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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“As I said to the Chair of the Committee, some of what we are doing is counter-strategic. I accept that. However, the Member needs to understand the situation we are in: 63% of my entire budget is used to pay staff wages, salaries, national insurance and pensions. There is no way in which I can touch that and make any savings. It is three years before any redundancy saves a single penny. Another 12% of the budget is tied up in contracts. We cannot simply say to the contractors at, say, the new Omagh hospital, "Sorry, folks, we've run out of money. You're gonna have to stop work." That cannot be done. Legally, we have to sustain that contract and all others. <BR /> <BR />The actual proportion of my budget that I can touch is roughly 25%.”
“Of course, the staff still remain in position. It may be that we are able to transfer staff from some of those minor injuries units to an adjacent hospital so that extra trained individuals are available to treat whatever extra number of people come through the door. <BR /> <BR />I remind the Member that we have added the £5 million extra, which will be invested in emergency departments (EDs) throughout Northern Ireland. We will be watching that situation very clearly. I have had representations from MLAs about the Whiteabbey decision. Whiteabbey enjoys the benefit of being relatively close to the Belfast provision, unlike some of the rural situations, where it can be 20 or 30 miles to the nearest minor injuries unit.”
“That applies to not only Whiteabbey but to Armagh and Bangor. Three minor injuries units are going to be closed temporarily until the end of the financial year. I will be absolutely honest and straight with Members today: some of those proposals may eventually become the subject of consultation for permanent closure. I am not going to try to say here this afternoon that all of what is being proposed is a temporary arrangement. <BR /> <BR />We have discovered from previous changes to minor injuries provision that you do not get a commensurate rise in demand in adjacent units. Some people decide to wait and go to their GP, some decide to go to their GP out-of-hours, and some simply do not go anywhere. I am confident that the Mater or, of course, the Royal could take any of the additional stress covered by the decision.”
“In all these decisions, all staff who wish to remain in the Western Trust will do so. When Mr Poots took over as Health Minister, it was predicted that there would be 4,000 compulsory redundancies in the health service. That simply has not happened. No one who wishes to stay has been sacked or moved on in any shape or form, and I know that the Western Trust will make a similar commitment to Ash Villa. Those staff clearly can be used elsewhere. They are experienced, and there are plenty of opportunities in other parts of the Western Trust, within reason, of course, given travel-to-work times and distances. I will investigate that, and I will ask why the first I heard of it was when the Member raised it a few minutes ago. I would have been keen to have been notified of that decision.”
“I have to tell the honourable lady that I was not aware of it. I will be absolutely truthful with her, and I am waiting for a briefing. I do not believe that it is part of the contingency plans that were outlined to me by the five trusts. Perhaps it is a knock-on from the Omagh situation, but I am unaware of that. I will investigate this immediately and come back to her. Equally, if she has concerns, I am more than happy to meet her and service users to see what the significance of this decision is. I try to keep my eye on everything that is happening in Northern Ireland as regards potential closures and changes of service, but I have to say that this one passed me by.”
“I will ask departmental officials for the information and write to the Member with as much detail as I can.”
“The cost is certainly an awful lot less than the penalty that my Department is taking because of the failure to agree on welfare reform. Whilst these issues may be high in the public interest, particularly in the 'The Irish News', it is also important to realise that, even if we solve them overnight, it is a mere drop in the ocean compared with the £87 million hit that we are taking as a community because of the failure of Members opposite to agree to welfare reform. My Department's cut of that would normally be £32 million. If I had that £32 million, the last two hours would have much more pleasant for Members and me. <BR /> <BR />I have made the political point, but I still accept that it is absolutely vital that we look at this issue and make certain that we are getting good value for money —”
“<BR /> <BR />In the very difficult incoming financial conditions — Members, if you think that this year is bad, wait until 2015-16 when we will have to take even tougher decisions. One decision might be that we will have to restrict greatly travel, conferences and expenses of all those involved throughout the health and social care system to balance the books.”
“I have read the recent press reports on the issue, and we have asked about it. The trusts and the board are implementing restrictions on conferences and travel. Indeed, at conferences that I attend as Minister, I notice that there are far fewer officials from the trusts and the board. We have also asked for a 2·5% reduction in administration costs to be taken out of the trusts and the board, which is an indication that we want the issue to be looked at. <BR /> <BR />The public find it difficult to understand the matter. Equally, we need to be careful, because we have some top-performing staff in the health service, and it is important that they travel to hear about best practice and learn about new techniques and new types of service. We have to learn from the rest of the world, because we do not have all the answers in Northern Ireland.”
“Nobody would be happier than me if they could come up with a solution to the budget problem that keeps everybody happy and means that we end the year without going into deficit.”
“There may be time yet, but he has been very responsible, and this is a very responsible question. <BR /> <BR />Yes indeed, there are other options, but I guarantee that, should I decide to implement some that I am aware of, there would be delegations from another part of the trust area, often led by the same MLAs who came to me to protest about the first set of decisions. We would simply be moving the problem down the road, because none of these changes in actual, physical services are popular. I would like to work with individual MLAs because they all tell me how bright and able they are. They all tell me how much they know about the health service that I do not, so, if they have their ear to the ground and know better, they should come and speak to me.”
“I thank the Member personally for the responsible stance that he has taken as an MLA on the Committee to the problems that the health service faces. There was a golden opportunity for him to wreak revenge on me, and I thank him for the fact that, in the interim few months, he has been —”
“<BR /> <BR />I also remind the Member that we, as a Department, spend £1·5 million a year funding full-time union officials. The vast majority of union officials employed in the health trusts are paid directly and entirely by the Department. If we are to look at consultants' bonuses, we will have to look at that as well because £1·5 million would mean that we did not have to take any decision on Ballycastle or on Bangor.”
“I have an awful lot of sympathy for what the Member for Londonderry says. In these very difficult financial times, I find it almost impossible to justify consultants' bonuses, enhanced payments, or whatever they are. There is a difficulty in that they may be part of a contractual obligation that we could have huge problems getting out of. I would like to say that they would far rather have a shield from the Minister than a mere £20,000 or £30,000 bonus — chance would be a fine thing. It is an important point. So many people are getting them and they cost us a lot of money. I think that they are an anachronism. They were a child of their time: we had to pay bonuses to retain and attract front-line consultants when many were moving down to the Irish Republic etc where big payments were made. We are looking at that.”
“The chief executive announced last week that the trust was to suspend its decision on the palliative care beds in Omagh, but — there is a very significant but — she realises, as does her board, that it will have to come back with an alternative suggestion to make exactly the same saving. It is not a question of the trust's saying that this is unpalatable and, therefore, it will not come up with the money. It will have to make its books balance in the same way as the Northern, South Eastern, Belfast Trusts etc will have to make their books balance. They are all finding this extremely painful.”
“The Member for East Londonderry knows that there will be a major Assembly debate on this issue. I think that it is scheduled for 27 November. I will listen with great interest to the considered views of all the MLAs affected by the Dalriada decision. I hope that, by then, they will have come to me with alternative suggestions that mean that all of us can avoid this very difficult decision. That is where this issue is best considered after I have consulted widely with so many of the groups involved. My door is and has been open to people who want to speak to me about it. <BR /> <BR />I accept what the Member said about the Western Trust's decision.”
“Over the past months, my officials have been liaising with the Health and Social Care Board, the Public Health Agency and the five trusts to help identify all available savings opportunities that could be used to deliver a balanced budget in the last four and a half months of the financial year, ensuring that patient safety would not be compromised by any such proposals. I very much regret — I mean that — that such measures are necessary, but the challenges facing my Department are significant, and the £80 million of additional funding provided by the Executive in the June and October monitoring rounds did not address all the identified pressures. That means that the trusts have been required to develop and implement a range of contingency plans to ensure that we break even financially, an obligation that is required of all Ministers.”
“If Mr Easton or anybody else comes up with alternative proposals, I would be delighted to see them and would look very sympathetically upon them.”
“— to deliver a balanced budget and cause less pain to their community. It is one thing to totally denounce all the proposals to make the books balance, but another not to make one suggestion for anything that could be done to balance the books by 31 March 2015.”
“The South Eastern Trust gave a commitment that it will look seriously at those alternatives. Here we are, well into Question Time, and not a single MLA of any description has suggested to me other ways that they believe would be more efficient —”
“The message that I outlined to my very valuable APS and others is that, if alternatives can be found, the South Eastern Trust —”
“A further £750,000 will be provided from board baseline funds.”
“To date, £2·3 million of that has been allocated to the trusts, including the Northern Ireland Ambulance Service. The funding is to provide additional consultants and pharmacy staff, as well as hospital ambulance liaison officers in the Royal, Ulster, Antrim and Craigavon hospitals. It is also being used to introduce new models of working and to fund external support specialists to improve health-care systems and hospital performance. The remaining £2·7 million will be allocated to the trusts to fund measures to improve patient flow and expand capacity over the winter. The board has asked trusts to submit proposals. It is expected that £600,000 will be used to enhance out-of-hours capacity in primary and community care; £400,000 for each of the five trusts; and £100,000 to the Northern Ireland Ambulance Service.”
“Each health and social care trust has provided assurances that their services will remain safe and effective and has taken steps to support and protect front-line services. For instance, where minor injury units are temporarily closed — again, Mr McKinney raised this — provisions are to be put in place in the large emergency departments and discussions held with GPs and GP out-of-hours services to maintain effective flows for minor injuries. Appropriate alternative arrangements must be made in the case of ward or bed closures. Any restrictions in domiciliary care must be supported by an individual needs assessment and risk assessment.”
“I hope that the extra £5 million that has been allocated will assure the Member that that will not happen. That is additional, new, fresh resources to that particular field. I listened with interest to Mr McKinney's radio interview this morning on that very subject. It somewhat spoiled my breakfast, but it was interesting to hear what he said about it. I think that the number of instances where that could happen are quite rare. For instance, in the Western Trust, it is very hard to see how services could spill over into the Northern Trust, given the distances involved. It may be a Belfast issue that will arise.”
“My priorities are to ensure that the services provided by Health and Social Care are safe and effective and that my Department achieves financial balance, as required of all Ministers. I have allocated £5 million additional funding to address winter pressures in delivering unscheduled care. That money will be used to improve patient flow from emergency departments and expand capacity, as required, over the winter period. <BR /> <BR />Significant progress has been made in tackling lengthy waiting lists in emergency departments, and the first six months of 2014-15 have seen the lowest number of 12-hour waits in five years. I am looking to the Health and Social Care Board and trusts to improve on that in the coming winter.”
“The letter that the Member refers to was not signed by me but by my predecessor. I am looking carefully at its contents because I think that it is relevant. However, my understanding of the wording is that it said that there were no plans to curtail future services provided at Dalriada. However, I expect that the Member has a learned counsel on those issues and he may believe that there was a future expectation. The advice that I am getting is that there was not but I accept that it is germane to the argument about the future of Dalriada.”
“In all the debate that has been held before and all the questions about it, everybody decries the fact that the Northern Trust has come up with its decision, but nobody has suggested an alternative to it. At the end of the day, I have to ensure that the trust balances its books by 31 March. I have no option whatsoever to take a debt forward into 2015-16, so I have to ensure that I land this large spaceship called public health spending on a postage stamp called balanced budget. Now, is anybody going to give me any help on that? I suspect not.”
“As I said to the Member from North Antrim, I have yet to meet the district council on that; I think that it has a very important democratic input. I also intend to visit the service at some stage to see for myself. I know Ballycastle extremely well, for reasons that I will not speak about today, but I am in Ballycastle many times in any given year. Equally, there are still some issues on the finances of it because the total from the temporary closure is £0·6 million, so it is a significant amount of money that we saved. <BR /> <BR />What I would be interested in hearing, from all the Members from that constituency — and also, to some extent, from East Antrim, because I also met Mr Oliver McMullan to discuss the issue — is whether they can come up with an alternative to the decision that would be more acceptable to their community.”
“Therefore, I am not taking this decision lightly. I want to hear from service users. I know personally three of the patients in that hospital, and they have all been on to me to indicate their perception of the care that they are receiving. Therefore, I am not going into this decision at all blind. I am taking it very seriously, and I have also met the trust to discuss it.”
“I assure the honourable Member for North Antrim that a large amount of my time in the last few weeks has been spent on this issue. I met a deputation led by the MP for the area, I have discussed it regularly with Mr Frew and I met a deputation led by Mr McKay on the issue. I am also receiving a petition today from those in Ballycastle who are very exercised about it, and I have received literally thousands of emails, text messages, Twitter messages, correspondence and phone calls about it. I am also pledging myself to meet the district council chair and a delegation from Moyle District Council. So, there will be a considerable amount of consultation on the issue, and I will want to hear from all those concerned. Of course, I also met Patricia Gordon and Brenda Maguire, who are officials from the MS Society Northern Ireland.”
“However, only 57 from the Northern Trust, two from the Belfast Trust and 10 from the Western Trust used the Dalriada respite care. That is 69 sufferers out of 4,000. Therefore, the trend of users was, unfortunately, quite negative. Many of those 69 have contacted me to tell me about the excellent care they have received in Ballycastle. I accept that, but, given the large number of potential users of that excellent facility, I am surprised that so few have availed themselves of it so far.”
“I thank the honourable Member for his supplementary. When I was a Back-Bencher, I found it very annoying when the Minister did not answer the question. So, if I am guilty of that, you are absolutely right to point it out. I think that as a Member for North Antrim who has been lobbying on this issue, he has to face up to some very difficult statistics. In 2013-14, the total number of bed days available at the Dalriada was 4,380. Of those, only 1,402 were used. That equates to a bed occupancy of 32% or an average of four beds occupied at a given time. That is a very stark statistic that shows that we are funding a lot of empty capacity there. <BR /> <BR />Secondly, there are 4,000 MS sufferers in Northern Ireland. I am acutely aware of the difficulty of that long-term condition.”
“My Department will monitor the situation closely over the coming months to ensure that the service provided to MS sufferers in the Northern Trust continues to meet the local population's needs.”
“However, it will simply not be possible to maintain the current levels of service provision in the absence of the entire funding required of an extra £130 million. The Northern Trust has affirmed that it will endeavour to minimise the impact on front-line patient care. Respite services to MS patients will still be provided and everybody who requires respite will receive it. The trust will be working with everyone involved to ensure that service users' needs are central to the process moving forward. <BR /> <BR />Furthermore, the trust has also provided an assurance that anyone who has been booked in to respite care in November will have no change to that booking.”
“In my statement of 30 October 2014, I said that my priorities were to ensure that services provided by the health and social care sector were safe and effective and to ensure that my Department achieved financial balance, as is required of all Ministers. To achieve those aims, health and social care trusts have produced a range of contingency proposals. Indeed, we debated those earlier. Each trust has provided me with an assurance that its services will remain safe and effective. <BR /> <BR />As part of its contingency plans, the Northern Trust has proposed the temporary closure of respite beds in the Dalriada Hospital for sufferers of multiple sclerosis. I regret that the trust has had to take that action as a consequence of the budget pressures.”
“If it assesses that the need is 15 minutes a day, it is 15 minutes; if it is half an hour or multiple visits, that will happen. That is entirely the decision of the relevant staff in each trust. It is not based on budgets or bookkeeping; it is based on need. The stats show, and the overall quantum indicates, that there is a very strong commitment to that by all the trusts in Northern Ireland.”
“I hope that I showed the Member for Upper Bann earlier that, in fact, the trusts have a very strong commitment to increase the number of hours, that there has been a 5% increase since 2012 and that we have secured additional resources in the monitoring round. A review of domiciliary care costs in Northern Ireland has been initiated by the Health and Social Care Board as part of TYC. The aim of that review is to obtain a better understanding of how domiciliary care is operating and to identify best practice within the various models of delivery in order to shape the future direction and operation of domiciliary care services. <BR /> <BR />With regard to her earlier point, I have to emphasise that the decision on the number of hours allocated to each client is based on the clinical assessment of the needs of that person by the trust.”
“In some trusts, it is a 2:1 ratio between private and public. Therefore, the normal rigour of the law has to apply, but with strong safeguards through the unions to ensure that those who are wrongly accused are given the full benefit of a strong defence.”
“First, the vast majority of the staff in that field are dedicated, honest and professional, and they make an excellent contribution to provision in Northern Ireland. Unfortunately and very occasionally — we have all seen examples reported in the media — one or two individuals breach the fundamental trust that they should hold within the community. When that happens, they have to be brought to book in the normal legal way, and there have been prosecutions. They also have strong representation from the unions, which give those who are accused wrongly the protection and support that they deserve. However, I do not want those one or two incidents to overshadow the tremendous work that they do in the statutory sector and the large number who are employed by private contractors, which is a growing trend.”
“In the Belfast Trust, we provide 47,000 hours; in the Northern Trust, we provide 48,000 hours; in the South Eastern Trust, we provide 58,000 hours; in the Southern Trust, we provide 53,000 hours; and, in the Western Trust, we provide 42,000 hours. That is a total of 249,000 hours of care. As the Member for North Belfast will see, provision is spread relatively evenly across the entire Province, and it is based entirely on the clinical assessment made by each individual trust. As I said, a total of 25,330 people benefit from that care. I know from the feedback that I receive in the Department that, in the vast majority of cases, the individual recipients are extremely happy with the dedication of the staff concerned and really appreciate the service, which enables them to stay in their own home in their community.”
“That has been emphasised by the fact that, in the October monitoring round, we bid for and, fortunately, received an extra £8 million, which has been allocated to the Transforming Your Care implementation for 2014-15. That will support a wide range of measures, including how we enhance provision for the elderly closer to home.”
“I assure the honourable Member for North Belfast that the contingency plans, which were the subject of the previous debate, have made it very clear that there will be no compulsory redundancies. Staff will be moved to adjacent facilities. For some of those individuals, that may not be possible. We will look at the potential for standard redundancies. <BR /> <BR />It is also worth saying that, at the moment, we provide 249,000 hours of domiciliary care in Northern Ireland to 25,330 people. That is a 5% increase on the same period in 2012. That gives an indication of my Department's commitment to that essential type of care. Certain areas of the media would have you believe that a cut has been made. We are actually increasing resources to that very important front-line care and hope to continue to do so.”
“Transforming Your Care recommended that homes should be the hub for care for older people. That is in keeping with my Department's policy direction to help people live independently, with the support of flexible, responsive and person-centred social care in their own home and community for as long as it is safe to do so. <BR /> <BR />As part of that, allocation of resources, including staff time, is based on a comprehensive assessment of individual need by the relevant health and social care trust. The actual length of time allocated for any one domiciliary care visit is the result of that individualised and professional assessment of need. Trusts have an underpinning responsibility to use their resources fairly and wisely and are responsible for assessing and prioritising needs within the resources available to them.”
“It is important that I intervene at this stage. I accept that some of the decisions that have been forced on the trusts are counter-strategic and are not where we want to be. However, we have to find £70 million, and we have to do so in four and a half months. It would be useful if other Members would indicate their alternatives if they feel that the trusts' decisions are so radically wrong.”
“I can also say that there was consultation on the future of Slieve Roe House in Kilkeel, where the decision to close it was reversed, and I therefore thought it was the most wonderful consultation exercise. <BR /> <BR />To finalise, older patients who need hospital care can now receive it in a more appropriate clinical setting, where there is consultant-led care 24/7 and access to the complete range of diagnostics and specialist clinical advice for patients who have multiple conditions and complex needs.”
“We will avoid multiple transfers, so, in essence, the changes really do represent the potential for improvement over the current arrangements. Developments in community care mean that patients who are suitable can remain supported and independent at home for as long as possible. <BR /> <BR />I have heard various Members decry the consultation. I am always quite interested in consultations, because, in my constituency, if a consultation decision goes against me, it is a dreadful farce that is meaningless and does not take into account the views of the community. If it goes in my favour, it is the most wonderful consultation since time began. You cannot have it both ways.”
“<BR /> <BR />When older people need to be in hospital, their care should be of high quality, in an appropriate setting and provided by highly skilled teams of staff with access to diagnostics, specialist knowledge and treatment. <BR />We should also do all we can to avoid multiple transfers from hospital to hospital. <BR /> <BR />Every Member this evening has paid tribute to the staff in Loane House. I will certainly accept Lord Morrow's invitation to visit Loane House. It is somewhere that I have not been and I think that would be useful. I would not for one moment undermine the care that people receive in Loane House, but times are moving on, medically, and we need to provide the best care in the best location.”
“This is a positive for older people and their families and carers because it shortens the length of hospital stay, reduces the number of moves needed and restores people to their familiar environment as soon as possible. Mr Flanagan made the point that people want to be close to their community, and that is exactly what it delivers. <BR /> <BR />It is incredibly important, especially in the face of the financial challenges that I outlined, that we use our hospital resource wisely, effectively and efficiently. Many hospital services are now provided without the need for an overnight stay, and our hospital services must now be based on evidence and provide what works best, in the right place and by the right people.”
“Again, the stats show that the Southern Trust is well ahead on re-enablement. There is much to congratulate the trust on. That is undoubtedly the way forward, and this proposal allows the trust to advance that approach. <BR /> <BR />Hospital care is also changing now that all agree that hospital care should be for only a short period for acute illness or injury. The majority of patients who transfer to Loane House will already have been a patient in Craigavon. One of the Members opposite said that they were being drawn in from a wide area; the vast majority have already been under the care of Craigavon. With the continued development in community-based care, more patients could be discharged straight home, and that is part of the whole Transforming Your Care process.”