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 is vital that we speak openly about mental health and encourage people who are experiencing emotional difficulties to seek help. Health and Social Care is working across a number of levels to reduce the stigma associated with mental ill health. The PHA and the Northern Ireland Association for Mental Health are working in partnership to deliver a future wide-ranging three-year anti-stigma programme entitled Change Your Mind. The cross-departmental ministerial coordination group on suicide prevention has expanded its remit to cover a broader range of activities to promote positive mental health. My Department is working with DARD and DCAL on a joint initiative to promote mental health awareness and help-seeking behaviour through rural networks and sporting organisations.”
“She will be aware that the Department is involved in working with the armed forces across a range of health issues and chairs a forum that meets regularly and which involves representatives from the charity Combat Stress. For serving members of the armed forces, mental health services are provided by the Ministry of Defence, and services for veterans and dependants are provided within Health and Social Care. She raises a very important issue, and I am very happy to contact her about any specific concerns that she may have.”
“Finalising the design of the model and financing such a service are significant challenges that we need to overcome. I urge all Members, including Executive colleagues, to work together to agree those arrangements as soon as possible. Just as the Royal Victoria Hospital is world class in dealing with physical trauma, I hope that we can agree that a mental trauma service would be a fitting legacy to those who continue to suffer as a result of the Troubles. <BR /> <BR />In respect of the point raised by my colleague Brenda Hale about post-traumatic stress disorder and unrecognised symptoms among armed forces personnel, I am happy to contact her about the issues that she raised and, hopefully, provide her with an adequate response.”
“A joined-up service will provide opportunities for organisations and groups across sectors to share expertise and resources, ultimately benefiting service users. <BR /> <BR />My Department, together with the Health and Social Care Board, has been concentrating on designing the medium- to high-impact, high-intensity support that, in the model, would be provided within Health and Social Care and involve treatment for people with diagnosable and complex mental health problems. Care at that level must be provided by registered mental health professionals. The current model estimates that we would need to recruit over 40 additional whole-time equivalent specialists to accommodate the volume of patients and levels of need. That gives a further indication of the scale of the challenge that we face.”
“<BR /> <BR />In establishing the service, I intend to achieve four main aims: to address comprehensively the legacy of the Troubles and unmet mental health needs; to improve individual, family and community experience of mental health trauma care; to improve the psychological and social outcomes for individuals, their families and communities who have been traumatised as a result of the Troubles in Northern Ireland; and to improve governance and accountability. <BR /> <BR />The last of those is very often overlooked, but I believe that it is important that we provide care either in the statutory sector or in the voluntary and community sector and that services are joined up, involve less duplication and enable more timely responses to psychological problems that are effective from the outset.”
“<BR /> <BR />The service would allow for a range of interventions, meeting the spectrum of need across our community, irrespective of where that is. It would involve leading-edge, evidence-based treatments in line with NICE guidelines and be based on the authoritative and internationally recognised stepped-care model that focuses on the recovery of the individual from psychological trauma. The model recognises that, for people to recover, they may often need a combination of evidence-based social, family, psychological and psychiatric interventions; in short, a collaborative partnership across community, voluntary and statutory services.”
“<BR /> <BR />Members will recall my announcement in September that I want Northern Ireland to become a world leader in treating people with psychological trauma and that I have tasked officials to create an innovative service that will meet the needs of those suffering from mental trauma. I welcome the amendment before us today. My announcement followed on from exploratory discussions in the Stormont House Agreement implementation group, which considered proposals to implement the agreement's commitment to establish a comprehensive mental trauma service in the health service. The full details continue to be developed, but the intention is that the final model will support the voluntary and community sector to create an integrated approach with the Health and Social Care system to address mental health need.”
“<BR /> <BR />I want to turn to an issue that was not raised but which is an important mental health issue nonetheless, and that is eating disorder services. Those are currently provided through a stepped-care approach that ranges from early detection and intervention, to community-based treatment, to specialist inpatient provision. However, I am aware that there is considerable support for a local specialist eating disorders unit. We need to be sure that any such service would be sustainable in the long term. I therefore asked my officials in October to start considering all the various options available to us.”
“I turn to the issue of CAMHS, which Dolores Kelly mentioned in her contribution. The Bamford review set out the strategic direction for children's mental health services, which are mainly delivered through community-based teams. There is also a 33-bed children and adolescent mental health inpatient unit at Beechcroft. In July 2012, the Department published a stepped-care service model for CAMHS, and this promotes a more consistent, person-centred approach to mental health service delivery for children and young people. Improvements include an increased focus on early intervention, better multidisciplinary working and collaboration with the community and voluntary, education and youth justice sectors.”
“I argue that we need to continue investment in this area.”
“<BR /> <BR />There is even an economic argument to support excellence in the provision of psychological therapies and mental health services generally. DSD has since 2008 provided funding to my Department to support the welfare-to-work agenda. A Queen's University/Health and Social Care Board report in 2014, published to support the continuation of this funding, found that 44% to 46% of people claiming illness-related out-of-work benefits do so because of mental ill health. However, for every £1 invested in psychological therapy services, there is a saving of £1·75 to the public sector. The report estimates that, within two years of recovery following successful treatment, the employment rate for those with moderate to severe mental health problems is increased by 11·4% and by 4·3% for those with mild mental health problems.”
“One of the key elements was the publication in 2010 of 'A Strategy for the Development of Psychological Therapy Services', which has largely been implemented. A range of services are provided, including psychology, psychotherapy, cognitive behavioural therapy and trauma therapy. The HSC Board estimates that between 75,000 and 80,000 sessions are provided annually. Recent investment has focused on the training of existing staff in psychological therapies and the establishment of primary care talking therapy hubs. The HSC Board is into the second year of a five-year plan to establish these hubs across each trust area. The hubs focus on providing a range of psychological therapies for people who are experiencing common mental health problems. They are developed around general practice and will improve access to earlier support and care.”
“At the time of the Bamford review, we were spending 60% of the mental health budget on hospital services and only 40% on community services. Now we spend 44% on hospital services and 56% on community services. We are working towards closing old, inappropriate institutions that are no longer fit for purpose, and we are steadily opening new, more appropriate community-based accommodation around Northern Ireland. <BR /> <BR />In October 2014, the Department launched a regional mental healthcare pathway called You in Mind. The focus of the pathway is to commit Health and Social Care to delivering care that is more personalised and improves the experience of people with mental health problems by adopting a more evidence-based and recovery-orientated approach.”
“Those changes have transformed how we care for people with a mental illness and have significantly improved the achievable outcomes. The Bamford vision is that people with a mental illness should be treated in the community, close to their families and friends, unless there is a clinical reason for not doing so. The focus in the last number of years in service development has been on early intervention, home treatment services and the development of psychological therapy services. Transforming Your Care endorses this approach. Since Bamford reported in 2008, investment in mental health services has increased to £247 million a year. That is an increase from £200 million a year. More importantly, the balance of funding has shifted.”
“As an Executive, we face the challenge of prioritising how we spend finite amounts of public money. One in four adults in Northern Ireland will suffer from a mental health problem at some stage in their life. Northern Ireland has higher levels of mental ill health than any other region in the United Kingdom. The Public Health Agency's 'Making Life Better' strategy, published in 2014, established that Northern Ireland has a 25% higher overall prevalence of mental illness than England. <BR /> <BR />In the past decade, significant reform and modernisation of mental health services has taken place, although I acknowledge that more needs to be done. The Bamford review, which was referenced by many contributors, set in motion some of the most significant changes ever seen in mental health services here.”
“I welcome the debate and the opportunity to participate in it. I welcome the opportunity to focus on mental health, which, as many Members have acknowledged during the debate, has historically been a poor relation in health and social care. As Mr Buchanan mentioned in his contribution, thankfully, things are starting to change. A lot of high-quality, essential work is carried out in our communities and in our hospitals by talented and dedicated people. They very much deserve our respect and our thanks. <BR /> <BR />We face significant challenges in the arena of mental health: the legacy of the Troubles; an ageing population; areas of deprivation; unemployment; and stress at work. There is barely an element of modern life that does not have the potential to adversely impact upon someone's mental health.”
“I will ensure that the trust does that. <BR /> <BR />In conclusion, I have no doubt that this report will make a valuable contribution to the discussions which the trust will have with the council and other stakeholders as the future of these services is discussed and shaped over the coming months. I can assure you all this evening that the Northern Health and Social Care Trust will engage fully with the people who use the services, the staff who deliver them, and the wider community in discussing the future of the Dalriada Hospital.”
“<BR /> <BR />I am aware, and it was referenced in virtually every contribution this evening, that the old Moyle District Council — now part of the Causeway Coast and Glens Borough Council — commissioned a report to support the case for a continued role for Dalriada Hospital. I have taken a look at the report; I think it is excellent. It recognises the need for a changing role for small local hospitals like the Dalriada. The particular recommendation for its future — as a hub for outreach, support and care for the frail, elderly and vulnerable people in general in the area — is an interesting proposition and one worth carefully considering. I will ensure that consideration is given to it by the trust. It represents change, but I think it is positive change to the service, and it is something worth studying more carefully.”
“To that end, the Northern Trust has been reviewing the range of services available across the trust area in relation to intermediate care and is developing a long-term vision, predicated on the need to maintain people at home for as long as possible and to provide services at home, or as close to home, as possible. It is its intention to engage with a range of stakeholders later this autumn. <BR /> <BR />The trust has worked closely with MS service users to capture their views and requirements in relation to respite care at Dalriada, what is available and how to access it. At the request of service users, the trust has developed a leaflet to highlight the range of respite care options available. At present, the majority of users do not want hospital-based respite.”
“I know that Members wish to have a commitment from me today that intermediate care and MS respite services at Dalriada Hospital will remain unchanged indefinitely, forever and a day; but that is not something which I can give. Decisions about the provision of services at Dalriada Hospital are, and should always be, in the first instance, matters for the Northern Trust to consider. In this, as in lots of other issues, I look to trusts, commissions and others for their expert advice on quality and, particularly, safety of services.”
“Of course, embracing innovation, as I have been encouraged to do by Mr McKay, involves challenges for us all because new ways of working, which maximise the considerable but also limited resources that are available to Health and Social Care, sometimes mean doing things differently. That can cause concern but, if the outcomes are better, I think it is well worth pursuing that path. Being innovative means taking decisions about how and where we deliver services to maximise the quality of care for patients, deliver the very best outcomes and ensure that patient safety is maintained. <BR /> <BR />What does that all mean for the future of Dalriada Hospital?”
“Transforming Your Care and the Donaldson report both make important points about the need for a mature debate on our overall hospital-based services. They need to shift from hospital-based care, and they need to ensure that our finite resources are maximised to provide the best value for money for patients and the services provided for them. The challenge for us today is to sustain and further develop the best in health and social care while embracing innovation. As Mr McKay pointed out, I am supportive of innovation across the public sector. <BR /> <BR />There is much evidence of innovation in the health and social care sectors. I have been pleasantly surprised by the evidence of innovation right across them since taking up post.”
“In the next number of weeks, I intend to come forward with my vision for the future of health and social care in Northern Ireland and how we intend to take forward the recommendations in the Donaldson report and future commissioning and the reform of the administration of the health and social care system in our country. That is a huge undertaking of major reform, but it is much needed reform. When you look at the range of challenges that our health system and social care system faces, you see that these are not decisions that we can continually push down the line. We need to take decisions, and we need to get political consensus on them. <BR /> <BR />Our current pattern of health and social care services is not sustainable and needs to change.”
“<BR /> <BR />It is a trust that is doing well. This is an indication that it is focused on the task in hand, which is to deliver high-quality safe and effective care in the most efficient manner possible. I would like to pay tribute to the hard-working staff in the hospitals and those delivering health and social care services in the community for their service to the local area and their commitment to delivering high-quality health services. I wish to pay tribute to the leadership of the trust as well. <BR /> <BR />When I took up post in May, I set out my vision for a world-class health and social care system in Northern Ireland building on the many world-class services that we already have. Delivering that vision requires innovation, change and reform across our health and social services.”
“Some 2·6 million hours of domiciliary care were provided through the trust and the independent sector, which equates to care for 4,600 people. <BR /> <BR />Despite the scale of the challenges that the trust has faced and overcome, it has also performed well. Performance in unscheduled care has improved remarkably. In 2014-15, across the trust, there was a 35% reduction in patients waiting more than 12 hours to be assessed, treated and either discharged or admitted to hospital. That improvement builds on the 50% reduction the previous year. In addition, the Northern Trust’s acute hospital network has been recognised among the 40 top hospitals in the UK for 2014. The 40 top awards are based on the evaluation of 22 indicators covering safety, clinical effectiveness, health outcomes, efficiency, patient experience and quality of care.”
“I am determined that the lessons learned from the turnaround process will be carried forward and become embedded as this organisation continues to improve. <BR /> <BR />It is important to set the context of what care the Northern Trust delivers on a day-to-day basis and the environment in which it operates. The Northern Trust area has a population of 440,000 people, the largest resident population in Northern Ireland. In common with the rest of Northern Ireland, the demand for health and social care in the Northern Trust area grows annually by approximately 6%. That includes demographic growth, resulting in more older people with complex health needs and co-morbidities and increased referrals. In 2014-15, the trust had 50,625 people admitted to hospital care and 26,581 day cases.”
“I think that we are all familiar with the pressures facing our health and social care services, which include a rise in chronic conditions driven by both our ageing population and unhealthy lifestyle habits; increasing demand and over-reliance on hospital services; growing expectations of our population; fast-moving opportunities in technology and medical interventions; workforce challenges; and, of course, the financial pressures that we face. The Northern Trust has not been immune to those challenges, and I want to talk a little bit about the Northern Trust if I can. <BR /> <BR />I acknowledge that there have been problems in the past, and it would be foolish to think that there will not be difficulties in the future. However, this trust is transforming.”
“It is the decision last year by the Northern Health and Social Care Trust to temporarily close the intermediate care beds and the MS respite unit beds followed by the restoration of the status quo as a result of the court's interim relief ruling in December 2014. <BR /> <BR />That cannot be and is not the end of the story. The pressures and service trends that lay behind the Northern Trust’s decision are very much still with us.”
“It is clear to me that the Dalriada Hospital and the services that it provides are held in the highest regard by the people of the community that it serves. As we have heard today from virtually every Member who has spoken, Dalriada Hospital provides a range of non-acute community hospital services, including intermediate care beds and a multiple sclerosis respite unit, along with outpatient and allied health professional clinics and a GP health centre. <BR /> <BR />We are all well aware of the background to this debate; if we were not, we have been familiarised with it during today's Adjournment debate.”
“I begin by thanking Mr McKay for proposing today's Adjournment debate. I have been impressed by the considered, thoughtful and valuable contributions that have been made in the Chamber this afternoon, and I hope to respond, in the remarks that I make, to most of the points that have been raised.”
“I think that it has been a good and appropriate response, particularly from those in the faith-based community, to problems that they see in the communities that they live in. It is worth taking time to praise them for the work that they do.”
“I will make sure that that is done. Now that food banks have been mentioned, it is probably worthwhile putting something on the record again. I remember a debate that Mr Douglas, who is still behind us, and I brought to the House some years ago. Our motion praised what was, at that stage, the very early work being done by food banks across Northern Ireland. Obviously and unfortunately, that work has had to increase out of necessity in recent times. We should always take time to praise those who, in many cases, volunteer for the work that they do and to thank those who have provided food banks with food and other materials that can be given to people in need across our Province.”
“That is why I have long supported, and will continue to support, not just the range and package of support that the Minister for Social Development's Department, or, indeed, the Department of Health or other Departments, puts forward to support vulnerable people and those in need but my colleague the Minister for the economy in trying to grow our economy in Northern Ireland and increase our competitiveness. <BR /> <BR />We may have many disagreements in the House about welfare reform and other issues, but I think that we are all in agreement that the best way out of poverty is to give people a job, to get them back into the workforce and to encourage them to earn money and contribute to society. That is the best answer to poverty, and it is a better answer than anything that the Minister for Social Development can do under his remit.”
“I am not aware of the report that the Member refers to, although I am happy to take a look at it, and I am sure that the Minister and Department will be aware of it and will have a look at it. I will ensure that they respond to you with specific comments around the report and its recommendations and on what the Department is doing to deal with it. <BR /> <BR />I think that we all accept that there are serious and significant poverty issues in Northern Ireland. Our region has gone through very difficult economic times in the past number of years that will have only served to exacerbate existing issues and problems around poverty, particularly child poverty.”
“<BR /> <BR />Some now have a choice to make on whether or not to live up to their commitments and responsibilities by moving forward with a form of welfare reform that is more suitable to the needs of the people of Northern Ireland. We have the opportunity, through devolution, to be able to fashion welfare reform — at a cost, yes, but it is an opportunity to fashion welfare reform in a way that better suits our citizens. That choice is still there for those who, up until now, have not shown any maturity or responsibility. That choice is there for them, and I hope that they grasp that opportunity in the coming days and that we move forward with sensible, good, sound welfare reform proposals that help put the Executive's finances back on an even keel and allow us to move forward and make some progress.”
“I again agree with the Member's analysis. Let us not forget that we are already seeing an impact on vulnerable people in Northern Ireland as a result of the failure of Sinn Féin and the SDLP to show some maturity and to live up to the commitments that they made last Christmas. The impact of their backing-off on welfare reform and failing to let welfare reform legislation pass through the House is seen nowhere more starkly than in the Department of Health, where the £9·5 million a month that we are losing could pay for a lot of hip and knee operations. It could take many people — to use the Member's phrase, very vulnerable people — off waiting lists on which they have been for a very long time.”
“It is up to others to make that decision. Do they want welfare reform as it is in Great Britain? We are all hearing various stories about how difficult it is to implement there and its painful impact on people. Or do we want our own version in Northern Ireland? We have the template in the Stormont House Agreement and Stormont Castle agreement. It is up to others to show some responsibility and maturity and to live up to the commitments that they made last year.”
“I agree entirely with the Member. I could not have put it better myself. He is absolutely right. I was going to say, "we have", but I do not think that my party or the Member's party has this choice to make; it is for others to make this choice. We agreed a way forward on welfare reform at Stormont Castle and Stormont House. That was being faithfully honoured until Sinn Féin, aided and abetted by the SDLP, walked away from those commitments. To be fair, the SDLP backed away from them much quicker than Sinn Féin did, and we are now faced with that choice. <BR /> <BR />The Secretary of State has said what she has said, and I think that it is a game changer. I think that it has unlocked the situation and has made the negotiations that we are entering into not easy but perhaps a little less difficult on this issue.”
“I have not seen the newly published report, although I was aware that it was being published today. I have not seen that recommendation or, indeed, any of the recommendations. It is a sensible proposal to put forward, but it is a little bit more difficult to execute in reality, in my experience.”
“That is not just because this year is one where we are challenged by the resources available to us but because it is a year with a one-year Budget. There is not the certainty for Departments to be able to do that, particularly in an environment where we are expecting further cuts to resource expenditure, especially in the years to come. It is very hard for Departments to give that degree of certainty to community and voluntary organisations or, indeed, to any organisations and even some units in their Departments about future spending. That does not always produce the best outcomes, and it does not allow you to tackle with any degree of certainty those long-standing ingrained problems that there can be in our society. <BR /> <BR />So, I accept the point that has been raised.”
“This is one of those conundrums that I can see in my Department, and I am sure that the Department for Social Development will have the same issues. I recall it very clearly from my time in DFP. It is one of those things where doing that is obviously the right thing. It does not matter whether it is the community and voluntary sector; it can be in the statutory sector as well. If you are trying to have long-term sustainable impacts on social problems, health problems or whatever it might be, having security of funding over a long time is self-evidently the best way to go about it. It is quite difficult to deliver in the public financial system that we have in this part of the world. It throws up particular challenges in years like the year that we are in.”
“<BR /> <BR />The Member and I know the Strangford area well. We are very fortunate to have in our constituency quite a large number of very good community organisations that are supported by a range of different networking organisations that provide good support and capacity and continued development and training in the constituency. I am sure that through his mailbag, emails and telephone, he is contacted by the same sort of people who I am contacted by. It is not perfect by any means, but, on the whole, from experience, I think that we have a very good relationship between the statutory sector and community and voluntary organisations in the Strangford constituency.”
“I am well used to Barry McElduff, as is everybody in the House, and parochial does not quite describe it. <BR /> <BR />The Department obviously has a role, remit and responsibility for the community and voluntary sector, which is, I suppose, underpinned by the concordat that has been in place for a great number of years. I think that the relationship between the community and voluntary sector and the Department or Executive as a whole will always be one of assistance and challenge. So, in that respect, I think that a healthy relationship has existed. I know from my current posting that there is a good, healthy relationship between my Department and the community and voluntary sector, and it is one where we are more than able to work together to resolve issues and problems as they arise, hopefully in a mutually beneficial way.”
“I would never accuse anybody who raises issues about the Strangford constituency of being parochial by any means.”
“They will now be able to exit the Civil Service. I am sure that they will be greatly relieved that they have that confirmed and do not have to live in limbo any more.”
“That will relieve pressure in the Department for Social Development. I know that it was seeking to exit one of the biggest numbers of staff from the Civil Service. If those people could not leave at the end of September it would create severe strain on the DSD budget in-year, and I do not think that the Department would have been able to live within its budget in-year, much as many other Departments would not have been able to live within their budget in-year, because they were relying on those savings coming forward. <BR /> <BR />The ability to move forward on the VES, which I very much welcome, will not solve all of the budget problems that all of the Departments, including DSD, have, but it will offer them some relief. More importantly, it has given certainty to those staff who were waiting to exit and who had notice given to them.”
“Obviously, the Finance Minister, when she was bringing forward her Budget towards the end of the last session, pointed out the financial realities that we were facing at that stage as a result of not moving forward with welfare reform. Her concerns — as they were my concerns when I was Finance Minister, and they remain my concerns in my current position — were on the failure or inability of us to move forward with a voluntary exit scheme (VES). Obviously there has been good news in that respect in the last number of days, when the Secretary of State, following her speech at the British-Irish Association, has made it clear that she is willing to let that funding be released. <BR /> <BR />I think that the Finance Minister confirmed yesterday that the first tranche of people exiting the service will go ahead at the end of this month.”
“We could talk for much longer than the two minutes that I have about the pressures in my own Department, as the Member will be well aware. I am not aware of any particular pressures that the Minister for Social Development is facing in his budget, but I am sure that, if his Department is anything like mine — although, having been Minister in two Departments, I am not sure if there are any other Departments quite like the Department of Health — he will be facing a range of pressures and will have to make very difficult judgement calls as to where to use the finite limited resources that he has at his disposal.”
“<BR /> <BR />In 2014-15, the increases were principally related to restructuring within the Housing Executive's corporate services division, which included a move to a HR business partnering model, the establishment of a corporate strategy and planning office and a temporary transformation team, as well as a regrading exercise, which resulted from a request for job re-evaluation on the part of the Housing Executive's team of solicitors, so there are a range of reasons that the Minister would offer as to why the number of level 8s has gone up. Whether the Member is satisfied with that or not, she can take it up with the Minister. If she or her colleagues have not taken it forward in the debate, I am sure that she can take it up in writing with the Minister.”
“I am aware of some queries. Actually, I think Mr Beggs mentioned level-8 staff in the previous debate, just as I arrived into the Chamber. The Member is right that there has been an increase from 36 to 66 level-8 staff — that is the information that I have — from 2013-15. The reasons given to me as to why that is the case are that, first, in 2014, the increase from 36-51 was principally around a restructuring of the landlord services section in the Housing Executive to a three-region structure, which was to better reflect the reform of public administration and the new council structures. In order to properly realign with the RPA, the stock and staffing size of the new area significantly increased, which led to the appointment of more level-8 area managers.”