Northern Ireland Assembly

The sitting begun and suspended on Monday 2 October 2000 was resumed at 10.30 am (Mr Deputy Speaker [Sir John Gorman] in the Chair).

Local Community Nursing

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Debate resumed on motion:

That this Assembly calls on the Minister of Health, Social Services and Public Safety to ensure that appropriate funding for local community nursing is available for those patients in acute hospitals for whom nursing care is appropriate, so that bed blocking is removed and consultants can treat additional patients currently on waiting lists. — [Rev Robert Coulter]

Mr Shannon:

I want to pick up on some of the points raised yesterday. First, however, I must mention a case that came to my attention this morning. It highlights the problems that exist with regard to funding for community nursing and is an example of the domino or knock-on effect. A lady from Donaghadee who had telephoned for an ambulance waited for four hours for it to come. She then had to wait in the hospital for eight hours before she was seen. She had to wait 12 hours in total. This illustrates the problems in the Health Service. It is no reflection on the staff as they do an excellent job; it does reflect very badly on the funding and finances available.

Rather than witnessing an increase in the quality of service to the local population over the past few years we have seen the National Health Service and the health care provision undermined and reduced. Many facilities, including the accident and emergency services have been withdrawn from hospitals such as Ards, Bangor and South Tyrone. There are similar plans for the City Hospital, while services at the Downe Hospital look set not to go ahead at all. No provision has been made at the Ulster, or any other hospital, which will compensate for such loss.

Consider the knock-on effect to local community nursing as a result of that. Much is made by the Government of the £15·1 million allocated for new sites such as Downpatrick, yet this large sum of money is only a fraction of what is required to provide a full range of services. To put this apparently generous offer in perspective, it would cost more than half this figure again to bring the Ulster Hospital up to a satisfactory standard.

We in Strangford and North Down do not have a monopoly on poor health care provision. The picture is the same all over Northern Ireland. I agree with the assessment that the Government never had a long- or short-term strategy for the future of health care services in Northern Ireland. The Government are and have been involved in a campaign of cutting funding and services to all areas of this country without any thought for the negative effects upon the standard of living for local communities. The Government’s plan over a number of years has been to decimate the Health Service and let the Assembly pick up the pieces and take the blame for the state of affairs.

We are aware of the delays for occupational therapist visits and those people who are waiting for work to be done on their homes. Rev William McCrea said yesterday that some of these people will unfortunately be dead before that happens. That is the reality. Is there a policy of waiting for a wee while to see what happens? Those people meantime are suffering in the short term. It is disgraceful that there are such delays in occupational therapy and even worse delays in getting the work done. The crisis currently emerging from the Ulster Hospital, for example, had been predicted by many over the past few months, only for those warnings to fall on deaf or unwilling ears. It was not a case of if, but when, this crisis would be manifested.

I take this opportunity to congratulate every member of staff for the good work that they have done. They have shown 100% commitment to fulfilling their duties. Many were called away from their families over the holiday period without any cajoling or encouragement. They are committed to their work — to them it is a vocation rather than just a job. These people endeavour day and daily to maintain the Health Service. At the same time they have witnessed a profound lack of movement from Wesminster to address the situation.

The Health Service was set up and exists to provide each and every member of society with a proper and adeqate level of health care. For years we have witnessed a rundown of services not only in Northern Ireland but also across the whole of the UK, and especially in our area. Warnings and demands about the Ulster Hospital in particular have been overtly ignored. As a result the problems of last Christmas, which cost lives, were inevitable — just as inevitable as the problems which will be witnessed in the coming months. This morning’s news was such an example. People are now dying because of the inadequacies of the Government. The situation has been allowed to drag on for far too long, with the result that the local Health Service has been stretched well beyond breaking point.

There have also been delays in relation to community nursing. A number of people have come to me over past months and they have all put forward the same case, they are all experiencing the same difficulties. They are trying to get people out of the hospitals and into community care, but cannot because the funding is not there. It is frustrating for us, as elected representatives, but it is more so for the families who want to move their family members to somewhere where they can be closer to them and look after them better. That opportunity is not there as long as the finance is not available. The community nursing system has fallen down and does not deliver what our constituents want. It does not deliver either the care or the commitment that the families want.

Mr Carrick:

Is the Member aware that in some of the community health trusts there is a cap of £200 on the care package? When that figure is exceeded, the patient must go into residential care, putting the personal assets of the family at risk. Does he find that iniquitous?

Mr Shannon:

We are all aware of cases such as that mentioned by the Member. It has become increasingly frustrating. We have to tell people that the money is not there and that it has been capped. That does not deliver the care that we wish to see. There have been delays of 16 to 20 weeks in getting people out of hospital and into care in homes. It is all down to finance, and I think that that is absolutely disgraceful. We must give credit to the staff. They work hard and are committed to the job, but Government policy has led to a decrease in technical and personal support, fewer beds and no movement towards improving the general provision of health care. The Government offers only excuses to explain the present debacle. Patients are still treated on trolleys; non-urgent operations are postponed; and the seriously ill are sent home when they should have been admitted for tests and observation. The Department of Health at Whitehall used the flu epidemic last year to cover up the serious cracks and flaws within the Health Service. Such a crisis was always on the cards; it was just a matter of time before it hit us here in the Province and elsewhere.

People are dying unnecessarily because of the Health Service’s profound inability to respond to the problems. It is mostly down to finance. It is very hard to convey to people the true seriousness of the matter. The Health Service is crumbling around us, and, unless something is done promptly, the NHS will soon be a thing of the past, in ruins. On the news yesterday morning, we heard warnings about how the Health Service is preparing for another difficult winter. Whenever we hear that coming directly from Government, it creates discontent amongst the staff in the Health Service. If the necessary resolute action is not taken now to address the problem, things will continue to worsen. Therefore, it is essential that sufficient funds be sourced in order that local community nursing can meet the demands of those who are ill, both at present and in the future. Any move to free up the ever-decreasing number of available beds in our hospitals must include increased investment in the local community nursing sector. We must do all in our power to maximise what health care provision we have left.

Mr J Kelly:

Go raith maith agat, a LeasCheann Comhairle. I support the motion, even though I find it a bit ambiguous. I wish the Minister well in making her bid to the Executive. It is a pity that such a serious debate on community care has, at times, degenerated into a slagging match and, from some quarters, an attack on the Minister. Perhaps it is timely to remind the House that all parties had the chance to grasp the nettle of Health.

All parties had the chance to grasp the poisoned chalice of health. Sinn Féin was the only party to grasp that nettle and to accept that chalice. Others, in an act of fright or political cowardice, let the chalice pass from them. Because of our different political philosophies on social issues, consensus on the politics of health may not be achievable. However, there ought to be consensus and generous acknowledgement that the terminal state of the Health Service is the result of 30 years of Westminster neglect and indifference. It has been left to Ms de Brún to attempt to redress the imbalance of 30 years, a task which any objective observer would agree cannot be carried out within weeks or months.

There has been much debate over whether Northern Ireland’s four boards and 19 trusts are a waste or misuse of scarce financial resources. The recent rise in golden handshakes to trust executives reinforces the view that the boards and trusts need a root-and-branch review that is both radical and just.

Community care is an attempt to deliver care in the community, a service which has been neglected to the point where it is almost non-existent because of a lack of funding and, perhaps, misguided policies. Society also has an obligation in this regard. People who feel that they cannot mind their elderly parents at home, because of social constraints or for other reasons, find ways of putting them into institutions. There is a social dimension to community care.

Insufficient effort and resources are being channelled into community care at the cutting edge, where it is possible to make both a meaningful difference and an attempt to alleviate the crush on hospitals. A Leas Cheann Comhairle, this area is separate to the broader issue of the abysmal state of wider aspects of the Health Service hospitals, operations, geriatrics, orthopaedics and coronary care. Community care involves more than just the nursing profession the district nurse, or the nurse in the clinic. It is carried out by carers who are not fully qualified but who take on many of the responsibilities of nurses by attempting to deal with situations that require medical attention. They are underfunded. Adequate compensation is not given to carers who stay at home to look after an elderly parent, aunt or uncle, and mostly in rural areas. In many ways, the health system is using their generosity to avoid situations it might otherwise have to attend to.

One of the ambiguities of the motion is that it does not seem to focus on care in the community as a major problem in our society. Community care aims to provide comprehensive health and social care and to retain individuals in their homes as non-hospital residents for as long as possible. It also aims to provide an integral package of care, allowing people to achieve maximum independence. Such an approach requires adequate resourcing. The system for managing care has been fully implemented since the mid-nineties, but this occurred in a climate of efficiency savings and cutbacks. Evidence indicates that the cutbacks have had an adverse effect on the provision of health and home-nursing care to such an extent that it is often difficult for individuals, family and informal carers to cope at home. Particular hardships are evident for elderly or disabled persons living alone. Without the support of families and informal carers, the system would collapse. Families are being expected to do work that should be being done by the Health Services, and they are doing that work as a matter of conscience.

10.45 am

There is a lack of resources for community care and acute hospital beds, and waiting lists and occupancy are encroaching more on home beds. We agree that all of those things have to be addressed and redressed. We ask — and we support others in asking — for some means to be devised to examine closely what is happening in the community care area of health today. If funding is a necessary part of the solution, we should work as assiduously as we can to ensure that it is provided.

Mr Savage:

I commend my Colleagues the Rev Robert Coulter and Mr McFarland for tabling this important motion. I am grateful to them for having had the foresight to enable us to deal with the issue as we head towards autumn rather than in the middle of winter when our hospitals will again be crisis point. I hope the Minister shows equal preparation. The downside of this situation is that we have just come out of what is regarded as the quietest period for hospital admissions, and yet we are already heading towards another crisis.

I am aware that so-called bed blocking — and the Department may have its own interpretation of this — is contributing to rising waiting lists and increasing waiting times. That that is a contributing factor at all, in this day and age, is disgraceful when we consider the massive advances that we have made in medical science in this modern era. If those advances cannot be delivered to patients, in part because we cannot recycle beds properly, we must despair of the way in which we order our society.

Three groups of people are affected significantly by the situation: those in hospital beds for whom funding for adequate community nursing is not available; those on waiting lists who do not get beds in the first place; and the medical profession. It must be so demoralising for any doctor, nurse, or consultant to have to put up with this situation. Bed-blocking and other factors contribute to growing waiting lists throughout Northern Ireland and these problems must be resolved on that scale.

I support those who have called for a proper review group to be established and to include Members of this House. As a Member representing Upper Bann I have more confidence in such a group’s ability to address the problems facing Craigavon Area Hospital than in any of the arrangements made by the Minister thus far. I ask the Minister to consider the situation in Craigavon. If budgetary stipulations made by her Department are to be satisfied, it has been estimated that two 36-bed wards at Craigavon Hospital would have to close. This would mean a reduction of around 3,500 in the number of patients being treated, and I ask the House to bear in mind that there are already 5,000 people on the waiting list of the Craigavon Area Hospital Group Trust.

We have already reached the point where little elective surgery is being done, and my fear is of the knock-on effect that that is having. I am particularly concerned that pressures will increase on the accident and emergency wards as patients find they are having to go through that channel to get treatment. In such a situation, GPs are placed in an impossible situation. They know only too well the pressures that their colleagues are under, yet they have a moral responsibility to ensure that their patients receive treatment.

I do not believe in scaremongering. Those of us in public office have a duty not to frighten people. We have a responsibility to deal with this issue both urgently and rationally. Telling people that they are not going to get better is not the way for responsible public representatives to conduct themselves, but making constructive suggestions is. Having said that, the Minister must recognise that we are facing a serious crisis of confidence in health provision, and bed blocking, as it is termed, is contributing to that crisis.

Six months ago the Minister’s Department published a report called ‘Facing the Future’, which addressed the issues raised during last winter’s hospital crisis. That report acknowledged that in the winter of 1999-2000 health and social services in Northern Ireland faced the most severe challenge experienced in recent decades. It proposed a number of means to ensure that those problems will not be experienced again. The Minister has a duty to come to this House and tell Members how many of the report’s target dates for action have been met. We need to be assured that the issue of bed blocking is being dealt with within the context of those areas identified as requiring action.

In terms of the motion before us, we particularly need to know the extent to which this bed blocking is being addressed in the development of both the waiting list action plan and the joint review of existing winter pressure plans.

In conclusion, it seems that the problem is best summed up by the spirit of today’s motion: everyone who needs medical treatment should get it, and get it promptly. This will mean freeing up beds, and, in order to achieve that, we must ensure that there is appropriate funding for local community nursing. If the Minister really wants to achieve a reduction in waiting lists then she should establish a suitably resourced programme to address the problems, especially while bed blocking continues.

Finally, thanks are due to members of the nursing profession for their dedication to patient care. The professionalism that they have shown over the years is something that can not, and will not, be allowed to go unnoticed.

Mr Neeson:

I wish to make a brief contribution in support of the motion. Members have given graphic details of the existing problems in the Health Service, and I am reminded — as you may well be, Mr Deputy Speaker — that we dealt with this same issue in the Northern Ireland Forum. That body bestowed no powers at all on its members. All that we could do was air the problems that existed in the Health Service.

I have sat through a fair portion of this debate, and I am concerned at some of the personal attacks made on the Minister. We are only a fledgling Assembly and we are still on a learning curve. I am extremely concerned, since this Assembly, unlike the Northern Ireland Forum, has powers to deal with the issues before us, including the problems in the Health Service. Over the past few months, I have been confronted with some of those problems such as delays in the examination of accident victims’ that never happened 20 years ago. The problems that we face today, not only in the Health Service, but with the railways and a whole raft of issues, stem from the underfunding of those public utilities over the past few years.

It would be wrong to point the finger exclusively at the Northern Ireland Office Ministers; we were dealing with a serious conflict situation, and moneys were diverted. There was underfunding, however, and it is now up to the Assembly to address that. Those who say that they want to bring the Assembly down are doing a great disservice to the people of Northern Ireland. The people want to see their politicians making decisions about their future, including the Health Service. Therefore, I appeal to those who wish to wreck the Assembly: the only people who can deal adequately with our current problems are those who have been elected to the Assembly. Bringing the Assembly down will make the situation much more difficult.

Mr Berry:

On a point of order, Mr Deputy Speaker. Is the Member sticking to the motion?

Mr Deputy Speaker:

Has the Member finished?

Mr Neeson:

The Assembly has a responsibility to address the problems outlined in the motion. The future of the people of Northern Ireland lies in our hands.

Mr McFarland:

We have heard examples today and yesterday of the parlous state of the NHS in Northern Ireland. A substantial number of those affected are elderly. It is of note that nearly a third of the population is over 50 years of age — 450,000 people — and the figure is rising. Of those over 65, nearly two thirds have a long-standing sickness.

Care in the community, which was introduced seven years ago, was supposed to deliver a better quality of life, but only 33% of suitable care packages are delivered at home, making institutional care the only option for many. The drama of last winter alerted the Department to the bed blocking crisis, and it does not appear that much has been done since to sort that problem out. The community care sector is in crisis. I use the term "bed blocking" deliberately, for it describes the problem more clearly than the politically correct term "delayed discharge".

Nursing homes have difficulty recruiting qualified nursing staff, and it is disturbing to find that nearly 80% of the social care workforce have no formal qualifications. Community care funding is consistently insufficient to meet demands. In 1999-2000, £25 million was allocated to community care, but only £13·2 million was actually spent on it. As with the children’s sector, the Department diverted the funds to meet other pressures. Given that history, can the Minister assure the House that such funding will in future be ring-fenced?

11.00 am

It is interesting that during the winter crisis a co-ordinated effort managed to move 140 bed-blocking patients from hospital into nursing care over a 30-day period.

The social services inspectorate, as a result of the winter crisis, carried out a review of community care in February this year. Its outline recommendations were that the Department should produce an effective method of funding and strategic planning to deliver community care; an infrastructure which facilitates all-year-round planning and resourcing to deliver the most effective use of resources; and a set of standards regarding assessment, care management, discharge arrangements and recommendations of previous inspection reports to be carried out.

It also recommended greater collaboration across hospital, primary and community care, so as to develop a co-ordinated approach to the planning and management of hospital admissions and discharges to ensure care pathways for patients and clients, with appropriate thresholds and settings to meet the needs of carers; schemes such as ‘Home from Hospital’ and ‘Rapid Response Service’, which prevent unnecessary hospital admissions and facilitate early and appropriate discharges; and an eligibility criteria and charging policy to provide consistent and fair access to care services for all people in Northern Ireland.

Also recommended were outcome measures to demonstrate the impact and effectiveness of schemes to address emergency pressures and their impact on the quality of care for patients and clients; and information systems to enable the Department to more effectively monitor community care and care management arrangements, and to inform resourcing decisions.

It stated that information on waiting times, cost of referrals, assessments and packages of care in the community should be developed as a matter of priority, and called for accountability arrangements sufficient to ensure that all recommendations made as a result of inspections are fully implemented. I wonder how many of its recommendations have been actioned.

Indeed, boards and trusts should have given action plans for this winter to the Minister by 30 September. Mrs Carson informed us that one organisation has not even started yet. Can the Minister assure us whether these have been received? Without a serious co-ordinating effort and additional funding for community care, it is difficult to see how the present crisis in waiting lists, block-beds and nursing care in homes will be solved. I commend the motion to the House.

Mr Deputy Speaker:

Before calling on Rev Robert Coulter to make the winding-up speech, I, as Chairman of the Northern Ireland Forum for Political Dialogue from 1996 to 1998, would like to echo what Mr Neeson said. We have a totally different situation from that which existed then. We have the Minister, with power and responsibility, present — a very different situation.

The Minister of Health, Social Services and Public Safety (Ms de Brún):

Go raibh maith agat, a LeasCheann Comhairle. Ba mhaith liom buíochas a ghabháil leis an Oirmhinneach Robert Coulter agus leis an Uasal McFarland agus iad a thréaslú as an tsaincheist thábhachtach seo a thabhairt go hUrlár an Tí. Tá áthas orm go raibh mé in ann freastal ar mhórán den díospóireacht, agus d’éist mé go cúramach leis an iomad pointe luachmhar a thóg Teachtaí.

Dála go leor eile dár seirbhísí poiblí, tá cuid mhór de na fadhbanna atá romhainn sna seirbhísí sláinte agus sóisialta ag carnadh leo le blianta fada. Agus beidh gá le hobair in éineacht sna blianta seo chugainn le rudaí a chur ina gceart.

I congratulate and thank Rev Robert Coulter and Mr McFarland for bringing this important issue to the Floor of the House. I am glad to have been able to attend much of the debate, and I have listened carefully to the many valuable points raised by Members. I have been moved, as have other Members, in listening to the personal impact on those waiting to go into hospital or waiting in the community for packages — the graphic details of the problems facing the community. I also echo what Members have said in praise of staff throughout the health and personal social services. The staff are working, with tremendous commitment, to deliver services of the highest possible standards with the resources given to them.

I also agree with the points made about the need for resources for both community care and hospital care — in fact, for resourcing the whole integrated system. The debate threw into sharp relief the interdependence of all our services. For our hospitals to work effectively, they are dependent on community-based services delivering the right care. Our task, in modernising health and social services, must be to develop community care and hospital care. We must provide the levels and quality of care in the appropriate settings that our people need.

To improve acute services in our hospitals, we need to develop and expand complementary services in the community — services such as community nursing — which dovetail with the necessary hospital development. We also need to remind ourselves that community care is not important only because of the impact that it has on acute hospital care: we also need to look at the position of those waiting in the community for care packages that will allow them to live their lives in the way that we would all wish.

I was also struck by the cross-party recognition of the need to fund urgent improvements in our health services; I welcome the support that Members have expressed. Health is a key priority for the Assembly, and I share Members’ belief that health and social care are simply too important to our people to be allowed to decline through continuation of the historic underfunding that we have seen. We also need to look for efficiencies, and that is at the core of my consideration of how to meet the ever-growing demands for care and treatment. Much has already been achieved in this area in recent years, but we need to consider how much scope we have for substantial further efficiency gains in this service.

The growth in demand for hospital care is only too apparent. Over the last decade, although the number of beds was reduced by more than a third, 23% more in-patients and 166% more day-patients more have been treated. Similar pressures are apparent in the community, and we need to remember that £190 million in efficiency savings were taken out of our services in the last decade. I certainly have no quarrel with setting the service such targets, or with ensuring that savings are made, and that the services operate efficiently. However, it is a pity that such substantial funds — £190 million in efficiency savings — were taken by the Treasury, instead of being reinvested in the Health Service. In future, I want to see savings ploughed back into the service.

I acknowledge freely that money alone is not the answer but I am convinced that we will require significant additional funding to improve performance. That view was strongly reflected in my statement to the Health, Social Services and Public Safety Committee, which I addressed last week on the question of the budget and of the present bids. I have already made — and will continue to make — a strong case to the Minister of Finance and Personnel and to all my Executive colleagues for the extra funding that is needed. I have taken on board many of the points that have been made by Members.

Many current problems have been building up for years, and it will take a strong, focused effort, over a number of years, to turn things around. Tackling such long-standing and deep-seated problems will require energy, imagination and sustained commitment of resources. I am determined to deal with these challenges; I am determined to seek the extra resources; and I am determined to ensure that, across the entire range of services, we make the necessary improvements, undertake the challenges, and make a focused, sustained and carefully monitored effort to ensure that we have the kind of services that our people deserve.

I would also like to pick up some specific points raised during the debate. I appreciate the calls from all parts of the House to increase funding for community nursing and wider community care; that is a key element in my bid for additional funding for 2001-02.

I am in no doubt that community care must be expanded to cope specifically with the growing numbers of frail elderly people and other vulnerable groups — as some Members have mentioned. This will include providing services to all of these valued members of society who deserve them.

The additional £11 million which was provided for community care this year will support an extra 450 community-care packages. These will directly contribute to reducing delayed discharges from acute hospitals. The politically correct term "delayed discharge" reflects a key point which was mentioned yesterday. The blame for a bed’s being blocked should not be placed on the shoulders of the elderly person who is occupying it but on the system which is supposed to ensure that places are made available. The idea of delayed discharge focuses on the system, rather than highlighting bed blocking, which focuses on the individual. However, I agree that the term "bed blocking" is much more graphic.

In the next few months the boards will be targeting delayed discharges to ensure that beds are free for emergency admissions during the winter. I share the Members’ concerns that waiting lists for hospital care are too long. This is a consequence of a growing demand coupled with historic underfunding over a number of years. We need to invest time and money in the long term in order to improve this situation.

The framework for action on waiting lists, which I published last month, provides a comprehensive programme for reducing waiting lists over the next three years, and I assure Members that careful monitoring of the outworking of this framework, and of the actions detailed in it is taking place.

The measures outlined here include the adoption of best clinical and managerial practices, the running of pilot schemes designed to manage admissions more effectively — which was mentioned in the debate — and the purchase of additional procedures.

An extra £5 million being made available this year would support initial action — and I stress initial action only — under the framework. Reflecting Members’ recognition of the integration and interdependency of services, this programme takes a systems approach which covers community care and hospital care. It is, of course, crucial that we develop a sustained and focused programme, which will need to be funded recurrently and which will tackle these problems effectively and progressively.

I appreciate the concerns expressed about whether services can cope with winter pressures. Since coming to office I have initiated a thorough review of winter pressure arrangements for this year, and I have taken urgent steps to boost key services such as intensive care provision. Members have referred to the reviews that I initiated after last winter, which began in February. These reviews were given public focus in that the media focused on the situation in the hospitals, but simultaneously I initiated a review of community care because I understand that the integration and the interdependency of services is a key factor.

I have received detailed board plans, which set out the arrangements for this winter. These plans confirm that a great deal of preparatory work has been undertaken across the whole health and personal social services range. As a result, initiatives that worked well last year will be repeated this winter. There will be more intermediate care, step-down beds, increased rapid-response community nursing, more hospital-at-home schemes and more hospital bed managers and discharge co-ordinators. In addition, new initiatives will include the provision of fracture rehabilitation beds, dedicated elderly-care beds, hospital discharge lounges and action to reduce the number of cancelled operations.

To support these initiatives arrangements are in place for the increased provision of ambulance services and GP and pharmacy out-of-hours cover. I can not guarantee that the Health Service and our social services will not be put under severe pressure this winter. What I can guarantee is that the lessons of last winter have been learned. In the interim, people have spent time addressing the questions that Members have so rightly raised during the debate. I am content that every effort has been made, and will continue to be made, to ensure that the service will be much better equipped this year to cope with peaks in demand.

11.15 am

I listened carefully to Members’ outrage over the payments made to former Health Service staff, as detailed in the recent Audit Office report. I share your unhappiness over these substantial payments; they were made at a time when a British Conservative Health Minister occupied the office that I now hold. I will certainly study this report with a view to ensuring that such circumstances do not recur.

The debate has been centred on the pivotal role of community nursing which is a key element of our primary care services. It provides a real alternative to hospital admission for many vulnerable people who would otherwise be admitted inappropriately to acute hospitals. Importantly, as part of our community care services, community nursing also provides part of the bridge back to community life for many older or chronically sick people who have completed their hospital treatment, but who need additional support to regain their independence.

I touched upon the role of community nursing in responding to wintertime health pressures. It is particularly important when it offers a better alternative to hospital admission, such as through the hospital-at-home and rapid-response teams. I note the praise that was given to these schemes by Members who spoke yesterday, and I share their wish to congratulate those who have developed such schemes. It is a development that I support as part of the necessary growth of community care.

There are also important developments in nursing care. I announced last week my approval for new nurse consultant posts. That is an important initiative, which will enable senior expert nurses to remain in clinical care and still advance their careers. I recognise the concerns expressed by some Members regarding the needs of older people and those with mental illness, or learning disabilities. Two of the new posts that I announced will address the needs of the elderly in intermediate care, and smooth the transition between home and hospital. A further two posts will boost mental health and learning disability services. I look forward to these post holders, as expert nurses, making a real difference for patients. I am also pleased to say that we are making good progress in establishing nurse prescribing in all the community trusts. All district nurses and health visitors will be trained for prescribing, we hope, by 2002. I expect a further extension of nurse prescribing to other specialist nurses in the next number of years.

I welcome this important debate and appreciate the attention that the Assembly is giving to such a crucial service. I thank the Members who brought the debate to the Floor of the House. I reiterate that the problems aired today cannot be resolved overnight, but all of them can, and must, be addressed urgently as part of the sustained process of modernising and improving our Health and Social Services. I have initiated a process of change and development, and I am committed to developing a longer-term programme, as well as immediate action. I look forward to your support in driving the necessary changes through. Our aim must be to provide a family of services that takes a holistic and integrated approach and provides efficient, effective, timely and responsive care to all who need it. That is the challenge facing me, my Department and the Assembly. I look forward to working closely with all of you in meeting that challenge.

Rev Robert Coulter:

This is perhaps one of the most important of our debates for the people. I realise that, in the space of a six-line motion, or a short opening speech, it is impossible to cover every aspect of the subject. I therefore thank all the speakers who supported the motion for their valuable contributions to the debate. In particular, I thank the Minister for coming here today to reassure us about what is happening in her Department and her plans for the future. I do not expect the Minister to rectify the problems overnight, but I ask that the problem be recognised, and that an immediate start be made to rectifying the defects in the system. I lay no blame at anyone’s feet, and I make a plea that all Members, for the sake of our people, work together to achieve a lean and efficient service.

I am reassured that savings made in the Health Service will be ploughed back into it and not put into a general budget. I am also reassured by the pledge to bid for more funding for community care. However, I am disappointed that the Minister has not addressed my plea for a review group to be set up to look at the problem of bed blocking; a group which would be comprised of Members and which would be accountable to the House.

I use the term bed blocking deliberately so as not to lay blame on elderly people. The core principle required — and I said it in my speech yesterday — is that people should receive the correct treatment, in the correct place, delivered by the correct people at the correct time. That should be the guiding principle of any action that is taken in the future.

I thank everyone who has taken part. We have had 100% support. I am disappointed to see the empty Benches in the House today. For a motion that affects every family in our country, it is a shame that there are so many empty Benches. I plead with the Minister to look again at what I have asked for — that this House be accountable and be the repository of the accountable system for the efficiency of our Health Service.

Question put and agreed to.

Resolved:

That this Assemly calls on the Minister of Health, Social Services and Public Safety to ensure that appropriate funding for local community nursing is available for those patients in acute hospitals for whom nursing care is appropriate, so that bed blocking is removed and consultants can treat additional patients currently on waiting lists.

Pensions

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Mr McCarthy:

I beg to move

That this Assembly calls for an immediate increase from the Chancellor of the Exchequer’s package of £5 per week in retiremant pensions and for restoration of the index-linking of pensions to earnings.

I am extremely grateful to be able to bring the plight of our senior citizens and pensioners to the Assembly. I am also ashamed that they are forced to live in almost primitive conditions half-surviving on an outdated and totally inadequate pension system.

Senior politicians, particularly those across the water, should hang their heads in shame when they see how many of our senior citizens cannot even afford to keep warm during the winter months. Regrettably, many people end up on a hospital trolley as there are no beds nowadays, not even for our elderly folk — although I am slightly encouraged by the remarks of the Minister of Health, Social Services and Public Safety this morning. I hope that what she has said does come to fruition during the winter months.

The appalling treatment of our senior citizens has got to stop now. Elderly people have served their community and country well. Last week, on behalf of a cross-party group of Assembly Members, I was privileged to sponsor a visit by a group of senior citizens representing over 15 different age-sector groups from all over Northern Ireland. I pay tribute to all those groups who are working quietly in our community without publicity. Their only role is to provide that something extra or useful for their elderly fellow citizens. I want to see senior citizens getting support from all elected representatives to provide them with a decent income and a decent environment in which to enjoy their latter years. Remember, fellow citizens and fellow Members, it is them today and us tomorrow.

I am proposing the motion for a number of reasons, not least fair treatment and responsibility. Members need to ensure fair treatment for older citizens. We must fulfil our responsibilities as elected politicians. It is fashionable, particularly in New Labour circles across the water, to talk about responsibilities that people owe to the state. Today I want to talk about the responsibility that we who represent the state owe to the people, particularly the elderly.

The motion urges the Chancellor to raise pensions immediately and to restore the link between pensions and earnings. The basic pension is currently £67·50 for a single person and £107·90 for a couple. Would anyone in this House, or any Member at Westminster, in the Scottish Parliament, the National Assembly for Wales or Dáil Éireann, like to live on £67.50 per week? I think not. Let us treat everyone equally.

This useless low pension, recently raised by the derisory amount of 75p, is the most important single element of income in retirement. Seventy per cent of pensioner households depend on state benefits for 50% of their income, and 13% receive all their income from state benefits. Therefore, pensions are crucial to our older citizens. However, many people, particularly older women, do not have a full contribution record due to having earned less than the lower earnings limit, spent time out of the labour market caring for and raising a family, or paid the reduced National Insurance stamp. Even if someone has a full basic pension, it is not sufficient to live on. Its value in relation to average earnings has fallen since the link with earnings was broken in 1980. Maggie Thatcher was the one who broke the link. She can supplement her pension with book tours, tobacco advertising and suchlike. The majority of our pensioners do not have that luxury.

I agree with Barbara Castle, who only last week said that a wealthy country such as the UK could afford to give dignity to its pensioners. She also said

"breaking the earnings link is tantamount to a fraud since contributions into the national insurance fund are based on earnings, but the value of the pension is linked to prices."

That is what Barbara Castle, a woman of 90-odd years of age and with much experience, has to say on the subject. I agree with her that we should restore the link with earnings. A leading trade union official warned last week that restoration of the link is no longer an economic necessity, it is a political imperative.

Had the policy that linked increases to earnings rather than prices remained, as Barbara Castle argued and we now propose, the basic pension would now be around £30 higher. We acknowledge that the new minimum income guarantee represents progress. Work carried out by Age Concern and other groups recommended a basic level of pension adequate to support people. Based on their research they recommend at least £90 per week for a single person and £135 for a couple.

In the long term the Government must seriously consider raising pensions and ensuring that they remain adequate. That is why the link to earnings must be restored. Until pensions are raised, this low rate — which is lower than the main weekly income support rates of £75 for a single pensioner aged up to 74 and £116·60 for a couple — will keep far too many elderly people in poverty.

11.30 am

Assembly Members should be aware that average weekly earnings in 1999 were £384. Using either the rate of pension or the rate of income support, pensioners receive less than one fifth of the average weekly earnings amount. However, they spend a high proportion of their income on the bare necessities such as housing, rent, fuel and food. For pensioners living alone, more than half their expenditure is on these essential items. The criminally low pension rate insults the elderly and keeps them deprived of comfort and dignity. It also keeps them isolated from society.

Members now have an opportunity to put this right. Fortunately, we are not powerless in the face of this situation. The Assembly has the ability to effect change and improve the lives of this large group of citizens. We have the responsibility to act, and it is our duty to see that we protect and care for vulnerable groups in society, such as the elderly and children. I propose this motion, and I appeal to Members for their support.

The Assembly must send a clear message to the Chancellor that our pensioners deserve more and that the politicians of Northern Ireland are determined to provide for them. Unlike the Labour hierarchy, we do not need pensioners from other nations to lecture us — we know our duties without having to be told them in the august presence of the former President of the Republic of South Africa, Nelson Mandela.

I want to assure, and perhaps warn, the Assembly that this is just the beginning, and it is part of a greater action. The motion seeks to influence the Chancellor in the clearest way possible. However, raising the pensions is not enough to ensure equality for the elderly in society. The Assembly has a wonderful opportunity to create the kind of society we desire to live in. I want a society that includes all sections and that promotes the sharing of resources with the vulnerable, thus enabling everyone to enjoy their lives to the fullest. Greater pensions are just a part of this.

I will also be asking the Minister for Regional Development to provide free transport for pensioners. I totally oppose the Minister’s plans to pass the financing of free transport on to ratepayers through local councils. If the Republic of Ireland’s Exchequer can provide free public transport for pensioners, then surely a wealthy country such as the United Kingdom can do likewise. Only 14% of pensioner households have a car compared with almost 70% of the population as a whole. Public transport that is easily accessible, clean, safe and timely is essential for the older population. This will ensure that they can move freely around Northern Ireland, and be given equality of access to shopping, leisure facilities and health resources.

My Alliance Party Colleagues and I will raise the issue of the winter fuel allowance with the Minister for Social Development. We want to ensure that the value of the allowance keeps pace with the price of fuel. We all know the astronomical heights that fuel prices have now reached. We welcome the £150 winter fuel payment for this year, and I hope that every pensioner who is entitled to it gets it. I will also work to provide free television licences for older people generally — not just for those over 75.

As a member of Ards Borough Council, I have already proposed the free use of council community centres for older people’s organisations during less-used periods of the day or evening. These are the things that can improve senior citizens’ quality of life.

Now that the Assembly is operational we have the power to effect changes and apply policy. As I have already said, I believe it is our duty to use this power to help the elderly. In the Alliance Party we use words like "integration, respect, pluralism, sharing" — not "separation", and today there is an opportunity, not only for the Alliance Party, but for every party in this House to show what is meant by those words.

Northern Ireland is a society beset by division — or at least it was. Let us hope we have moved on. It is a place where politics is too often about somebody being "anti-" this or "opposing" that. This motion challenges that mindset and that manner of doing business. Instead of saying "No", we can all say "Yes". We can say that we do not want pensioners cut off or isolated. I do not want to express this motion in negatives; I want to be positive. I want to use this Assembly to make the changes we need and deserve. I want to say to the older citizens of Northern Ireland "You are valued and respected; you deserve a decent pension, because you deserve to live in dignity; you deserve to decide how to spend your own money; you deserve to have options; you deserve to make up your own minds." Elderly people are a very important part of society and should not be shunted off to one side as a group who has had its day. They should be regarded as a vibrant segment of the community — people who still have so much to offer every one of us. This was witnessed last week in this very building when, as I have said, we met 15 different groups.

No less of an authority than the Secretary of State for Social Security, Rt Hon Alistair Darling, has admitted that in the UK the latest statistics show that a further 100,000 pensioners are living below the breadline. That is shameful. The total has now risen to the scandalously high figure of 2·3 million. Tessa Harding of the Help the Aged organisation said that it shows that the pensioners’ situation is more desperate than ever.

This Government must heed this as a warning that their policy on pensions is simply not working, and because of that, I want to end this speech with an appeal. It is not an appeal for a change in policy or a motion offering further advice to Ministers in London. I want to issue a personal appeal — a challenge — to everyone in the Chamber today.

Every one of us knows a pensioner, and every one of us owes something to pensioners. The Assembly should be sending out its message of support and encouragement, and we, as individuals, can do this by saying thanks to pensioners by saying "You are important", by saying "You are valued and remembered", but mostly by saying "You are part of us. As individuals and as a society we will not let you down".

This motion was proposed for a variety of reasons, but chiefly because we must ensure fair treatment for the elderly. As elected representatives that is our responsibility.

In the days of Toryism and Thatcherism — thank God, they are a thing of the past, never to return — we referred many times to that Government’s being an uncaring Government, probably because of their uncaring policies towards pensioners, amongst others. Those pensioners have endured such misery over the years that we appeal to this New Labour Government never to abandon or treat senior citizens with such contempt again. Thatcher was dubbed "Thatcher the Snatcher". It was her party which left pensioners in the abominable state they are in. Shame on her!

"Hague the plague", who is now on his knees pleading for the pensioners, would be no better. Members can be assured that Mr Hague is looking for votes — once a Tory, always a Tory. I appeal to those parties with Members in the Executive to do their duty. There is no use in empty promises. Now they have a chance to prove their worth and their commitment.

Mrs Carson:

The motion is very topical and important for all those approaching, or over, 65 years of age. It matters to them. Younger people think it does not matter, but it catches up very quickly, and they all have to think about pensions. Whereas I would support any increase, it is difficult to plump for a nice round figure of £5 without considering its relevance to inflation and to the redundant earnings related pensions level. There is some debate as to whether state retirement pensions should reflect and protect against inflation or set out to reward retired people on the basis of the earning levels of the workforce. This is further complicated by the large number of people who have been able to contribute to occupational pension schemes — for example, Civil Service, local government and company schemes.

The Chancellor of the Exchequer told us that one in six pensioner couples retire on more than £20,000 per year, but this is mainly due to the contribution being made from their occupational pensions — and that is two people, do not forget. The Public Service Pensioners’ Council is concerned with a widening gap between what pensions are and what they would have been had the wages index not been dropped in 1980. We heard a lot of grief there about Mrs Thatcher, but as a woman I have to protect her. I agree, with the way things have gone, that dropping of the index link was a mistake. When it was dropped things were level and not too bad, but they have now been overtaken by inflation.

The Public Service Pensioners’ Council has commissioned the trade union research unit at Ruskin College Oxford to undertake a study on the effectiveness of pension provision for former public service employees. This study will assess the extent to which these pensions provide adequate financial means as the recipients get older and draw their pensions for a longer period. With our increased ageing population pensioners will depend more and more on other services — for example, the home care service and care in the community.

Labour has made many statements in an endeavour to retain pensioners’ votes. On 7 February, in the House of Commons, Mr Darling stated

"Our objective is to make sure that retirement is a time to look forward to".

The Rt Hon Gordon Brown said in his Budget speech that a strong caring society takes seriously its obligations to the elderly, but 75p is hardly serious. It would be better perhaps if the £150 tax-free fuel allowance were paid out at £3 per week — it might help a wee bit in that way.

This is a quote from a speech given at the Labour Party Conference on 27 September by Alistair Darling:

"No pensioner should have a weekly income that is so low they cannot meet their basic needs and we plan to increase the Minimum Income Guarantee to £90 per week."

That is another promise we should hold the Labour Party to.

I urge the Government to develop a scheme that will help those with modest occupational pensions and savings and not penalise those who have worked hard and saved for their retirement. That is an important issue that has not been touched on yet today.

The Government should listen not only to those with occupational pensions but to the increasing base of pensioner power and treat it with respect. I have great sympathy for the motion, but I remind the proposers that this is a reserved matter, and the Assembly has no power to initiate change. We can, however, send a strong message and make representations to the Chancellor in the hope that he will make changes in his next Budget and thus hold the Labour Party to its promises.

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