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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“It started pretty high; under the tenure of Mr McGimpsey when he was Health Minister, it started with around 390 full-time equivalents in the board, and it has grown to 600. It was always quite a big beast no matter what his intentions were for it. <BR /> <BR />Over the same period — since 2010 — the number of staff in the Department of Health, Social Services and Public Safety has dropped dramatically. In March 2010, the number of full-time equivalents in the Department was 670. In November 2015 — the most up-to-date figure we have — the number of staff within the Department is 466. So there has been a one-third reduction in the number of staff in the Department over the last four years, and that number is set to go down further.”
“There will be an impact on creating a more efficient system, which is what I want to see, and that is where the impact of the reforms that I have put forward will be most targeted on. I do not want to dwell on staffing issues, because, as I said during my statement in Ballymena a couple of weeks ago, we have some tremendous staff in our system who are working exceptionally well and doing some exceptional things, but we are not getting the best out of their talents because of the system that they operate in — that very bureaucratic system that we have. <BR /> <BR />Some have wanted to focus on the issue of staff, saying that it was an easy decision to get rid of the board because its numbers had become big. Yes, the numbers have risen.”
“— who are very sick and rely on new drugs.”
“Unfortunately, there has been a misunderstanding with the campaign; the proposal that was made in a recent consultation was for a small charge of around 50p or £1 up to a maximum of about £20 or £25 a year. Given the lack of political consensus, I do not think that there will be any reintroduction of prescription charges in my time as Minister, but there will be consequences. Not having the income from prescription charges is not without consequences in terms of paying for some of the very expensive new drugs and treatments that are out there. Some people may see some success in not having prescription charges reintroduced, but there will be consequences, sometimes even for those —”
“We have had to fund innovation, and money has had to come from the front line, and that is never an easy thing to do. <BR /> <BR />In and of themselves, the reforms do not depend on more income generation. The reintroduction of prescription charges might have been a way of getting more money into the system in the short term. I am aware that a campaign has been running recently that is opposed to the reintroduction of prescription charges or, perhaps more accurately, wants to exempt certain people from prescription charges. My view is that, if we were to reintroduce prescription charges, it should be for everyone, or we should stick with no one and have no exemptions.”
“We need to be clear that in wanting to transform our health and social care system we need more resources. That might seem almost counter-intuitive to wanting to get the most efficient use out of the resources that we have. Understanding the pressures we face across our entire budget, we need to see more money going into health and social care in order to get a more efficient system. In the short term, in order to make the changes that might come forward as a result of the recommendations from any panel a reality, we need a boost and an injection of cash over the next number of years. <BR /> <BR />If we want to do some of the innovative things that many of our trusts are doing, then we need to have money to do it, which is not money that is coming away from the front line. That has been the challenge in the past.”
“I want to see any savings that are realised going back into the front line to help patients and people across Northern Ireland.”
“That will then result in a resolution of welfare reform, which will result in more money for waiting lists, and that is what I have been lobbying my colleague the Finance Minister for. In the short and the long term, we need an injection of resources to tackle waiting lists. That is what I am seeking, that is what I want, and that is what I hope will happen. In and of themselves, those changes will not address that, other than the fact that they will make the £4·7 billion health and social care system in Northern Ireland work more efficiently. By taking out the layer of bureaucracy that she and I have focused on, we can make that system — which has not been working to the full and to the optimum over the last number of years since its inception in 2009 — work more efficiently and get more resources into the front line.”
“I, like her, do not wish to dwell on that. I hope that, in other parts of this Building and this estate, we will be able to reach a swift conclusion to the issues around our Budget and welfare reform that have been bedevilling us.”
“I, again, welcome her welcome of the proposals that I put forward nearly a fortnight ago. I particularly welcome that because I think that the Chair has taken the proposals that I put forward in the proper spirit, recognising the fact that there is an additional layer of bureaucracy in our system that is getting in the way of front-line delivery, which is what she focused on. In the past, that has also proved a barrier to innovation across our health and social care system. I think that she and I are as one in wanting to see that bureaucracy removed from our system. <BR /> <BR />The Finance Minister was just in her place, outlining the difficulties that we have this year with finances. Pressures are increasing, driving up demand and our waiting lists, but we have also had the situation of losing money through welfare reform penalties.”
“Yes. Sorry, Mr Deputy Speaker, I thought that that was requested beforehand, but I appreciate that. Thank you. <BR /> <BR />All health and social care bodies are subject to challenging efficiency savings and, until detailed work has been completed, it is not possible to identify whether any additional savings can be delivered. I hope that all political parties will embrace the opportunity for change and work positively to create a world-class health and social care system in Northern Ireland.”
“<BR /> <BR />As I have said before, these changes are about moving towards a more streamlined and accountable structure so that we can make the most of the talent of our staff, encourage innovation and create a more efficient system. Although there may be some savings, my focus is on getting the structures right. All health and social care bodies are subject to challenging efficiency savings and, until detailed work is completed —”
“<BR /> <BR />It is important that this is a clinically led debate with clinical evidence for any proposed changes to services and evidence about the implications of failing to make changes. I envisage a panel comprising around half a dozen experts drawn from across the sphere of health and social care. I hope to be able to announce the membership of the panel shortly and that it will begin its work before Christmas. One of its first tasks will be to convene a summit involving political parties to gather ideas, suggest solutions and, I hope, collectively reach agreement on a shared vision for the future of health and social care in Northern Ireland.”
“I want our trusts to be responsible for the planning of care in their areas and to have the operational independence to deliver it. I want to see my Department take firmer strategic control of the health and social care system. I have therefore announced that we will close the Health and Social Care Board, as I believe that we no longer need a stand-alone organisation. I intend to retain a Public Health Agency, with a renewed focus on early intervention and prevention, which will work more closely alongside the Department in that essential work. I have also announced a panel to lead a debate on the best configuration of health and social care services in Northern Ireland.”
“With your permission, Mr Deputy Speaker, I would like to answer questions 1, 5 and 15 together. <BR /> <BR />It has been clear for a number of years that our health and social care services in Northern Ireland are facing the significant challenges of rising demand, rising expectations and tightening finances. We cannot hope to respond to those challenges unless we are focused on ensuring the highest quality and safety of care, configure our services correctly and have an appropriate administrative structure. <BR /> <BR />There are simply too many layers of administration in our system, which are making it difficult to meet those challenges to drive change and weakening accountability. I want to drastically delayer the system to remove complexity and bring about greater accountability and better responsiveness.”
“<BR /> <BR />I remain committed to the all-Ireland congenital heart paediatric care network, and I want it to be developed as quickly as possible.”
“In my speech, I said that I want to create a transformation fund to encourage and to finance those innovations that we all know that we need and that sometimes, within current budgets, trusts or others find difficult to fund because they are spending so much on keeping front-line services going. However, they know that these will be beneficial for cost savings and better outcomes for patients and people. That is what the funding is about. I cannot commit to any amount of funding because I do not know what any increase might be or whether I will get an increase at all in the health budget for the next Budget period. I am determined to parcel off a significant portion of that for a transformation fund so that the changes that we know we need can be made.”
“I am glad to have received broad support about the board, but it is not a matter of my standing up in Ballymena, in the Chamber or wherever to announce this and its happening overnight. A process must be gone through. A legislative process will have to be undertaken before my proposed changes are fully implemented. We are talking about some time off in the near future for implementation. In the short term, the current arrangements remain in place. <BR /> <BR />I cannot say how much any project will get out of a transformation fund that has not yet been created.”
“I appreciate the Member's particular interest in the issue. He has raised it with me in the past in the Chamber. <BR /> <BR />I welcome the fact that he recognises and characterises the board as a "stumbling block" — I think that he used that phrase. I do not want a system in which there are stumbling blocks. All too often, I have heard such a characterisation of our health and social care system: stumbling blocks, barriers, hurdles and entities get in the way and allow the buck to be passed while, ultimately, very little is done. <BR /> <BR />I think that the Member is jumping ahead a couple of stages on the transformation fund and the board itself. Obviously, this is my view and is what I want to do.”
“Whilst some posts will be no longer required, as I tried to outline to Mr McGimpsey, a substantial number will be required because of the important work they do. At the minute, they are doing it in the board. They may be doing it in the Department, in the trusts or elsewhere in the future, but there will still be important work for those people to do. In some cases, they are doing a good job already, so that will need to be tapped into to ensure that it continues to be the case. They may be in a different place, but that is less important than removing the bureaucracy that I think the Member and I share concerns about, making sure that we get that efficient system, and getting the best from the talents of those who are operating within our health and social care system.”
“I did not address that point in response to Mr McGimpsey's question. The announcement has been made and there will be discussions with the unions as we roll it out. They will be very much involved in the process. There will be a consultation on the proposals for the board and removing that layer of bureaucracy, and I expect them to participate fully in that. <BR /> <BR />As I said before — I tried to say it last week — this is not an exercise in trying to make savings by getting rid of the board. There may be some monetary savings, and what monetary savings there are will be redeployed back to the front line. That is a very important point; we are trying to get the most efficient system that we can possibly get. <BR /> <BR />I do not envisage the need for compulsory redundancies; that is not something that I think we will be looking at.”
“That will continue to be undertaken, but it will just be undertaken in a different place. We can sometimes get a little obsessed about where people work and the name of the entity they work for. I want to create a system-wide approach and get the best out of the system we have. Unfortunately, the reforms that were implemented in 2009, which the Member will be all too familiar with, have been tried and tested and have not worked. They have not made the best of the talent within the system. That is why I made the suggestions and proposals last week to take away that layer of bureaucracy that has blurred the lines of accountability and has got in the way of getting real innovation across our system. I hope that the Member recognises that and will support the reforms that I have proposed.”
“We are undertaking a scoping exercise to look particularly at what the announced reforms that will close down the board will mean in actual actions that need to take place. As I said in my speech last week, there are clearly implications for the board and its staff. As the Member highlighted, some staff will move to the Department, some will move to the trusts, particularly those who are involved in planning for care, and some may move to the Public Health Agency, which I intend to align much more closely with the Department and focus more on early intervention and prevention and the good work that it can do on the public health agenda. <BR /> <BR />We are not definite on the numbers yet, and work will be undertaken to do that. Those people are doing useful tasks and jobs, particularly on planning for care and need.”
“The current figures as of March this year show that the net average persons employed by the board were 584, of which 544 were permanently employed.”
“That obviously includes tackling many of those health inequalities. <BR /> <BR />One of the other things that I announced last week — it did not get a terrible lot of attention — was my support for the creation of a transformation fund so that we can develop and fund some of the innovation that is out there, which sometimes gets funded through the system and sometimes does not. Much of that will tackle issues around health inequalities, as well as trying to get new, innovative, very creative ways of tackling many of the problems and challenges that we face, not just in our society but right across the world. Many aspects of it will have an impact on tackling the sort of issues that she mentioned, if not directly, at least by making a more efficient system, which will be better for everybody in Northern Ireland.”
“I thank the Member for welcoming the statement. I accept the point that she is making. One of the principal objectives of the reforms that I have outlined — which I hope the House will, in time, support the implementation of — is to get the most efficient use of the £4·7 billion that is currently spent on health and social care in Northern Ireland. One of the ways in which we can better tackle the health inequalities that she referred to is by the more efficient spend of that money that is going into the system. <BR /> <BR />Getting rid of a layer of bureaucracy will help, certainly, but that is not what will automatically come from that. I appreciate that, but it is about creating a system where that money — which is close to half of the complete Budget — comes out at the other end as better outcomes for people.”
“That is not about the numbers of people; it is about the system. <BR /> <BR />My objective is to dismantle and de-layer that system so that we can get the best out of the people in our health and social care system. There are some incredibly talented and gifted people. I want them to serve in a system that makes the most of their talents, not a system — which, unfortunately, is the one we have at the moment — that has got in the way of their talents and has not unlocked them in the way that we should all be seeking to achieve.”
“Even in administration, I am sure she will accept that there are some incredibly gifted and talented people who are working in the board and on other parts of administration within our health and social care system. It is not about them or their number; it is about developing as efficient a system as we can possibly have. <BR /> <BR />When I go out and speak to people on the front line, as I mentioned, they tell me that the layer of bureaucracy that was created in the last Assembly term got in the way of them being innovative and caused confusion. When you have senior consultants saying to you that they do not understand the system, how it works and how it benefits the people they are serving and the patients they are working to make better, you have to listen to that feedback and appreciate that there is a problem with bureaucracy.”
“I do not accept the criticism. What we need to be careful about — I sought to be careful about it last week, and I hope that the Member does not take the argument down that line, now or in the future — is that we focus on the staff within the system. In fact, as I said in response to Mr Easton, I think we are blessed and very fortunate to have some fantastic staff in our health and social care system.”
“However, given the fact that his party's stance in blocking progress on welfare reform is costing the whole Executive £9·5 million each and every month, which will mean £200 million to be lost by the end of this year — countless thousands of operations, assessments and treatments could have been carried out using that money — if there is anywhere that the finger of blame should be pointed for the difficulties that our health service is facing, it is at those who seek to squander that money at a time when it is needed at the front line in Health, in DRD and right across the board.”
“I am glad that I was able to make those decisions. I think that it ill behoves the Member to do what he is unfortunately prone to do and try to criticise. I think that he would do well to take a lead from the Chair of the Health Committee and the stance that she is taking. <BR /> <BR />The Member also seeks to criticise the state of the health service at this time. I appreciate, and no one knows better than me, the difficulties that the health service currently faces in Northern Ireland.”
“I made it clear that I wanted to be in office but, equally, I did not want to see people murdered on the streets of Northern Ireland. The Member and his party were offered the opportunity to do things in a much cleaner and clearer way through having an adjournment or supporting a suspension, but they did not take that. Action was required in those circumstances, and we took that action. <BR /> <BR />No one was as frustrated as I was, because I know the extent of the decisions that needed to be taken to reform our health and social care system. I wanted to take those decisions, and I am glad that I was able to outline my vision and announce those decisions around reforming our health and social care system, getting rid of a layer of bureaucracy, appointing a panel, and talking about how we can finance transformation moving forward.”
“When you go out on to the front line and speak to them, and they tell you to your face that they believe that the system of bureaucracy that we have, currently, is getting in the way of them doing things that they know that they can do and that will achieve better outcomes for people in Northern Ireland, you have to listen to them, and you have to take action, and that is what I am proposing to do. I am encouraged by the feedback coming from the front line; from clinicians, doctors, nurses and others. I think that we would all do well to listen to their response, to be encouraged and emboldened by that, and to try to move forward and make the reforms to our health and social care system that we all know that we need to make.”
“But we need to listen to what people on the front line are saying, and the feedback that has come from clinicians, many of whom have written to me or emailed me about the decisions or announcements that were made, has been exceptionally positive. They see the opportunities in de-layering the system and in getting rid of bureaucracy. They see the attempt to remove barriers to innovation as a vote of confidence in them, and that was what it is intended to be. <BR /> <BR />We have a fantastic health and social care system in Northern Ireland. Yes, there are challenges, and we know that there needs to be change, but we have some incredibly talented and gifted people.”
“I thank the Member for his question. The feedback so far has been positive, and significant political communications have been made that have been quite supportive of it. I acknowledge the comments made by the Chair of the Committee today and last week, which I think are helpful and bode well for trying to build the political consensus that I spoke about last week and have spoken about in the past. <BR /> <BR />I might agree with the Chair, and we might be able to agree with others on the way forward, and that is important. I think that it is a critical factor in trying to reform our health and social care system.”
“That is why we need to do our level best to set aside the political differences that we have from time to time on some health issues and try to build a shared vision of a world-class health and social care system for Northern Ireland.”
“It was the First Minister. <BR /> <BR />The reforms that I announced yesterday were additional to Transforming Your Care. I am prepared to accept that some mistakes may have been made in implementation in the past, and we need to learn from those mistakes. It would be churlish to attack each other on the basis of those mistakes. We need to learn from them, because the challenge that is before us to get health and social care right now and to get it right for future generations is too big a prize for us to get petty about. We need to build the political consensus that I have spoken about; if we do not, we will have a health service and a social care system in Northern Ireland that will fail. That is the evidence that is coming forward, whether it is from the Donaldson report or from clinicians on the front line.”
“I look forward to attending the Committee tomorrow. I was pleased to accept the invitation of the Chair to attend. I am happy to go into much more detail on the announcement that I made last week in questions from her and fellow Committee members tomorrow. I welcomed her comments last week, which were supportive of the announcement, and I welcome her comments here today. I accept that there has been on different occasions a consensus of sorts. I think that I said to the Chair when I appeared before the Committee in early July that there has been in the past a degree of consensus on some health reforms, and I am sure that she appreciates that the reforms that I was outlining went significantly further than what has been said in the past, particularly on Transforming Your Care.”
“OK. I am sorry that I cannot answer the Member on that.”
“I suspect that it was not. <BR /> <BR />Typically, Mr Allister, the big macho man who wants to be seen as the one who takes on Sinn Féin, is not taking on Sinn Féin on this issue but is instead singling out the DUP. That, of course, is Mr Allister's style. That is what he always wants to do. He does not really want to take on Sinn Féin; in fact, he wants to embrace them in government, in line with the latest policy position that he has adopted. <BR /> <BR />On the issue of the Public Health Agency, I think that public health is incredibly important —”
“It is of considerable significance to that sector, as, I am sure, Mr Allister will appreciate, and I wonder whether a question for urgent oral answer has been tabled by him about why that was announced by press statement and not in an oral statement in the House.”
“I also wonder why the Member seeks to pick out a particular Minister for criticism for not making an announcement in the House. You could draw up a long list of Ministers from probably every party who have made statements outside the House by way of press statements, radio or newspaper interviews or speeches at events — by whatever means. In fact, only today, the Agriculture Minister made a major announcement after a big consultation on the value of basic payment scheme entitlements and young farmers' top-up rates, something that I understand the industry has been waiting for an announcement on for the best part of a year.”
“I welcome the fact that, latterly, he asked a question about the substance of the speech instead of concentrating on a peripheral point about process. I am not surprised that Mr Allister would want to do that; that is his style.”
“Mr Speaker, the Member is some fellow to be talking about treating the House with contempt. He has fallen foul of the Speaker's Chair, whether it was with you or previous Speakers, on more than one occasion.”
“Let me begin by thanking you, Mr Speaker, for accommodating the question at this time. My speech to an audience of front-line health and care leaders on Wednesday 4 November was a follow-up to the speech that I made at the cancer centre in May, where I addressed a group of care professionals in order to set out my vision for health and social care. <BR /> <BR />Wednesday's speech provided some detail on how I expect to deliver that vision. I wrote to the Chair of the Health, Social Services and Public Safety Committee last Wednesday to set out the content of my speech, and I will appear before the Committee this Wednesday to answer questions about the announcement. Oral Answers to Questions next week will provide a further opportunity for Members to quiz me on what I have said, as do written Assembly questions and correspondence.”
“People with a mental illness must be supported to take control of their lives and live purposefully in their communities. While our mental health services have come a long way since Bamford, we have much more to do. I am committed to further reform and innovation. That will require funding. Some of that can be found by reprioritising existing resources, but new money will also be needed. That will be difficult to find, but we all have a responsibility to ensure that we have sufficient means to meet the mental health challenges that we face as a community.”
“<BR /> <BR />The point is that the plans that are out for consultation at this time are looking at better integration with elsewhere in the service, particularly with the Ambulance Service, and better coverage across Northern Ireland. That recognises a criticism that the service has not been up to standard outside Belfast. There should also be improved governance. The important point for Members to remember is that, at the end of this consultation and at the end of this work, the Lifeline service will be retained, and we are seeking to improve the service that people receive. <BR /> <BR />In conclusion, improving people's mental health is vital for their well-being and that of their families. It is as important as their physical health.”
“Those are a free-to-call crisis telephone helpline that will be accessible 24 hours a day; skilled helpline staff trained in crisis de-escalation and in assessing suicide risk; signposting callers to the most appropriate service for their needs; and referral to follow-on support where necessary. By splitting the provision of immediate helpline support from follow-up support, the proposals avoid a potential perverse incentive whereby the helpline provider would gain financially from referring a client to follow-up support that it also delivers. By ensuring that follow-up support is locally based, access to that service should be improved, particularly for rural dwellers.”
“I understand that an extension has twice been offered to the current provider of Lifeline services but has been refused on both occasions. The Lifeline crisis response service is a key component of the Protect Life suicide prevention strategy. The PHA is keen to engage with the relevant stakeholders to ensure that the future service specification is appropriately informed, and the agency has already undertaken a Lifeline pre-engagement public consultation, the findings of which have assisted in identifying the most effective and efficient model to obtain the best outcomes for taking the service beyond 2015. <BR /> <BR />The proposals for the future delivery of the Lifeline service retain four essential core components of the current service.”
“<BR /> <BR />Another progressive development is the Mental Capacity Bill, which is currently at Committee Stage. If passed, it will be an international first in establishing a fused approach for mental health and mental capacity law. I am very grateful to Members from all sides who are considering the Bill so assiduously, and I urge colleagues to continue to work together to ensure that we pass Final Stage before the end of this mandate. <BR /> <BR />In her remarks, Jo-Anne Dobson mentioned the Lifeline service, and I want to use this opportunity to provide an update to the House. The current Lifeline contract ends on 31 December this year, with the possibility of extension until 30 September next year.”