and 10 minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes. Please open the debate on the motion.

Ms Flynn: Go raibh maith agat, a LeasCheann Comhairle.

I am conscious that we had a debate in the Chamber yesterday about autism and mental health services. The intention behind today's motion is to raise awareness of the stigma and unfair challenges that many people who have a diagnosable mental illness often face. I am probably preaching to the choir, because the Minister who is in post has been a champion for mental health for many years. I know that from working alongside him in my time as an MLA.

Stigma, prejudice and discrimination against people with mental illness can be, at times, very subtle and, at others, very obvious, but, no matter the magnitude, they can and do lead to harm. People with mental illness are marginalised and discriminated against in various ways, but understanding what that looks like, how to address it and, importantly, how to eradicate it can help.

Therefore, this motion is, hopefully, an important step in tackling the problem of calling out stigma.

The design of the motion came directly from people who have that type of lived experience. A group of service users had hoped to be here for the debate, but, sadly, because our timings have moved ahead of schedule, they might miss all of it. For anyone in the Chamber who has an interest in this topic, some service users will be in the Great Hall at 1.00 pm today, and you are more than welcome to pop out and say hello to them and get a wee chat with them. As I said, they are the people who designed the motion and who wanted it to be debated publicly today in the Assembly Chamber. Feel free to pop out to the Great Hall at 1.00 pm. It is exactly those types of people who deserve to have their voices and their experiences heard clearly in the Assembly.

While the focus of the debate is on those who are living with mental illness, it is important to state, in the context of stigma and how it affects people, that it also impacts on every type of mental health disability, whether it is people living with autism, which we debated yesterday, or people living with a learning disability, physical disability, trauma or, indeed, schizophrenia, bipolar disorder, PTSD or eating disorders. They all experience social challenges that are directly caused by the stigma that they face. Stigma is a horrible thing. Stigma is real, it is rife, and it is being felt, sadly, by many people who are living with a mental illness. It lacks understanding, and it promotes social exclusion, loneliness, isolation, hopelessness and shame. It can and does create a reluctance for those who are the victims of stigma to ask for further help or seek treatment.

The impact that it has on those living with a mental illness can be debilitating, and it can be dangerous. Put yourself in the shoes of someone who may already be struggling to come to terms with a mental illness diagnosis, someone who may already be struggling to make it through their day, and who then experiences a situation where they are made fun of or where someone passes a negative comment under their breath or even just gives a strange look. Just imagine any simple scenario that can and does take place daily for people who are mentally ill. They are simply made to feel different. Why? Because they do not live a "normal life" like the rest of us.

For me, that type of stigma can often only be understood or felt if it is experienced at first hand, either where you have been a victim of it or where you have witnessed that type of discrimination against a loved one. I think that it is difficult for each of us individually to reflect on that, because I think that you always assume that you would never be the person to make someone else feel that way — you would never be the person to try to make someone feel discriminated against or stigmatised — but it is so easily done. I said earlier that it can be so subtle, and it can be so subtle that sometimes people do not even realise that they are doing it. My own lived experience is through family members who have been diagnosed with quite serious mental illnesses. One of them is around the same age as me and is such a beautiful person, so kind and so gentle. However, he really struggles to live with his diagnosis. When I am out with him, I can see that, in a lot of cases, people do not mean it, but stigma is there, and that is why I am saying that it is rife. If we open our eyes to it and if we notice it, I think that we all have a responsibility to try to acknowledge it and also be aware of our own prejudices, which, sometimes, we do not even know exist. We all have a responsibility to challenge any discrimination and stigma that we might witness or any negative comments that we might hear. We have to send out a united message that discriminating against, stigmatising and shaming, whether we mean to or not, people who are living with an mental illness is wrong. As elected representatives, we share a responsibility to listen to those with lived experience of mental illness, champion their needs and promote education and general awareness through public campaigns. We should not accept such biased attitudes as the norm in the modern-day world, as they are, at the very least, hurtful, and, at the very worst, harmful, to some of the most vulnerable groups of people.

The first step towards making a societal change is to bring awareness to unwanted behaviour or attitudes, which is the intention of the motion. The service users and the people who have that lived experience can, hopefully, watch the debate back, because, as I said, some of them are missing it. Hopefully, when they listen to everyone's remarks throughout the debate, they can take a bit of comfort in seeing that we care and that we are trying to raise awareness and call out the stigma and negative attitudes towards them, because those are wrong.

To finish, the motion calls for awareness campaigns, which are in the first theme of the mental health strategy, to be delivered as part of what we can do to try to help stamp out stigma and discrimination. All those points were covered yesterday in the discussion on the challenges in the Health budget in the context of autism and specialist mental health services. We might have the same conversations today; we are having the same conversations in the Health Committee every week.

All that having been said, I get it. The Minister does not have a blank cheque to sign off to have a big advertising campaign on the issue. However, even if the message coming from the Minister and Members to the people whom we are speaking about today were that we are giving a commitment to make the matter a priority — I know that that means nothing until it is actually delivered — and if we were in the space of having three-year Budgets and with additional money — please, God — coming from the British Government, this is something that the Minister of Health might, hopefully, be able to prioritise and push forward. I know that it would be really appreciated by the people who designed the motion.

Mr Robinson: I am stating the very obvious by saying that mental illness never discriminates. It affects everybody from every walk of life, from all backgrounds and from every corner of the Province. Despite how common it is, so many individuals are suffering in silence, being weighed down by an illness and an unjust stigma that often accompanies that illness. Whether it is depression, OCD, phobias, eating disorders or addictions, no person experiencing mental ill health should feel shame due to their illness. Traumatic events, such as COVID-19 and violence in Northern Ireland, have all had an impact on the well-being of people in the Province, and that is borne out by the mental health services all being under extreme pressure. Even our EDs are populated by individuals who are suffering from poor mental health.

In 2021, the 'Review of mental health statistics in Northern Ireland' reported that we have:

A youth well-being survey in 2020 reported:

In 2024, the Public Accounts Committee's 'Report on Mental Health Services in Northern Ireland' said:

Evidence shows that the stigma surrounding mental illness is a barrier to people seeking help and accessing treatment. That stigma can create an environment where individuals feel isolated and sometimes ashamed of their struggles. That sense of shame prevents people speaking openly about their experiences, reaching out for help and, therefore, finding support. As a result of mental illness, mental health issues often go unaddressed, worsening over time and leading to greater long-term consequences, and they can lead to someone taking their own life. Why is mental illness still viewed by some as a sign of weakness, or worse, as something to hide away? Why are people more likely to seek help for a broken leg than they are for depression or anxiety?

All of us in the Chamber want to see the full implementation of the mental health strategy 2021-2031, which lays out the 35 actions under three overarching themes and provides the road map for the improvement of mental health services in Northern Ireland over the next decade. The success of the mental health strategy depends on more than just better treatment and care; it will also depend on changing the way in which we all think and speak about mental health in Northern Ireland. It will depend on us all challenging outdated beliefs and stereotypes that fuel stigma, which is why action 1 under theme 1 of the mental health strategy is important. However, given the implementation costs of £1·2 billion, there is increasing risk that the strategy will become outdated due to those costs. The success of the strategy requires a coordinated, sustained effort that involves not only our health service but schools, workplaces, communities, the media and the entire Executive. There is no doubt that reducing stigma is a long-term project. We need to normalise conversations about mental health to ensure that, when someone is struggling, they feel able to speak out without fear of judgement or rejection. The Department of Health and the Executive must continue to ensure that mental health is seen as a medical condition and not some kind of character flaw. People should not be defined by their illness.

In the course of my work as a public representative over the past 20 years, I have met many individuals who have bravely shared their personal stories of mental illness. I have listened to the struggles that they have faced in trying to deal with not only their condition but the stigma that they have faced. For some, seeking help for the first time was the hardest step because they feared how others would judge them. All too often, men struggle to seek help. The 2021 NI life and times survey showed that 50% of males reported having difficulty talking to other people about their feelings and emotions. That needs to change. We have seen in other areas of health across the world that stigma can be reduced with the right efforts. Public education campaigns, awareness training and open dialogue have all played a role in reducing stigma. We can do the same for mental health. I genuinely believe that we are making headway.

My party will support the motion. The message from the House must be that the Province and the Assembly will stand with those individuals, not against them, and that mental health is just as important as physical health. The Province must be a place where no one feels ashamed of their struggles and no one is made to feel isolated because of their mental health.

Mr Donnelly: I thank the Sinn Féin members for tabling the motion. Alliance is happy to support it.

Unfortunately, stigma persists across our society in respect of mental health challenges, including in our political system and sometimes even in the Assembly. All parties in the Assembly should improve their efforts to support friends and colleagues who are experiencing mental ill health. We often hear the phrase "It's OK not to be OK", but many people living with long-term conditions sometimes feel judged, isolated or discriminated against. In 2024, evidence from Inspire, which is launching phase 2 of its If It's Okay campaign in March, highlighted the difficulties that people who experience mental ill health face. For example, 64% of respondents said that they felt shame because of their mental ill health. What we say about mental health matters. That applies particularly to those of us who are in a public role: for example, in the Assembly. Therefore, I encourage all Members to be cautious in their language, especially given the unfortunate history of debates in the Chamber at times. Just yesterday, we heard an MLA recite lyrics from a musical to joke about a marginalised group that experiences higher levels of mental health problems.

The levels of mental ill health are higher in Northern Ireland than in the rest of the UK, as Mr Robinson highlighted. We have seen the impact of that in the increase in waiting lists for CAMHS referrals. As other Members have mentioned, it is extremely concerning that more people in Northern Ireland have died through suicide since 1998 than died during the Troubles. We have not seen adequate investment in mental health through departmental resources. Last year, around 7% of the departmental budget was allocated to mental health. That is well behind England at 11·4%, Scotland at 9·4% and Wales at 13·3%. We also have to be aware of the long-standing mental health issues that relate to the Troubles. The trans-generational trauma in our society is a legacy of decades of violent conflict and is likely to persist for decades.

Mental health services in Northern Ireland have faced a difficult period over the past few years. In particular, that is a consequence of the political instability that prevented any decisions being taken in this place in five out of the past eight years.

That includes the absence of multi-year budgets, which are essential for long-term planning in our health service.

During the previous, reduced mandate, Minister Swann introduced the mental health strategy 2021-2031. I commend Minister Nesbitt for his efforts to ensure the continued implementation of the strategy. Progress has been made, but more needs to be done. I remain convinced that, on the road that we are taking, we will not see its completion by 2031. At a Health Committee meeting in November, we received an update from the Department of Health on the funding plan for the mental health strategy. It is worrying that the funding allocated in the years since 2021 has increased only slightly compared with the huge increase that is required each year as the strategy develops.

Funding is not everything, of course, and one step that the Minister could take is to engage with our experienced community and voluntary organisations on what they can assist with to fully realise that vital strategy. That is a key requirement of the strategy, specifically action 17. As the motion states, we need a work plan, and I look forward to hearing the Minister's suggestions on that and on how the Health Committee can work with him to help deliver it.

Another vital issue is the need for anti-stigma and anti-discrimination public awareness and education campaigns. The first action in the mental health strategy outlines what we must do in that respect: increase awareness of the different kinds of mental well-being, mental ill health and mental illness; encourage understanding and acceptance of their impacts; and recognise the signs of mental ill health. We should use public mental ill health education and effective awareness raising as methods of improving public knowledge of the key measures that we all can and should take to look after our well-being and that of others and, most importantly, to reduce stigma through encouraging discourse and dialogue. I appreciate that, on previous occasions, the Minister has indicated that the pressures facing his Department impact on his ability to carry out such public awareness campaigns, so I again encourage him to engage with mental health organisations in our communities, as they do invaluable work, including on public awareness.

It is important to emphasise that mental health is not solely a Department of Health issue. Although Health is the primary responsible Department, mental health should be a cross-departmental priority. The Programme for Government (PFG) acknowledges the role of the Department for Communities, for example, in noting the importance of sports in supporting mental and physical health. Ministers have also highlighted the overlap of poor mental health and economic deprivation. I know that one of the Minister's priorities is to focus on health inequalities, and I would like to hear him expand on that in his response.

There is no shame in mental ill health or illness. It is like any other sickness. No one would feel ashamed of having asthma or a physical injury, so no one should ever feel ashamed because of their mental health.

Mr Deputy Speaker (Mr Blair): Time is up.

Mr Butler: I thank the Members from Sinn Féin who tabled the motion, particularly Órlaithí Flynn from West Belfast. Órlaithí is one of those visible and consistent champions who speak about mental health and suicide prevention. I have worked with Órlaithí probably since we became MLAs, and we cross-pollinate on many all-party groups (APGs) with that interest at heart.

In 2025, it is really good to hear collectively from the parties here — some of the independents will hopefully partake in the debate shortly — that we are facing in the same direction. The starting point is for everybody to recognise that the Assembly is limited, as every legislature in the world is limited, in what it can and will deliver, but the fact remains that we have to deliver as much as we can on the promises that we make. I hope that, in my time and before I leave here, if there can be a legacy from the Assembly, I will be able to say not that I can put my name on that but that I was part of transforming the face of mental health in Northern Ireland.

Mental health problems exist for a multiplicity of reasons. We cannot neglect the fact that we have a past — the Troubles — and high levels of poverty and political disengagement. Until we, as people with the power to make change, learn that all those things play a part to the detriment of people's lives, we consign future generations to more of the same. We need to take the lead. We need to be careful with our language; I agree with Danny Donnelly, who has a professional background in the field as a mental health nurse. We have to take the lead consistently and demonstrate that by example in every debate. We can be robust and hold one another to account, but, if we label, sling mud and call one another things, we are hypocrites when we tell everybody else to do something different. That is just the way that it is. I thank, again, the proposer of the motion for recognising that my leader, Mike Nesbitt, the Health Minister, can probably legitimately lay claim to being the politician who has driven the topic of mental health in this arena.

I will not reiterate the brilliant words that have been used so far on tackling the stigma, but I want to address something that Órlaithí picked up on: the unintended although maybe not malicious stuff. I know that it exists because I chair the all-party group on disability. I speak to young people from the disability community, and the biggest threat that they face is not the facilitation of their disability but the discrimination that they experience, which is probably sometimes unintentional. That has a real impact on their mental health. Take alcoholics and drug addicts: the use of language about the people in that comorbid space is disgusting. It fries my head at times to see people who should know better descending into a space where they should not be, which compounds the difficulty that the addicts find themselves in.

I will pitch for men today, because, of every five suicides, four are men. Some people do not know that. Men rightly come under a lot of pressure, and they should be called into question, particularly on the issue of violence against women and girls. However, the men involved in such behaviour are not real men. Real men struggle, cry and reach out, but the world tells them to, "Man up. Pull yourself together. Catch yourself on". Those are all slurs and derogatory remarks that stop men from reaching out for help when they need it.

There is unintended discrimination in pregnancy that Órlaithí will know about very well. Sometimes women face the greatest threat to their mental health during pregnancy. About 20% of women suffer from perinatal mental health issues. Sometimes they are not asked the right questions by professionals because everything centres on the baby. We know that pregnancy is a precious time, but are the right questions being asked, even in the professional sphere? I wish that they had much more time.

Places like the Prison Service, which I spoke about yesterday, are highly charged atmospheres in which to work. The mental pressure and distress that those women and men come under is not recognised in the Civil Service code of conduct. The sickness policies are not fit for purpose, and we need to see changes to address the reality of the mental health struggle for people across Northern Ireland.

Mr McGrath: It might surprise some, but I support the motion, even though it is from one Executive party to another. It is really important that we send out a clear message from all parties on the need to reduce the stigma. I welcome the motion because the words that we use in this place and the message that we send can and will act as a beacon of hope for some people that might be enough to get them through and beyond the issues that they face. It is important that we take that opportunity.

The Minister has been a strong advocate in the area of mental health and will send that equal message out from here today. That will let people know that we are on their side and are trying to do everything that is possible. It will also let them know that we recognise that there is more that we can do and that we will strive to do more.

Mr McCrossan: Will the Member give way?

Mr McGrath: Yes, of course.

Mr McCrossan: I completely agree with the Member's sentiment about a unified House on the issue, but surely the time for nice words is long past. People need to see action and a reform of our mental health services in Northern Ireland. As we talk about them, those services are failing people, and the Executive need to take meaningful action to transform them.

Mr Deputy Speaker (Mr Blair): The Member has an extra minute.

Mr McGrath: I thank the Member for his intervention. His message is the underlying one that we want to send out today.

We must also recognise that the stigma around mental health exists. As many Members have said, we would be naive to think that it does not. There are two approaches to reducing the stigma. First, for adults, we can reduce it through the work that we do, the help that we provide, the words that we use and the messages that are sent out. In our contributions, each of us has concentrated on a different sector of people. I want to speak up for young people, because the first hurdle for the many who suffer from mental health issues is wondering, "Am I the only person who has this? Are there other people like this? I've never felt like this before". They almost have to get over the hurdle of identifying that it is a mental health issue, because nobody gives a rule book to people when they are born that says, "That is what anxiety feels like" or, "That is what depression feels like". They have to have services around them that they can reach out to so that they can understand what mental health is, and then we need to push them beyond that to get to the services. Hopefully, by sending out a message that we want to reduce that, we can help young people in our community.

There is another element to the stigma and the work that we do here and how we can help to motivate society to move on. I am always struck by this: I live in the shadow of the Downshire Hospital in Downpatrick. There is a map in my old place of work that was about 100 years old — it is maybe about 115 years old at this stage — and it was listed on the map as the "Lunatic Asylum". I see how we have moved on: that is not the sort of terminology that we use. Some of the older people among my neighbours — the houses were populated by people who worked in the hospital — were able to tell me the stories of the individuals who were there. Many of the reasons for people being left in a place such as the Downshire were things that, nowadays, we would have utter disbelief at: maybe being a single parent, having a form of anxiety or being a little bit depressed. Their families brought them up, left them and went away. I was always touched by the story that, when somebody had passed away, they had to go round the staff to see whether they could get pall-bearers to bring them to the graveyard that is part of that complex, because the families were not there for them. We have moved on an awful lot; so much so that people who would have formerly lived in that institution now live in houses in my street. We welcome them as our neighbours and friends. We all live together in the street and all know one another. That is how much we have moved on. We need to continue with that work to address the issues that we can.

One such issue, as referenced, is the mental health strategy. Again, it is not funded to the level that it should be. We need to fund it to a level that will allow the continued work that will help to address the stigma.

I took the opportunity, in advance of today, to talk to a number of my constituents and ask them about their views. Some of the things that they said were enlightening, because they remind us of the daily experience that people have. Parents of children with anxiety who are waiting to be seen by child and adolescent mental health services said that the wait increases their anxiety rather than helping to address it. They feel that they are just left to manage and to get by without any help. I have been told about the impact of childhood trauma and the need for ADHD assessments for people who are sick, sore and tired of hearing that no support is available and are asking for help and being denied it. As one parent said to me, "People like ourselves deserve better because we already go through enough. We are battling every day as it is, so we need to see things change".

That said, it takes enormous courage to change things. I implore the Minister — he knows the funding issues — to take that courageous step and find what funding he can for the mental health strategy, so that we can get it out and provide more services. Then, if people are accessing services, hopefully that will help to reduce the stigma.

Ms Á Murphy: This issue transcends all political divisions, touches every corner of society and affects individuals and families across the North. Mental health challenges do not discriminate. They impact on people of all ages, genders and backgrounds. It is our collective responsibility to ensure that no person facing mental ill health feels shame or isolation because of their condition.

Mental illness remains one of the most significant public health concerns in the North; yet the stigma continues to be a barrier that prevents too many people from seeking help. Stigma isolates and silences and, tragically, can cost lives. Behind every statistic is a human story: a mother juggling work and depression; a farmer in a rural area facing financial hardship; or a young person afraid to speak up about their anxiety.

I want to draw attention to the unique challenges faced by rural communities in particular and especially by my constituency of Fermanagh and South Tyrone. Rural isolation compounds mental health struggles. Limiting access to services, the stigma is tied to close-knit communities, and cultural pressures to keep going can make it far harder for people in those areas to seek the help that they desperately need. We must address those disparities through targeted interventions and by ensuring that mental health services are accessible to everyone regardless of where they live.

We must also recognise the needs of vulnerable groups, including victims of historical institutional abuse and people working in the health and social care system. The legacy of that abuse leaves deep psychological scars that cannot be ignored, and health and social care workers who have given so much to support others often face burnout and trauma. Those individuals deserve focused, tailored supports through the framework of the mental health strategy.

The stigma surrounding mental health cannot be eradicated through words alone. The mental health strategy provides us with a road map, especially through its first theme on stigma and discrimination. Public awareness and education campaigns are an absolutely essential tool to fight that. We also need a tangible, measurable work plan to tackle stigma head-on. I take this opportunity to call on the Minister to bring forward such a plan — one that includes collaboration with community organisations, healthcare providers, educators and employers. Reducing stigma is about more than awareness. It is about creating a culture of understanding and action; it is about recognising the humanity of every individual and ensuring that those who face mental health challenges feel valued, supported and seen. Let the Assembly stand united in its commitment to reducing stigma, supporting mental health and ensuring that no one in the North feels shame or isolation due to mental ill health.

Mrs Dodds: I thank those who tabled the motion, and I thank those Members who have spoken for the tone that they have used and the issues that have been raised in the debate. It is good to see the Assembly united and speaking with one voice about the stigma with mental health difficulties.

In my few remarks, I want to focus on the word "stigma". In preparing for the debate, I looked it up to see what it means. The definition that I looked at describes "stigma" as:

Sadly, that definition, too often, prevents those who have mental health difficulties from asking for help and leads to them feeling completely distressed and alone. People view mental health in different ways. We have talked about the kind of inadvertent stigma that people who have a mental illness can face, but it can also contribute to how they feel at work. People are worried about their chances of promotion, or how it will impact on their work, if they say anything about it. In social situations, they fear that they will be treated differently. Colin talked about past attitudes to mental health. When I was younger, many people whom I knew, particularly women, were told, "Snap out of it. It just happens. Get on with it". I am glad that, now, we recognise the persistent difficulties, particularly experienced by women in menopause and in that period of their lives, with mental health and anxiety. That is really important.

I think that we have three types of stigma: public stigma, which involves the attitudes of others at work and out and about in social situations; self-stigma, through the internalising of stigma within one's own self, the feeling of shame and not being good enough and so on; and structural stigma, which is systemic in the like of government and organisations' policies. That is where the mental health strategy comes in. I know and acknowledge that the Minister has done an enormous amount to promote mental health during his time as an MLA. Campaigns that tell people that it is OK not to feel OK are really important.

When I was reading around the issue, I found a quote that was incredibly instructive about how we deal with mental health, particularly in the public space. The quote was from Charlene Sunkel, the founder of the Global Mental Health Peer Network and co-chair of 'The Lancet Commission on Ending Stigma and Discrimination in Mental Health'. She said:

That is someone who is a leader in her field in mental health, talking about attitudes towards mental health and stigma. We must erase those attitudes. It is really important.

A number of Members referred to different sectors and their impact on the relief of mental health issues and their associated stigma. Let us also commend the voluntary and community sector. So many of our groups work at a community level, day in, day out, with those who suffer from mental health issues and fear the stigma that is associated with that.

Robbie Butler mentioned the Prison Service. We also must acknowledge the difficulties with mental health that are associated with serving in the public sector. Staff in the ambulance service and PSNI officers — people who see —

Mr Deputy Speaker (Mr Blair): Time is up.

Mrs Dodds: — very difficult things. The debate has been good, and I commend the Members who tabled the motion.

Miss McAllister: I thank the Member who proposed the motion. I give credit where credit is due, because, at most Health Committee meetings, she brings up issues to do with mental health and dual diagnosis and how we can tackle those. She is very passionate about those issues, and I am glad that we have the opportunity to highlight them.

On overall mental health, when we read background information, research or surveys, one key statistic that always comes out is the fact that one in four people suffers from mental ill health at some point in their lives. I look around the Chamber and see, maybe, 16 people here. It is more than likely that four of us will be affected by a mental health issue, be it an issue that we might have had from a young age or when we are older, such as postpartum depression or anxiety, or any other issue. It affects all of us, the people whom we love, our friends and our families. It is important that we do what we can to tackle the stigma around mental health, given the fact that it is so prevalent in society.

I will talk a little bit about the local issues that are being targeted towards tackling stigma, which are really important to highlight. I am keen to hear from the Minister about the work that he has been doing on the kind of advertising that can take place to highlight the issue. I think back to the campaign that said, "It's OK not to be OK", which many Members have mentioned. At a Health Committee meeting, the Minister said that there was a moratorium on public advertising. However, we should look at whether advertising is effective and whether it has positive outcomes. We do not need to talk about spending millions, but we can target it where it is needed.

Many issues cause poverty, and we need to get to the root of those as well. First, though, we must acknowledge that mental health issues cause poverty, exacerbate it and make it worse. I think of my area in North Belfast. Poverty is one of the key drivers of mental health issues, as are legacy issues from the Troubles. When they combine, they create a problem, and we are really not getting to the bottom of it. Five out of the 10 most deprived areas in Northern Ireland are in North Belfast. It is the third most deprived constituency overall, based on income, health and disability. We can think about health inequalities that are exacerbated every day that we do not tackle them. They will get worse unless we do something about it.

I turn to suicide rates in North Belfast. In my constituency office, we hear every day about different issues that affect people. Suicide is the issue that goes most to our core, and, unfortunately, it happens too often in North Belfast. Between 2015 and 2019, the rate of suicide per 100,000 population was 25·6, compared with the overall rate for Northern Ireland, which was 9·6. We need to ensure that we tackle that by talking about the problem that exists in the first place. As I said, there are organisations in my constituency that are doing really well. I think of PIPS and Lighthouse. I have spoken about them quite a few times in the Chamber. I want to touch a little bit on Lighthouse because of the work that it does, particularly in local schools. When I visited it for the first time after becoming an MLA, the team spoke about the work that they do particularly with young boys. We know that it is hard to get young boys to open up, speak about their problems and accept help where it might be needed, but they do fantastic work. They speak to young male teenagers about the need to talk about whether they are OK and how, if they are not, to get help. That peer-on-peer support is very valuable. I look forward to going back to hear more about their evaluation of their work with local schools over a number of years. That is just one example of how the community and voluntary sector — I know that the previous contributor highlighted this — is already doing what needs to be done. It is about taking what works best, not reinventing the wheel, and putting that into the areas of Northern Ireland where it is most needed. We know that more areas need that work.

Staying on the issue of young people's mental health, I know that the Elephant in the Room campaign has been excellent. It is a class campaign. It was designed by young people for young people.

Mr Butler: I thank the Member for giving way. I will keep this as brief as I can, because you will get an extra minute. I recognise your point about Elephant in the Room. Obviously, we had Pure Mental NI, which was established, but, unfortunately, we have now lost it. There is an opportunity to recover it. In and around the education sector and early intervention is where we could see real transformation in the future. Does the Member agree?

Miss McAllister: I do agree. It is worth highlighting the fact — you mentioned the education sector — that there are young people taking the lead in their schools. Teachers and staff could learn a lot from them. There is a lot of pressure in education: a lot of pressure to do well, even from the young age of 11, in the transfer test, GCSEs and A levels, not to mention social media. However, young people often have the answers too, so the Department could engage with youth sector organisations on how best to reach out to them. It is about all of us in society — young people and older people.

With regard to postnatal issues, I know that when I did my prenatal care, postnatal mental health issues were not really touched on. That is one area that has improved, I am learning from friends, but there could be more improvement there too. It is very important that we tackle those issues.

I am glad to speak on the motion today to highlight the good work that is —

Mr Deputy Speaker (Mr Blair): The Member's time is up.

Miss McAllister: — taking place in my constituency. We are happy to support the motion.

Mr Deputy Speaker (Mr Blair): The Member had an extra minute.

The Business Committee has arranged to meet at 1.00 pm today. I propose, therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The debate will continue after Question Time, when the first Member to be called will be Cara Hunter.

Mr Speaker: Question 14 has been withdrawn. Mr Durkan is not in his place, so I call Stephen Dunne.

Mr Givan (The Minister of Education): I wrote to my Executive colleagues on 18 November last year setting out the policy proposals underpinning a school uniforms Bill and seeking agreement for my Department to formally engage with the Office of the Legislative Counsel (OLC). I received Executive agreement on 5 December last year. The Bill's underpinning policy proposals have been consulted on, receiving a high level of support across the almost 7,500 consultation responses. Those included responses from the online survey, children and young people and a range of organisations. The consultation report was published on 12 December last year and is available on my Department's website.

The draft school uniforms Bill, which will make departmental guidance statutory, is being finalised. Once that is done, I will provide the Executive with the draft Bill, seeking agreement to it and to its introduction in the Assembly. When I receive that agreement, I will write immediately to the Speaker to confirm a date as soon as possible to introduce the Bill. I will then look forward to working with Assembly colleagues to progress the legislation and make a difference for those families who are most in need of our assistance.

Mr Dunne: I thank the Minister for his answer and for his efforts in tackling the issue. Will he outline what the timescales are for the legal process to bring the Bill into operation? How does he think that it will benefit hard-pressed families?

Mr Givan: I thank the Member for raising this important issue. The timeline is that I will bring the draft Bill to the Executive to seek their agreement to introduce it, and, as soon as that is granted, I will bring it to you, Mr Speaker, and confirm a date for its introduction. Standing Orders allow a minimum number of timescales between the various stages of Assembly scrutiny, so it is my hope that I can bring the draft Bill to the Executive at our first meeting in February.

Upon introduction and then subject to the way in which the Education Committee and the Assembly decide to deliberate on the Bill, there would be the potential to complete all the Assembly stages before the summer recess. I would then expect the legislation to come into operation in autumn 2025, but I am entirely at the mercy of the Assembly and the Education Committee in fulfilling that time frame. Once implemented, however, the legislation will have a positive impact in trying to help hard-pressed working families to meet the costs of school uniforms and the associated PE kits.

Mrs Mason: Is the Minister considering a cap as part of the legislation as a way of keeping costs down for families?

Mr Givan: I confirm to the Member that I will be seeking to take a power in the legislation to introduce a cap. We have consulted on that. It is important, and I am sure that the Education Committee will look into it. What will be the consequences of a cap? Some evidence suggests that a cap can, at times, suggest a limit for schools to reach, rather than keep costs down. There are commercial market considerations, and I have no doubt that the Committee will want to hear from retailers as it considers the issue. I can confirm, however, that the legislation will contain provision that would enable a cap to be brought into place.

Mr Mathison: I welcome the continued commitment to bring legislation on the issue. I assure the Minister that the Education Committee is ready to do the scrutiny work. He will be aware of some of the issues that arose in England when the legislation was changed, as parents reported back that it did not have any real teeth, despite being on a statutory footing, and that schools often continued some of the unhelpful practices on cost. How will the Minister ensure that this legislation can be enforced and that it will deliver meaningfully reduced costs for parents in Northern Ireland?

Mr Givan: I thank the Member for his interest in this subject. He is right to draw out comparisons with other jurisdictions. We have looked at those experiences. England put its guidance on a statutory footing. We will now do that through this legislation, which will contain a provision to allow the Education and Training Inspectorate (ETI) to monitor the guidance. The overwhelming majority of schools follow current guidance, but that monitoring will provide us with information and will allow the inspectorate to assess how schools meet the guidance once it is on a statutory footing.

In recent legislation introduced at Westminster, England is looking at limiting and prescribing the number of items that constitute a school uniform and PE kit. I am sure that Members will want to consider that as part of the legislative process. Creating law is one thing; making sure that it has effect and can bite when it needs to is another. In passing this legislation, we need to ensure that it has a meaningful impact for those who need it.

Mr Givan: My Department has instructed the Education Authority (EA) to undertake urgent remedial health and safety works to the modular building at Maine Integrated Primary School. The works are being scoped and will be delivered as quickly as possible.

Drainage, structural and condition surveys of the modular building are being commissioned to determine whether any additional, longer-term works are required. Alongside those actions, a scheme is being progressed to replace the walkway and to provide a replacement classroom with a group room at the school. The Education Authority is preparing a technical feasibility report for the scheme, which will inform the business case. Should the school identify any works required to other modular units on the site, it should submit an unavoidable minor works application to the Department. However, you will appreciate that, due to ongoing budget constraints, minor works are being prioritised on the basis of health and safety, statutory compliance and the need to address urgent and emergency repairs that, if not addressed, could close a school or present a significant health and safety risk. I can assure you that I will continue to make a strong case for the increased and sustained investment that our education system needs.

Mr Speaker: Linda Dillon is not in her place. I call Paula Bradshaw.

Ms Bradshaw: Question 5, please.

Mr Speaker: Oh, sorry. Apologies, John. [Inaudible.] [Laughter.]

Mr Blair: Thank you, Mr Speaker, for that additional time to prepare. [Laughter.]

I also thank the Minister for his answer and the attention paid to this matter. Given that the Departmental Solicitor's Office (DSO) has advised that health and safety issues can be addressed, apparently, and that the EA has been instructed to carry out urgent health and safety works, is the Minister, given the number of issues that have arisen at that site, prepared to visit it to see the problems at first hand and how lessons might be learned on how to deal with contractual issues?

Mr Givan: My immediate priority is to make sure that that work is carried out. It causes me concern that nearly £1 million was spent in 2015 and we now have issues around the suitability of what was purchased within the past 10 years. That is not a satisfactory position to be in. I know that legal opinion, including from the DSO, was being sought on Construction and Procurement Delivery (CPD) and how this could have happened. Setting that aside, what is most important is health and safety, and that takes precedence over whatever legal dispute there may be with the way in which this was procured and any potential liabilities that flow from it.

The immediate priority is providing support to the school. Education Authority maintenance staff, as I understand it, visited the school last week to review the issues. The maintenance officer agreed, in consultation with the school and the term service contractor, a programme of works to address those immediate health and safety issues. I trust that that work will be expedited with the urgency that it requires. If that is not the case, I will absolutely take up the invitation to visit the school myself, but I trust that that will not be necessary with regard to the immediate need. However, I am, of course, always happy to visit schools as part of the rolling programme of engagements that I undertake.

Mr Givan: With your permission, Mr Speaker, I will answer questions 4 and 8 together.

Through the Teachers' Negotiating Committee (TNC), a joint pay group is operational, and meetings are taking place with employers, sectoral support bodies and the recognised teaching trade unions — represented by the Northern Ireland Teachers' Council (NITC) — to explain to and update them on the current financial pressures in education and discuss the current pay claim from the NITC. The claim was substantially higher than what has been recommended by the United Kingdom Government and accepted by teachers in England.

In line with the requirements of public-sector pay policy, any proposals for a teachers' pay award must be affordable, and that is proving difficult to resolve, given the pressures that already face the Education budget. Four of the five unions on the NITC balloted for industrial action and action short of strike action, and that was due to commence on Monday 13 January. I provided confirmation that I am committed to securing the funding that is required to make a formal pay offer in the context of the agreement reached in the summer of last year in England and Wales and on the understanding that we secure agreement on a sustained period of stability, free from industrial action, including action short of strike, in our schools. As a result of that, the four trade unions agreed to suspend their industrial action for four weeks to allow further discussion aimed at finalising the ongoing pay negotiations.

The workload agreement, TNC 2024/2, is effective in providing clarification, advice and guidance on teachers' terms and conditions to boards of governors, principals and teachers. Management side and the NITC have jointly designed a framework to address the recommendations contained in the eight completed workforce reviews.

Mrs Dillon: I thank the Minister for his answer. Minister, as you will be well aware, the pay issue goes much wider than just our teachers. Our classroom assistants are very frustrated by their pay increase. Have you met classroom assistants and engaged with them directly? They are among the lowest-paid workers across society, yet they do vital work by supporting our young children, including our most vulnerable children.

Mr Givan: I agree with the Member on the hugely important contribution that our teaching staff and support staff make. That is why, when the institutions were restored, the Executive prioritised them. The Finance Minister made funding available, and I worked with the unions to negotiate a pay settlement that resolved a three-year dispute. We increased the starting salary for new teachers from £23,000 to £30,000. We increased teachers' pay by double digits, and a backdated payment was made for that. We also resolved the industrial dispute by support staff through the pay and grading review, and that has resulted in significant pay increases for all support staff.

We are now trying to resolve the issue for the current financial year. I am engaging in good faith to get a resolution. My team is meeting the unions right now, and diaries have been cleared to allow negotiations to continue tomorrow and Thursday. We have an opportunity over the next number of weeks to bring those negotiations to a conclusion. I have outlined the parameters within which we need to reach agreement, and I have been working incredibly hard to try to identify the funding that we need in order for a formal pay offer to be made. I will continue to do that.

I absolutely accept that support staff require support. I met the Member's party colleague the Member for Foyle, who did some work on the role of classroom assistants and provided me with a report. That was very helpful and demonstrated their value, which I already knew. During that meeting, he provided evidence that was helpful to me. I know that it is a shared aim of all of us in the House to support teachers and the wider support staff, and I know that the Executive want to do that.

Mr Dickson: Thank you, Minister, for your answer. Will you outline for the House what plans you have to consult teachers' unions and other trade unions to review teacher and classroom assistant workloads in order to better represent the reality of life in the classroom for them?

Mr Givan: I thank the Member for that question. Three of the four unions balloted purely on the pay issue, but one union included issues to do with workload. My original response highlighted issues to do with workload, including commitments that were made and work streams that we have been taking forward.

A timetable for the implementation of the areas that can be progressed, immediately and over the short to medium term, has been agreed with the trade unions. The focus of both management side and the NITC is to determine the areas of work that, once revised and implemented, will have the potential to impact positively on working practices in the education sector. A programme of work has been prepared, grouping the recommendations that are in progress and those that can be progressed with existing resources into themes, one of which relates to school leaders. I will continue to do all that I can to progress those measures and to secure the funding and resources that are needed to provide a pay settlement. I will work with the unions to get a resolution over the next number of weeks.

Mr Kingston: Can the Minister advise whether teachers' terms and conditions in England are the same as those in Northern Ireland?

Mr Givan: We are incredibly fortunate in this country: teaching is a valued profession here and we have high levels of application to all our initial teacher training colleges. As an Executive, we want to attract the brightest and best to the profession. I and the Executive support that position. Northern Ireland negotiates terms and conditions through the management side, which is made up of employers such as the Education Authority, the Council for Catholic Maintained Schools (CCMS) and others. We negotiate those terms and conditions for Northern Ireland.

When a pay settlement is reached in England, the terms and conditions for teachers there are not the same as those in Northern Ireland. For example, in Northern Ireland, there is a legal right to automatic pay progression, so teachers here automatically move up their scales. In England, pay progression is subject to an annual performance review by the employer, so a teacher may not move up. It is important that we recognise that there is a different context in Northern Ireland. The exceptions to the directed working time budgets are tighter in England. There is greater flexibility in Northern Ireland. When looking at pay, it is not as simple as saying, "We demand pay parity with England", because the terms and conditions are not like for like. We need to find solutions to such issues that recognise the legal framework in Northern Ireland.

Mr Crawford: I appreciate the Minister's work on the issue. Is there a long-term strategy to ensure competitive pay for teachers in Northern Ireland? How often will teachers' salaries be reviewed?

Mr Givan: I thank the Member for that question. Every year, we seek to review and reach a settlement on pay. A short time after the Executive's restoration, teachers' pay increased by over 10%. That was backdated. We resolved the industrial action by our support staff and delivered a significant increase in their pay. We review pay every year. I want that to happen sooner, but we have not been in a position to move forward, because the Department of Education has not had the funding to do so. I have had to work to identify what funding there could be. That will require difficult decisions for me, as a Minister, and I have no doubt that Members will criticise me for the decisions that I will need to take, but we are prioritising teachers' pay. That will have implications for the next financial year, because there will be a cumulative impact. That is why I unashamedly make the case for additional resource for the Department of Education.

We want to attract people into the profession. It is a deeply valued profession. People often go into it because it is vocational, and we should never take that for granted. We should always pay them the appropriate salary to reflect their contribution to our children and young people, who, ultimately, are the future. We have workforce strategies in place. We are struggling to recruit people to teach particular subjects at post-primary level. That requires us to look at those issues, but I want to make sure that we pay our workforce the right rate to reflect the important work that they do. I will continue to seek to do that in the years ahead.

Ms Hunter: Minister, many Irish-medium schools have voiced their frustration that teachers make more money in the South of Ireland. Therefore, we lose a lot of our Irish-speaking teachers to the South. Will a pay award that increases salaries be enough to keep teachers in the North? What further steps will your Department take?

Mr Givan: I am not aware of salary being an issue in attracting people to Irish-medium schools. There is an issue with how we make sure that people who are qualified and proficient in the Irish language are able to deliver education through that medium. The Department recognises that that is a particular issue for Irish-medium schools, and work is being done to make sure that we provide support. For example, the reductions in the number of placements in our teacher training colleges did not apply to the Irish-medium sector. That recognised the needs of the sector and the legal duties on the Department in that respect.

I recognise that that is an issue for Irish-medium. It is an issue for some other subjects at post-primary level when it comes to attracting staff. We need to make sure that terms and conditions are attractive and that teachers can be supported in the working environment, which we can do through a number of measures. As I reform the education system, we will look at curriculum and ways in which we carry out assessment. Key to that will be teachers' professional development and empowering our teachers who want to be provided with that support to carry out their job. I am determined that we seek to do that.

Mr Givan: Area planning is the process of strategic planning of primary and post-primary education provision. The process has been developed to support the implementation of the sustainable schools policy. The Department requires the statutory planning authorities — the Education Authority and the Council for Catholic Maintained Schools — working with the managing authorities and the sectoral support bodies, to identify future education needs and develop solutions to meet those needs on an area basis.

Ms Bradshaw: I thank the Minister for his answer. As you know, Minister, the grammar schools in particular in South Belfast are popular not just with those in the constituency but those from neighbouring constituencies. What consideration is given to that? The children of a lot of the families that I represent cannot get into schools in their neighbourhoods and have to leave the constituency. What consideration does area planning give to that?

Mr Givan: That is a valid point. I know about that from my constituency, where there are two grammar schools that are heavily oversubscribed, so that often people are not able to get into the school of their choice, which, at times, creates frustration. The issue that the Member has articulated in relation to South Belfast is reflected in other constituencies.

When we consider increasing enrolment in some schools — we have been and still are doing that in South Belfast to address some of the capacity issues — we need to take into account what impact that could have on another school. The process always involves looking at the implications of development proposals to increase enrolment and what they might mean for the wider area. Such things are not often straightforward. When I looked at the overall post-primary admissions process, I saw that 12 children remained to be placed in South Belfast but a total of 45 year 8 places remained available. Places are not always in the parents' school of choice, and I recognise that that can create tension and cause difficulty. We need to look at those things in the round, however, and consider the implications for all schools.

Mrs Erskine: Hopefully, the Speaker will allow me some latitude for this question, as it points to school places. Last week, the Minister made a decision on closing Lack Primary School. I have spoken to a number of parents who are concerned about the lack of school places in controlled schools in the area. Will the Minister act to increase school places? What is his Department doing to support parents, pupils and staff through the process?

Mr Speaker: That was about 80 miles of latitude [Laughter.]

I will leave it to the Minister to decide whether he wishes to answer.

Mr Givan: I am happy to speak on that, Mr Speaker. I thank the Member for the work that she does to represent her constituents. I understand that such decisions can be difficult. A number of decisions were taken last week that caused controversy, and a lot of views were expressed on them. Amongst those, I closed schools, one of which was Lack. I do not take those decisions lightly. In taking that decision, however, I made it clear that there needs to be support for the families, particularly the children, to enable them to transition to alternative schools as seamlessly as possible. If it requires temporary variations to ensure that children are placed in a suitable school, I will, of course, take that forward. The Education Authority is working through those decisions and seeking to support those families and children. Where I need to take decisions to facilitate that, I absolutely will.

Mr O'Toole: Minister, in your answer to Paula Bradshaw, you talked about the statistics for South Belfast. Are you, your Department and the Education Authority actively looking at the huge increase in housing that we will see in South Belfast? On the stretch up the Saintfield Road to Four Winds, Newtownbreda and Carryduff, thousands of homes are going in. Can we look at that proactively to ensure that there will be school capacity in the constituency and in neighbouring schools such as Lagan College, Our Lady and St Pat's and Inst to support the huge increase in housing and young families that we will see in our area?

Mr Givan: I outlined the process for area planning. It is critical that the managing authorities look at that kind of information and plan for and address what the needs will be in their community. They must also look at the particular sectors to make sure that provide parental choice in that regard. I responded to an Adjournment debate that Ms Bradshaw secured on the issue, speaking at length on some of the decisions that we are taking to provide that.

Yes, we need to make sure that that forward planning is done to meet the needs of the local community, but we cannot take South Belfast in isolation. A significant number of pupils from my constituency access schools in Belfast. It is their choice and their right to do that. We need to consider all those things and look at the implications for other schools. A clear legal process is laid out as to how to do that. I will continue to support the managing authorities and take decisions, as appropriate, to facilitate that.

Mr Givan: The Education Authority's special educational needs inclusion service medical needs team operates a central point of contact for schools and parents who have questions around the inclusion of children with medical needs, including those with allergies and anaphylaxis. The Education Authority advises that, in many cases, advice and support for children and young people and schools on severe allergies can be provided without the need for a statutory assessment. For children in respect of whom a healthcare specialist has confirmed that the anaphylaxis is severe or where a child has significant and complex difficulties, schools or parents can request that the Education Authority carries out a statutory assessment of their individual needs. That will help to determine whether any additional provision is needed over and above that which the school can provide.

Ms Nicholl: Thank you, Minister. I have been working with a young girl who has anaphylaxis. She is allergic to milk, dairy, eggs and nuts, which is a lot, and has really struggled with the inclusion service. Given what parents with children who have food allergies have to go through and the stress that it entails, the Food Allergies NI group has asked whether you would be willing to meet it to discuss what more can be done in schools and, in conjunction with the Health Minister, as regards a public health awareness campaign. Would you be willing to do that?

Mr Givan: I thank the Member for raising the issue. Through the census return of 2022-23, we were able to identify that just over 3,000 children were recorded as having anaphylaxis as a medical condition. Her constituent is an example of the 3,000 children in a similar position.

There is already provision of departmental guidance on medication in schools. We are reviewing that with the Department of Health to make sure that the available guidance is there. To assure Members, all catering staff, for example, get annual training to make sure that they provide the right support for children and young people with allergies. They follow a plan to make sure that the foods that are prepared recognise those differences. The Education Authority is working on the area, and we are reviewing it. I would be more than happy to meet the group that the Member has asked me to meet to look at the issues.

Mr Buckley: I thank the Member for her original question. Whilst we know that children and parents face significant challenges in dealing with severe allergies, additional stress is also put on teaching staff who have to administer medication and, often, feel under-equipped to do so. Can the Minister outline whether those steps will include additional support for teachers, who often have to administer medication in difficult circumstances?

Mr Givan: I thank the Member for that, because he is right: making sure that the teaching profession and support staff have the confidence to know how to react in certain situations is important. We are reviewing the medication in schools guidance to make sure that it is as up to date as possible and that there is support in those scenarios.

Mr Speaker: We move on to topical questions.

Mr Givan: I do not have the precise figures, but the Member highlights an issue that is of concern and on which we are proactively engaging. If you are not in school, you are not able to gain the benefits of that educational environment. Driving up attendance rates is an important issue for us. The situation has been exacerbated as a result of COVID and the lockdown approach. Those who advocated lockdown, denying children the opportunity to be in a school, have a lot of questions to answer about why they took that approach. We are living with the outworkings of that, where children and families have been impacted on. The attendance figures are significantly lower now than they were pre-COVID.

To encourage Members, Knockmore Primary School in my constituency has a scheme called HERO, which stands for here, every day, ready and on time. It is a competitive process by which classes drive up their attendance levels. There are updates every week, with assemblies in which good attendance is rewarded. The measures that that school is taking have increased the level of attendance.

I do not have the particular figures, but that is an area that we are actively working on.

Ms Hunter: Thank you, Minister. Some of the children who spoke to me to about their reasons for staying off mentioned bullying, anxiety and awaiting ADHD and autism assessments that would help them in the classroom. What is your Department doing to address those issues, and what do you say to children who are at home today when they should be at school?

Mr Givan: I thank the Member for the invitation to speak to children. I say this to them: schools are a great opportunity for you to develop socially and educationally. We will be there to support you to overcome the barriers that you may have for not wanting to be at school. They can be varied, but support is there.

A huge amount of work goes in to facilitating and supporting young people who, at times, have legitimate and very difficult issues to overcome in order to get to school. The Education Authority is there to provide that support. I want those children to be in school. It is the best place that they can be in order to develop. We will provide the support that is needed to those children to be able to facilitate them in our schools.

Mr Givan: I thank the Member for this opportunity because, whilst I could not take part in the debate earlier, I sat in for a good hour. It is useful for Members to be reminded of the significant work that the Department and my party have driven forward in the past year. When we took up office, we secured £25 million of Executive funding. We have been able to provide for 14,000 children, which has far exceeded our expectations. We believe that that is reaching over 90% of children in Northern Ireland who could avail themselves of that support. That is making a real difference in terms of the subsidy. To date, the scheme has provided over £5·4 million in savings for working families. Combined with tax-free childcare, that sits at £11 million.

We have invested an additional £7·6 million in existing early years programmes such as Sure Start, Pathway and other schemes that Departments asked us to support, such as the Department of Health's fair play grant schemes. We have also reintroduced the Bookstart programme for Northern Ireland. We are training more childminders. We have enhanced funding for Irish-medium preschool support. We are piloting schemes for additional approved home childcare providers. We have commissioned the Royal College of Speech Language Therapists to produce resources for those working with young children. We have launched a new preschool education inclusion support fund. We have increased the funding for PlayBoard to provide training on the importance of play in early years. One of the most significant developments has been a major expansion of preschool education so that an additional 2,500 children will get a full-time place in September this year. More will follow in successive years.

Ms Brownlee: I thank the Minister for that fantastic answer. Can you provide any assurance about the continuation of the childcare subsidy scheme? I have received a number of emails from parents who have benefited from the scheme and welcome it but want to know whether it will continue into the next financial year.

Mr Givan: I thank the Member for the opportunity to continue, because I was running out of time.

We have also commissioned NISRA, which is undertaking a major household survey. That will provide us with information through data that has been collected from the childcare subsidy. That will inform our next steps as we develop the strategy. We have allocated funding to the Department for the Economy to carry out the in-depth assessment of sustainability challenges. Whilst my Department has delivered on countless measures, one Department was asked and volunteered to support me to put in place financial support for providers. We are waiting on Invest NI to do that scoping work to allow us to provide that support. I listened to some Members being critical, but I have listed everything that I have been doing. This is an Executive-wide approach, yet there is one Minister who is doing the work. All I ask is that other Ministers step up. I will happily take forward the work, but I do need their Departments to provide me with that support.

On the continuation of the childcare scheme, we secured £50 million. I bid for more. Give me more and I will do more, but I can only use what the Executive allocate to me when that funding is provided. I will happily institute more measures to support our hard-working families when it comes to meeting those costs and getting more places in our nursery schools.

Mr Givan: The Education Authority landscape review, which was published in June 2022, gave a comprehensive review of EA's overall operation and governance and the extent to which it effectively delivered against the Executive and departmental priorities when it was established in April 2015. That included an assessment of the effectiveness of the EA's system of financial management and internal control, including demonstration of value for money when compared with the previous regional model. I have spoken before about the need for transformation in the EA. I have been critical, but I have made appointments — some appointments that Members in the House actually criticised me for. We are starting to make a difference, and that is coming to the tune of millions of pounds of difference. I ask Members to support me when I make those decisions, because they are yielding results.

Mr Kingston: I thank the Minister for his answer and for that detail. I do not doubt that efficiency savings are a priority in each budget-setting process. Perhaps now, with the 10th anniversary of the establishment of the EA approaching, this would be a timely opportunity to review what further efficiency savings and reductions in duplication have resulted and what further could be done, given all the demands on his departmental budget.

Mr Givan: I thank the Member for that, and I encourage him and other Members to continue to ask those challenging questions of all our public bodies around efficiency, because I ask the questions of all my arm's-length bodies that are accountable to my Department. Please continue to ask those questions.

The Education Authority and the Department will progress recommendations that came out from the landscape review. As part of that, I expect that there will be opportunities to identify further efficiency savings and reduce duplication across the services that the EA provides. In addition, I assure the Member that, in light of the challenging budget outlook that Education has faced and continues to face, my Department continues to press the EA for savings and efficiencies with a view to maximising my Department's budget allocation for the benefit of children and school communities. Every pound that we save through a more efficient public administration is funding that I can put towards our children and young people. I am not about protecting institutions and structures; I am about reforming them to make sure that we maximise every pound for the benefit of our children and young people. That should be our priority when it comes to taking these decisions.

Mr Givan: I absolutely agree with the Member. They are deeply valued. I suspect that the question goes back to the statement that I made on the reform of special educational needs. I outlined clearly that principals whom I meet have said, "I can support our children and young people in a more effective manner that is beneficial for young people's educational output and development and that creates a higher level of independence". Therefore, as we move through the reform of the SEN statementing process, we need to ensure that we give that flexibility to our schools, work on an evidence-based approach and act in the interests of the children and young people when are providing them with support. There are exceptional classroom assistants, and I want to identify pathways to develop their professionalism. I would love to see a pathway on to which we can move classroom assistants to allow them to become teaching assistants and teachers. It is an indictment of our system that one classroom assistant, whom I met in a school, has had to step out of her employment to go into full-time education to become a teacher. In other jurisdictions, they can take those classroom assistants, provide support and train them to become teachers. We need to find ways to provide those pathways.

Mr Baker: I thank the Minister for his answer. On that basis, Minister, will you give further reassurance to classroom assistants that you will continually consult with their trade unions and ensure that their pay and conditions and future pathways reflect their vital role in the classroom?

Mr Givan: Absolutely, I will do that. It is as a result of the positive relationship that we have developed with the trade unions that the pay and grading review was carried out. That was a significant piece of work requiring tens of millions of pounds to implement, and the Finance Minister worked with me so that we could secure the funding for it. That implementation process had two stages in order to reflect those agreements. We have implemented the first stage, and, come 1 April, the second phase will be implemented. That came about through the kind of cooperation that I believe there should be between the public sector, government and trade unions to make sure that we support our workforce. Similar to me, they want the needs of children to be front and centre of the kind of model that we seek to implement. I will continue to engage with them.

Mr Givan: I thank the Member for that question. I spoke on the need to make sure that we have the appropriate allied health professions aligned to those impact teams that are being set up. That will require the Department of Health to work with us to make sure that we can provide that support. Again, it is about making sure that we provide the right support when it is needed. It should not be the case that parents have to seek legal recourse to get a statement of educational need. That is a result of a failure in our provision, and we need to reduce the number of statements, but we will be able to reduce them only by providing the services in the first place.

Ms Nicholl: I agree wholeheartedly with the Minister's sentiment. What conversations has the Minister had with the Minister of Health about the number of allied health professionals that will be needed in schools not only now but in the future?

Mr Givan: I assure the Member that I have engaged with the Minister of Health on those issues. We have met the Member's party colleagues about special schools, but I have also engaged with the Minister separately. We have a joint Health and Education oversight group that will assist in how we develop that work. That group is led by senior officials in both Departments, and it will make sure that there is that collaboration. I have no reason to believe — in fact, I am more than confident to state this on the record — that the Minister of Health does not share the same ambition as me, which says that Education on its own cannot meet the needs and that those issues require the Department of Health to be involved in as well. I am confident that there will be collaboration as we seek to put forward a new way to provide support to those children and young people who need it.

Mr Speaker: That brings to a conclusion questions to the Minister of Education.

Mr Durkan: On a point of order, Mr Speaker. I apologise to you, the Minister and the Assembly for not being in my place to ask my question. I think that it is the first time that that has ever happened.

Mr Speaker: We will forgive you, Mr Durkan. You were 25 seconds late, so you were not too bad. [Laughter.]

You were a tad unfortunate today.

Just when we are on issues of protocol, Members, I see everything from up here, though people might not realise that. Over the past number of weeks, I have witnessed people bringing in coffee cups, cans and so forth. The only thing that you are allowed to have in the Chamber is the glass of water that is provided for you. This is not a Committee meeting; it is a plenary session of a parliamentary Assembly. All other receptacles are not to be in this part of the Building.

Most Members acknowledge the Speaker on their way out through the Chamber Doors. Some do not, which is not following the code. I also remind Members that the dress code is "smart". Some of you have a very loose interpretation of "smart". I encourage Members to dress smartly when they come to the Chamber. I am not demanding that gentlemen wear a shirt and tie, but I ask that Members dress smartly and look as though they are up to doing the job.

Those are just a few wee reminders

before we move to the next item of business. Members may take their ease for a moment while we change the Chair.

Ms Hunter: Thank you, Deputy Speaker. Mr Speaker will be delighted to know that I have just finished my can of Sprite.

I am delighted to speak in this important debate. I thank Órlaithí, most importantly, for tabling the motion. I know that the issue matters very much to her and is close to her heart.

In Northern Ireland, one in five of us is on an antidepressant. That means that, out of the 90 of us in the House, at least 18 are on an antidepressant. We all know that mental illness could impact on us at any time of our lives. I want to start by thanking the remarkable mental health advocates across my constituency who serve our community every day in East Derry. I will name but a few: the Olive Branch in Coleraine, the Limavady Initiative for the Prevention of Suicide (LIPS) and, of course, the many men's sheds from Coleraine and Portstewart to Dungiven and Foreglen. We are blessed to have many charities and trusts in my constituency that are committed to tackling those issues.

We cannot talk about mental illness in the North of Ireland without addressing the complexity of our past, which was so traumatic. That trauma has travelled through the generations, contributing to high levels of post-traumatic stress, alcoholism and, sadly, domestic violence. It has shaped our homes. To this day, our past shapes who we are. The North's legacy of violence and intergenerational trauma is undeniably linked to higher levels of mental illness in the place that we call "home". The best way for us, as political reps, to serve our citizens with regard to mental ill health is by knowing how traumatised they are due not only to the Troubles but to the lives that they have lived and their childhood experiences. On that, I ask the Minister of Health to look into conducting a Northern Ireland-wide survey of adverse childhood experiences (ACEs). I would like to see that. It would be really important.

What are ACEs? They include experience of physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, witnessing domestic violence, substance abuse in the household, mental illness in the household or the incarceration of a family member. Sadly, owing to the complexity of our past, those things are prevalent in our society. We need to recognise the impact of adverse childhood experiences on physical and mental health. We are talking today about tackling stigma. An important part of that is about being led by data and research. It is evidenced that adverse childhood experiences can shape health later in life, increasing the risk of chronic diseases, mental health disorders and unhealthy behaviours.

All the issues that I have just mentioned are met with stigma in our society. A survey is badly needed to understand the complexity of childhood experiences that can contribute to mental ill health. Mental ill health affects families across our region, particularly young people. As I mentioned during Question Time, a profound issue is the lack of access to services and assessments and the pressure that that puts on our young people to thrive in an education system that is not built for them and their needs.

Mr McNulty: Will the Member give way?

Ms Hunter: Certainly.

Mr McNulty: Does the Member agree that it is recognised that students are coming into our third-level institutions with major anxiety issues and mental health challenges and that universities need to be resourced with expertise and funding to help those people navigate their mental health challenges as well as the education system?

Mr Deputy Speaker (Mr Blair): The Member has an extra minute.

Ms Hunter: Thank you, Mr Deputy Speaker. I thank the Member for his intervention. I absolutely agree with him: mental ill health can affect all aspects of our life at any time. That is especially so when you are a student, which is a difficult time for anyone, and our university campuses should drive home the strong message that mental health support services should be available and should be robustly funded.

A huge aspect of the wider social issues that contribute to mental ill health is the lack of available housing. I see the stress that housing stress can put on people who are unable to provide a safe and happy home for their children, despite many efforts to seek housing. I see that at first hand in my constituency every day.

Substance abuse and misuse highlights the fact that there is real complexity when it comes to dual diagnosis. People fall between addiction services and mental health support services and are often ping-ponged between the two. Those people are a really vulnerable group in our society, so, when we speak about the mental health strategy, it is so important that we realise the urgency of the issue.

Earlier today, I touched on how there is so much financial pressure on parents, with the increasing cost of housing, rates, rent, bills and food. It is really vital that we think about that and about how economic challenges feed into poverty.

I got into politics after, sadly, I lost my best friend, Zachary, who died by suicide in 2017. In this job, on a range of issues, I think of him often. I always think, "He really is the funniest person I have ever met and probably ever will meet". There is a sadness and an irony in that, because he was probably the happiest person whom I have ever met, yet he is no longer with us. We should all keep an eye on our friends, family and colleagues and remember that depression is not always obvious. Sometimes, people think, "Am I depressed only if I am experiencing suicidality?". No. If you have been down for long periods and are considering therapy, go for it. Do reach out. People are there, and they are keen to listen. It is so important that we have essential services in place for people bereaved by suicide and for those who have experienced miscarriage.

Minister, I know that mental health is a priority for you. I hope that, in the coming months, we will see a well-funded mental health strategy.

Mr Deputy Speaker (Mr Blair): The Member's time is up.

Mr Durkan: I welcome the motion; indeed, I welcome the progress that we have made as a society on tackling the stigma around mental health. To be fair, I recognise the role that some in the Assembly have played in that battle. I very much include the Minister in that, from long before he was the Minister.

I have had a huge interest in mental health for many years. I am not saying that that by any means makes me an expert. My interest predates but could not prevent my sister's suicide, which, if anything, highlighted to me — we all have experience of this, and Cara has shared hers — the fact that nobody is immune to mental ill health and that just because someone is smiling that does not mean that they are not suffering.

Over the years, we have seen mental health go from being a niche issue to something that is on everyone's mind and every politician's lips. I remember a time when a school visit would consist of questions about ice rinks and the school curriculum, but now the first question from any group of young people is invariably about the need for improved mental health support and services. People have much less bother talking about mental health — young people certainly do — but what are the Executive doing about it?

"Reach out and seek help", is the message that we hear and propagate. We encourage people to take the courageous first step, and society rightly applauds them when they do. However, we do not often ask, "What next?". What happens when a person in the depths of despair drags themselves up to reach for a lifeline that just is not there? They free-fall and often self-medicate or self-harm; they try anything that might help them escape, even if only for a wee while. Some suffer in silence, and others do the opposite, their pain laid bare as they try to numb it with drugs or alcohol. The failure to provide timely, accessible and meaningful support results in escalation, a spiral into addiction and more difficulty in accessing appropriate services. That is where stigma and judgement really do still exist. We need to be able to distinguish someone who is in pain from their destructive behaviour. Too many vulnerable people fall through the gaps, and, if the fact that drug-related deaths have trebled in a decade does not underscore the need for a dual-diagnosis approach to mental health and addiction, I do not know what will.

There is still a lot of work to do despite the advances that I have mentioned, and, of course, we support the motion. The mental health strategy needs to be fully implemented, but it also needs to be fully funded. The Minister outlined his funding difficulties yesterday, and I am sure he will do so again today. Reducing the stigma will need more than public awareness and education campaigns: it also depends on improved access to proven treatments and work in support of and partnership with other organisations to provide people with the support and safety nets that they need.

With cuts in funding to and the closure of vital projects — I think of the Men's Action Network in my constituency — and the perennial threat to other services, such as our much-needed crisis intervention service, along with the long waits to access support, the valiant efforts of so many in the statutory and community sectors are being undermined. Breaking mental health stigma is about more than raising awareness; it depends on government action to create a society in which mental well-being is valued and supported. We need to invest in and improve mental health services to smash the stigma that is now developing around them.

Mr Carroll: I thank the Member who moved the motion. There is no doubt that we, as a society, need to change our attitude towards mental health. Mental ill health is nothing to be ashamed or embarrassed about. If mental health was destigmatised, more people would speak up and more people would realise the struggles that are faced by many — unfortunately, too many — across the board.

It is also vital that we look at the structural issues that affect people's mental health. Mental ill health is not a personal failing. Viewing the issue as a personal failing ignores structural oppression, especially that faced by women, people from ethnic minority communities, people with disabilities and many others. Issues like anxiety and depression are 25% more common among young people who live in the North than they are among their peers across the water, and we need to listen to the voices and experiences of the people who are impacted by those issues.

Anti-stigma and anti-discrimination public awareness and education campaigns are important and worthwhile. We should destigmatise mental health issues, but we cannot normalise the mental health epidemic, and that is what it is. Poverty, debt, income inequality, discrimination, loneliness and climate breakdown have a devastating impact on mental health. The North has some of the highest levels of multiple deprivation in the UK and across these islands, as well as the highest prevalence of mental illness. That is no coincidence. We cannot solve the mental health crisis without challenging capitalist ideology and reality, which has created the conditions for mental ill health to thrive.

Our social security system is supposed to support people who are experiencing illness, including mental health issues, but instead the system is causing its own mental health crisis. Too many people experience anxiety when attending jobcentre appointments and personal independence payment (PIP) assessments. They experience depression when they are sanctioned and forced to live below the breadline. Our housing crisis is also driving our mental health crisis. Poor living conditions, such as damp and mould, overcrowding and hidden homelessness massively impact on a person's mental health. A 2023 survey by Depaul and the Simon Community shows that, of all the people experiencing homelessness in the North, a shocking 70% have a diagnosed mental health condition. Again, those connections are not coincidental.

It is one thing to talk about the issues but another to act and create a change. Unfortunately, the North spends less per head of population on mental health than other regions across these islands. That reflects a systemic and repeated failure on the part of the Executive to take the mental health epidemic seriously. Funding needs to go directly to services that help people who need it most. Services, such as West Wellbeing in my constituency of West Belfast, which provides essential care to the community, are constantly battling for funding so that they can keep their doors open, pay workers and keep delivering services to people who desperately need them. Where the state has failed to provide mental health services for people in need, charities such as West Wellbeing and many others are often left to pick up the pieces. Mental health services —.

Mr McCrossan: I thank the Member for giving way. Will he join me in voicing our appreciation to the community and voluntary sectors throughout each of our constituencies, which have worked tirelessly to support people? If it were not for their work over the past number of years, mental health services in Northern Ireland would have collapsed.

Mr Deputy Speaker (Mr Blair): The Member has an extra minute.

Mr Carroll: I agree with the Member and thank him for raising that point. Community and voluntary services do a vital job, but they need to intervene when the state has failed to treat mental health as a public health issue and an emergency. Therefore, I agree with the Member's point.

Mental health services need sustainable, long-term funding. Without that, all the positive sentiments in the world from here and elsewhere will make no difference. The Executive need to be held responsible for not prioritising funding to support the mental well-being of working-class communities and communities across the board.

There should be no economic barriers to accessing mental health services. It is frankly inhumane to allow those with wealth to access the services that they need via private healthcare whilst working-class people are left behind.

Mrs Dillon: I thank the Member for giving way. Does the Member agree that, for all the reasons that he has outlined, it is vital that the Minister stays loyal to his commitment to tackle inequalities in health? It is absolutely one of the biggest issues. The Member for Foyle Mark Durkan referred earlier to the issue of addiction to drugs and alcohol. We absolutely need to tackle that, because it is where the stigma lies. The Member is absolutely right.

Mr Carroll: I thank the Member and agree with her. We must tackle health inequalities, and the Minister should proceed with that. We also need to tackle wealth inequality in our society. There are too many rich people and too many poor people. That is often not talked about or addressed in this Building or by the Executive.

It is inhumane to allow those with wealth to access the services that they need via private healthcare whilst leaving working-class people just to deal with it or to get on with it, as if that is a normal way of running life and society.

I support the motion, but it was important to air those points in the debate.

Mr Deputy Speaker (Mr Blair): I call the Minister of Health to respond to the debate. Minister, you have up to 15 minutes.

Mr Nesbitt (The Minister of Health): Thank you, Mr Deputy Speaker. I begin by acknowledging and thanking the mover of the motion. I have known and worked with Órlaithí Flynn for long enough to know of her genuine passion for the area of mental ill health and of her willingness to set aside party politics to get consensus. We will see that at the end of the debate, because the House will not divide on the motion. I thank her for that. I thank my officials. As always, they have provided a comprehensive speaking note, but, on this occasion, because we are focusing so much on stigma, I will, with no disrespect to those who authored the speaking note, speak slightly differently. I also acknowledge the loss of loved ones, particularly of Mr Durkan and Ms Hunter.

It is well documented that my main experience of mental ill health was with my wife, Lynda Bryans, who, 30 years ago, was diagnosed with clinical depression. It turned out to be antenatal depression. She was bearing our first son. Mr Deputy Speaker, if you do not mind, he turns 30 on Monday, so, if I say in advance, "Many happy returns, Peter J Nesbitt", I guarantee that he will not speak to me for at least another month. [Laughter.]

Because of her experience, Lynda decided to talk about it and to confront that stigma. She gave many interviews in the media; she did many, many talks for community and mental health groups; and she was the face of the first Public Health Agency (PHA) campaign on mental health. On more than one occasion — not a huge number, but on more than one occasion — somebody has told me that they had read what my wife had to say about mental health, or that they had attended one of her talks, and then said, "I believe she saved my life". We do stuff, but we can never do enough. As is the case with suicide, the only acceptable number is zero.

Another experience that I have had of mental ill health was as a victims' commissioner. Mention has been made of the great work that is done by community and voluntary groups. I saw that at first hand in their dealing with victims of our conflict. There is no stigma with those groups when people who have poor mental health come to them, because it is so common; it is probably the most toxic legacy of our Troubles. They understand it, they name the problem and they embrace it. They are role models for us and, yes, we can do more, working with them, to address the stigma.

Where else should we be tackling the stigma? In schools. We work on the emotional well-being of pupils, but, some years ago, I read research from the Department of Education that stated that the majority of pupils surveyed said that they would be reluctant to discuss, or have some degree of difficulty in discussing, their mental ill health with a teacher or member of the non-teaching staff, and that they would be much more likely to engage with their peers. It is not a question of teaching and empowering a school-aged boy or girl to be a counsellor; it is about empowering them to know how to engage with a friend of theirs who they can see is clearly not quite right, and, potentially, signposting them to where help is available.

We can also do it in the workplace. Mrs Dodds made the point about so many women being told that they should get over themselves and get on with it. When Lynda had her clinical depression, she was working for the BBC in London. She came home for a couple of days one time, and I knew that she was not right. I decided to phone her editor — I would love to name him, but I will not — to try to engage him and tell him that Lynda was not well. His response was, "Pour her a large Bushmills and make sure she catches up on her sleep". That was the advice.

There are things that we can do, as MLAs and elected representatives. Some years ago, in my constituency, I started the Ards Suicide Awareness Group, because of people in the constituency who had lost loved ones to suicide. We raised some money and, with it, started commissioning safeTALK programmes in the big housing areas in Newtownards. They are for only a few hours and, again, do not make you a counsellor, but they give you the confidence to engage with people whom you think are behaving in a way that is worrying. You know the right questions to ask, and you know how to signpost them to help. Again, that safeTALK group and the people whom we were talking with in the housing areas in Newtownards were not talking about stigma any more. They were talking about how we could practically help people who were in trouble.

Somebody said that I would mention funding, and, of course, it is an issue. I will say something gently to Mr Donnelly. He said, quite rightly, that the percentage of spend here on mental health issues is not as high as that in England, Scotland and Wales. Let us remember that percentages are not absolutes. Look at the absolute budgets. I will make a point that I have made before: independent analysis, not least that by the Fiscal Council, says that, for every £100 that NHS England spends, we need between £104 and £107 to deliver the same services. If we include social care, the figure would be £109. Under next year's Budget, it will be £101·50. There is a problem with the funding.

Miss McAllister: Will the Minister give way?

Mr Nesbitt: Yes.

Miss McAllister: I appreciate that your Department did not get all the budget that you require. While I respect that the requirement could be between £7 and £9 more per head, it equates to £144 more per head right now, as I highlighted in Committee. Clearly, something is going wrong. We need to look at the way in which we spend our money, so that we can tackle the root of the issue, instead of spending more money at the top and not getting to the problems at the bottom. The reality is that more money is spent here than in England and Scotland, but why is that happening? Why are we inefficient?

Mr Deputy Speaker (Mr Blair): Interventions should be brief.

Mr Nesbitt: It is a very complex area, as the Member will acknowledge. I believe that, if we achieve the shift left, it will take a lot of pressure off the acute hospitals, which is where the very expensive stuff takes place. It is incredibly complex, and we have seen that in the pressures on EDs over the winter. It is about the flow. There can be a blockage in the flow at any point from leaving the home to being discharged from the acute hospital.

I wanted to make a point about public awareness campaigns. There has been something of a moratorium on advertising by the Department. I am exercised by that. I wonder, had we been doing the sort of advertising that we would normally do to promote vaccines, particularly the flu vaccine, whether the uptake would have been better and to what extent? I wonder whether it may be a false economy to save money by not advertising on specific issues. I have not come to a conclusion on that. I am aware of a successful businessman, who might have been a Fortune 500 chief executive. Many years ago, he famously said, "I spend millions every year on advertising and marketing, and I know that 50% of it is wasted. If I can ever find out which 50% that is, I will cut it out". Again, it is a very complex issue.

I turn to public attitudes to mental health. An exploration was undertaken through the mental health survey to inform future work to address stigma and public awareness-raising activities. Mrs Dodds gave a definition of stigma. It is a complex, multifaceted phenomenon for which there is no universally agreed definition in health. There are many aspects to stigma, and therefore measuring it is complex. A multisectoral subgroup has been developed to progress work on communications and public awareness. Currently, it is focused on three key areas: research, best practice and targeting brand and digital campaigns.

The Public Health Agency carried out a digital discovery exercise in April and May last year. The aim was to explore the role of digital tools in supporting mental health promotion, early intervention and prevention across Northern Ireland. More than 110 stakeholders engaged in that process through one-to-one interviews, focus groups and workshops. Reports from the digital discovery exercise have been shared with contributors and stakeholders. It provided an analysis of the current digital landscape for mental health promotion and early intervention. It outlines a road map for the phased development of a collaborative mental well-being platform.

Mr McNulty: I thank the Minister for giving way. Minister, how concerned are you about the digital area in which we now exist? The proliferation of social media means that young people have to deal with a whole new set of circumstances online, which has an enormous impact on their mental health and well-being.

Should social media companies be levied? Should they be obliged to have signposting corners or awareness campaigns that are constantly active on their platforms to direct young people who are in a place of crisis to the fact that there are always avenues for relief?

Mr Nesbitt: I thank the Member. In trying to transform the laws of defamation, I tried to address issues with the internet, though not necessarily the specifics to which he refers. We all know about people searching what is commonly known as "Dr Google" — other search engines are available. That can lead to bad outcomes. Then there is the pressure, not least peer pressure, particularly for young people, on the internet. As politicians, not just here but in London and, indeed, probably globally, we are always playing catch-up with the advances in technology that necessarily include significant downsides that may pose significant health risks, particularly but not exclusively to young people.

I am looking for a strong partnership approach, but it will need significant funding to progress all these plans. Discussions are under way with my departmental digital mental health forum to identify potential avenues to take all that forward. If we genuinely want to achieve the required improvements in our mental health services and ensure that the services that we provide can meet current and future demands, mental health services need real and sustained funding to ensure full delivery of the mental health strategy. As I said yesterday, for this year's action plan, we should have £42 million: we have £5·9 million.

I will begin to conclude by encouraging all Members to support my efforts to achieve that outcome. In answer to the motion, I am open to all discussions, ideas and proposals that enable us to provide better mental health services for people across Northern Ireland. I want to deliver anti-stigma and anti-discrimination public awareness and education campaigns. Where collaboration with other Departments or community and voluntary sector partners can achieve that, we must take those opportunities. Again, I stress the incredibly valuable role played by community and voluntary sector organisations. I close as I began by thanking the Member for moving the motion.

Mr Deputy Speaker (Mr Blair): Thank you, Minister, for that response to the debate. I now call Liz Kimmins to wind up on the motion. You have up to 10 minutes.

Ms Kimmins: Go raibh maith agat, a LeasCheann Comhairle.

I too thank the proposer of the motion, my colleague Órlaithí Flynn. As others said, Órlaithí is passionate about the topic. Her contribution demonstrated her passion so clearly, and she led us to challenge ourselves in how we talk about mental health. Órlaithí and one of the other Members talked about how we often say things and use connotations and language that we do not generally even mean to be harmful, but that in itself is symptomatic of some of the issues that impact on people who have mental ill health and the stigma that they feel.

The debate was excellent. We are all agreed that reducing the stigma around mental health and mental illness is absolutely crucial for improving access to care so that people feel comfortable to take that step and get the support that they need when they need it. We recognised very strongly today that stigma leads to discrimination and social isolation and a real reluctance to seek help or treatment. As others have said, that leads to further problems when a crisis develops. Stigmatised beliefs about mental illness can prevent individuals from getting treatment. As I said, that leads not just to their problems worsening but to the care that they need escalating. We talked earlier about the acute pressures on our hospitals. If we are able to get this right at the earliest possible stage, it can lead to a reduction in pressure elsewhere and better outcomes, which are key to all of this.

Many Members talked about the historical connotations and how our parents and grandparents potentially talked about people with mental ill health. We have lots of examples. I know, even in generations of my family, about the stigma that surrounds someone in the family who has mental ill health, and I am talking about decades ago. Throughout our family, we were always very much aware of someone who, in times gone by, had probably been hidden away or institutionalised. In today's society, they may not need that form of treatment and might be able to get the right support in the community and have the opportunity to thrive, be part of the community and lead the life that they wish to lead. There are so many sad stories from our past, and some of those things are, to an extent, probably still happening. However, there has definitely been a real shift towards better understanding and a real willingness to try to reach out and help people where we can.

The importance of raising awareness and talking has been critical to the conversation. I thank the Minister for sharing his personal experiences. I know, Minister, that you have talked about your wife on many occasions and how she has used her experiences to advocate for others. It is so important that people do that, and we have had service users here today who are advocating on behalf of all the many other people who are experiencing mental ill health so that we can make the changes that are needed. We have to move forward. We have talked a lot about raising awareness, and that includes education, but this is a real cross-cutting issue.

Robbie Butler talked about the Prison Service and his experience with it. When we look at the experiences of young men in particular in the justice system, whether they are in custody or on remand, we see that issues can arise because of the stigma around mental health. If they are not getting the right support, that can lead to reoffending and other issues. We really have an opportunity here to try to reduce that stigma so that those people can get that support, whether it is in a facility such as a prison or other community facilities. That could be the catalyst for making the changes in their life in many other ways.

When it comes to raising greater awareness, we also have the early intervention piece. We have a real opportunity to ensure that our schools and third-level colleges etc play their part as well. However, I think that our young people are very in tune with mental health, and that is a testament to the huge amount of work that has been going on for so many years to normalise those conversations. A culture of change is definitely happening at school age, because it is normal to have those conversations and to talk about your mental health and your feelings from a very early age. Some of the things that my children, who are of playschool age, say when they come home show me that change is really happening in that people are able to talk about their feelings. The fact that that is being done in an age-appropriate way that helps children means that it is something that they can carry through. Work is happening, and things such as the Healthy Happy Minds funding and all those initiatives can also play a huge part.

The debate has crystallised the Assembly's willingness to work together not only to dispel the myths around mental illness but to reduce stigma and support people in seeking help and in talking about the issues. We talked about the various elements in all our lives that can trigger mental ill health and how the things that we take for granted will not have that impact. We talked about antenatal and postnatal health and the menopause. We also talked about the impact on males. A lot of the debate has focused on the huge role of the community and voluntary sector in addressing mental illness and suicide prevention. The Well, which is in the Ballymartin/Kilkeel area, is one example of how a community came together following a number of incidents of suicide to form an organisation that is run completely by fundraising but that, I have no doubt, has saved many lives. That was born out of a number of suicides of young males in that area, and the community knew that it had to do something.

Mr Carroll: I thank the Member for giving way. She mentioned young males in particular dealing with mental health. Is she as concerned as I am that, given the lack of funding, resources and services here, it is quite often the case that young males in particular are being dealt with by the police when they are locked up, when they should instead be dealt with in a mental health setting? Does she agree that that is the wrong approach to take to people with mental ill health?

Ms Kimmins: I thank the Member for his intervention, and I agree absolutely. That goes back to my original point about people who have been arrested or are in custody or on remand. A lot of the reasons behind what is happening are to do with a lack of understanding about what people may be dealing with when it comes to mental health. If those people could get the right support at the right time, things could change for them.

Mr Nesbitt: I thank the Member for giving way. I just want to address Mr Carroll's concerns. He might be aware that a new policy is coming forward called Right Care, Right Person, which is a collaboration between the PSNI, the Department of Health and the Department of Justice, and it will address that very concern.

Ms Kimmins: Absolutely, and I thank the Minister for his intervention. The Health and Justice Committees had a joint briefing on that important policy. However, we need to ensure that the resources are in place for that to be delivered properly. Concerns have been raised about who will do that, and that will be a job of work.

I think that we are all in agreement that this is an issue that must be addressed. It is important to tackle the chronic issues that many people are facing. As some Members said, we are in a post-conflict society, which, I believe, has led to the high number of cases of mental ill health that we see. That is why there is a greater need for us to tackle that head-on and ensure that we are doing everything that we can. There is a responsibility on us all. I understand the budgetary pressures that the Minister outlined. Funding the mental health strategy is critical, and I know that the Minister, as a champion of mental health, will do all that he can to ensure that we achieve what is needed. I hope that we can continue to work together across the Assembly, the Department of Health and all Departments to really tackle this issue, reduce the stigma and improve the lives of people across the North.

Mr Deputy Speaker (Mr Blair): Members, take your ease before we move to the next item of business in the Order Paper.

Mr Deputy Speaker (Dr Aiken): In conjunction with the Business Committee, the Speaker has given leave to Pádraig Delargy to raise the matter of improved access to the accident and emergency department at Altnagelvin Hospital. The Member has up to 15 minutes.

Mr Delargy: Go raibh maith agat, a Leas-Cheann Comhairle.

We have heard much in the media and in our constituency offices about winter pressures. Addressing those pressures requires a coordinated response involving the Department, trusts, community organisations and others to ensure that the emergency services remain effective during the challenging winter months. That involves expanding access to primary care and community health services in order to manage non-emergency cases outside emergency departments, which can help to alleviate the pressures. In Altnagelvin, those pressures are faced all year round. There is a clear and demonstrable need for a new fit-for-purpose emergency department at Altnagelvin.

Our role is to highlight issues that our constituents are facing and to be the voice of our community and every single person whom we represent.

The focus of the debate is on highlighting the transformative impact that a new, adequately sized and adequately resourced emergency department would have on the people of Derry and the north-west. Today, I will focus on the voices and experiences of our healthcare staff, ambulance crews and patients. I will focus on two strands: the need for a new department and for immediate solutions.

Altnagelvin Hospital has the oldest emergency department in the North. It was built to see 40,000 patients a year, and it now sees between 70,000 and 80,000. Derry is the heart of the north-west region. We have seen what can be achieved when we deliver healthcare on a joined-up, all-Ireland basis. We have seen the change that the North West Cancer Centre (NWCC) and coronary care services deliver when we look at provision in that context. It has significantly enhanced the lives of people in our area and, as the evidence shows, delivers more effective health outcomes.

Recent changes in circumstances have added to Altnagelvin's workload. They include the removal of general and emergency services and general emergency surgery at the South West Acute Hospital (SWAH); the reduction in orthopaedic and urology consultancy at Antrim Hospital; and no max-facs care in Sligo. In addition, Altnagelvin has been the trauma centre for the north-west and the point for coastguard referrals. We need an adequately sized and adequately resourced emergency department.

Altnagelvin has reported the longest waiting times of any emergency department in the North. From arrival to admission, Derry's accident and emergency waiting time was 19 hours and 52 minutes in 2021, while it was 19 hours and 58 minutes in 2023. Those figures do not accurately reflect the reality, because some coronary care incidents, strokes and accidents are admitted straight away or referred to Belfast, which distorts the figures.

In achieving a new emergency department at Altnagelvin, we need to future-proof it to ensure that we do not face the same problems in years to come. We need a flexible plan to cope with population growth and increased demand. It is about the impact that that has on individuals, however. It is about those in mental health crisis, children, older people, those with chronic conditions and those with dementia.

We have received dozens of testimonies from staff and patients in Altnagelvin. We have been contacted by scores of people who have been there themselves or with a loved one in extreme despair or distress but have no separate facility to go to. They often feel stigma when sitting in A&E, sometimes accompanied by police officers, and are afraid of knowing someone there and of the judgement that comes with that. There is one consultation room for patients who are undergoing a mental health assessment. Staff have told us that they need at least three.

There is another side to that. A lack of consultation rooms also means a lack of privacy to deliver bad news to families or a loved one or to inform patients who have a terminal or life-changing illness. We have heard from the mother of a child aged seven with a broken arm who, because of the lack of beds in the paediatric ward, waited for eight hours until her child passed out from the pain. There are two beds in what needs to be a five-bed department. Dozens of older people have contacted us to tell us that they feel afraid in A&E. We have also heard numerous times about the lack of physical infrastructure. There is one toilet in a waiting room. That is one toilet for upwards of 100 sick people; one toilet for people suffering with Crohn's, kidney stones or many other issues; one toilet in which there have been multiple reports of drug-taking; one toilet for clinically unwell patients. Where is the infection control? Where is the dignity and safety for patients?

We have heard from Ambulance Service staff, who have told us that they are tied up, sometimes for 16 hours, at A&E, preventing them from getting to other emergencies. Faster processing times at A&E would mean that ambulances could return to service much more quickly.

All the staff we spoke to mentioned feeling burnt out and having extremely low morale that has been exacerbated by an inadequately resourced A&E. They mentioned assaults — verbal and physical — and leaving due to the lack of consistency and training. I thank the Minister for his recent visit to the A&E at Altnagelvin, during which he thanked the medical staff for the:

We in the Chamber have the power to begin to change things in Altnagelvin. We can upgrade support for healthcare staff to reduce burnout and introduce flexible staffing solutions and incentives, along with targeted recruitment drives, to increase workforce numbers. None of that will happen overnight, but getting a business case signed off and fast-tracked would be a good start.

There are immediate solutions that the Health Minister could implement today. He could commission inpatient beds in Altnagelvin; look at the number of consultants and junior doctors who serve their placements in Altnagelvin and work in Altnagelvin; and increase the number of nursing home beds and access to domiciliary care. On the issue of commissioning inpatient beds, it is difficult to get a bed in the emergency department, but it is also difficult to get beds across our hospital. We heard from a patient who was triaged at 7.00 pm. They were on an IV drip and had to sit on a plastic chair in a corridor overnight. Inpatient beds can be commissioned for Altnagelvin today. I would love to hear from the Department on whether it has looked at demand and capacity, whether there has been an assessment of how appropriate the bed numbers are for the population and what metrics are used to do that assessment.

When it comes to staff training and consultants, Altnagelvin's numbers reflect neither the local population nor the need. The Belfast Health and Social Care Trust has 2·8 times as many consultants as Altnagelvin. In addition, while Altnagelvin does between 60% and 70% of the cardiology work that Belfast does, we have two cardiology registrars when Belfast has 14. That accentuates the higher poverty and deprivation stats as well as the health inequalities, which the Department of Health has acknowledged.

This is not a zero-sum game. It is not about removing staff from other areas. I acknowledge that specialist services are reserved for certain hospitals to ensure that patients receive the best life-saving treatment, but a 7:1 staffing ratio does not stack up. That is significantly higher, even with an allowance for specialist provision. Our objective today is about equity and adherence to the Department of Health's commitments to regional balance, tackling health inequalities and removing barriers to healthcare. People in my constituency are as entitled to that as anyone in any other part of the North.

The number of doctors trained in Altnagelvin is also lower. Why does that matter? It matters because fewer trainee staff get experience in Altnagelvin, fewer get experience outside Belfast and fewer get experience in the areas in which, we know, they are needed. We need to bring in more locum staff at junior and middle levels, because that would have a positive impact on the number who stay and train here before they become consultants.

We spoke to numerous junior doctors during their strike who mentioned friends in Belfast, talent leaving our area and never getting the chance to gain employment in our trust area. Why would they work in Altnagelvin when they would have to work every three or four weekends, while their friends in other trust areas and other specialities sometimes have to work only two weekends per year? As with strand 1, what metrics does the Department use to allocate junior doctors across trust areas.

On nursing home beds and domiciliary care, a colleague mentioned in the Chamber yesterday that there are hundreds waiting to get into hospital and hundreds waiting to get out. Last weekend, 532 people across the trust areas were fit to be discharged. Implementing a more efficient triage process and patient management system to ensure faster assessments and healthcare would help to tackle that. We know that nursing home beds and domiciliary care are scarce in all areas, but it is particularly pertinent and most acute in the Western Health and Social Care Trust. Patients face prolonged stays due to insufficient community care options. A lack of sufficient capacity in domiciliary care means that beds are used for longer, even though patients have been deemed medically fit to leave hospital.

I ask the Minister to press ahead at pace to pay domiciliary care staff and social care staff adequately — I acknowledge the fact that he is already working to do so — and to implement a specific recruitment strategy in the broader social care sector.

I say this to the staff in Altnagelvin A&E: "We have your backs. We will be your voice in Stormont and in every other political Chamber to ensure that a fit-for-purpose emergency department is delivered for Altnagelvin." To the patients who have shared their experiences with us I say, "Thank you. Thank you for putting your trust in us to represent you. We will stand with you and with every person in Derry and across the north-west to demand equality in access to healthcare."

Building a new emergency department in Altnagelvin will not happen overnight, but we need to work together to get the business case agreed and fast-tracked. We cannot stand still until that happens. Today, I ask the Health Minister to commission more inpatient beds in Altnagelvin; to look at a recruitment strategy that mirrors the demographic trends and meets the guidelines for tackling health inequality that the Department of Health has published; and to ensure that there are clear pathways for patients who need nursing home and domiciliary care packages. I thank the Minister for being here today and sincerely hope that we can work together to deliver.

Mr Deputy Speaker (Dr Aiken): Thank you, Pádraig.

Ladies and gentlemen, because of the number of Members who want to speak, Members who are called will have five minutes, and, if you take any interventions, you will not get any extra time.

Gary Middleton, you have five minutes.

Mr Middleton: Thank you, Mr Deputy Speaker, and I thank the Member who secured the Adjournment debate.

I begin by paying tribute to the staff at Altnagelvin, to Neil Guckian, the chief executive, and his team for all the effort and the work that they put in daily to make Altnagelvin the hospital that it is. Over the past years, we have seen some fantastic advancement in the facilities at Altnagelvin, not least of which is the radiotherapy centre. Those are positive steps forward in ensuring that the best healthcare is available to people when and if they need it.

As has been mentioned, Altnagelvin Area Hospital is the oldest hospital in Northern Ireland and was built in 1960. When it opened, it had 391 beds. Today, it has 472 inpatient beds and 36 day-case beds. The Altnagelvin emergency department is one of the busiest in Northern Ireland. The statistics on Monday showed that the average waiting time was 89 minutes. I appreciate that that is the average and that, in many cases, people will wait much longer than that. We hear and see stories in the media of those who, unfortunately, are left in an unacceptable situation where they wait for many hours, if not many days. That said, there are many positive experiences in the emergency department too, and we must recognise that there are people who go in and get out and are dealt with efficiently and effectively.

As for the emergency department, there will not be a person in the Chamber or, indeed, anyone across Northern Ireland who would not want to see a new and improved emergency department. We all want to see that. We know that the emergency department at Altnagelvin is not fit for purpose, not least in providing support for those who come in with particular mental illnesses. We were contacted today by the Alzheimer's Society. What special arrangements are in place for individuals who suffer from dementia, for example? When a new A&E department comes along or when a business case is put forward, all those issues need to be taken into account. It needs to be an inclusive facility that meets the needs of everyone in our society, regardless of their background or the issue that brings them to A&E.

One of my concerns about access, which has not been touched on just yet, is access to GPs. That is an issue that we really have to grapple with. From my personal experience, many people feel that, if they cannot get access to their GP to address the issues that they have, they have no alternative but to show up at the emergency department, even though that, obviously, is not the best place for them. We have to look at why people go to the emergency department in the first place if they do not particularly need to be there.

The other issue, which has been touched on, is that of bed-blocking and the lack of beds and community care in our communities. That is another issue that needs to be addressed in order to ensure that people can be discharged effectively and in a timely manner to allow more people to come forward.

It is important that the Minister come forward with timelines. My understanding is that a business case has to come forward. We would like to see that approved as soon as possible. Politically, there is an onus on all of us to support the Minister in his work to ensure that he receives the funding. I offer that commitment: I will be lobbying to ensure that that finance is there. Not only do the people of the Foyle constituency deserve it, but the staff and those who meet the needs of the community in that facility very much deserve it.

Mr Durkan: I welcome the discussion and thank the Member for bringing it to the House. I welcome the opportunity to put on record our sympathy with the hundreds, if not thousands, of families who feel failed by the situation at Altnagelvin, our solidarity with the super staff who are struggling day and night to see and care for a steady tsunami of patients and our support for any initiatives to improve the situation and any investment required to do so.

Most of us will have borne witness to the huge demand at Altnagelvin. I had to bring my two-year-old son to accident and emergency one night in the run-up to Christmas. Believe it or not, it was not that easy a decision to make, knowing the pressure that staff and the system were under, but, on the advice of a health professional, we packed our bags and prepared for the long haul that lay ahead. Once there, I spoke with elderly patients who sat on chairs for hours on end, and families who lamented the lack of privacy and dignity as loved ones were treated in hospital corridors or cupboards. There was a look of sheer exhaustion on the faces of overstretched staff as they worked doubly hard again to cover for colleagues who had fallen foul of flu. Every patient to whom I spoke that night, and every person from whom I have heard since, or even before, about their Altnagelvin experience have praised the staff but cursed the system and the set-up. I should add that the care that our Naoise received and the reassurance that we, as parents, received that night was amazing.

Of course, the problems that we see at the emergency department interface are symptomatic of many other problems that plague our health service, not just our hospitals, including a lack of access to care packages to let patients get home, workforce issues and delays in treatment and discharge. Many patients cite referrals from their GP, and others cite the fact that they could not get to see theirs. The issue is much wider than A&E alone, but that is where many of the problems come together. Combined with a combustible mix of people presenting in mental health crisis and others often under the influence of all sorts of substances, it creates a chaotic picture that leads some people in need of urgent care opting not to seek it.

The Western Trust has made efforts. Plans for a new emergency department at Altnagelvin have been in the pipeline for some time. The trust does not need us to tell it that the current provision is not fit for purpose. Almost six years ago, we were told that the business case was submitted to the Department for consideration as part of its 10-year capital priorities plan, but the cash to deliver that upgrade was not there, and there was no voice in the Chamber at that time to do anything about it because the Assembly had collapsed. A new business case has been submitted. As others have said, we need to see that being progressed without delay. Other improvements have been made. We have seen the introduction of a children's area and the opening of a new minor injury unit, which aims to divert 17,000 patients a year away from the main ED. The patients are all singing its praises. The PSNI has a new custody suite, only across the road, and that takes another bit of pressure off.

Despite those interventions and the Herculean efforts of our heroic health workers, the situation is worse than ever. Why? Years of inaction, underinvestment and political paralysis have pushed our health service into a state of emergency. There has been no driving of, or funding for, the transformation that we need. Instead, we have seen the collapse of services across the North and then a transformation or reconfiguration sticker put on them. It is evident that the situation at Altnagelvin has worsened since the reconfiguration at the SWAH and elsewhere, as Mr Delargy indicated. Have bed capacity and staffing resources at Altnagelvin been increased to cope with an increase in patient numbers?

I have spoken before about the particular challenges that trusts face in border areas. We used to risk losing staff to Brisbane; now, they can go to Bridgend for better pay and conditions. That needs to be recognised in the capitation formula. The Member who secured this topic for debate called for a joined-up approach between trusts, the Department and community organisations, but we need to see a joined-up approach here and in the Executive. The Executive need to agree priorities and agree to fund priorities.

Mr Deputy Speaker (Dr Aiken): Mark, can you bring your remarks to a close, please?

Mr Durkan: OK. The health and well-being of our constituents will always be our priority.

Mr Deputy Speaker (Dr Aiken): Thank you, Mark.

Ms Ferguson: Like many other Members, I commend the work of the chief executive in the trust, the senior management staff and our healthcare workers, who are going way beyond the realms of supporting our most vulnerable people when they are in crisis and where they need support. I commend the work that they are doing, despite the circumstances and the conditions in which they operate.

As we all know, long waiting lists have become the new norm. That is all year round now, not just as a result of winter pressures. The Royal College of Emergency Medicine, in a report last year, reemphasised that. Like you, Gary, last night at 11.00, I checked the waiting times. It is fantastic that we have those statistics. Altnagelvin had the worst of the 10 A&E departments across the North. Last night at 11.00, the wait was 339 minutes. So, if I had felt really unwell last night and needed support, I would have had to consider whether it was worth my going there to sit for five and a half to six hours before I could see someone. Tom Black from our local GP federation has emphasised that people who are sitting in Derry today are thinking twice about going to A&E despite the fact that they are seriously unwell. That is something to consider.

We can go on about statistics, and we have all the information and statistics. The most up-to-date hospital statistics that you can get are for September 2024. There are statistics on the number of attendees and performance against a four-hour target at type-1 EDs during September. The Royal children’s hospital saw 67·8% of patients within four hours. It was the highest performer. None of our EDs was performing. Altnagelvin's ED saw 30·6% of people within four hours, which is fewer than one in three. Similarly, targets for the number of attendees and for performance against the 12-hour target are not being met. In A&E in September 2024, 1,182 people waited for more than 12 hours, the fifth worst across the 10 hospitals. That shows the scale. We are all truly aware of it. Moreover, the people in our communities are fully aware of it. I know that the Minister is aware of it, and I thank him for coming to the A&E and meeting the staff and meeting local patients who had been sitting waiting for days.

Most Members will have had experience of A&E. I have had local experience with a mum who is 82 with dementia and who was brought in by ambulance and lay in a corridor in a plastic chair for many hours. She was diagnosed 10 hours later in a corridor and was crying and confused. It took until 4.00 am before she got a bed. I am not blaming the staff — they were absolutely amazing — but this is what we are dealing with. I have been in with a grandchild, who was throwing up after a fall and had vomit all over her. You are trying to get her to a toilet, which you have to queue up for, despite the fact that others require it. It is really bad and so many people are queuing outside the doors, particularly at night. They cannot even get a seat in the waiting room of A&E.

It is really bad, and it is critical that we are discussing it today. We simply do not have enough space in A&E in Altnagelvin. We have myriad people with complex medical conditions waiting for treatment in confined spaces; that is totally inappropriate. Likewise, we have staff trying to provide healthcare in those settings who are under immense stress and pressure. They do not have the space and the equipment, As we know from the Royal College of Nursing report last week, they have said that they are going home feeling that they cannot do their job and provide healthcare with dignity and respect. They have highlighted the idea that patients are at risk of infections etc.

As my colleague Pádraig Delargy emphasised, we need to look for solutions in the short term to support our healthcare staff and, likewise, to provide good care for our patients. That is about expanding our primary healthcare services, community healthcare services and district nurses at a local level. It is also about increasing our workforce numbers with targeted recruitment, particularly for A&E, and increasing bed spaces. I just want to re-emphasise that there are key areas of work that we, in the Assembly, along with the Minister, the Department and the trusts can be looking at in the short term —

Mr Deputy Speaker (Dr Aiken): Will the Member draw her remarks to a close, please?

Ms Ferguson: — before, hopefully, securing a new A&E for Altnagelvin. Thank you.

Ms McLaughlin: I thank the proposer of the Adjournment debate. He has clearly articulated the dire state of the A&E facility in the second city. I also thank the Minister for being here and listening to the facts and figures and the testimonials from the citizens of the city and the wider region. It is a regional hospital that is important to many people throughout the West. My biggest thanks go to the chief executive and all the staff in the Western Trust, particularly those staff who are working under really poor conditions in the emergency department.

One of the things that has been clearly articulated today is the need for regional balance when it comes to delivering healthcare. People are probably quite sick of me talking about regional balance constantly in an economic context, but it is absolutely vital that we have health equity because poverty drives inequalities in health, and we can see that in the Western Trust. It is often under the most severe pressure. People are struggling to meet the demands placed upon them in our growing population and increasing complexity of needs, as others have said. Altnagelvin is situated, as I said, in one of the most deprived places anywhere in the North, where people bear the brunt of health inequalities. The Western Trust has 24 health outcomes that are worse than the Northern Ireland average. Male life expectancy in the most deprived areas is 73 years — five years lower than the trust average. I have heard the Minister talk about those inequalities in the House as well. In the most deprived areas of Derry City and Strabane, people are dying seven years earlier than the Northern Ireland average.

Let me be clear that the physical state of the emergency department is no longer fit for purpose. We cannot wait for the long-term solution for this, which is a complete rebuild. We need to think of short-term interventions. It is too small to cope with the volume of patients coming through its doors. Shockingly, as others have said, it has just one toilet, and it is disgusting. I cannot begin to tell you how disgusting it is. It is not only inadequate, it is utterly unacceptable for the staff and patients who rely on this vital service.

The Health Minister has indicated that it could be five years before a new emergency department is built — five years. That is five years of continued overcrowding, patients waiting for hours without care and staff battling to provide dignity and support in conditions that would challenge the most robust system. I have heard a GP call the situation in Altnagelvin "Third World healthcare". She had to go there to advocate for her patient, who she knew was having a stroke, because they had nobody else to turn to in that situation. That is not good enough.

The delay is unacceptable. It fails the people of our city and region. The situation has become so critical that, over the recent holiday period, Altnagelvin was forced to issue an appeal for staff on Facebook. For a hospital to rely on social media to ensure that it could provide basic care to its patients is a stark illustration of how close to breaking point our health service has come.

As others have articulated, we are consistently witnessing bottlenecks in the emergency department. That is not just in our emergency department; it is across the region. Those bottlenecks are not just a capacity problem but a symptom of the failure to reform the system to deliver a preventative approach. If we want to break the cycle, we need to start addressing the root causes. We talk a lot here about those root causes. It means investing in community care, expanding GP services and tackling chronic staffing shortages. It also means tackling poverty and its symptoms, including poor health.

We have spent decades talking about transforming the health service. Reports have been commissioned, consultations have been hosted and debates have been —

Mr Deputy Speaker (Dr Aiken): Sinéad, can you draw your remarks to a close, please?

Ms McLaughlin: — [Inaudible.]

We need interventions now.

Miss McAllister: I thank the Member who proposed the topic for the Adjournment debate. I appreciate that, usually, Adjournment debates are very much constituency-based, but, as health spokesperson for the party, I will say that, regardless of the constituency that you are based in, it is important that you advocate, raise awareness and highlight issues across Northern Ireland.

It is my understanding — the Minister will correct me, if I am wrong — that Altnagelvin's A&E department has the oldest physical structures of any such department in Northern Ireland. On my last visit to Altnagelvin A&E, which was in a personal capacity, I was reminded of the structures that previously existed in the Royal Victoria Hospital. The state-of-the-art facility that is there now stands in stark contrast to what we have at Altnagelvin. That provides hope that we can do better and have better facilities. However, we also need to learn from what is going on at the new maternity hospital that is being built in Belfast and ensure that, when the Western Trust completes the development of Altnagelvin, all those stumbling blocks are not there in the first place. There are lessons to be learned from that.

Like many Members who sit on Committees, we in our party are contacted by constituents from across Northern Ireland. Some of the contact that I have had about Altnagelvin in particular has been about some of the issues that have been raised. I recall a mother who contacted me. She had left her young child in order to bring her mother to A&E. Her mother was elderly and frail but perhaps not as frail as those who were waiting in ambulances. One issue that she raised about the time that she was waiting with her mother was that older people — they are more susceptible to confusion, may not know where they are if they are sick with infection and may need help with their basic needs — may not be able to be assisted in the physical structures at Altnagelvin due to its washing and toilet facilities. In Committee, the Minister confirmed that. He said that, when he visited the department, he came across a patient who had been there for days and did not have access to those facilities. We hear it not just from constituents but from the Department and the Minister.

I recognise that there is a commitment for a new build. However, short-term measures are needed. When we debated the motion on ambulance waiting times last week, I reached out and spoke to colleagues in emergency medicine and the Ambulance Service. I understand that they presented short-term measures that could be implemented because of the winter pressures and then stepped down. Maybe the Minister could relate to us any such measures that could be taken to make physical changes at Altnagelvin.

I will move from short-term measures to transformation. My party advocates transformation, and I have no shame in saying that. Across Northern Ireland, we have seen the consequences of doing it piecemeal. Piecemeal transformation or transformation by service collapse results in pressures elsewhere: it is about just shifting it from one place to another. That is why, when it comes to true transformation, we need to do it on the basis of looking at the whole approach: what impact will closing one area have on another area? I would like to hear from the Minister about the opening of the minor injuries unit. Has there been a review of that? What has been the benefit? What analysis has been done to make it better? I also want to encourage a holistic approach to transformation. We need to ensure that people outside Belfast, particularly in rural areas or areas that are harder to reach, are not left behind. It is really important to ensure that all our hospitals are on a community transport network.

I am encouraged by hearing from Members today about the new business case that is being put forward by the Western Trust. I am perhaps not encouraged by not knowing that we will not come under the same pressures or face the same issues as the Belfast Trust. Perhaps the Minister could commit today to keep on top of that as we move forward over the next five years; hopefully, it will not be longer than five years.

Ms D Armstrong: I hope that the Member does not mind my adding a few brief remarks to his Adjournment debate. As he will understand, there are deep ties between Altnagelvin and the South West Acute Hospital in my constituency. Not wishing to fall foul of your direction, however, Mr Deputy Speaker, I will focus my remarks on the emergency department at Altnagelvin.

Following changes to emergency general surgery, more and more of my constituents have to attend Altnagelvin ED. The winter pressures that have been on display in recent weeks have once again shone a spotlight on the fragility of our emergency departments. Patients sometimes do not receive the care that they deserve, and far too many staff are asked to work in environments that are wholly inadequate. Whilst corridor care is by no means unique to Altnagelvin, no one who has been in the ED will be in any doubt that a new building is required. The current facilities are too outdated, too limited and far too small for the sheer number of patients and staff whom they are meant to accommodate, so I welcome the Department's ongoing commitment to delivering a new emergency department at Altnagelvin.

I am conscious that the Minister has been in Altnagelvin emergency department in recent weeks and witnessed first-hand the many physical limitations of the existing facility. Equally, I am mindful that, whilst the Department is supportive, delivering the scheme will require financial wherewithal. The Department of Health, probably like every other Department, likely has a capital plan that is more ambitious than the available funds allow. Given that, difficult decisions will undoubtedly have to be taken, with some individual projects being prioritised over others. As I said, however, the Minister of Health can operate only within the financial envelope that he has available.

I am hopeful that, if the project has cross-party support, as, I sense, it does, the Executive collectively will not only prioritise it but make available the funds to deliver it. In the meantime, I appeal to the Minister to keep pressure on the Western Health and Social Care Trust and his departmental officials to maintain momentum in the development of the full business case for the new build. That would allow the project to proceed as quickly as funding becomes available.

I add my tribute to the staff of Altnagelvin Area Hospital, who operate in the conditions that we have heard about, and I thank them for the work that they do.

Mr McCrossan: I thank the Member who secured the Adjournment debate.

There is no week or weekend that I do not receive a text message, phone call or other form of communication from people who are sitting in the emergency department at Altnagelvin. They sit there for endless hours in pain, on hard seats, if they are lucky enough to get a seat — some sit on the floor — some of them desperate to be seen. As we speak, at this very moment, there are people in such situations in Altnagelvin's emergency department. Although we have recognised for years the serious situation that we face there, we are still talking about it and not seeing any action taken. The culpability for that lies with Members of the House. It is our responsibility to do something about it. When we should have been taking action on the business case six years ago, the Assembly was not functioning. Today, when it is functioning, we are unified in our view of the emergency department at Altnagelvin and are well aware of the problems there, yet we are still talking about them.

The Minister must know, as the rest of us do, that all the problems in our health service will not be fixed today or tomorrow — there is a lot of work to do — but what can be fixed is the situation and environment in which people wait for urgent care in the emergency department at Altnagelvin. With the greatest respect to everyone who works there, animals do not sit in such conditions. I have personal experience of that emergency department, so much so that it frustrates me to the point of anger. I have seen the inhumane conditions that vulnerable people from our communities — taxpayers who have worked their entire life — are expected to sit in. Reference has been made to the one toilet: it is disgusting. It is a hive of infection. There is no access to water or food, and people have had to sit there for hours — 19 hours or 21 hours — over and over again.

Weeks before I sadly lost my mum in August, we made our trip to the Altnagelvin emergency department. One of my last memories of my mum, in the final weeks of her life, was that she cried sore because she did not want to go to that emergency department. She knew what she was about to face: chaos. We could not even get her a nebuliser. She sat for so long that we had to take her from the emergency department back to Strabane, get her nebuliser and take her back down the road. Is that the level of healthcare that we offer people who are struggling with illness and disease, vulnerable people and people who expect and deserve better from the system? We have had enough of excuses. We have had enough of talking about planning. There is no justification whatever for any of our people — family members, friends, neighbours or constituents — having to sit in those dire conditions.

The staff have lost the will to work there. They are at their wits' end. We talk about the retention of staff in hospital emergency departments. Why would they work there when they have been treated so badly? They are worked to the bone. They are exhausted. Some staff have said that Altnagelvin's emergency department is not safe, while others have said that they cannot cope. On every occasion that I have visited someone in that emergency department and walked into the waiting room, which is the size of a prefab hut, people call me over and say, "Daniel, I have been sitting here since last night. Please speak to someone", "We cannot get this. We cannot get that", "Please get my mother seen" or, Please get my father seen". That is real life. While this place sometimes operates in a bubble, there are people out there in pain, struggling and suffering, and nobody in our society should endure what I have witnessed in the Altnagelvin emergency department. It is unforgivable.

Let us stop talking about the business case for the new emergency department. Let us get it done. Let us hope that the Minister of Finance speaks to the Minister of Health and gives him the money in recognition of the situation and that he then gets it done, for enough is enough. All of us at some point will rely on that emergency department to save our life or that of a loved one.

Mr Deputy Speaker (Dr Aiken): I call Maolíosa McHugh. Maolíosa, you have four minutes.

Mr McHugh: Go raibh maith agat, a Leas-Cheann Comhairle.

I welcome the opportunity to contribute to the debate. I am an MLA who lives in Castlederg, and the hinterland includes the parish of Aghyaran, the Corgarys and Meenakeeran, which goes up almost to Barnesmore Gap. The residents must travel 40 miles to get to the nearest hospital and emergency department, which is at Altnagelvin.

I will comment on the experience of two families. In the first case, an elderly woman, who had come through an operation for cancer, was referred to A&E by her doctor and went there. She sat there for three nights — three nights — on a chair. I am often surprised at some of the statistics for waiting times. She spent three nights on a chair. So critical was her condition that her family took her home because she was in greater need of rest than she was of seeing the doctor in Altnagelvin. In the second case, the family had a similar experience, but they stayed the three days. The man's wife carried food into him in the waiting room in Altnagelvin. He described the hospital as being like something from a Third World country. Security was needed for those who were in the waiting room, given some of the antics that were happening there. Food was carried in to that man for three days. He was then admitted and operated on immediately, and he had stents inserted. Had his family taken him home, as the other family did, he could have died on the street on them. It is as simple as that. That is the kind of pressure that we are experiencing at Altnagelvin, and it is imperative that we react to it.

I welcome the suggestions by my colleague to the Minister on the short-term measures that may be adopted. We know what the long-term solution is, but money has to be found to implement the short-term measures. It is not good enough for the Minister to say to me, as he did yesterday, that I am living in a utopian world because I desire and hope for better medical provision for all residents of the north-west.

Mr Deputy Speaker (Dr Aiken): I call the Minister to respond. Minister, you have up to 10 minutes.

Mr Nesbitt (The Minister of Health): Thank you, Mr Deputy Speaker. I thank Pádraig Delargy for securing the Adjournment debate. It is an important issue, and I very much accept that.

Let me start with a very important positive. I am fully supportive — fully supportive — of the need for a new emergency department at Altnagelvin Hospital. I am aware of the depth of concern and feeling that surrounds the issue. I was there recently. I have been to six EDs since Christmas. I will be in the South West Acute Hospital — the SWAH — tomorrow. While they are all different — Altnagelvin, as we have acknowledged, is the oldest, which presents its own infrastructure problems — there is a commonality that I have picked up from all six. Patients who check in are not just asked for their health and care number: far too many of them are also asked to surrender their dignity and their right to privacy. When I was in Altnagelvin, I talked to the wife of a patient. The two of them had been in chairs for four days. Four days. That is not right, and it is not fair on the staff — the nurses and doctors — who are suffering moral injury, because they know what they can do.

That is not just the case in Altnagelvin; it is happening in the six EDs that I have recently visited. Generally, in the resuscitation area — the resus area — of an ED, there will be clinicians and nurses. However, if the resus area has five bays and there are six or seven patients who need resus, how do you square that circle? How do you riddle that? What you have to do is make a decision, not on the best option but on the least worst option. You are going to have to move a patient out of resus who is not ready to be moved because there is a patient who is worse off and needs in.

We talk about winter pressures, but I have stopped talking about them. I now talk about "additional winter pressures" in recognition of the fact that the pressures on EDs are now happening 365 days a year. I will say to the House what I have said in all those EDs to members of staff: I understand that we cannot continue endlessly to try to run healthcare, and particularly emergency departments, on goodwill, because goodwill is finite. It will run out at a certain point. That point will be different for different people, but everybody has a limit to their goodwill.

Returning to the specific issue of Altnagelvin, the current space is not adequate to support current or future numbers. As Mr Delargy said, it was built to support approximately 35,000 patients per annum. It is probably receiving double or just over double that number. We will get a new ED at Altnagelvin. If I am being realistic, I think that five years is the quickest time in which it could be done. Mr Durkan mentioned the fact that we have been at this for a while. The first business case was for multiple facilities, and the decision of the Department was that it would be more realistic, practical and achievable to break it up into single units. That is why there has been a second outline business case, specifically for an emergency department. I have been told not to suggest that getting it through to final business case and then to construction will be done in fewer than five years.

Mr Durkan: I thank the Minister for giving way. Will he clarify that that was the decision of the Department and not the decision of a Minister?

Mr Nesbitt: My decision?

Mr Durkan: No, any Minister.

Mr Nesbitt: Any Minister. Yes, OK.

Mr Durkan: Because we had none.

Mr Nesbitt: I do not want people to think that nothing is happening. A couple of Members mentioned the relatively new minor injuries unit, which opened on 25 March 2024. The direction of travel here is that it is often not required. If you go to the GP, get a diagnosis and are told by the GP, "You need to go to an acute hospital", you go and sit for those 300-plus minutes, waiting for a second assessment. The second assessment is redundant — it is not required — in some cases. Therefore, a referral directly to a minor injuries unit would take some pressure off. It is also a much better pathway for the patient. Some settings have dedicated areas, such as respiratory and cardiac units. Again, we are moving to the point where GPs make the direct referral, so that second, unnecessary assessment, which comes at the cost of sitting for hours or, perhaps, days in chairs or standing in the ED, is done away with. There is a respiratory hub at Altnagelvin — it was established in September 2021. I have been in it. It is a really good facility. There is also a cardiology assessment hub. That was initiated as a result of COVID-19. Patients are triaged there and assessed by an experienced cardiac nurse. Those things are happening.

It is important to ensure that the proposed solution for the new ED delivers the benefits that are needed and represents value for money. Nuala McAllister made the point about what has been happening in Belfast. I do not think that anybody can stand over that. We certainly do not want to see it repeated. Nuala also talked about not doing these things piecemeal. That is why, in October 2024, I launched the consultation, 'Hospitals — Creating a Network for Better Outcomes'. We have to view Altnagelvin and all the hospitals, including SWAH, in the other geographic trusts, as an network. Not every hospital will do everything. The result should be that we develop hospitals that have specialisms. I want to see best practice rolled out across Northern Ireland. That does not mean in every hospital, but every service should be best practice. As well as that consultation, I published the three-year strategic plan, in December. It sets out a path for the future, based on three pillars: stabilisation; reform; and delivery. By April 2027, subject to additional funding, which is a big question, we will further reform urgent and emergency care through exploring and, subject to analysis, developing a regional 111 urgent care service. Through investment in Hospital at Home and immediate care services, we will offer better and more appropriate alternatives, where appropriate, to emergency departments.

I turn now to some of the remarks that were made by Members. I very much welcome Mr Delargy saying that he and, I believe, everybody in the Chamber wants to work with me and the Department. However, with respect, we need some common agreements. Mr Delargy suggests that faster processing times would help ambulances. I agree, but: it is a, "Yes, but", from me, because, even if you doubled the size of the ED at Altnagelvin, with the appropriate staff, you would not cure the problem. The problem emerges and is evident in EDs, but the problem is not the EDs. It is the flow. Over this winter, the biggest block has been at the back door, not the front door. It has been the lack of community capacity by way of domiciliary or home care packages and care home beds. Those issues cannot be fixed very readily, but I am determined to work on them. Mr Delargy acknowledged that I have decided to give the real living wage to people who work in domiciliary care. It is important to make that sector more attractive. The salaries and the daily rate simply are not attractive at the moment.

At one point, I think that Mr Delargy compared staffing levels at Altnagelvin with the levels in the Belfast Trust. With respect, that is not really comparing like with like. We can compare the Western Trust, which has more than one hospital, with the Belfast Trust, which has more than one hospital, but comparing one hospital with a whole trust does not really do it for me.

Mr Delargy: Will the Minister give way?

Mr Nesbitt: Yes.

Mr Delargy: Minister, for clarification, I mentioned Altnagelvin, but I intended to say "the Western Trust", so it was a comparison between trusts.

Mr Nesbitt: I accept that.

Sinéad McLaughlin mentioned equity and regional balance. I am very keen on that. She will be aware of the fact that my Live Better initiative to tackle health inequalities has two demonstration areas, which are coming soon, and one of those is the Moor district electoral area in her city. I am very optimistic that it will start a process. One of our measures has to be healthy life expectancy. Since devolution came back in 1998, we have not shifted the dial in the right direction.

Thank you for the debate. It has been very helpful for me. Let us be aware of and absolutely honest about the issues. Let us address them urgently, but let us not use language that might have the effect of putting people off visiting EDs when that is where they really need to be in order to get the healthcare that they require.

Mr Deputy Speaker (Dr Aiken): Thank you, Minister. Thank you, Pádraig and everybody for taking part in the debate.