Jim Wells
South Down · Democratic Unionist Party · Northern Ireland
“On a point of order, Mr Deputy Speaker. In November 1982, I made my maiden speech in the Chamber, and, here we are, 40 years later, and I am making my last speech in the Chamber as a DUP MLA. I was the last person in the Public Gallery when the Assembly collapsed in 1976.”
“<BR /> <BR />Mr Deputy Speaker, I thank you for your indulgence and for your patience with me over many years. Unfortunately, Mr McGlone has just left the Chamber; I was about to thank him. I have enjoyed my 27 and a half years in this Building.”
“I wish that I could, but I have only five minutes. <BR /> <BR />That was so that a very small number of Irish language zealots could go in and register their marriage or civil partnership in Irish or in dual language: £261,000. Did anybody stop to think about whether there was a more cost-effective way of doing that?”
“We are all perfectly happy with a genuine expression of people's culture. That is fine. However, when the language is so cynically used by militant republicanism, unionism has difficulties. Why, for instance, is there no translation into Irish of the words, "United Kingdom", "Londonderry", "Northern Ireland" or "Her Majesty The Queen"?”
“The Member has made the point for me. The official who came to the Committee made it absolutely clear that £261,000 had been spent already. It was farcical to bring that before either the Finance Committee or the Assembly, because the money had been spent and the processes had been set up.”
“If they want the unionist community to accept the Irish language as a genuine cultural expression, they should get rid of the political baggage and extremism, and stop using the Irish language as a political weapon to try to subjugate unionism.”
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“Rev William McCrea, MP for South Antrim, has raised the issue with particular reference to Antrim Area Hospital and the distress that this can cause families. Without prior notice, I cannot give the Member the figures. Mr McCrea's approach prompted me to make a mental note to investigate the issue because it seems to be a problem throughout Northern Ireland, apart from in the major Belfast hospitals. We will investigate the issue and see what can be done to help families in this very distressing situation.”
“Once again, we are in a situation where there is only a finite number of experts on this issue at consultant level. We are finding it hard to recruit. I am afraid that this issue will come back time and again: the labour market in health is tightening rapidly. From nursing to middle-grade doctors to consultants, we are finding it very hard to recruit the necessary staff. At the end of February 2015, there was a total of 555 patients waiting for diagnostic sleep study, and 128 of those had been waiting for nine weeks. A total of 127 patients have been waiting for over nine weeks in Belfast, and one in the South Eastern Trust area. I will expand on those figures and send the Member full details.”
“I do not have the exact details on the numbers that are waiting. We would have to obtain those from the five trusts, but I am more than happy to write to her with specific details and to provide a bit more update on what we are doing to improve this service, particularly with the link to Edinburgh and trying to take the load off the Belfast Trust. I think that we are running out of time here.”
“It is disappointing that some sleep clinic patients are waiting longer for appointments. That is a particular problem in the regional services that the Belfast Trust provides. Again, that is due to staffing issues. The Health and Social Care Board is working with the Belfast Trust to expedite the transition of sleep clinic services to other trusts to help waiting times. The Belfast Trust is also making every effort to cover the workload until the staffing issues are resolved; for example, by obtaining additional limited capacity in Edinburgh.”
“He mentioned the Robinson Hospital, and I think that we need to disseminate this good practice throughout Northern Ireland because we are still losing far, far too many people to this awful situation.”
“<BR /> <BR />Another issue that I will highlight relates to the fact that the majority of those who commit suicide in the Londonderry area do so in the river. I congratulate the Western Trust for taking action on that. For instance, it is putting up cameras at the appropriate spots to identify those who perhaps are considering suicide. The trust is making signs on the bridges — it really is the bridges that are concerning — more informative by giving warning to those who are considering taking such drastic action. Foyle Search and Rescue has told me that the vast majority of people who it rescues have not slipped but have jumped into the river and, therefore, are contemplating suicide. <BR /> <BR />Therefore, the Member is right to say that there are examples of good practice.”
“I recently attended a meeting in Gransha with the Western Trust. It is quite clear that the Western Trust is taking the lead on this issue. It worries me slightly that, as you go around Northern Ireland, you see little pockets of excellence being carried out by various trusts but not much evidence of it being shared with the rest of Northern Ireland. One of the things that the Western Trust told me is that 72% of those who commit suicide in Northern Ireland are totally unknown to the health and social care system. That shows you how difficult it can be to identify those who have mental health issues that can lead to suicide. What is even more worrying is that over 40% of those who subsequently committed suicide had presented to A&E and were not picked up as suicidal during that visit. The Western Trust was concentrating on that.”
“I would like to think that the lead that some Internet providers like Sky have already adopted will be brought in for all the companies. If someone wants to access this material, that is up to them, but they need to register for it, and it needs to have a blocking mechanism so that no one under 18 can see it.”
“That is why I welcome strongly that the entire Executive — this is unusual — have agreed to jointly fund a strategy on the issue. The money — I think that it is £80,000 — has been made available, and we are going to develop a strategy for Northern Ireland. Without pre-empting that, I would like to hope that the situation will arise that means that this hard-core material, bullying and all the associated risks to our young people will be automatically blocked unless an adult registers to opt in to it. I simply cannot understand why the big multinational Internet service providers allow our young people to have unlimited free access to material that is totally unsuitable and desperately damaging to their emotional and physical welfare.”
“The Member has asked a very useful question. If he was on my Back Benches, you would say it was a plant. It is something that is incredibly important, because unfortunately the growth area, as far as danger to our young children is concerned, is in the Internet and electronic media. There have been some extremely worrying developments. As a recent BBC 'Spotlight' programme showed, several hundred young girls had their Facebook images used for pornographic images. Also, there was a report recently that showed that a high proportion of eight-year-old boys have been exposed to sadistic pornography, which is absolutely appalling. <BR /> <BR />Issues that were totally unheard of when many in the Chamber were young are now rampant.”
“Therefore, both jurisdictions agreed that that was the core area that we needed to analyse in particular. We are going to work together to see what is best practice in the Republic and Northern Ireland.”
“I had a very useful meeting with the Health Minister of the Irish Republic last Wednesday in Londonderry, in Altnagelvin Hospital. We found ourselves singing from the same hymn sheet on this issue. Both jurisdictions are bringing forward strategies to deal with suicide. We are at different stages in the process, and we agreed at that meeting that there was little merit in having a joint all-island strategy but that there was huge merit in officials from both jurisdictions getting together on a regular basis to share best practice on this very important issue. <BR /> <BR />We identified that, on both sides of the border, the particularly difficult area is males between 15 and 50, particularly unemployed males from socially and economically disadvantaged areas, and the important role that alcohol unfortunately played in suicides.”
“At least there is some encouragement that these policies are beginning to work.”
“Therefore, the various activities that have been carried out by the Departments have been successful. However, we cannot be complacent, because 280 — I think it is 286 — suicides have a hugely devastating impact on a society the size of that in Northern Ireland. It is reckoned that every suicide in the Province affects 60 people directly, because of the close-knit society that we have. <BR /> <BR />Therefore, I am pleased that at least we seem to be getting some progress on this very difficult issue. The Lifeline initiative has had 655,000 callers in the last year up to February 2015, and interventions were required for 13% of those callers. It is handling 2,244 calls per week. We are putting a total of £7 million into the budget for suicide, and almost half of that goes into Lifeline.”
“I found the meeting last week — last Thursday — to be very useful, and not because I chaired it. There was buy-in from all of the Executive, which was shown by the fact that Minister Durkan, Minister Storey and Minister McCann were all present. If other Departments were not represented by Ministers, a very high-powered group of officials came along to represent them. We worked well together. <BR /> <BR />The main work of the group is to refresh and update the Protect Life strategy, which was rolled out over the last two years. The good news is that the number of suicides in Northern Ireland has dropped from about 303 in 2013 to a provisional estimate of just over 280 for 2014. That is despite a situation in other parts of western Europe where the numbers have inexorably grown. So, we believe that the strategy is working.”
“The ministerial coordination group on suicide prevention has helped to ensure improved cross-departmental engagement in addressing suicide. Cross-departmental work has taken place through sporting organisations, rural networks and in justice settings, libraries and schools. The group last met last week on 16 April, a meeting that I chaired, to consider the first draft of the front-line intervention section of the suicide prevention strategy that is in development.”
“However, I am sure that, in the Chamber, Members have at least a dozen or 15 similar projects, and if I conceded on this one, no doubt they would be in to see me to demand similar treatment. I had a group in the other day from Crossmaglen demanding similar provision in that area. Both made the point, as you have, that the present facilities are very poor. I accept that, but the present budget does not give me much in the way of funding. <BR /> <BR />That is in the Southern Trust, to which a large range of schemes have already been committed. For instance, we are putting £16 million into the health-care hub in Banbridge, £11 million into Craigavon for rewiring —”
“A new Ulster Hospital general ward and acute services block is costing us £210 million. The Omagh local hospital will benefit some of the lady's constituents, and there are new health and social care centres in Ballymena and Banbridge. There is the new children's hospital on the RVH site, and paediatric services at Daisy Hill and Craigavon hospitals. <BR /> <BR />We are trying to squeeze as much as we can out of that budget, but, in the absence of something happening post-general election or some great success in the monitoring round, it is difficult to see how I can commit myself to that sort of funding. The Member will, of course, say that it is only £3·5 million out of a £203 million budget.”
“I have promised the Member and Lord Morrow that I will visit Loane House in Dungannon, so I could easily combine a visit to Oakridge with that. I am sure that, now that she has reminded me, my diary secretary will be beavering away to ensure that that happens. <BR /> <BR />That project would have a capital cost of £3·5 million. For next year, I have an entire capital budget of about £203 million. By the time you take in all that I have committed to, and what my predecessor Mr Poots, and, indeed, Mr McGimpsey, committed themselves to, that leaves us with next to no money for any new initiative. <BR /> <BR />It is important to emphasise what we will be spending money on in 2015-16. I mentioned the new radiotherapy block at Altnagelvin; we are doing a new north wing in the same hospital.”
“My Department is in the final stages of reviewing the business case for the replacement of the Oakridge social education centre in Dungannon. Due to current financial constraints, a number of projects under consideration, like this one, cannot be progressed as no funding is available. The timeline for completion will, therefore, be dependent on appropriate business case approvals and, ultimately, budget availability.”
“We have moved a long way from the Twelfth field at Markethill, assuming that it is still relevant to the question. The 15% efficiency saving in the PHA is in administration; I need to emphasise that. We targeted administration as the way to make savings in the health service without affecting front-line care. We examined carefully the savings proposed by the PHA, and we believe that they are achievable in a way that does not cause difficulties to the essential work that we all recognise that the PHA is carrying out. It will be a stretching target; I accept that. Still, many of the programmes that the PHA has been rolling out across the Province will remain intact despite the huge difficulties we are in as far as funding is concerned.”
“For the first time ever, more people are alive than have died. Therefore, cancer is rapidly becoming a long-term condition, rather than an acute condition that leads, ultimately, to fatalities. We need to keep that going, and we are doing well. <BR /> <BR />The Member for Upper Bann has highlighted an issue that has caused me concern, and I am worried about what has been said. We need to tighten up on the 62-day target, and we owe that to the people of Northern Ireland. I know what a worrying period those 62 days are for many people, and we have to try to bring it down to a more manageable level.”
“<BR /> <BR />The problem in the South Eastern Trust is the lack of urological consultants, but, once the diagnosis has been made, the South Eastern Trust is meeting its target — I think that I quoted 97% earlier — of patients who are then treated within the 31-day period. I would be very interested in any evidence that he could give me of that happening. From my point of view, the evidence is that we are moving forward to a healthier society, with fewer of us dying from cancer, as a result of that work. <BR /> <BR />I said this before, and I keep mentioning it, because I have noticed that good news does not travel very fast out of this Building. Last year, for the first time ever in Northern Ireland, more people with cancer were alive after 10 years than had passed on. That is very, very important — almost a Rubicon that we have crossed.”
“I would be very interested in the evidence of that, because, in Northern Ireland, we have taken the very sensible step of centralising acute cancer services into the Belfast City Hospital cancer centre, and that has led to a concentration of resources and skilled clinicians, consultants etc in the one building. We have had experience of that for about 10 years, and all the evidence indicates that that has been the right way forward. Therefore, someone in a trust who has been diagnosed with a serious cancer should be referred to that service, without any difficulty with a postcode. There is no real evidence to indicate that people are being turned away because they happen to live beyond Glengormley or Carryduff or whatever.”
“For instance, it visited the field during the sham fight in Scarva on 13 July, and it was in Markethill on the Twelfth, and it was interesting to notice that it picked up conditions amongst those members of the Orange, the bands and their families that would have been missed had the Man Van, as it is called, not been out in the field. I also understand that it is exploring that initiative with the GAA. This is an excellent opportunity of taking health provision to the community and identifying conditions that, up to that point, would have been missed totally.”
“Therefore, we feel that it is important to get out into the community and speak to young men in particular to emphasise the importance of giving up smoking, drinking sensibly and, more importantly now, reducing skin cancer, which is now the most prevalent form of cancer in Northern Ireland. Therefore, people who tend to be out in the sun a lot need to be very careful to take protective measures, whether they are marching or simply out enjoying the countryside. <BR /> <BR />I was very enthusiastic about the Cancer Focus NI initiative, which is to go out into the community, not just to Orange and band events but also, for instance, to reach those in the farming community. Male farmers tend to be very loath to report a problem to their GP.”
“The meeting with the Orange Order and the PHA will provide an opportunity to discuss how we can raise awareness around a number of health issues. Of course, the vast majority of those who participate in Orange Order parades and band parades are, basically, male, and often young male. We are looking at issues such as heart disease, stroke, diabetes, obesity, physical activity, alcohol problems and, of course, the promotion of smoking cessation. <BR /> <BR />We know that men are four times less likely to visit their GP than women and, often, men find that, by the time they do report with a condition, it is too late; it has progressed.”
“I have invited representatives of the Grand Lodge of Ireland and the Confederation of Ulster Bands to meet the Public Health Agency and me to discuss how public health messages can be disseminated to their members. I also met Cancer Focus Northern Ireland to discuss its initiatives to improve community health, including its work with the Orange Order.”
“Once that is up and running in the autumn of 2016, it will provide new capacity for radiotherapy, not only for Northern and Western Trust patients but also those from Donegal. It will also relieve the pressure on the Belfast cancer centre. Therefore, we should see a general improvement in treatment throughout Northern Ireland. I was delighted to hear, when I was up there last Wednesday, that it is on time. That will interest the Chair of the Committee. The building will be state of the art. Indeed, it will be the most modern radiotherapy centre on the island of Ireland and, we think, in the United Kingdom. Therefore, the people of the north-west will get a marvellous new facility that will help in the diagnosis and treatment of cancer for over 450,000 people.”
“The main pressure points are in the Northern and South Eastern Trusts. I expect both to take urgent action to reduce the time that patients wait on a urological pathway. That will involve moving urology services temporarily to the Western Trust until issues in the Northern Trust have been resolved. As a result of that action, the number of patients waiting longer than 62 days on the urology pathway in the Northern Trust has been reduced from 140 in August 2014 to seven in the provisional reporting that the board issued at the end of February 2015. <BR /> <BR />Last week, I was in Londonderry with the Irish Health Minister, Minister Varadkar, and we inspected progress on the new radiotherapy unit that is being built at a cost of £69 million and has been partially funded by the HSE in the Irish Republic.”
“The comments that Mrs Dobson has made will not be addressed by a more flexible IFR strategy, but it will help those who have a terminal diagnosis to live out their life on an extended basis and more comfortably. That is a very valuable role that those drugs perform. Still, the overall figures show that Northern Ireland, particularly through the Belfast cancer centre, has achieved so much in a very short period, and that is to be welcomed. We should not beat ourselves up on this issue; we are doing well.”
“That is a fairly valid comment. If he carefully reads the statement that I made on the IFR report, the Member will see that, implicit in that is a very significant increase in the funding for cancer drugs; I think that it is a trebling of the amount. That presupposes that the new two-committee system that we are setting up will have a much more flexible approach to IFR requests for individual cancer drugs. Therefore, we are determined to deliver on that, even in terribly difficult financial situations, but remember that that will not greatly improve survival rates. The vast majority of the drugs enhance and extend life; very few of them save life.”
“However, we are certainly moving in the right direction as far as cancer treatment is concerned. <BR /> <BR />The one issue that I do not have control over is staffing. If the staff are simply not there and the qualified urologists and oncologists are simply not available for recruitment, it makes it difficult for the trusts to meet their targets. Workforce planning, I am afraid, will become a more and more dominant issue in health. I think that we have 11 workforce reviews on at the moment, and at almost every level in the health service at the moment, we face workforce pressures. The tide has turned inexorably in that area, and we will have problems ahead. This is not about money. I must make it absolutely clear: we have the money to employ the specialists; we simply cannot get them at the moment.”
“It is worth saying that, in Northern Ireland, we are achieving remarkable outcomes on some cancers. For childhood leukaemia, prostate cancer and breast cancer, survivorship is way beyond 80%, which shows that we have made remarkable advancements in the treatment of those cancers. Taken as a whole, Northern Ireland can hold its head up when it comes to overall survival rates, but I accept that, for conditions such as lung cancer, pancreatic cancer and ovarian cancer, we are still way behind where we want to be. Our rates are similar to those in the rest of the United Kingdom. I accept that in countries such as Sweden, Norway and Denmark, where there are far more resources available for cancer treatment — with commensurately higher taxes, I have to say — the outcomes are better, and we need to learn from those countries' experiences.”
“Clearly, once a diagnosis is made, the clinicians are very quick to organise and deliver treatment. The problem lies after the earlier reference from a GP for diagnosis, where there seems to be a delay. <BR /> <BR />Some of the issues are outside my control. There is a shortage of urologists throughout the United Kingdom, and, at the moment, we have vacancies in the Northern Trust and the Belfast Trust that are proving difficult to fill. In the absence of those clinicians, it is difficult to deliver a service, but I accept that there is room for improvement on the 62-day target, which we are determined to deliver.”
“The short answer to the honourable Member for Upper Bann is, "No, I do not think that it is acceptable." There is massive room for improvement, and, indeed, the board has set challenging targets for the trusts to meet in the coming year. <BR /> <BR />I emphasise that there are two targets: the 62-day target and the 31-day standard, which is the time between diagnosis and first treatment. In fact, the trusts are doing exceptionally well on that target. For instance, the most recent figures that I have are 91% in the Belfast Trust; 100% in the Northern Trust; 97·6% in the South Eastern Trust; and 100% in the Southern Trust. Those figures are for up until February 2015. The latest figure that I have for the Western Trust is for up until December 2014, and, again, it is 100%.”
“I am disappointed that the number of patients who are referred as urgent by their GP with a suspected cancer and receive their first treatment within 62 days remains below the ministerial target of 95%. Recent performances are 70·1% in October 2014; 74·1% in November; and 74·7% in that December . The majority of patients waiting beyond 62 days are in the urology specialty. Urology services across Northern Ireland remain challenging, and the Health and Social Care Board (HSCB) is leading a service improvement initiative across all trusts to improve the position.”
“<BR /> <BR />It is one of those areas in which the problem is almost insoluble. It is extremely difficult. I am working on it at the minute, and I hope to have something before the Executive within the next few weeks.”
“As the Member knows, this is a very emotive and difficult issue. There have been various attempts to introduce guidelines in Northern Ireland. The last set of guidelines was successfully challenged by one of the pro-life charities. There have been various attempts to produce a document that the Executive can agree. We are still in that process, and I have to admit to the Member that this is perhaps one of the most difficult issues facing me and the Department at the moment. I have no doubt that, whatever document is produced, it will be judicially reviewed. If it is seen as too liberal, it will be judicially reviewed by the pro-life groups; if it is judged to be too strong on the pro-life stance, it will be judicially reviewed by one of what are euphemistically called the pro-choice charities.”
“That is how difficult the situation is, so I watch with trepidation to see whether that will happen. It would certainly lead to a deterioration in services and waiting times. The quality of services provided to patients would be compromised, we would have an inability to respond to the growing needs of the population of Northern Ireland, and we would compromise the delivery of key ministerial priorities and commitments. It is as black as that. Certainly, as one who has seen the figures, I urge the Assembly to step back from anything that would lead to a reduction in my budget in 2015-16.”
“When I heard that, I automatically did the sums, and, at 40%, it means that £120 million would be taken out of my budget for 2015-16 to fund welfare claimants. I cannot even find the £29 million to bridge the funding gap for next year or the £100 million to introduce new services. Therefore, it would be absolutely disastrous. <BR /> <BR />Members need to know the consequences of that. We are into such serious cutbacks in health that we could not guarantee public safety. That £120 million cut would come on top of £170 million of savings that have been obtained this year and £163 million next year, as well as another £50 million that has to come out of arm's-length bodies such as the Fire Service, the PHA and the Business Services Organisation (BSO).”
“That is why the new medicines fund is a very good idea: something such as Bexsero could be brought in and implemented using that money. We have got rid of meningitis A and meningitis C. I hope that soon we can get rid of meningitis B, and we are going to tackle meningitis W. The question is this: is it a worthy objective to make certain that, when their child gets flu-like symptoms, parents no longer experience the anguish that it could be meningitis? However, I have to find the money, and I need the support of the House before I can do that.”
“As things stand, we have no money at all for those things. I will give you just one example: the previous Minister quite rightly pledged that, once Bexsero was introduced in GB and approved, and agreement reached between the drugs company and the Department over there, we would introduce it here as a vaccination to prevent anyone in Northern Ireland from contracting meningitis B. That is a very worthy initiative, but, at the minute, figures quoted suggest that it might cost £1·5 million to £2 million to do that for all children under one. I want to do it, but, when I have literally no money in the budget even to balance the books for what we are already committed to, it is very difficult to see from where we can get the cash to introduce the vaccine.”
“I alluded to that earlier. We are in an extremely difficult position. Even looking at all the difficult efficiency savings that we have to make, we are somewhere between £29 million and £30 million short for 2015-16. On top of that, we have identified about £100 million of new service developments that, ideally, we would like to deliver in things like elective care, nursing levels, public health initiatives, including vaccinations, NICE drugs and special service, mental health and learning disability and Transforming Your Care (TYC) transitional funding.”
“It is not going to produce the crock of gold at the end of the rainbow that can be used forever and a day to introduce new non-NICE-approved drugs in Northern Ireland. We need something that is much more sustainable.”
“I hope that the £20 million efficiency saving that I am imposing next year will force everyone to have another look at the issue. <BR /> <BR />With regard to the report, we have to be careful, because it is still going through the process of the Public Accounts Committee. We have a view on some of the assertions made in it, and it is not all as black and white as it seems. The experts in the Department tell me that it is just not entirely correct in its assumptions. However, with regard to the basic question of whether we need to drive down more efficiencies in our prescribing budget; yes, we do. However, all of that will simply be gobbled up by other demands within the health service.”
“We continue to look at that issue. Remember, it is a decision for the individual GP as to what he or she prescribes. GPs tell me that there is a certain resistance among their patients when a different box appears, even though, clinically, it is exactly the same product. If it is not the yellow and orange, or whatever, that they have always had, and you move them on to the generic drug, which can be 90% cheaper, they say that it does not have the same impact. Therefore, there is pressure on the doctor to prescribe the branded product. We need to continue to do that. <BR /> <BR />I can assure you that the overall trend is very much in the direction of further generics: there is no question about that; we are getting there. We need to take the BMA and the doctors with us on the issue.”
“If we get it right, we can have a long-term funding stream, which will mean that many of the arguments about various drugs, vaccinations, etc, will no longer apply, because we will have the money to pay for them.”
“The problem, of course, is what while we do so, demand continues to rise. There has been a very significant rise since we went to totally free prescriptions. I think that we need to give prescriptions a value. It is a bit like a free newspaper. When a free newspaper comes through my door, it is hardly read because it is of no value, but if I buy a copy of the 'Mourne Observer' or the 'Down Recorder', I read it because I have invested some of my hard-earned cash in buying it. The same principle applies: a very small charge will encourage people to think, first, whether they need a prescription and, secondly, now that they have paid £1 or whatever for it, they should use it properly. <BR /> <BR />This matter is out to consultation. I want to see the views of the industry, individual pharmacists and the public on this very important issue.”
“First, our generic rate at the moment is 72% and, because of our concern about the alleged wastage, we have imposed a £20 million saving on pharmacy for next year to try to ensure that clinicians, pharmacists and hospitals grind down on any perceived wastage. Over the last 10 years, the use of generic drugs has gone from 41% to 71% and is now at 72%. In the four-year period from 2013-14, the Department, through the HSC, has delivered £132 million through efficiencies in prescribing. This gives an indication of just how important we consider the issue to be. <BR /> <BR />We are up there with many other nations in our generic cost base, and I think that we are doing very well in that sense. However, there is clearly wastage in the system, and we need to drive that down.”