Simon Hamilton
Strangford · Democratic Unionist Party · Northern Ireland
“I have emphasised to the Member and the House before, that, whilst I accept that those are not good enough — that is why we have been developing the plan — there are alternative technologies in place that can present opportunities for those who just cannot get acceptable speeds.”
“I thank the Member for his intervention. There are some initiatives that I believe will help and act as a driver to improve broadband access. One such intervention is the broadband universal service obligation (USO), which is being taken forward by Her Majesty's Government.”
“I thank the Member for his question. However, he is conflating two issues. I wrote to his party leader, and indeed to all Assembly party leaders, before making the announcement that I did last week about wanting to publish the details of the businesses in receipt of the non-domestic RHI scheme. It was my intention to do that tomorrow.”
“<BR /> <BR />The Chancellor, in his autumn statement, made some more funding available for telecommunications, and my Department is studying that and seeking to avail itself of that to the fullest possible extent.”
“In addition, my Department is managing a contract for the delivery of the superfast rollout programme, which, by 31 December, will provide access to superfast broadband with speeds of at least 24 megabits per second to a further 38,000 premises, both business and residential, across Northern Ireland, including in the Newry and Armagh cons…”
“I signalled the intention to do this a few weeks ago. The Member and the House will know that inspections of all installations would have taken place over the 20-year lifetime of the RHI scheme.”
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“As you would expect, I speak with clinicians in this field and others on a regular basis about how we can improve whatever the services might be. Particularly in respect of transplant services in Northern Ireland, we have a real success story to tell about how live donor rates in particular have increased significantly over the past number of years. That is testimony to everybody in the system, but particularly the team operating in the transplant centre in the City Hospital. They are an impressive group of people who openly tell you that they want to be the best in the world at what they do. That is not something that we in Northern Ireland are prone to say, but they are very clear that that is their ambition.”
“It is significant that not one clinician has come to me and said that they want us to make the change that has been suggested in this legislation. Whilst I know that the intentions of the legislation are good, we need to be incredibly careful and listen to what the clinicians are saying clearly and with one voice before rushing to make what could be bad legislation.”
“There is no certainty that it would have the desired effect of increasing organ donation rates in Northern Ireland, and there is a real concern among the transplant surgeons and ICU clinicians who gave evidence to the Committee that it could have a detrimental effect on organ donation. I do not think there is anybody in the House who wants to see legislation going through that is to the detriment to something that is so important. <BR /> <BR />It is significant too that we, as legislators, are faced with any number of organisations, even in the health sphere, and people who are on the clinical front line coming to us and saying, "You need to make a change in the law here, because that will improve things".”
“I know that the Committee has been scrutinising the Bill for the past few weeks, and I thank the Committee for the work that it has done. It has been useful scrutiny of this legislation. Since I came into this post, others have encouraged me, and I have made it crystal clear that I will always be guided by science, the evidence and the views of our clinicians. It is significant that with this legislation — the Human Transplantation Bill — the clinical voice has almost been as one. In fact, it has been as one in respect of the concerns that many have about the Bill as it is drafted.”
“As we move into the future, I want to look at not only the pay issue but other issues that have been raised at Question Time on the shortage of nurses and the need to have training in place, what we can do with bursaries and how we retain staff. I want to work with our nurses, and I want to work with the Royal College of Nursing to get a positive outcome on those issues and, indeed, on future pay.”
“I put it on the table that I would be flexible within the budget that I had and that I would look at other terms and conditions that their counterparts in England and Wales, for example, had negotiated away as part of other pay settlement discussions over there. They were not prepared to do that, and, in those circumstances, I was not prepared to wait any longer without giving some certainty to staff. <BR /> <BR />I greatly value the contributions that our nurses make to the health service. I am scheduled to engage with the Royal College of Nursing in the not-too-distant future, and I look forward to working with it, not just on this issue.”
“The reason for the difference is that that would have been the cost for a one-year 1% consolidated increase. The unions' pay demand was that they wanted to go back over 2014 and do the same for that again. That would have incurred a cost for last year as well that would have taken it closer to £40 million. That is why there is a perceived difference or discrepancy, as the Member described it. <BR /> <BR />I want to be in a position in which I am working with our trade unions to agree pay awards and settlements. We are all realistic enough to know that unions will come in and demand lots of things, perhaps not all of which are achievable. However, they came in wanting to reopen the 2014-15 settlement and were not prepared to work with me.”
“In those circumstances, making a 1% non-consolidated pay award for those who were at the top of their band and then making incremental payments at an average of 3·7% for all other staff was the appropriate balance, particularly when the unions were not prepared to negotiate seriously in any other way.”
“They told me that they were not mandated to go beyond that, and they tried to reopen last year's pay award, which had been paid out to staff many months beforehand. Their pay demand of me would have cost us £40 million. <BR /> <BR />The Member will know from his experience as a Minister that being in ministerial office is all about making what are sometimes very difficult choices. The £40 million that it would have cost to meet that pay demand would have been the entirety of what we are putting into tackling waiting lists in Northern Ireland.”
“The Member's premise is that there is a difficulty in recruiting and retaining nurses. Some have made those arguments, but I have seen no empirical evidence to back them up. I would put back to those people the argument that nurses' pay in Northern Ireland is a little below the pay in other parts of the United Kingdom, but it is about 99% of that. The average pay in Northern Ireland, for example, is 86% of what it is in England, so, in that respect nurses' pay is keeping in line with national pay in a way that many other professions are not. <BR /> <BR />I understand the concerns of many nurses and other front-line Health and Social Care staff about the pay award that I announced early in the new year. When I met the unions before Christmas, I did not find them to be prepared to move beyond last year's pay award.”
“If that is what comes back from the analysis, I will certainly make sure that that happens.”
“However, I think that it was right that we froze the consultations at that time just in case other things happened in the market. Thankfully, nothing similar has happened up to this point, although I do have concerns, which were affirmed through my recent meeting with the independent sector. It was only right that we took the decision that we did, and included in that is a review of whether it is appropriate to reopen the homes for new admissions.”
“I always worry when the Member says that I have made a "useful statement", but, on this occasion, I will agree with him that it was a good statement. To be fair, he did congratulate me on the day for making that statement. I have halted that decision and started a review, and the terms of that review have now been agreed between my Department and the board. One of the things that they will be looking at is the reopening of the homes for new admissions, and it is only right and proper in that context that that is done. <BR /> <BR />However, we should bear in mind that the decision that I took was due to an uncertainty at that time around the market as a whole, and most of the residents in the Four Seasons homes were nursing care patients as opposed to residential care patients. The decision that I took was on the basis of that.”
“<BR /> <BR />In respect to residents who are currently in homes, my information is that — the Member will be, I suspect, particularly interested in the two homes in his constituency that are being closed — all the residents in those homes will be successfully moved to other homes and that they have all agreed to do that. I accept that that is far from ideal. I would rather that they stayed in their current homes, but, unfortunately, that is not case because of the decision taken by Four Seasons. The board, the trust and the RQIA have worked very closely with Four Seasons to ensure that there is minimum disruption for residents, and I hope to see that continue.”
“There are about four questions there, certainly three anyway. <BR /> <BR />As a Department, we were aware of issues with Four Seasons, not least because its financial difficulties were well publicised, certainly in the mainland press. Obviously, in addition to this, officials kept in close contact with Four Seasons about the possibility of closures. That said, we, or I, were certainly not aware of what was happening until the day that it announced the seven closures. There had been indications of potential closures, but nothing had been confirmed until the day that it was announced to the press.”
“I welcome the Member to the House. I am sure that he has been welcomed plenty of times before, but I particularly welcome him to health questions. I am not aware of any particular issues around the said home in Strabane. Rather than guess at it, I will come back to the Member in writing. I am not aware of any particular problems.”
“Realising the issues that will come to the fore over the next number of years, with a growing and also ageing population, we acknowledge this as an area that we need to start giving attention to on the same scale that we have with the reconfiguration of hospital services. That can be done in a way that has been done with successive pieces of work before, including the expert panel currently looking at the issue. It is something that will cause all of us long-term problems if we do not get to grips with it, starting very soon.”
“<BR /> <BR />I reflect on the fact that, a couple of months ago in the Chamber, people called on me to throw all sorts of money at some of those companies, knowing full well that the reason why Four Seasons in particular was closing homes was because of the very particular financial problems that it was experiencing. The fact that three of those homes are being sold to other providers shows that there is viability in them. <BR /> <BR />I understand the pressures that the system is facing and the pressure that the sector is facing, and that it is a critical part of our health and social care sector. I do not think that we have always given it the attention that it deserves in the past. I think that we have always tended to focus more on primary care or on secondary care and not given social care the consideration or thought that it needs.”
“I do not need to accept the Member's invites to know what is going on in residential care homes. I see plenty of them, so I know what is going on. I speak to people from the sector, including those from Four Seasons. I have met the chief executive of Four Seasons in a different capacity, but I am seeking to meet the company in the not too distant future. We are still very concerned about its decision to close some of its homes. Sadly, the sale of the one in Garvagh fell through, but I welcome and am thankful that three of the others are being sold. That will ensure that residents can remain in what have become their homes.”
“We need to be strategic and long-term in our thinking, but we also need to carry forward some of those initiatives and, indeed, others that will increase the number of nurses that are coming out of our universities. <BR /> <BR />I recently announced — I think it was in the Chamber just before Christmas — that I do not want to do away with the bursary, as it will allow us to encourage nurses to stay and train here. In that context, I think it is also important to look at ways of keeping our nurses, particularly our newly qualified nurses, practising in Northern Ireland, whether that is in the statutory or independent sectors.”
“We are not just trying to work to get numbers up in the statutory sector, which people might think is our priority; we realise and appreciate the importance of the independent sector and the work it is doing. We saw that, particularly with emergency departments and the pressures that we faced over the holiday period. That is why the board and the PHA are trying to work very closely with the statutory sector and the independent sector to increase the number of nurses. That is also why we have the return to practice campaign, which will hopefully bear some fruit. <BR /> <BR />It is a challenge. I think we need to be realistic and to realise that we cannot wave a magic wand or click our fingers and make the change overnight. A shortage of nurses is not just a Northern Ireland, a British or a UK problem; it is a worldwide problem.”
“I am well aware of the issues with the sector. I met representatives of the Independent Health and Care Providers (IHCP) a couple of weeks ago. Whilst they wanted to discuss a range of issues, as you might anticipate, that was one that they wanted to particularly talk about. I wanted to listen to them and to the concerns they had. I can quote all sorts of figures, and people can quote figures back at me, but unless you are talking to providers, as the Member has, you do not get a sense of what it means on the ground. <BR /> <BR />It was a useful and interesting conversation that highlighted the fact that there is a shortage right across nursing, whether that is in the statutory sector or the independent sector, where it is particularly pronounced. That is why we are trying to work at it.”
“<BR /> <BR />I am aware that the Health and Social Care Board and the Public Health Agency are continuing to work closely with independent sector providers to review the current workforce within private nursing homes. It is important to keep up to date with changes in patient complexity and to identify and develop competency levels of practice for senior care assistants and to explore the potential for maximising their role within nursing homes.”
“We have just launched a return to practice campaign that is designed to encourage nurses in Northern Ireland who have been out of nursing practice to renew their registration and return to the profession so that they can make a valued contribution to the care of our local population. I have provided funding for an additional 100 places on that return to practice programme, which is to be delivered by Ulster University in spring 2016. That initiative will support the statutory and independent sectors. In addition, we have just launched a career pathway for nurses and midwives showcasing opportunities for development in a range of settings, including the independent sector. The career pathway has profiled the independent sector as a means of encouraging staff to apply for positions there.”
“It is developing a strategic approach to the future supply and demand of nursing in Northern Ireland that addresses the needs of the statutory and independent sectors and which will take a long-term approach to workforce planning.”
“All registered residential care and nursing homes are required by legislation to employ an appropriate number of staff to enable them to meet the health and welfare needs of residents. The registered person and registered manager must ensure that enough staff of the appropriate skill level are on duty at all times to meet residents' assessed needs. The Regulation and Quality Improvement Authority (RQIA) has responsibility to regulate, register and inspect a wide range of specified services delivered by HSC bodies and by the independent sector. <BR /> <BR />I recognise that there are many challenges facing nursing recruitment in the statutory and independent sectors which need to be addressed on a range of fronts. My Department is taking forward a number of measures to address those.”
“Importantly, between 2010 and 2015, the number of nursing, midwifery, professional and technical, social services, medical, dental and ambulance staff — those at the front line in health and social care in Northern Ireland — have gone up by 2,113 whole-time equivalents. So, this party has been investing in the front line and in the staff who have been working on the front line helping people in Northern Ireland while the Member was bloating the board when it was born.”
“He caved in pretty quickly and allowed them to increase the number of staff on the board by 100 when he was in office. He did not take a lot of pressure from civil servants and caved in pretty quickly and allowed it to go up by 100, and, when he was leaving office, it was at 436. So, if there was any bloating in the organisation, it started under the Member's tenure. <BR /> <BR />At the same time, the number of departmental staff has gone down by a third between 2010 and 2015. So, whilst there has been an increase in board staff, there has been a reduction in departmental staff.”
“He will always be remembered as the Minister who took that decision. <BR /> <BR />In respect of the board, he quotes a figure about the number of staff that were there when he left. In 2010, when he was still in office, the figure on the board was 436. It has increased, but he was quoted in the 'Belfast Telegraph' recently as saying that he wanted the board that he created — which has been criticised inside the system and in various reviews, such as the commissioning review that flowed from the Donaldson report — to be a lean organisation. He said:”
“I think that the Member is missing something. I do not think he is listening to answers that have been given in the House. In fact, the question he asked is very similar to a question that was asked in my previous Question Time. The Member tries to inform the House that, when he left — and we all remember what he did towards the end of his time in office; he will always be remembered as the Minister who pulled the plug on the cancer centre and radiotherapy unit at Altnagelvin.”
“I have met nothing but support inside the system for the changes in the direction of travel in which we are going. The general public may have some concerns about how it impacts on them, but they know that we need to change, and I think that most people out there know that. The biggest challenge and biggest barrier, and I am on record as saying this before, is us and whether political parties in this place that sometimes have not supported common-sense reforms can embrace the need for change which is being suggested to us by those in the system.”
“<BR /> <BR />We see that no more clearly than in the report launched last week in this Building by the Northern Ireland Confederation, an organisation of some 50 healthcare organisations, including organisations inside the Health and Social Care system. They were encouraging not just me but every one of us and every political party in this place to embrace the need to reform, because they understand — better than us and better than anybody — the immensity of the challenges that our Health and Social Care system is facing now and into the future. They know that we need to change, reform, and do things differently if we are to sustain the health and social care system that we have and develop that and ensure that our people get the best possible outcomes. So, they are encouraging us to change.”
“Mr Milne mentioned some concerns expressed by board staff. I can absolutely understand and sympathise with the fact that the staff most directly impacted by this might be somewhat concerned about how it impacts on them personally. However, I have to say that, in broad terms right across the system, since making the announcement back in November, I have met nothing but support for the direction of travel that we are going in, not just in trying to strip out and remove a layer of bureaucracy, which closing the board will do, but in bringing in the broader reforms, including the appointment of the expert panel, under the chairmanship of Rafael Bengoa.”
“If they are doing jobs that are important to the system, those jobs will continue, whether they are working for the Department, the PHA or trusts. <BR /> <BR />The Member mentioned the location of jobs. Again, I can understand the concerns that some might have about moving, but moving from one location to another happens quite frequently in the public sector, and it is something that we would handle, if required and needed. Obviously, staff will have to work from some location, and, again, it is something that we would seek to handle in the most sensitive way to ensure that there is a minimum amount of disruption.”
“I think that we have a lot of really good people working right across Health and Social Care whose capacity and capabilities are not maximised because of the overly bureaucratic system that we have in place. <BR /> <BR />Even though some will be concerned about the changes that have been made, equally, I have spoken to staff in the board who have agreed with the principles that I outlined: that there is an overly bureaucratic system that gets in the way of innovating and making quick decisions. Obviously, if we follow through with the decision to close the board, we will have to do that in a way that is mindful of the sensitivities around staffing issues. Clearly, many will be concerned about their jobs, but they are doing jobs that are important to the system.”
“I am aware of the impact that this has on staff, particularly board staff, although it will mean change for staff right across the system. It is not just board staff who will be affected, but I am particularly mindful of the impact on staff currently working in the board. That is why, right from the very outset, in announcing the reforms, as I did on 4 November, I made it absolutely clear that this was not in any way, shape or form an intended criticism of the staff who have worked and currently work in the board. What it was actually about was getting the structure within which they work right for Northern Ireland and right in the sense of trying to make the most of their talents.”
“<BR /> <BR />The consultation document entitled, 'Health and Social Care reform and transformation — Getting the structures right' was published on 15 December 2015. The consultation to hear the public's views on those important issues will run for eight weeks, until 12 February. The Department will work closely with HSC colleagues, including those in the board, in the coming months to define the best Health and Social Care structures for Northern Ireland. Any decisions in respect of Health and Social Care Board staff will be part of that work.”
“I announced my intention to remodel the administrative structures of the Health and Social Care system to make them more streamlined, to reduce complexity and to remove bureaucracy. <BR /> <BR />In short, I proposed that the Health and Social Care (HSC) Board cease to exist and that its functions should transfer to the Department, the Public Health Agency (PHA) or the health and social care trusts. The Department would take firmer strategic control of the system; trusts would have more responsibility for the planning of care in their areas and the operational independence to deliver that; and the Public Health Agency would be retained, with a renewed focus on prevention and early intervention.”
“On 4 November, I outlined ambitious, far-reaching and radical plans for transforming our Health and Social Care system.”
“Unfortunately, those have headed back upwards, and that has in part been because of the inability to spend money that was being lost through welfare reform fines. It is regrettable and a pity that we lost that, because that took the momentum out of the efforts that were being made to tackle waiting lists. Obviously, I am very keen to do that and will ensure that money is spent from the budget next year to do that.”
“The £40 million that I have been able to invest is starting to make an impact, and some 60,000 to 70,000 people will see the benefit of that over the coming weeks. Some already have received the benefit of that. I want to continue with that investment. I want to ensure that some of that increase that my Department has received for the coming year also goes into continuing to keep that momentum so that we are continuing to address that need that the Member and his constituents will appreciate is there. <BR /> <BR />There were over 100,000 people on waiting lists for outpatient appointments when Edwin Poots took office, and that number started to go down gradually over a period because of investments that were being made.”
“In a perfect world, lots of things would be much better, but we are not in a perfect world. We have to live with the restraints that we face inside the system that we have. Even though we obviously are operating in a less than perfect or ideal world, the Executive have again underscored their commitment to health and social care by giving it the best budget settlement of any Department in the Northern Ireland Executive, increasing expenditure next year by around £130 million, which is an increase of 3%. Obviously, that comes at the expense of other Departments, which have to make sacrifices, and I am always conscious of that fact. <BR /> <BR />As I said to Mr Beggs in response to his initial question, I want to see waiting lists go down. I think that they are at unacceptably high levels and people are having to wait too long.”
“<BR /> <BR />Members will appreciate and understand, although some, I think wrongly, opposed its use, that we have had to go to the independent sector to ensure that that money can be maximised. We have awarded some 27,000 outpatient appointments, and some 15,000 of those have already been referred. Some 8,000 inpatient appointments have been awarded for procedures and so forth, and 5,500 have already been referred. So, even in a very tight timescale, with all of the strictures of that, we are doing a good job of getting this money spent where it is meant to be spent, helping people in Northern Ireland.”
“Since that outcome, where we got £40 million for waiting lists, we have been working assiduously to ensure that that is being spent where it is meant to be spent, which is on getting people off the waiting lists and getting people the treatments that they need. We have done that in two different ways. One has been to try to increase capacity in-house, within our health and social care sector. Some of the investment will ensure that there will be around 9,000 more inpatient and outpatient appointments. There will be about 13,000 more diagnostic tests going on, and there will be about 15,000 more appointments with allied health professionals, and those are inside the system.”
“I am aware of some coverage in the press, and, indeed, comment by some Members, questioning the impact of the £40 million investment. As I said in my answer, the money will have a much better impact that I originally thought, in that around 60,000 to 70,000 people who would otherwise have been waiting longer will be getting the benefit of that investment. When we are thinking about this, we need to bear in mind and consider the fact that there has been a very tight timescale for the board and trusts and the independent sector to gear up and to be ready to spend this investment. <BR /> <BR />The long delay in resolving issues around welfare reform meant that the then Finance Minister was not able to come to the House until November to announce a monitoring round outcome.”
“The Member may be aware that, this year, the Department has been seeking to invest around £10 million in a scheme to modernise GP surgeries. That money is starting to get out on to the ground, and a number of surgeries are modernising as a result. <BR /> <BR />He will also be aware of the investment that has started to roll out in primary care centres. A centre has been built in Ballymena, for example, and the one in Banbridge is, I think, officially opening tomorrow. I had a chance to see round that absolutely fantastic centre, where people can get treatment closer to their home and community without necessarily having to go into hospital elsewhere. <BR /> <BR />There are also huge opportunities with GP federations, and I am keen to see what we can do to work with them to increase the capacity in primary care.”
“As I said in my answer, I do not think that waiting longer than 18 weeks is acceptable. The numbers waiting are not acceptable, and I would not dispute that with anybody. Neither was it acceptable — I know that the Member will agree with me — that the actions or inactions of some in the House cost Northern Ireland's public purse £150 million. If half of that — roughly the Budget allocation to health — had gone to health, we would have been able to keep waiting lists under some control. The almost 14% increase in referrals for appointments over the last five years has obviously had an impact. <BR /> <BR />The Member is right to highlight the important role that GPs and primary care can play in addressing need at its earliest stage. He asked about capital investment priorities.”
“Broadly, this investment will benefit between 60,000 and 70,000 patients who would otherwise be waiting.”
“I understand what the stress and strain of being on a waiting list will have meant for many people. The allocation of an additional £40 million from the November monitoring round will begin to address issues with waiting lists. <BR /> <BR />Since November, significant efforts have been made across health and social care within a very tight time frame to secure additional outpatient clinics and treatments within trusts and to put in place appropriate arrangements with independent sector organisations to transfer suitable patients for assessment and/or treatment. <BR /> <BR />The additional funding is being targeted at those who have been waiting longest. I want the number of patients who can be assessed and treated quickly to be effectively and safely maximised.”
“My focus is on ensuring that the health, social care and public safety services that are provided are safe and effective while seeking to achieve financial balance for my Department.”