Northern Ireland Assembly
Tuesday 18 September 2001 (continued)
If we are to talk about transparency and accountability, the Executive must clearly explain to the Assembly what is happening to the review of public administration. This issue is one of directing best value to councils alone. Where is the rest of the quango state? Where are all the agencies that look after what would be council functions if we were in England, Wales or Scotland? We cannot simply compare a body such as Moyle District Council with Glasgow City Council, Cardiff City Council or a London borough council. The population is minute by comparison, and the range of functions is totally restrictive. What we still have, although there are modest changes in the way that best value is to be administered, is the best value regime being introduced in England. That regime is being applied to a completely different set of circumstances in Northern Ireland.
The Department's original proposals were like using a sledgehammer to crack a nut. We now have a heavy single-handed club hammer to crack a nut. My Colleagues and I shall seek to design a suitable nutcracker, both in Committee and when the Bill comes back to the Chamber, rather than use what the Government have suggested.
Mr S Wilson:
I endorse many of the remarks that have been made about the necessity to drive the legislation through as quickly as the Minister has suggested. I suspect that one of the reasons behind driving through quickly is that it will provide the Minister with an excuse for not including many of the concerns that people have, and many of the legitimate amendments that should be made to the legislation. It strikes me as odd that we have to rush the Bill through in Northern Ireland, when voluntary best value could be extended in Scotland for a period of time.
I have served in local government for a long time, therefore I am not against local government being forced, and legislation being introduced, to ensure that ratepayers get good value for money.
Many Members who have served on councils know that value for money is important because ratepayers are increasingly asking questions about the delivery, cost, quality and nature of services. Let nobody run away with the idea that asking for the legislation to be delayed is an excuse for not wanting value for money at local government level. Serious questions need to be raised about the legislation. However, I suspect that the impetus being applied by the Department will drive the legislation through.
I wish to deal with two aspects of the legislation; one aspect is included in the legislation and the second is not. First, the Minister spoke about the need to make allowances for local variations. He referred to clause 2 (Best value guidance, performance indicators and standards) and said that he would establish a joint working group to make best use of the knowledge at local government level. The working group would advise the Department as to what should be contained in guidance.
Looking at the record of the Minister and of the Department to date, I doubt very much if anyone will pay any attention to the working group. As mentioned earlier by Mr Ford, one change in the new legislation is that it will not allow for indicators to vary between councils. Allowance was made for that in the original legislation. The working group that was set up to look at the indicators recommended that there should be different indicators for different councils, given the diverse nature of some councils. One example is street cleaning in Belfast. It is unfair to impose an indicator of cost-per- head-of-population for street cleaning on a city that has so many daily visitors, whether they be tourists or workers. It does not make sense to apply the same indicator to Belfast as to a rural town that does not have the same numbers of visitors and therefore does not have the same street cleaning problems.
The original intention was to allow variations in indicators between councils. However, the Minister has removed that allowance, despite the fact that it was recommended by a working group that was made up of practitioners at local government level. If that is an example of how he intends to heed the views of local practitioners or the people who he says have knowledge of local government, we should be sceptical about his promise.
When the Environment Committee goes through the legislation clause by clause, I hope members will re- examine clause 2(4) and ensure that the words
"different performance indicators or standards may be specified for different councils"
are reinstated. It is logical to include those words in the legislation. Having worked in local government, I know that if something is measured, it is likely to be done. I am in favour of indicators. Problems arise when a bad indicator is set and resources are pushed towards meeting that indicator; the exercise is futile and wasteful and does not give good value for money.
My second point relates to something that is absent from the legislation here but is included in the legislation for the rest of the United Kingdom.
Section 16 of the Local Government Act 1999 allows the Department to confer additional powers on councils so that they can enact best value. Those additional powers might change the way in which councils do things or they might allow councils to enter into partnerships. That is important.
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Six pilot studies were carried out before best value legislation was introduced, and 75% of them showed that the authorities believed that partnership was important in their approach to best value. The team reported that partnerships enabled innovation in service delivery and made more effective use of existing resources.
Despite the evidence from the pilot studies in England the Minister has dismissed the inclusion of any clause enabling him to give additional powers to councils to let them have partnership arrangements if it was believed that they would lead to a more effective delivery of services. The Minister has made a number of arguments. He wrote to the Committee Chairperson with the usual "I am committed to broader powers for local government, et cetera, et cetera." However, the first argument was that this legislation must go through. One reason why the Department wishes the legislation to go through is that it will allow the Department to avoid having to look at whether or not to give those additional powers to local authorities.
During my time in local government I learned that the local government branch of the Department of the Environment wants very little to do with local government; it certainly does not want local government to have too much power. I suspect that there is an element of in-house fighting going on.
The Minister did not believe that the councils were large enough to benefit from partnerships. However, the joining of three bodies - the councils that joined together to look at waste management - has shown that it is possible for partnerships to be effective.
As long ago as 1997 - I remember this because I was involved through Belfast City Council - Lord Dubs promised to look at the possibility of allowing councils to enter into partnerships for economic development purposes. Yet, here we are four years later, and nothing has been done about that. Lord Dubs has gone; there is a new Minister; and we are still getting the same promises.
For the Minister to say that he is looking at ways of enhancing the powers of local government but that consultation will be required is an excuse. The Local Government Act 1999 allows for scrutiny when a council asks for those extra powers, and that means that the process does not need to be delayed any further.
The Minister says that he does not believe that partnerships are critical to the early success of best value. That is bizarre considering that 75% of the councils involved in the initial pilot studies said that that was the case. Surely the Minister has to give cognisance to the evidence from local government where best value has been practised and partnerships have been used.
The Minister should respond to the first position adopted by the Committee, that the legislation should not be pushed through. There is no need for haste.
If the Department insists that the legislation come before the Assembly it could be voted down. If that does not happen then it is important that the legislation be amended to change clause 2 to allow individual performance indicators for different councils. Belfast could have a performance indicator that is the same as those used in medium-sized cities in other parts of the UK. That would be reasonable.
A clause should be inserted to allow additional powers to be given to individual or groups of local authorities. Additional powers are believed to lead to a more efficient use of resources when entering into partnership with other bodies or with the private sector. This would lead to a council's achieving best value objectives.
Unlike the situation under direct rule, we can look at flaws in the legislation. This is the view that has come from the practitioners, the people who have to implement the legislation. The Minister ought to use the evidence that is coming from the Environment Committee, local government and Members of the Assembly to see the folly contained in the Bill as it presently stands and remedy it.
Mr ONeill:
The thought of getting rid of compulsory competitive tendering is wonderful to me. The depredation that the policy has wreaked on councils and the delivery of public services is sufficient to encourage me to support the legislation.
I am convinced that the concept of best value, if not always its practice, emphasises, reinforces and values public service. This is something that was vilified by previous Administrations in England and led to the introduction of compulsory competitive tendering.
Public service is, and could be in the future, excellent. However I am amazed at the approach, not just by the Minister and his Department, but by the entire Executive towards best value. Why does it apply only to councils? If we look at the concept of best value and at the statistics that the Assembly Research and Library Service can provide, we see that the estimated net expenditure by councils in 2000-01 amounted to £275 million, out of a total Northern Ireland public expenditure of £9·9 billion. This is approximately 2·8%, even lower than the figure of 5% that Mr Ford referred to.
There are 148 other public bodies operating in Northern Ireland that are run by 2,000 appointees. There are 46 executive non-departmental public bodies and 32 National Health Service bodies with an expenditure of £5·5 billion, approximately 56% of public expenditure. Nothing is being done about best value in that sector. Why should Departments escape the discipline and rigour of best value; they are responsible for the rest of the expenditure? If we look at best value and its introduction into the Administration in Northern Ireland, 2·8% of that expenditure is hardly exciting.
I am not a member of the Environment Committee, so there are a number of points that I would like the Committee and the Department to examine. First, on page 1 of the Bill, clause 1(1) (The duty of best value) refers to the three Es - economy, efficiency and effectiveness. Although there are differences between local government in Britain and in Northern Ireland, we can learn from the experience of the operation of best value there.
Economy, efficiency and effectiveness are good things, but they apply principally to finance. There is little emphasis on the human element, or on delivery to the population. Now, instead of three Es, we talk about five Es: economy, efficiency, effectiveness, equality, and environment. This is often referred to as the well-being factor, as it addresses the well-being of the community and not just the monetary aspect of best value. I would like to see that emphasis included in the amended legislation.
Mr Wilson referred to clause 2(1) of the Bill. The introduction to that clause reads
"The Department may issue guidance to councils as to the carrying out of their functions under this Act."
Although it is hinted at, nowhere does it actually say that there should be consultation with the people involved. An amendment should be included to emphasise that the Department may issue the guidelines as to carrying out of their functions under the Act, "following full and detailed consultation and agreement with all stakeholders". I am suggesting an emphasis on the well-being factor. It would not be a big job for the Department to discover who its stakeholders are - they are councils, community groups and various other people. Departments could quickly investigate that through an audit.
Mr S Wilson:
I agree with the Member's point. Clause 2(5) states
"Before specifying performance indicators or standards, the Departments shall consult -
(a) (persons appearing to it to represent councils; and
(b) (such other persons (if any) as it thinks fit."
How would you see that being strengthened?
Mr ONeill:
I was referring to clause 2(1). Mr Wilson is referring to a clause that is specifically on performance indicators. Consultation should apply to the whole operation of the introduction of best value.
In addition, I refer to clause 3(4)(b) where there is a requirement for inspection in circumstances indicated in the Act. It would be sensible, fair and wise to have a specified date for the inspection to be carried out. Such a date could be chosen to allow local authorities time to compile a full annual report.
A date such as the end of June would give councils an opportunity to compile that report and help people adjust to the requirements of the Act.
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Finally, I refer to section 16 of the Local Government Act 1999, which Mr S Wilson has already mentioned. I emphasise again that the experience in Britain has been good. In fact, I understand that Nick Raynsford has agreed for work to be done on that sector to improve the regulations under section 16. The well-being concept and partnerships have been highlighted. Mr S Wilson made the arguments very well, and I do not need to reiterate them. Among the regulations is a new power to provide indemnities to members and officers involved in partnerships and external bodies.
While we have had bad experiences here, the ravages of compulsory competitive tendering in England have produced some frightful cases. I read recently about an employee who has five pensions because he was shoved around from one private contractor to another. He has lost all the stability and security that he had as a council employee.
In addition to the partnership emphasis, section 16 helps to ensure that employees are safeguarded and that their benefits and job standards are not lost or interfered with through any of the partnerships or public-private deals that might be made. It is, and should be, an area of great concern to us as we embark on a best value approach. We should learn from what has happened in England in that regard and be very wary of the damage that could be done to individuals.
The Minister of the Environment (Mr Foster): I thank the Members who contributed to the debate. There is, undoubtedly, a keen interest in this matter. Members have dwelt upon the issue and looked into it, and it is right and proper that it should be debated thoroughly. The responses mirror the genuine interest shown in the earlier consultation process, which sought to deliver best value in the interests of council residents and district ratepayers.
I have listened to the debate carefully and I will try to reply to as many points as possible in the time available. My officials will, in any case, scrutinise Hansard, and I will write to those Members who raised issues that require further clarification.
Rev William McCrea asked why we need legislation if councils have already introduced best value voluntarily? First, the requirement for compulsory competitive tendering (CCT) has merely been deferred using subordinate legislation that remains on the statute book and cannot be deferred further. That means that the CCT obligation becomes effective again on 1 April 2002 unless the legislation is repealed before that date. Secondly, experience of voluntary implementation of best value to date indicates that a statutory framework is essential if we are to deliver transparency, accountability and consistency.
Should best value legislation be deferred pending the review of local government? In accordance with the Programme for Government, the Executive are committed to a full review of public administration, including the administration of local and public services. I have been pushing for that for quite a while but other events have taken over. However, best value principles apply irrespective of the structure and responsibilities of local government. I therefore see no need to defer the introduction of best value legislation on those grounds.
Why the urgency with the Local Government (Best Value) Bill? Why does the Minister not simply defer it? That approach has been used in Scotland, where a moratorium has been placed on CCT pending the development of appropriate best value legislation. However, it is not possible in Northern Ireland, where a different legislative framework exists. The Department has already used subordinate legislation to defer the implementation of CCT, but it is still enshrined in primary legislation. Legal advice indicates that further deferral in this way is not viable.
Should the Bill deal with the repeal of CCT alone, leaving the framework of best value to be formulated by the Department and local government at a later date? That is a good question; indeed, there were several good questions. The clear objective underpinning best value is that it is a policy designed with the interests of residents and ratepayers at heart. If we are to deliver the transparency and accountability, which local people deserve, while ensuring consistency of approach, experience to date of voluntary implementation of best value indicates that the framework needs to be clearly defined in legislation. That is vitally important. As drafted, the Bill would allow local people to have their say on the levels and standards of service provision in their areas.
Rev William McCrea also asked if all councils were happy with the redrafting of the Bill. The draft Bill has been circulated to all councils, and they have not advised me of any particular problems. That does not surprise me, as the redrafted Bill addresses their key concerns.
Mr Doherty asked why the Bill did not apply to Government Departments. I contend that central Government already operates under a value-for-money or best value framework. Elements of that include a Government accounting manual and accompanying financial regulations; a requirement to operate resource accounting and budgeting; a detailed Programme for Government incorporating departmental public service agreements, corporate and business plans, internal scrutiny and Northern Ireland Audit Office scrutiny; and the Public Accounts Committee of the Assembly. I assure the Member that we are very well scrutinised.
Mr Doherty also asked if best value would concern process at the expense of outcome. That issue was highlighted during the consultation process, and I am anxious to ensure that it will not occur. At the same time, councils expressed a need for guidance concerning best value.
Mr Doherty wanted to know why the Department had not conducted an equality impact assessment of draft best value legislation. My officials have closely screened the proposed policy and have identified no issues of concern on equality grounds. A decision not to undertake a full equality impact assessment was ratified with the Equality Commission. Under section 75 of the Northern Ireland Act 1998, councils are required to produce equality schemes for approval by the Equality Commission. Councils will therefore have a legal obligation to operate best value within the parameters of their approved schemes.
Mr McLaughlin referred to support for the partnership approach. I have already advised his party that we have delayed the introduction of this legislation pending local government reform. Mr Ford asked why we need a statutory framework for CCT, and why we do not adopt the Scottish approach. I referred earlier to the Scottish approach and to our legal difficulties. Is it true to say that the Department has ignored the concerns of councils and the Environment Committee in bringing forward the draft Bill? I assure the Member that that is definitely not the case - we do not do business like that. We want to work with people and we co-operate with people. I refute any suggestion that my staff override any Department or area. The draft legislation was subject to an extended consultation process. My officials and I met the Environment Committee to discuss the draft proposals. That approach proved most useful and led me to instruct my officials to redraft the legislation and address many of the concerns expressed at that time. In particular, there was a genuine concern that my Department would use subordinate legislation to establish a framework that placed more emphasis on process than on outcomes. We have examined that issue and dealt with it, we do not want to override anyone's responsibility.
Mr Sammy Wilson made a number of points. He referred to individual performance indicators, which are not appropriate to all councils. He asked why councils do not have the freedom to set their own performance indicators. I see clear merits in having a set of four indicators, which are used by all councils, instilling some consistency across local government. However, I recognise that individual performance indicators will not be equally relevant to each council. No indicator, taken in isolation, can accurately measure the performance of a council. We need benchmarks, and that is why we seek them. I therefore expect councils to supplement cross-council indicators with local indicators, which they will develop themselves to reflect local circumstances. The joint use of cross-council and local indicators should prove an effective means of summarising council performance.
Mr Sammy Wilson also asked whether the Department would genuinely listen to local government when producing guidance. I have assured the Assembly that the Department collaborates with the Environment Committee and all relevant agencies and groups to ensure that we are working together for the common good.
I emphasise that my record shows that my officials have worked positively with council officials and I refute the suggestion that we are not working in co-operation with others or discussing matters with them.
Great Britain's legislation gives the Secretary of State the power to amend or remove the legislative barriers to achieving best value. Mr Sammy Wilson asked why those powers were not replicated in the Local Government (Best Value) Bill. As in Great Britain, certain legislative barriers to best value might become apparent over time. Any legislation that could impede the full implementation of best value would need to be examined and discussed, in the first instance, with the appropriate Department. If a decision were reached to change existing provision the relevant Department would be responsible for any amending legislation, which would be channelled through the normal legislative process.
Mr Sammy Wilson asked about economic development powers, a matter that has been referred to many times in my years as a councillor. The issue has cross-cutting implications for many Departments; it will be addressed in due course through interdepartmental discussion. However, the matter should not be allowed to delay the progress of the important task of establishing a sound framework for best value.
Mr ONeill welcomed the demise of CCT, and asked whether the statutes of guidance would be subject to consultation. I have responded to that point and his question on whether we could draw on the English experience.
I assure the House that I do not wish to be over- prescriptive in regard to best value. I recognise that best value touches all aspects of local services; none is more important than the well-being of local communities. I have every confidence that councils will continue to address that issue within the best value framework.
As the Minister responsible for local government in Northern Ireland, I consider it my duty to further promote transparency and accountability in the use of council resources and the provision of local services. In bringing the Local Government (Best Value) Bill to the Assembly, I sought to achieve that objective. I listened carefully, therefore, to all of the representations, and I thanked everyone who contributed to the consultation process. It is true that concerns were expressed about the labour intensive nature of best value and about the apparent emphasis on procedures rather than outcomes.
Rev Dr William McCrea:
In the light of today's debate, the Minister and the Department of the Environment should realise that if they press ahead with the Bill there will be great difficulty in getting it passed by the House. As Chairperson of the Environment Committee, I ask the Minister to reflect calmly on today's debate and to consider the appropriate way forward.
Mr Foster:
If the Bill were delayed now, it would be too late to get rid of CCT by next April; therefore we would be under contract for another three or four years. I appreciate the points and concerns expressed. I want the Bill to proceed. I am not trying to push something through against anyone's will. However, while some negative points have been made, not everybody has said that they do not want the Local Government (Best Value) Bill. Members are concerned and have questioned some points, but, in the main, they welcome the Bill. I would not therefore give way on that point.
Many people support the provision of greater guidance to help streamline processes provided that allowance is made to accommodate the diversity of circumstances among councils. There was uniform agreement that CCT should be replaced, with greater emphasis on quality service delivery rather than the lowest-cost option.
12.15 pm
It was also widely recognised that in order to achieve quality services a framework for best value - which I still contend is necessary - must be developed to engage local people in meaningful consultation. I have fully considered all of these matters; we need a common statutory framework to ensure that people in different council areas have equal opportunity to participate in local services provision and to obtain quality local services. Again, such a framework must be transparent, consistent and accountable to ratepayers and users of local public services. The framework should provide a basis for local people and councils to work in partnership with each other. The framework has to be workable and proportionate to the requirements and circumstances of district councils. That is why I have made provision in the Bill for my Department to develop further guidance on partnership with local government. The guidance should benefit councils in their implementation of best value by providing the necessary consistency of approach and enabling councils to learn from one another. It is important that we have benchmarks and that we learn from one another.
In the Local Government (Best Value) Bill I have responded to the representations made to me. I firmly believe that the Bill makes provision for the framework that I described. The Bill is proportionate to the needs of local government in Northern Ireland and at the same time it addresses the needs of residents and ratepayers, giving them the assurances that they require. The Bill needs to proceed, and, although I understand everything that was said, I know that not everyone is against the Bill because we have discussed and co-ordinated the matter across the realm. I commend the Local Government (Best Value) Bill to the Assembly.
Question put and agreed to.
Resolved:
That the Second Stage of the Local Government (Best Value) Bill (NIA Bill 19/00) be agreed.
Mr Speaker:
I am conscious that efficiency was a topic of the last debate, and the House has been particularly efficient in dealing with this morning's business. In so doing, it has earned itself a longer lunch. The House will now rise and is suspended until 2.00pm, when it will resume with the motion on hospital waiting lists.
The sitting was suspended at 12.18pm.
On resuming (Madam Deputy Speaker [Ms Morrice] in the Chair) -
2.00 pm
Hospital Waiting Lists
Mr McGrady:
I beg to move
That this Assembly views with concern the ever-increasing waiting lists for medical and hospital treatment in our local health services, and requires immediate action to remedy this unacceptable and growing problem.
One of the most urgent issues facing the Assembly, which acts on behalf of the community, is the spiralling increase in waiting lists for medical and hospital treatment and the consequential increase in waiting lists for all types of health care, including community care.
I - and, no doubt, others - will quote many statistics today. Behind those statistics is a huge amount of human suffering and misery. Waiting for surgical appointments means additional suffering, and that should be and can be avoided. In some cases, waiting leads to premature death, and society should strive with all its might to eradicate death and suffering. That is what health care is all about.
There are continual stories and statistics in the press about the rise in waiting lists. In September 2000, we were told that the waiting lists in Northern Ireland were the longest in the UK. In November, we were told that one of the reasons that the waiting lists were extended was that one plastic surgeon in the Royal Victoria Hospital could not be replaced. As a consequence, waiting time for plastic surgery increased to two years for elective surgery. Such is the fragility of the current system.
As the Minister said at Question Time yesterday, the quarterly figure for ordinary and day-case admissions stands at a massive 54,246 - and that includes elective and non-elective admissions. In the quarter from March to June of this year, the waiting list increased by 2,251 - a 4·3% increase. Examined from a different angle, the figure for those ordinary and day-case admissions from June 2000 to June 2001 rocketed by a massive 4,728, to 54,246.
Last Tuesday, a news item referred to Northern Ireland's chronic nursing shortage, which has caused the closure of 55 beds in the Royal Victoria Hospital and has doubtless contributed to the waiting list. The issue is not simply the number of surgical procedures performed, it concerns capital back-up, existing facilities and time.
For example, according to the Eastern Health and Social Services Council, 93 patients in Northern Ireland waited more than seven days for emergency repair to hip fractures. Medical guidelines state that the waiting time for such treatment should be no more than 24 hours. Yet, not just one or two people, but 93 people waited seven days for treatment.
The Acute Hospitals Review Group has published the most up-to-date, analytical, independent report into the issue, and it is entirely divorced from departmental figures. Indeed, the Minister of Health, Social Services and Public Safety appointed that review group, which provided startling statistics about hospital and medical waiting lists in June 2001. On page 20, at paragraph 3.9, it states:
" Northern Ireland has the longest per capita hospital waiting lists in the UK. In March 2000 there were over 47,000 people waiting for elective treatment, an increase of nearly 11,000 compared to March 1996. More significantly, there has been a huge increase in waiting times, with the number of patients waiting 18 months or more for treatment increasing from 632 in March 1996 to 5,200 in March 2000."
The Hayes report refers to the rising numbers on waiting lists for outpatient departments:
"the number of people recorded as waiting for an outpatient appointment has increased significantly from 59,000 in March 1996 to over 102,000 in March 2000."
Yesterday, the Minister told the House that that figure had risen to 128,438. Should we not be anxious about those figures? There is something wrong with a society that cannot focus on such a massive failure to provide normal public health care. The report continues:
"Of these patients, the number waiting six months or more for an appointment has increased from 7,300 to over 26,700."
Those are frightening figures. Supplementary material to the Minister's oral answers, available in the Assembly Library, shows that 498 people are waiting for cardiac bypass surgery in the Eastern Health and Social Services Board area; of those, 63 have been waiting for six to eight months. There is a waiting list of 1,385 people for hernia operations; of those, 810 have been waiting, in much discomfort, for more than two months. There is a waiting list of 638 people for knee replacement operations; of those, 118 have waited for six to eight months.
Considering the size of the population and the number of hospitals in Northern Ireland, the average waiting time for specific operations such as cataract removal, heart bypass surgery, hernia repair and knee replacements is longer than in England, Scotland or Wales.
The despair engendered by such a long waiting list is obvious, and I see it in my constituency surgery. It increases day by day. A Rostrevor constituent has been on the urgent cardiac bypass list for 13 months. Another constituent, from Downpatrick, has been waiting for over two years for quadruple bypass surgery. Recently, a consultant told him that surgical slots had been reduced by 50%. The average waiting time for cardiac bypass surgery is two years. Earlier this year, I visited an elderly woman in Mayobridge who has a chronic hip condition and has been waiting for over two years for a hip replacement. An Annalong constituent has been waiting for a lung transplant for two years, even though he has a donor who has been medically approved. The consultant cannot give him a date for the transplant surgery because he has been given no surgical slots for September. We are talking about human suffering.
Mr McCartney:
Is the Member aware that elective orthopaedic surgery in the Ulster Hospital was suspended entirely because of lack of operating time, lack of surgeons and lack of available funding?
Mr McGrady:
I have concentrated on my constituency, but every Member could tell horrific stories of unnecessary human suffering.
Since the introduction of devolution, there has been a concentration on deficits, underfunding and the need for adequate capital revenue expenditure on health. Substantive additional allocations have been made. I am grateful to the Minister of Health, Social Services and Public Safety for finding the time to be present at today's debate. I ask her to respond to the growing problem of waiting lists. She may say that the problem could be solved by additional financial investment in the health service, despite the fact that there has been substantial additional funding. The amounts were £3 million last year and £8 million this year. We are entitled to ask how the additional money has been used and managed, and what changes to the waiting lists have been brought about by it.
At Question Time yesterday, the Minister again identified under-resourcing and overall capacity problems as the main factors contributing to the lengthening waiting lists. Have the Minister's officials sought, or thought about, other ways of improving the position? For example, has consideration been given - I am not making a political point - to further cross-border co-operation? Hospital waiting lists in the Republic of Ireland have decreased in the past year. A news report that I saw in April showed that waiting lists in the Republic of Ireland had decreased by 9,000 patients. That means that there is a capacity there that we should be able to buy into.
What consideration have the Minister and the Department given to the reversal of the political dogma of centralisation? Why not decentralise surgical procedures and use hospitals in the more rural areas - or not so rural areas - where surgical expertise still exists, before it is lost altogether? On 11 September, the Minister referred to the work already undertaken to address the waiting list problems. What was the outcome of the 'Framework for Action on Waiting Lists', policy that was announced last autumn? What significant changes have taken place in the past 10 months? In a press release of the same date - I am sorry to quote her, but she is the authority on, and has responsibility for, our health care - she said that:
"the only long-term solution is money."
As a layperson, I disagree with that analysis. Certainly, extra money is essential, and it must be provided. However, is the money given to the Department of Health, Social Services and Public Safety - especially that given specifically for reducing waiting lists - managed effectively? The Minister should examine such issues, instead of simply saying that money is the solution to everything.
The lack of resources has been referred to by the Minister, by the Assembly's Health Committee on 2 July, and by the Eastern Health and Social Services Council on 12 September. However, the debate about the lack of resources should not detract from the need for the Department to manage the current health budget more professionally and to deploy resources more effectively than at present. Some trusts are allowed to run up deficits while those that manage budgets properly suffer as a consequence. Residents in those trust areas have a diminished health service.
It is also interesting to note what Dr Hayes and his committee said about waiting lists:
"While undoubtedly there is a need for a substantial injection of funding, it is of even greater importance that existing resources are used as effectively as possible."
The report also states:
"It is difficult to argue for additional resources for hospital and community health services against other national and regional priorities if we cannot also demonstrate that existing resources are being used to the best effect by generally accepted levels of comparison."
I must emphasise that point. An independent report is saying that there must be a clear demonstration that existing funding is being used effectively.
2.15 pm
The Hayes team demonstrated that spending on acute services in Northern Ireland was higher than in any other region in the British Isles, apart from Scotland in this particular instance. Another study of comparative waiting times for elective surgery demonstrated that the problem of lengthy waiting times had not even been targeted in Northern Ireland and that an initiative to tackle the problem was urgently required. The report also stated that Northern Ireland had more acute beds and staff per capita than many regions of England. Up to 10% or 15% of acute beds could be unavailable due to bed blocking caused by their use as follow-on accommodation for patients waiting to be transferred from residential to community care.
The time is now ripe for the Department to address urgently the problem of hospital waiting lists. It is clear from recent newspaper coverage, questions posed in the Assembly, and contributions made this morning and on the radio that people are anxious about what is happening to their health service. Everyone has experienced in some way the dire consequences of extended waiting lists. The problem is creating unnecessary pain and suffering for many in our community. I submit the motion to the Assembly for its consideration; we should not allow that situation to continue.
Madam Deputy Speaker:
Given the large number of Members who have asked to speak, and the high level of interest in the matter, Members should limit their contributions to five minutes.
The Chairperson of the Committee for Health, Social Services and Public Safety (Dr Hendron):
I could not possibly cover the main points in five minutes, but I understand the restriction. I congratulate Mr McGrady on bringing such an important motion to the House, and I thank the Minister for her presence.
Mr McGrady mentioned waiting lists and waiting times. Waiting times are a far more accurate means of measuring delay in the delivery of health care. People - in some cases, those with cancer - can wait long periods before getting an appointment with a consultant. We are all aware of the importance of early diagnosis and proper treatment, a massive subject in Northern Ireland today. I therefore draw the Minister's attention to waiting times, as opposed to waiting lists.
Some things are being done, and I appreciate that money has been spent and that several projects are under way. For example, lower back pain, one of the most common cases for referral in the primary care sector, can be caused by muscular problems rather than secondary cancer. Next month, a clinic will open at Musgrave Park Hospital at which physiotherapists will play a key role - and rightly so. Doctors in the Eastern Board area can refer patients to the clinic, rather than to an orthopaedic surgeon. Unfortunately, I do not have enough time to elaborate on that point.
Similarly, if there is the slightest chance that a patient's chest pain is caused by problems with a coronary artery there must be a diagnosis and, if necessary, treatment. However, a good deal of chest pain is caused by other factors. The Royal Hospital Group has, therefore, set up a clinic to which a patient can be sent if his doctor concludes that he is unlikely to be suffering from ischaemic heart disease. Skin cancer is another common illness in Northern Ireland, and a clinic at Belfast City Hospital treats patients affected by that disease.
I appreciate that the Minister has made a bid for £122 million for next year. However, the Health Committee fears that, if the full allocation is not made, the waiting lists will get worse. That point needs to be addressed by the Executive. Elderly people who live at home but who require residential care or increased packages of care are affected by waiting lists. Massive waiting lists also affect the professions allied to medicine, including occupational therapists, chiropodists, and speech and language therapists.
Trusts will have to overspend dramatically, because boards and fundholders cannot provide enough funding to cover demand. Unsurprisingly, elective procedures will be the first to be affected, and there will be an obvious impact on waiting lists. For every pound that is now spent on the National Health Service in England, the equivalent in Northern Ireland is 75p.
On 31 July in the Eastern Health and Social Services Board area alone, there were approximately 22,000 people on waiting lists for elective surgery. Of those, 3,600 had been on the lists for longer than the charter time limit.
Orthopaedic surgery is a major problem in Northern Ireland. The elective orthopaedic service at Musgrave Park Hospital is reaching a crisis, and patients are now waiting for up to three years for some operations. Even waiting for an outpatient appointment to see a specialist orthopaedic surgeon can take up to three years. The current fracture crisis has caused the Department and area boards to concentrate on trauma problems. Although that is necessary, the elective service has been allowed to deteriorate, storing up a crisis in waiting times. Musgrave Park Hospital has been asked to help in operations on trauma cases, which the hospital has been able to do without cancelling other operations.
There is a massive problem; orthopaedic surgery could be the subject of a debate on its own. As Mr McGrady mentioned, people with fractured femurs at Craigavon Area Hospital and Antrim Hospital have had to wait for a week; 24 hours is the stipulated waiting time.
What can we do about it? I will not talk about finances; I accept that we need more money, but there is more to it than that. It is important how the resources are used. In her statement on 11 September, the Minister said:
"the increases [in waiting lists] highlight the fact that, without major new investment, our hospital and community care services simply cannot cope with the present, growing levels of demand."
We agree with that. The Minister also said:
"all boards and trusts are working on measures at the moment to improve efficiencies in the system."
For goodness' sake, let us look at the system. That is where the problems are. There are 19 trusts for a population the size of Greater Birmingham - I say that with respect to the Minister. We must look at the trusts. If Sir Reg Empey can merge LEDU and IDB without waiting for a review of public administration, there is no reason why we cannot examine the whole structure of the Health Service. Primary care can be talked about another day.
Madam Deputy Speaker:
I thank Dr Hendron for his understanding of the time constraints. Fifteen Members have asked to speak, and we want to allow them all the opportunity to do so.