NORTHERN IRELAND ASSEMBLY Tuesday 5 June 2007 Executive Business Private Members’ Business The Assembly met at 10.30 am (Mr Speaker in the Chair). Members observed two minutes’ silence. executive business Health (Miscellaneous Provisions) Bill First Stage The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I beg leave to lay before the Assembly a Bill [NIA 2/07] to amend the Health and Personal Social Services (Northern Ireland) Order 1972 in relation to the provision of health care; to amend the Smoking (Northern Ireland) Order 2006 to provide that in certain circumstances premises may not be smoke-free only in relation to performers; and for connected purposes. Bill passed First Stage and ordered to be printed. Mr Speaker: The Bill will be put on the list of future business until a date for its Second Stage is determined. private members’ business Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to wind up. All other Members will have five minutes. Two amendments have been selected and are published on the Marshalled List. The proposers of the amendments will have 10 minutes to propose and five minutes to wind up. Ms Ní Chuilín: I beg to move That this Assembly calls for the establishment of a Rural Health Taskforce with the objective of delivering a focused and co-ordinated response to the health needs of people living in rural areas, including: a shared vision and co-ordination of activities; the development of strategic alliances; proper healthcare as part of a Bill of Rights; and an assessment of best practice and examination of how other European countries which share common borders deal with access to healthcare. Go raibh maith agat, a Cheann Comhairle. A large proportion of the population lives in rural areas. Rural communities face particular challenges with regard to transport, access to services and sustainability of local communities. Those differences must be recognised and models of care to meet rural needs must be explored. However, we realise that hospitals cannot be provided at the end of every street. Indeed, in many cases, it is not hospitals that rural communities need most. That is in direct contrast to the default centralisation response embedded in the organisational psyche of the Department of Health, Social Services and Public Safety (DHSSPS) through items such as the trauma report and the reviews of pathology, maternity and children’s services — I could go on. Suffice to say that almost all consultations and strategies under direct rule have defaulted to the centralisation of services of the so-called golden six hospitals. There are many reasons for that — a lack of staff; a lack of consultants; and a lack of clinical safety. However, most people believe that services are centralised because of a lack of vision and strategic thought in the DHSSPS and that the overarching goal is to cut costs and services. Bairbre de Brún did much to rectify that imbalance and challenge the bias against rural communities. It is unfortunate that her ambitions and plans faltered under direct rule. A rural health task force is needed to address all issues affecting rural communities in accessing health and health services and to ensure that the health and well-being of people living in rural communities is paramount. Such a task force must explore how to work with the rest of the island: that is common sense. Currently, there are two competing health systems, and it is rural communities, particularly those located along the border corridor, that are losing out as a result. The task force should study best practice from across Europe. When faced with similar problems, other countries have developed new and innovative approaches to rural healthcare. We must learn from their example. To that end, a Sinn Féin working group visited the Centre for Rural Health in Scotland last year. The centre has worked with the Scottish Executive and in partnership with Norway. I am happy to furnish the Assembly with details. Having taken the political decision to protect, enhance and sustain rural communities, the Scottish Executive adopted a specific system of healthcare that, while not perfect, did not adopt a one-size-fits-all approach. The Kerr Report in Scotland sought to retain, maintain and maximise the services that could be safely provided in rural towns and villages via a range of innovative proposals and models. The proposals included aspects such as extended primary care; a resilient system of urgent and emergency care, including air ambulances; a rural general hospital, which meant re-exploring the issue of general surgeons with the royal colleges; midwife-led maternity units; and 24/7 care provided by rural practitioners, etc. As yet, there is no clear agreement between politicians and those charged with delivering services on the best way forward. Furthermore, it is true to say that those involved in delivering services have not reached agreement on the best way forward either. The outworking of that situation has meant that political and electoral considerations have, on occasion, dominated what should be real health considerations. We need to look at examples of good practice, such as the strategic approach of the Cooperation and Working Together (CAWT) programme, which considers health inequalities. That programme, and others like it, should be supported and resourced. Health inequalities should become a stand-alone issue, which would help to put the information and recommendations emerging from current work on addressing inequalities into operation, particularly for those in the rural community. The work being undertaken to address health inequalities in the CAWT region should be co-ordinated, as it appears that everyone is doing their own piece of work. No one is co-ordinating the overall picture, and there is no overall plan. People living in rural communities therefore fall between two stools and miss out as a result. Community and partnership development is ongoing in health action zones in the North, and the county development boards in the South should be further developed. We need to develop an ethos of considering how to tackle health inequalities in rural communities when developing services or initiatives. That would give life to equality, and individuals could begin the process of delivering their own services. Further health profiles for rural areas are needed. A regional health profile should be developed so that an updated plan on the health status of each region could be provided. Most of all, lessons should be learned from the models already cited in the CAWT region, such as health action zones and county development boards, which must be taken into consideration in future plans. Sinn Féin believes that it is crucial that a rural health task force should develop a common vision for rural healthcare that will regain the support of rural communities. It should develop an innovative strategy and an action plan with which the Assembly and others can agree, and it should provide good leadership and deliver health improvements to those in most need. Go raibh maith agat. Rev Dr Robert Coulter: I beg to move amendment No 1: Leave out all after “Assembly” and insert “notes the ongoing work of the Rural Medicine Working Group and urges the Minister of Health, Social Services and Public Safety to ensure that rural communities have access to safe and sustainable health services.” In May 2002, the Assembly adopted a policy of rural proofing all legislation in Northern Ireland to recognise the essentially rural nature of much of the land area of the Province. The implementation of that policy was placed in the hands of an interdepartmental steering group, which was chaired by the then Minister of Agriculture and Rural Development. In 2001, a rural proofing co-ordinator had been appointed in the Department of Agriculture and Rural Development (DARD). That Department had primary responsibility for implementing the directions of the Assembly in rural proofing all measures taken by the Assembly and the Executive. I recall that while leadership on rural proofing was firmly in the Department of the Minister of Agriculture and Rural Development, other Departments in the Northern Ireland Government had a less than enthusiastic approach to the issue. That ethos clearly emerged during a meeting of the Committee for Agriculture and Rural Development on 3 May 2002 in a session chaired by my colleague George Savage MLA. Rural proofing was essentially about proofing draft policies and making recommendations, on a cross-departmental basis, on the implications for rural communities. In May 2002, it appeared that the interdepartmental committee had not even agreed a working definition of what rural proofing meant in practice. The Burns Report and the Hayes Report were both due for publication at that time. Then, of course, the suspension of the Assembly in 2002 intervened, and the matter has almost certainly been on ice since then, given the somewhat patchy record of direct rule Ministers in such matters. I mention that because the essence of what is contained in the motion is partly subsumed into the provisions that the earlier Assembly had already put into place for the rural proofing of all legislative and administrative measures adopted by the Assembly and the Executive. If rural proofing were implemented adequately, there would be no real need for a dedicated and specific rural health task force. The rural proofing of all health issues would ensure that all the impacts on the rural community would be covered adequately. As an example, I cite the air ambulance, which I successfully proposed when major cuts in rural Health Service cover were being proposed during suspension of the Assembly from 2002 to 2005. If there had been no suspension, then the impact of the effective withdrawal of emergency ambulance cover would have been raised through the rural proofing of that policy. As it was, there was no effective rural proofing of health reorganisation policies, and I had to lead a public campaign to demand air ambulance emergency cover for remote rural areas of the Province, especially in the glens of Antrim. I contend that the motion has more to do with doctrinaire North/South health co-operation than with improving healthcare in rural areas per se. Excellent, professional-led relationships already exist between health authorities north and south of the border, and those should proceed on a health-led basis without cheap political capital being made from them. 10.45 am Some Members: Hear, hear. Rev Dr Robert Coulter: This is yet another example of a motion proposing objectives that have not been properly costed. The Assembly cannot insert proper healthcare into some bill of rights without saying how we shall pay for it. The motion is also subjective, because what is “proper healthcare”? It must be defined. One man’s “proper healthcare” may not be another’s. Everyone wants the best healthcare for everyone; no one can question my commitment to that aim after years of defending and extending patients’ rights. However, putting proposals to the Assembly without costing them properly or saying from where the money will come does nobody any favours. In fact, it could lead to a great deal of embarrassment. Such proposals raise hopes that could be dashed for lack of available finance. There is an ongoing examination of the situation, so let us reactivate or properly cost rural proofing as the Assembly envisaged back in 2002. This time, however, let us ensure that the civil servants implement rural proofing and that all Departments conform to Assembly policy. Let us use the machinery that we already have at our disposal to look after the rural population. We must stop talking about it and get on with the job. Dr Deeny: I beg to move amendment No 2: Insert after “alliances” “• equal access to life-saving services for all, irrespective of postcode;” Thank you, Mr Speaker, for allowing me to speak to my amendment. I also thank the two Sinn Féin MLAs for tabling this motion so soon. The issue is close to my heart and important for us all. I take on board what Bob Coulter has said, but I cannot accept his amendment, because it is too specific. I have worked on the rural medicine working group, and, although its work is to be commended, it does not look at maternity, paediatric, surgical or accident and emergency services. The working group focuses primarily on medical services for coronaries, pneumonia and so on. Its remit is not wide enough. I have asked it to widen its scope and to look at other issues that affect people in all areas, not just in rural areas. Health provision — or the lack of it — in rural areas is extremely important to Northern Ireland’s large rural communities. Equity and equality across Northern Ireland is what this Assembly is all about, and that must also apply to healthcare provision. The Department of Health and Social Services’s ‘Fit for the Future’ paper from 1998 cites equity as the first principle of healthcare delivery. In 2002, the Department of Health, Social Services and Public Safety’s Investing for Health strategy proposed to reduce health inequalities. The vast majority of our landscape is made up of small villages and rural communities. Some 54% of our people live in small villages and rural communities, not in the more densely populated cities of Belfast, Newry, Derry, Armagh and Lisburn. It is important to bring to Members’ attention the difference between elective treatment and emergency treatment. People are generally fair-minded and do not mind travelling long distances to receive elective treatment, which is non-urgent. Emergency treatment — when one’s life is seriously threatened — is a completely different ball game. Those of us who work in front-line healthcare know that. Accessibility is vital in that area of healthcare, as it will very often mean the difference between life and death. Indeed, accessibility is really the major determinant in measuring standards of emergency healthcare provision in any area. Therefore, however inconvenient the idea of running smaller acute services for rural areas may be, those who live in rural areas need — and quite rightly expect — to have effective, safe, modern and accessible health services, just like urban dwellers. The motion is therefore admirable, and I support it. However, it is essential to agree my amendment in order to stop Northern Ireland’s current postcode lottery, which certainly applies to the area in which I live and practise. I tabled the amendment because, having been a senior Health Service doctor for some years, I believe that we cannot simply accept that our postcodes should determine our standard of healthcare provision or whether our children or grandchildren will survive sudden and severe life-threatening illnesses such as meningitis, severe asthma attacks or prolonged epileptic seizures. Similarly, our postcodes should not be the deciding factors that condemn our wives, daughters and granddaughters to delivering their babies on floors or on the roadside, rather than in the safety of a maternity unit. All Members must bear in mind that such incidents occur. I refer not just to those who have been involved in such single isolated cases in remote areas; I am talking about the many thousands of people who are risk because of where they live. It has been well documented that in my constituency this year there were four such dangerous births in a 10-week period. Healthcare provision is essential for expectant women and for rural people in general, and a dearth of such care is, to say the least, primitive and unacceptable in any developed twenty-first century country. I have repeatedly asked whether it is not more beneficial for those who live in rural areas to be served by a small and well-managed rural hospital rather than to die en route to a hospital in a larger location that has state-of-the-art facilities? It is fine to have facilities in huge hospitals, but they are no good to people who were dead on arrival. It is clear that infrastructure in rural areas is far worse than that in other locations. For example, my own county has dreadful roads, no rail network and no dual carriageways, never mind motorways. There is one dual carriageway as we leave the county, but that is it. Such a poor infrastructure worsens greatly people’s accessibility to healthcare provision and therefore contributes significantly to an unacceptable standard of that provision. The problems with rural healthcare provision in Northern Ireland are exactly the same in other parts of these islands and in Europe. I agree with the Members who tabled the motion that we should learn from our European neighbours about how countries that share common borders deal with access to healthcare provision. I live in a border county, and I know that similar to tourism and infrastructure, people on both sides of the border must work on healthcare provision. That is known as joined-up thinking. Many Departments work in that way, and it has been mentioned with regard to healthcare. ‘Cross-border Co-operation in Health Services in Ireland’, a report by the Centre for Cross Border Studies, stated that: “It has been suggested that people living in the vicinity of the border are materially disadvantaged on account of low levels of economic activity, rurality and geographical isolation.” The report continues: “As need for health services is highly correlated with material deprivation, it is likely that people living in border areas will have higher than average health needs.” Indeed, Professor John Appleby’s report ‘Independent Review of Health and Social Care Services in Northern Ireland’ demonstrated that medical admission rates for those who are from deprived areas are 41% higher than for those who are not from such areas. CAWT is one good example of cross-border joined-up thinking on healthcare. It is good that CAWT’s work, which has been ongoing for several years, covers places such as Cavan, Sligo and Enniskillen. However, an example of a dreadful lack of joined-up thinking is the main road from Dublin to Donegal, which is approximately 170 miles long. It is soon to be upgraded on both sides of the border — the A5 in the North and the N2 in the South — to either motorway or dual carriageway status. That long stretch of modern road network will always be the main road north-west from Dublin, and many thousands of cars will travel on it, yet no acute hospital with any form of emergency services is to be located anywhere along that major route on the island of Ireland. What would happen if a major incident occurred with no emergency services nearby? That is another example of an absence of joined-up thinking, and it clearly shows the importance of adopting such an approach. As medicine progresses and medical treatments continue to improve, the healthcare provision of the future will be different. In the not-too-distant future, GPs will lead primary-care teams in providing the majority of health services. We certainly do not want, or need, large acute hospitals at every corner. However, we must realise that there is a need for smaller acute hospitals that are equipped to provide life-saving resuscitation and ventilation services. GPs are neither qualified nor insured to provide those services. Furthermore, the failure to provide such essential services in rural areas will have an extremely detrimental effect on GP recruitment in those areas. GPs do not want to set up home and practise in an area bereft of emergency hospital backup. I can vouch for that, as it is happening in my area. For any Department with responsibility for health to suggest that rural hospitals are no longer required because rural GPs will be able to provide such emergency services in future is a totally false and dangerous assertion. In fact, the lack of rural hospital services will lead to fewer GPs practising in rural areas. Scotland has large rural communities, but there are small hospitals in the Shetland Islands, Orkney Islands, Western Isles and the Highlands. The six acute hospitals in the Highlands provide services for less than 8% of Scotland’s population. Some 168,000 people live in my county, yet there is a real possibility that there will be no services for 10% of the population. The previous session of the Scottish Parliament established a steering group to focus on remote and rural areas, and the Assembly should do likewise. I intend to visit a hospital in one of the areas that I mentioned to see how healthcare is provided in rural areas. I ask Members to support amendment No 2. Mrs I Robinson: The motion refers to healthcare across borders. I shall focus on cross-border co-operation in healthcare, especially in rural areas. In the 1998 agreement, health was one area where North/South co-operation was to be developed. The DUP has consistently stated that it does not oppose cross-border co-operation, as long as it is based on sound practical grounds for the benefit of the people of Northern Ireland and that it is not driven by an underlying political agenda. In the aftermath of the Omagh bomb, professionals from both sides of the border provided emergency care for victims. Few would disagree that it makes obvious common sense to co-operate in such instances, or in response to road traffic accidents, for example. Indeed, lives can be saved as a result. One current project involving GP out-of-hours services allows patients to attend the nearest centre, irrespective of whether it is in the same jurisdiction as their home. However, we must remember that it is the people of Northern Ireland whom we ultimately serve, and that they are our responsibility. As an illustration of that, an agreement between Altnagelvin and Letterkenny hospitals includes one condition governing co-operative action that provides that no proposal should undermine the service currently provided in either hospital. Furthermore, both hospitals have vowed that co-operation must be confined to services that a particular hospital cannot see itself providing in five to 10 years. On a slightly more negative note, the EU publication, ‘Patient Mobility in the European Union: Learning from Experience’, states that: “There is also a long-established practice of residents of the Republic of Ireland accessing free care in Northern Ireland through the use of an ‘accommodation address’.” The publication further states that the extent of the practice is: “very difficult to quantify, but may be substantial.” That concern should be investigated and action should be taken. In 1996-97, 0·3% of patients treated in Northern Ireland were from the Irish Republic. By 2003-04, some seven years later, that figure rose to 0·4%. The corresponding statistic for Northern Ireland patients being treated across the border fell from 0·13% to 0·11%. 11.00 am The significance of, or potential for, cross-border activity may well have been exaggerated. In its conclusions on the rationale for cross-border co-operation in healthcare in Ireland, the authors of the EU report on patient mobility admitted that: “we have not been able to find any detailed appraisal that could be used to justify public investment in a cooperation strategy or in individual initiatives. For example, although there is a general presumption that the population of border areas suffer from unmet need for hospital services, comparative analyses of mortality and utilization data conducted for the earlier study failed to confirm this.” The people of Northern Ireland have benefited enormously from the tripartite relationship with the National Cancer Institute in the USA, and will continue to do so. Northern Ireland is producing world-class research into innovative treatments for cancer. Such co-operation, which threatens no one, is to be welcomed and can have positive consequences. However, its impact on general health provision must be kept in careful perspective. The DUP supports the Ulster Unionist amendment. Mrs Hanna: I welcome the opportunity to contribute to the debate. We can learn from the rural medicine working group mentioned in the motion. However, the amendment proposed by Rev Coulter dilutes the substance of the motion. I support Dr Deeny’s amendment. Rural life is often thought to be idyllic and good for one’s health. However, that is not necessarily the case in reality. Deprivation and social exclusion have a negative impact on the health of people who live and work in rural communities. More research on rural health issues is required to better understand and target the complex health needs of people in rural areas and, in turn, inform policy that will positively influence their health and well-being. I hope and expect that the new health framework will result in the adequate decentralisation of health services and the necessary coterminosity. Complementary and interdependent community, primary and acute services are required. Those services will require adequate staffing levels: doctors; nurses; physiotherapists; occupational and speech therapists; and all allied health professionals. Many rural areas do not have a doctor’s surgery or pharmacy nearby, and going to hospital requires a lengthy commute. Poor transport, poor geographical access to services and poor roads infrastructure all contribute to what is known as the “distance decay” effect on those who live in the country. Availability and choice of services in rural areas are very different to those found in the towns. Social facilities, especially for disabled people, are often inadequate. All countries with a significant rural populace face similar healthcare challenges. In developing a vision for healthcare provision, Northern Ireland can learn how to establish best practice from its European counterparts. The highly developed Scandinavian rural healthcare system can provide knowledge and experience. Turning to cross-border co-operation, I have worked with CAWT. That body has been very helpful in that regard, but its work must be built on. Mr P Ramsey: The Member mentioned decentralisation, and I note that the Minister of Health, Social Services and Public Safety is in the Chamber. Given that thousands of people in the rural north-west are waiting for cancer screening and breast screening, why has a consultation document on the centralisation of pathology services from Altnagelvin Hospital to Belfast been published? Over 10,000 tests that were carried out over the border have been analysed in laboratories in Altnagelvin Hospital. Why is the Department insisting on centralising such services in Belfast? Mrs Hanna: I thank my colleague for making that point. I will allow the Minister of Health, Social Services and Public Safety to answer those questions. I agree with Mr Ramsey; I support decentralisation, particularly with regard to healthcare. Road traffic accidents are also a major problem in country areas, with young people often suffering major traumas. I am in favour of the trauma centre. However, to base the centre in Belfast will have implications for people who live in the countryside. There is concern that that will lead to downgrading of local hospitals and will have an adverse effect on rural communities. In order to alleviate those concerns, local hospitals must remain capable of dealing with emergencies. Training and skills retention are problematic when exposure to major trauma is sporadic and access to training courses is limited by time, distance and money. That must be tackled. An efficient and adequately trained ambulance service is essential for the provision of an efficient trauma system that is based on the principle of equity of treatment for all. The bottom line is that hospitals must have the ability to stabilise trauma patients should the need arise. There is also the problem of recruitment and retention of healthcare staff in rural areas. There is no quick fix when approaching the complexity of rural healthcare, but the issue must be tackled. Health promotion is crucial. Dissemination of education and information, as well as outreach working, is important for the improvement of rural communities’ overall health. Elderly people who live in rural communities endure major problems. I am a firm believer in community care. The Assembly must ensure that the right services are provided in good time to those who need them most and that those who receive help can have a greater say in whether they stay at home in a domestic environment for as long as possible so that care in residential nursing homes and hospitals can be reserved for those whose needs cannot be met in any other way. A concentrated multi-departmental and agency approach is required. Mr Buchanan: Members will be aware that people who live in rural areas, particularly those who live in the south-west of the Province, feel that facilities are much too heavily focused on Northern Ireland’s larger population centres. No place has suffered more from a decline in rural healthcare provision and life-saving facilities than my constituency of West Tyrone. That issue has been well documented and brought to the attention of direct rule Ministers on numerous occasions over the years. I am sure that all Members will agree that people across Northern Ireland are entitled to the same level of provision, equality of access and live-saving facilities no matter from where they come. I want to focus on primary-care provision in a rural setting. People in rural areas must be able to access services conveniently. Better-organised public transport is essential. Improved co-ordination and planning of transport schemes is needed locally and regionally. Transport considerations must be integrated into any healthcare planning for rural or remote communities. There must be multi-professional working across different disciplines. Patients in rural areas must also have access to self-management programmes. The use of telemedicine must be encouraged. It permits increased flexibility for healthcare service providers and allows them to expand the scope and quality of services. It is also cost-effective and provides expertise that would otherwise not be available. In order to maintain optimum services in rural areas, it must be possible to recruit and retain sufficient staff. The 2005 British Medical Association (BMA) report, ‘Healthcare in a rural setting’, identifies areas where recruitment and retention can be maximised. It suggests that health professionals should all have received rural placements when they were students. That opportunity should be seen as a positive contribution to a student’s development. Placing students in a rural area should promote working in such an area as a positive career choice. Postgraduate training programmes must use the opportunities that are provided in rural primary and secondary care to teach healthcare professionals general skills. Continuing professional development should be flexible and responsive to meet the range of needs in rural or remote areas. For far too long staff employed in rural areas have not had appropriate access to training, and that must be addressed urgently. Schemes to support healthcare professionals and their families in local areas are vital, and flexible employment arrangements must be made available so that highly professional standards are retained. The general medical services contract for medical services and primary care contains a specific adjustment to cater for rural areas. That adjustment takes population sparsity and dispersal into account and ensures that rural practices are not short-changed. Staff working in rural areas have many extra burdens — just getting to training courses, for example, can be problematic. Given the areas in which they live, many people are often involved in providing emergency care outside the hospital setting. Healthcare in rural areas depends on two vital matters: recruitment of healthcare professionals and the accessibility and sustainability of services. To bring that about there must be more joined-up working across the Departments to ensure that there is good quality of healthcare provision in rural areas. I call on the Minister to give a commitment that rural communities across the Province will have access to safe and sustainable services. Mr McHugh: Go raibh maith agat, a Cheann Comhairle. The debate is timely, and as someone from the rural constituency of Fermanagh and South Tyrone, the subject is close to my heart. As a Member for a rural constituency that continues to be affected by the Department of Health, Social Services and Public Safety’s centralization agenda, I say that the debate should not focus on hospital services only but take a holistic view of all health services, primary and acute, and preventative public health strategies such as Investing for Health. There is no doubt that hospital services, and equal access to them, are vital for rural communities. It should be totally unnecessary for people to have to travel to cancer services in Belfast. Chemotherapy, and similar treatments, could easily be delivered at a local level instead of having sick people make taxi journeys because of the centralization agenda. Those services should be made available in places such as the Erne Hospital in Enniskillen and in the new hospital. The rural health task force must resolve that problem and move well beyond it. My constituents raise concerns about a wide range of health issues and services. Recent research highlighted increasing levels of child poverty and its correlation with ill health west of the Bann, yet access to children’s services in hospitals and in the community is still difficult, with long waiting lists for even basic services such as speech and language therapy and physiotherapy. Mental health is another great concern given the social isolation of many people, particularly the elderly, in rural areas. A solution must be found to break the cycle of isolation that leads to poor mental health for which there is also poor access to services. Mental health services should have been included in the list of services that the new hospital in Enniskillen will provide. A further range of services could be brought to rural areas. A rural health task force could do much innovative groundwork to improve the lot of rural communities. It cannot and should not focus only on the provision of acute services. A new approach is needed. We have looked at Scotland and at the Hebrides, areas that have proved that rural communities can be well provided for by acute and other services, which would normally be found in places such as London or Belfast. 11.15 am Therefore precedents for such approaches have been set. Having visited the areas in which those services have been adopted and having given them consideration, it is clear that they can be used as examples. It is not enough merely to supply the services: quality services must be provided. In order for that to happen, a health network must be established. That need not necessarily be initiated in Dublin; perhaps either Belfast or even London could establish it. People are much better off going to London for treatment that will save their life or improve their long-term health than going to a local hospital where they will receive mediocre services. Due to certain difficulties, of which Dr Deeny is aware, that is presently the case for many people. Although I agree with his postcode lottery theory, Dr Deeny knows the difficulties that local hospitals face in trying to deliver quality healthcare provision. Given that rural hospitals cannot offer career progression, they find it extremely difficult to recruit nursing staff and consultants and doctors. Staff members simply do not want to come to places such as Fermanagh; Belfast’s greater career opportunities mean that they want to stay there. It does not matter how many new hospitals are built: if quality staff and consultants are not recruited, the outcome for patients will be no better. We know that statistics have proven that that is true of any services, even those that are provided by garages and so forth, and it applies to maternity and to other hospital services. The inability to attract highly qualified personnel plus the necessity to recruit abroad present major difficulties. Young people must also be considered, and the lesson that preventive medicine is the best medicine should be taught in schools. Rural areas must be included in any broader consideration of education on those matters. Go raibh maith agat. Mr Savage: I support the amendment tabled by my hon Friend Dr Coulter. I commend Members from the other side of the House on their interest in rural health matters. However, I cannot support Dr Deeny’s amendment, because the rural medicine working group already delivers for the rural community. As a rural dweller, I am pleased to thank that working group and to record my appreciation of its sterling work. The second half of Dr Coulter’s amendment: “urges the Minister of Health, Social Services and Public Safety to ensure that rural communities have access to safe and sustainable health services.” I echo that call, because there is a feeling of isolation in the rural community. If one is not fortunate enough to own a car, the lack of public transport can deepen that sense of isolation, which, in turn, has a negative impact on social relations. Furthermore, isolation affects people’s health as well as their access to healthcare provision and public services. Stress is a major concern for many people in rural areas, especially older people and the lonely. Sometimes, having someone to speak to can have a major impact and can bring many benefits. The home-help programme is the main link to the outside world for some older people. It should be expanded and given a budget increase so that the elderly, particularly those who are in rural areas, can reap greater benefit from such a good scheme. I ask the Minister to consider my request sympathetically. The needs of older people should be at the heart of a flexible and holistic response in the development of a more integrated Health Service. The value that results from older people remaining in their rural communities should be a core vision. Therefore I am pleased to support Dr Coulter’s amendment. The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I welcome the opportunity to debate the establishment of a rural health task force. I am aware that people living in rural areas can feel a sense of isolation and may have difficulty accessing health and other services. Many people, particularly those in the south and west of the Province, have genuine concerns about that, and the topic must be discussed in a mature and measured way. In expressing concern for the health and welfare of rural communities, I am in no way dismissing the needs of the many urban people who also face difficulties. My concern as Health Minister has to be for the health and social care needs of all of the people of Northern Ireland, wherever they may live. Those needs will be different in different parts of the country, and are often dependent on economic conditions and the age profile of the local population. Some needs may be specifically related to either rural or urban factors. The key point is that our system of care must be flexible enough to address those needs, irrespective of where and how they materialise. I want to emphasise that many factors that impact on people’s health cross Government Departments — factors such as housing, employment, education and the quality of the environment. Health is a cross-cutting issue that is the business of all Government Departments. My priority is to improve the health and well-being of the whole population of Northern Ireland, regardless of where they live. I will start by referring to the Investing for Health strategy that was launched in 2002 by my predecessor as devolved Health Minister. That strategy is regarded by many, including many outside Northern Ireland, as a model for public health strategy. Effectively, it recognised that health and well-being issues crossed a number of Departments and issues, rather than simply being “health”. The general health of the people of Northern Ireland has improved in recent years. The implementation of Investing for Health, in particular, has brought about many tangible gains. Life expectancy has increased in all areas and in all socio-economic groups. Death rates from diseases such as heart attacks, strokes, cancers and respiratory diseases — the main killers in our population — have fallen over the past few years. Among those under 75 years of age, deaths from coronary heart disease have fallen by 55%, and deaths from strokes by almost 50%, in the last 10 years. Cancer-related deaths in the same age group show an 18% drop. However, inequalities remain, and we must not become complacent. Mortality rates in Northern Ireland are still too high and lag behind those of many other European countries. A review of Investing for Health will begin next year. I see that as a valuable opportunity to ensure that the strategy is still fit for purpose. I will also be looking for any other actions that can be taken to improve the health of our population, whether they live in a rural or an urban setting. It is inarguable that accessing services can be more difficult for some people living in rural areas. However, it is interesting to note some key health indicators that compare the 20% most rural areas with the 20% most urban areas in Northern Ireland. Men in rural areas can expect to live, on average, about one and a half years longer than their counterparts in urban areas. Women living in the countryside can expect to live almost six months longer than those living in cities or towns. Infant mortality, a key measure of the health of a population, is lower in rural areas. The rate of teenage births in rural areas is less than half that in urban areas. The suicide rate is also lower in rural areas. Members will understand from that that the needs of some urban communities are, potentially, as great as those of rural communities. That is not in any way to dismiss the needs and concerns of rural communities; I just want to illustrate that not all health indicators for rural communities are negative. Living in the country has its upsides. Investing for Health is being taken forward through a partnership approach between statutory, voluntary and community organisations. A health partnership has been established in each health and social services board area, and each partnership has developed, and is implementing, a health improvement plan for its area. That is in line with the priorities set out in the strategy document and takes account of the needs of the local population, including the particular needs of rural communities. We have some excellent examples of innovative practice involving working in partnership. The partnerships work with rural networks to take forward a range of health improvements including, for example, research to explore the impact of rural isolation on poverty and disadvantage, and the promotion of dedicated transport to enable access to services. My Department and the Department of Agriculture and Rural Development (DARD) currently fund Rural Support, an organisation that provides a telephone helpline, so work is being done. I firmly believe that living in a rural area should not prevent people from receiving the necessary high-quality care. In response to Bob Coulter’s point, I must say that all healthcare policies are subject to rural proofing. My Department’s strategy for hospital services was developed through the Developing Better Services programme and recognises that a balance must be struck between ease of access for all and securing the medical benefits that are realised when the expertise and technology needed for the treatment of more complex conditions is brought together in an acute centre. Mr D Bradley: Will the Minister give way? Mr McGimpsey: I will be happy to give way when I finish this point. We cannot all live close to an acute hospital, but, through the plans for a network of acute and local hospitals, we ensure that everyone, including those who live in the most rural communities, has access to the required services for scheduled and emergency care. Developing Better Services delivers a model of hospital provision that ensures that the vast majority of people will be within 45 minutes of emergency care and consultant-led maternity services, and that, on arrival, everyone will have access to those services within one hour. Mr D Bradley: Does the Minister agree that there is a pressing need to retain resuscitation and stabilisation facilities in hospitals such as Daisy Hill in Newry, and other rural hospitals, in the event of major trauma? To do so may save lives in areas where the “golden hour” may not be met because of poor rural roads. Mr McGimpsey: There are nine acute hospitals in Northern Ireland. Daisy Hill is one of them, and it will retain the services to which the Member referred, particularly trauma services. Across Northern Ireland, health boards and trusts have introduced plans to make their services more responsive to local needs. I will continue to drive plans to bring high-quality primary-care and community-care services closer to where people live, and to invest in and improve the Ambulance Service, to which Mrs Hanna referred. That is another key area. The vast majority of services that people receive in hospital settings do not need to be carried out at a large acute hospital, and local hospitals will continue to deliver those services in future, typically at outpatient, diagnostic, urgent-care and day-procedure services. The decentralisation of some services that, in the past, have been delivered solely from Belfast, such as chemotherapy for cancer patients, is also a feature of my Department’s strategy. Mr Ramsey mentioned pathology services. A new laboratory at Altnagelvin Hospital opened last year at a cost of £18 million. There are no plans to move that; it is very much part of the fabric of services in the area. Consultation on the future of pathology services is under way. By the end of February 2007, the closing date for responses, we had received 280, which we are working our way through. We are not yet in a position to decide on the future of pathology services, so I will not predict what the final recommendations might be. Mr McGlone: We are dealing with the topical issue of healthcare and health services for rural areas. As someone who lives in a rural area, the Minister may be aware of detrimental changes to the care practice for nurses in some smaller GP practices. Those changes undermine confidence in the level of medical care available there. 11.30 am Secondly, I was unfortunate to have to attend the accident and emergency department of a local hospital from Friday evening until the early hours of Saturday morning. I discovered that the only method of communication that medical staff had with ambulance control to obtain an ambulance was to dial 999. That is totally unsatisfactory. Some members of staff at the hospital asked me to highlight that to the Minister. Mr McGimpsey: I thank the Member for those points. I am not in a position to comment, but I will be happy to talk to him afterwards. It is not satisfactory that the only way for medical staff to get an ambulance is to ring 999. The Department will look at that matter along with other issues concerning ambulances. Care practices for nurses have been brought to my attention again. I have not had the opportunity to deal with the subject, however, I would be happy to talk about care practices for nurses in the Member’s area. Linking services is a critical part of the review of rural medicine, which is being carried out by the Chief Medical Officer. That review is examining how inpatient medical services can be delivered in local and rural hospital settings. I am sure that Members agree that the review is important, and I look forward to receiving the Chief Medical Officer’s assessment of the findings at the end of the summer. The largest proportion of health and social care needs are met by primary and community services in Northern Ireland. My Department’s 20-year strategy for health and social care, which is called A Healthier Future, is currently beginning, and will ensure a front-line role for primary and community care services. It is important that the strategy will focus on making services, such as out-of-hours services, more accessible as well as expanding the range of services that are available close to people’s homes. To support the strategy, there will be major investment in primary and community care services through an extensive network of health and care centres across Northern Ireland over the next 10 years. It is anticipated that there will be 41 health and care centres, each of which will be designed to meet the needs of the local population. It is expected that each centre will provide a generic range of services including treatment, care, information, chronic-disease-management programmes and some diagnostic services currently only provided in a hospital setting. The strategy is about placing an emphasis on primary care — that is what people have told me that they want from local health and social care services, and that is what I want to see delivered. I will continue to work with cross-border agencies such as CAWT to explore opportunities for more effective healthcare solutions to the problems faced by people living along the border. Our health boards are working with their counterparts across the border; a cross-border pilot scheme is underway in the north-west, which is creating mutually beneficial cross-border arrangements. I am not convinced that a rural health task force is the best way forward at the moment. I say that in light of ongoing developments — the review of rural medicine; the pending review of the Investing for Health strategy and the prospect of duplication that may arise from the creation of another task force. I believe strongly that rural health and well-being must involve a wider response across Government. However, I will consider how to best take forward the spirit of the motion and address the issues involved in improving the health and well-being of people living in rural communities. In doing so, I will take the views of my ministerial colleagues, as the health and well-being of our local communities is an issue for all of us. It is a shared— Mr Speaker: I remind the Minister his time is almost up. Mr McGimpsey: Thank you. It is a shared responsibility. Dr Deeny: I thank the Minister for his presence. He has been at many of the debates on health, which is good. Nobody is suggesting that there should be large acute hospitals in every town in Northern Ireland — that is nonsensical. We are talking about establishing rural hospitals that have acute services that will save lives. Such hospitals exist in the National Health Service Scotland system, for example. Carmel Hanna, speaking as a former health professional, made a good point. We are requesting the establishment of rural hospitals that have stabilisation facilities — they work in Scotland and can work here. Such hospitals need not be huge; the important point is that their acute facilities would allow patients to be stabilised before they are transferred to larger hospitals for appropriate treatment. The current plans to develop better services do not apply to some areas, including my own. Currently, transporting people the length of the M1 is a chance that must be taken in the hope that patients are still alive when they arrive at the acute facility. Smaller acute services in rural areas can be run efficiently and effectively with the approval and guidance of the royal colleges. The colleges have not been mentioned, but they are important players that decide which hospitals close. If consultants’ skills cannot be maintained, and facilities and services are not provided for the training of junior doctors, a hospital has no future. Gerry McHugh made a well-made point about staff, and I agree that attracting good staff to country areas is a serious problem. The answer lies in staff rotation, which occurs in some places. If that were adopted on a wider scale, a condition for employment in larger urban hospitals would be that consultants and junior doctors would spend some time in smaller rural hospitals. If rotation were introduced, the problem of attracting doctors to rural areas would be removed and doctors’ skills would be maintained. Therefore rotation is the future. The Minister mentioned the healthcare needs of the urban population, and although I am proud of the fact that I live in the country, I do not suggest for a minute that the needs of urban dwellers should be overlooked — of course they should not. However, I have come across a mother who told me that before she has children she plans to move from her home to live with her sister because where she lives is unsafe. In Belfast, where each hospital can be seen and walked to from the others, people argue over whether a baby should be born in one hospital or another. I see that disparity day and daily in healthcare provision. We must not deny city dwellers what they need, but let us have a sense of fair play. People are actually leaving the area in which I live and work in order to give birth safely. Despite the UUP amendment, I ask that party’s Members to vote on health issues instead of according to party direction. Amendment No 1 is well made and well intentioned, but it focuses on medical care, which includes coronary heart attacks, pneumonias and strokes. That is a single area of medicine that I know and of which I have been a part. The UUP amendment relates simply to medicine. People outside the medical profession do not realise that “medicine” is simply a branch of what is known collectively as medicine. I made that point to the rural medicine working group when I told it that it must widen its scope to consider the needs of children and mothers and the future of trauma services in rural areas. If Members support the UUP amendment, they will neglect and deny the rights of our mothers and children and those of us who will suffer trauma. That amendment does not consider the needs of rural areas, and therefore, as a doctor, I cannot support it. A rural health task force is a good idea and is the way forward. That is why I support the motion. The remote and rural steering group was established in Scotland. I assume that it is still in place, and I volunteer to investigate how the Scottish Parliament looks after rural people. Members owe it to all the people in Northern Ireland, whether they live in cities or in rural areas, to provide decent and acceptable modern-day healthcare. I urge Members to support the motion and my amendment. Mr McCallister: The UUP’s commitment to rural areas and to rural proofing is well documented. My party colleague Mr Elliott has championed that agenda for several years. I am much encouraged that this debate has not been characterised by an urban-rural divide, because that is not a helpful road to travel. Our aim is to secure quality healthcare for everyone. I am encouraged that the Minister is, again, present for the debate. He mentioned several points that are of great interest to me. At a meeting of the Committee for Health, Social Services and Public Safety last week, I asked the Minister about establishing a good cross-departmental arrangement. On too many issues, when one mentions the word “rural” the matter immediately goes to DARD, and everyone else forgets that they share responsibility. If one mentions mental health, the issue goes to the Health Department, and other Departments forget that they too have some responsibility for those matters. The Minister has, quite rightly, made it clear that he will take up this vitally important matter with ministerial colleagues to secure a proper cross-departmental response. Dr Coulter and I have tabled our amendment because, as Dr Coulter quite rightly said, issues of cross-border co-operation must be entirely health-led and not, as Mrs Robinson put it, driven by some other agenda. Mrs Hanna quite rightly said that we want to establish best practice. I am sure that no one in the House would disagree with that. We want best practice across the board. Mr McHugh mentioned the Scottish experience. In the Scottish isles, there are areas of isolation that go way beyond anywhere in Northern Ireland. There may be excellent examples of best practice in Scotland to examine and from which to gain knowledge and ideas. I do not accept Dr Deeny’s arguments on the UUP amendment. Our amendment is quite clear, and I do not see how Dr Deeny can argue with urging the Department of Health, Social Services and Public Safety to: “ensure that rural communities have access to safe and sustainable health services.” That is what we are seeking. There is nothing weak or watery about “safe and sustainable services”. Mr Elliott: Was the Member more than surprised when the Member for West Tyrone Dr Deeny, at the last meeting of the Health Committee, indicated that no hospital should be built in Omagh or the Tyrone area? Mr McCallister: I was very surprised that Dr Deeny did not want the building of a new £190 million hospital in his constituency. Dr Deeny: It is not a hospital. Mr McCallister: It is being called a hospital and it represents £190 million of investment in health in his constituency. It was a great surprise that Dr Deeny wanted to stop that project. I am encouraged by the Minister’s comments on Rural Support and the work that his Department and DARD have been doing to fund that group. That is an organisation with which I have had previous involvement. Our amendment sums up our approach to this matter. The Minister has, in his short period in office so far, driven home the message that he is not interested in quick fixes for health services — he wants a sustainable future for healthcare; sustainable safe access for all our citizens, urban and rural; no postcode lottery; and the best health system in the world, provided by the best staff in the world. 11.45 am Mr McElduff: Go raibh maith agat, a Cheann Comhairle. Tá sé beartaithe agam féin agus ag Carál Ní Chuilín go nglaonn an Tionól seo go mbunaítear tascfhórsa um shláinte tuaithe. As the Speaker knows, Sinn Féin is strongly calling for the establishment of a rural health task force to respond to and meet the health needs of people who live in rural areas. We appreciate the Minister’s attendance and participation in the debate and in respect of all health-related debates that have taken place in the Assembly so far. People who live in rural areas are more likely to suffer ill health. Healthcare is a basic human requirement and a basic human right; it should be included in a future bill of rights. This has been a well-informed debate, and as many of those who took part have personal experience of the deficit of health services in rural areas, I am glad that the Minister has taken every opportunity to apprise himself of the special health needs of people in rural communities. Sinn Féin will accept the amendment tabled by Kieran Deeny. It makes eminent sense to include the reference to: “equal access to life-saving services for all, irrespective of postcode;”. As proposers of the motion, we are not inclined to accept Rev Coulter’s amendment, as it is too minimalist and does not have a wide enough scope. Essentially, we seek strong acknowledgement and strong investment of the necessary resources by the Department in relation to special health problems that arise from living in a rural community. Distance from essential health services is a real issue, and poor road infrastructure and lower socio-economic status are just some of the reasons for the major deficit in health provision experienced by people living in rural areas. There are general low levels of health in the North, both urban and rural, but the rural situation must be accentuated. Mr B McCrea: I thank the Member for giving way. Would he support a £190 million investment in healthcare provision in the West Tyrone constituency? Mr McElduff: I thank the Member for his intervention. I would accept the £190 million and seek to build on it, in order to provide proper acute services in the area. Mr Simpson: Will the Member give way? Mr McElduff: No. I will carry on, because it gets out of hand sometimes, David. A significant proportion of the population lives in rural areas; urban models do not support the rural situation. How often have Members heard the excuse that investing in 20% of facilities will cater for 80% of the population? The 80:20 rule and figures should be thrown out of the window. I am glad that several Members drew attention to the Cooperation and Working Together (CAWT) model. I ask Members to study the report on health inequalities that was published by CAWT following a one-day conference in March 2005. As other Members said, CAWT is an agreement between health boards adjacent to the border with the stated objective of improving the health and social well-being of the population. It is regrettable that too few areas for joint working have been carried forward despite the fact that health is an area of co-operation under the Good Friday Agreement. To respond to Rev Coulter’s comments, Sinn Féin is not being doctrinaire in relation to the health issue. This motion is not about cheap political capital. Far be it from me to quote someone of whom I am not the biggest fan — and in fact on one occasion, I joined one of the DUP Members for West Tyrone and others to occupy the office of this Minister; I do not think we were breaking the law, Tom, but we did it anyway. Nevertheless, I agree with Sean Woodward’s view that North-South co-operation in relation to health was “the patients’ solution”. Let us put the patients first. My colleague John O’Dowd challenged Members to name an area of service provision or social policy where North/South cooperation would produce a better outcome than that of healthcare. More initiatives are needed to reduce health inequalities in rural areas, not least in border communities. I commend to Members an initiative in the Carrickmore area of mid-Tyrone. The initiative is well known to Dr Kieran Deeny, who is a GP in the area. Indeed, I wish to put on the record that he is my GP. [Laughter.] I appeal for calm. [Laughter.] The rural link to health scheme is an excellent initiative that transports people to the local health centre to attend their appointments. The scheme also affords people the opportunity to go to the post office at the same time, for example. It was created by GPs in the Carrickmore practice, with input from the health action zone partnership and the Investing for Health strategy. The scheme is a good example of how the provision of transport can help to meet the needs of rural communities. I hope that that pilot scheme will continue to be funded in the future. In a rural area such as mid-Tyrone, the scheme performs an essential service. As has already been well articulated, the needs of that community are great. On the issue of North/South cooperation, I wish to highlight the issue of GP out-of-hours access. Sinn Féin is not being doctrinaire or engaging in cheap political point scoring on that issue. A person living in Lifford in County Donegal — one mile from Strabane — who falls sick in the evening or at the weekend is expected to travel to the North Western Association of Doctors on Call in Letterkenny, around 15 miles away. There is a perfectly good GP out-of-hours service just one mile away in Strabane, but that service has not been part of either of the two cross-border schemes that have been piloted to date. Those pilot schemes struggled to get off the ground because of resistance from within DHSSPS. One scheme was located in the Castleblaney, Keady and Crossmaglen areas; the other in the Derry and Inishowen areas. A similar pilot scheme should be introduced in the Lifford and Strabane areas. That is the patient’s solution; in supporting it, I am neither being doctrinaire nor engaging in cheap political point scoring. Sinn Féin does not support Rev Coulter’s amendment because it is too minimalist and its scope needs to be widened. My party specifically wants a task force to be established as it would be a demonstration of political will. The Minister said that he would take forward the spirit of the motion. I commend him on classic departmental-speak. What did he mean? Why will he not set up, or be seen to set up, a properly resourced task force with the objective of reducing health inequalities in rural areas? That would demonstrate real political will and real investment. Other Members have spoken in their capacity as constituency representatives. As a Member for West Tyrone, I ask the Minister to intervene to ensure that the urgent care treatment centre and the high-dependency unit at the Tyrone County Hospital are retained, developed and expanded to meet the needs of people as a part of a wider solution to the problems of health provision west of the Bann. He should not allow an urgent-care treatment centre to become a minor injuries unit. Go raibh míle maith agat. Mr Speaker: Before I put the Question on amendment No 1, I wish to advise Members that if amendment No 1 is made, amendment No 2 will fall. I shall then put the Question on the motion as amended. Question put, That amendment No 1 be made. The Assembly divided: Ayes 44; Noes 36. AYES Mr Armstrong, Mr Beggs, Mr Bresland, Lord Browne, Mr Buchanan, Mr Campbell, Mr T Clarke, Rev Dr Robert Coulter, Mr Cree, Mr Dodds, Mr Easton, Mr Elliott, Mrs Foster, Mr Gardiner, Mr Hamilton, Mr Hilditch, Mr Irwin, Mr Kennedy, Mr McCallister, Mr McCausland, Mr McClarty, Mr B McCrea, Mr I McCrea, Dr W McCrea, Mr McFarland, Mr McGimpsey, Miss McIlveen, Mr McNarry, Mr McQuillan, Lord Morrow, Mr Moutray, Rev Dr Ian Paisley, Mr Poots, Ms Purvis, Mr G Robinson, Mrs I Robinson, Mr P Robinson, Mr Ross, Mr Savage, Mr Shannon, Mr Simpson, Mr Spratt, Mr Weir, Mr S Wilson. Tellers for the Ayes: Mr Armstrong and Mr McClarty. NOES Mr Boylan, Mr D Bradley, Mrs M Bradley, Mr Brady, Mr Burns, Mr Butler, Mr Dallat, Dr Deeny, Mr Doherty, Mr Durkan, Dr Farry, Mr Gallagher, Mrs Hanna, Ms Lo, Mr Lunn, Mr A Maskey, Mr P Maskey, Mr F McCann, Mr McCartney, Dr McDonnell, Mr McElduff, Mrs McGill, Mr McGlone, Mr M McGuinness, Mr McHugh, Mr McKay, Mr Murphy, Mr Neeson, Ms Ní Chuilín, Mr O’Dowd, Mr O’Loan, Mrs O’Neill, Mr P Ramsey, Ms S Ramsey, Ms Ritchie, Mr B Wilson. Tellers for the Noes: Mr P Maskey and Mrs O’Neill. Question accordingly agreed to. Main Question, as amended, put and agreed to. Resolved: That this Assembly notes the ongoing work of the Rural Medicine Working Group and urges the Minister of Health, Social Services and Public Safety to ensure that rural communities have access to safe and sustainable health services. Provision of Speech and Language Therapy Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes for the winding-up speech. All other Members who wish to speak will have five minutes. Mr P Ramsey: I beg to move That this Assembly notes the inequalities in the provision of speech and language therapy throughout Northern Ireland, and calls on the Executive to provide adequate and equitable resources and financial support. The motion is not intended as any criticism of, or reflection on, the good work of speech and language therapists, managers or technical assistants. For the past five years, I have been working closely with a group of parents in Derry whose children have been statemented and require speech and language therapy. Unfortunately, for some of those parents, their children have come of age — they are 18 — and no longer have access to speech and language therapists. Their stories are alarming. However, the parents are continuing with their campaign to ensure that other children do not face similar disadvantages. I have attended numerous meetings with health boards and trusts. I remember a meeting with a direct rule Minister whose arrogance and ignorance left a lot to be desired. He took a telephone call during the meeting and did not even introduce his departmental officials to the parents who had accompanied me. Imagine the impression that his behaviour made on those parents: it did not give them much confidence in direct rule. In 2006, a follow-up review carried out by the Northern Ireland Commissioner for Children and Young People (NICCY) reported that over half the children who required assessment or speech therapy in the Western Health and Social Services Board area could not access those services. NICCY found also that speech and language therapy services are allocated on the basis of a postcode lottery, meaning that the area in which one lives has a huge bearing on the expected waiting time for assessment and treatment. In my constituency of Foyle, children can wait for up to 18 months to be assessed by speech and language therapists and receive the necessary therapy. In anyone’s life, especially that of a five- or six-year-old child, 18 months is a huge amount of time. Such a delay in assessment and treatment impedes a child’s learning and his or her enjoyment of school. Parents in my constituency are being forced to fight with health authorities to obtain the services that their children need and are entitled to as of right. That situation cannot be allowed to continue. There has been systematic failure of leadership and management. For example, in 2004, John Hume tabled a series of questions in the Westminster Parliament about speech therapy services. It transpired that the most basic information about the length of the various waiting lists, waiting times and budget allocations for speech and language therapy across the trust areas was not available to the then Minister to allow for strategic decision-making, allocation of resources and equality assurance. Clearly, there was no central control and, more worryingly, no democratic interest in providing an essential service for our children. It is clear that there are simply too few speech and language therapists in the system generally, and, particularly, in some areas such as Foyle. I mentioned earlier that I met repeatedly with Health Service managers. They told me that they could not recruit and retain speech and language therapists. It turned out that speech and language therapists in the Foyle Trust area were earning less than those employed in other trust areas. That is no longer the case, but it seems that posts are simply not available for speech and language therapists who want to work in the Foyle Trust area. (Mr Deputy Speaker [Mr Dallat] in the Chair) Parents and users have serious concerns about moneys allocated by the Department through the children and young people’s funding package for 2006-08. The use of that funding will discriminate against children in mainstream education who need speech and language therapy. The Department has made £1 million available. However, parents have serious concerns that the money is only to be used by special schools and language units attached to special schools. That presents a serious problem for children with special needs who attend mainstream schools in that they will not be able to avail of the services being offered to children who attend special schools. That situation cannot be tolerated. In the Foyle Trust area, there is a ratio of one speech therapist to 3,200 children, compared to the Southern Health and Social Services Board area, which offers one speech therapist to 1,700 children. That difference in provision leaves a lot to be desired. I want to talk about the current lack of resources and the costs that will no doubt rise from our call to provide more speech therapists. Given the money that is spent on public administration in Northern Ireland — Members are all aware of Northern Ireland’s burgeoning public sector — is it not amazing that front-line services in speech therapy and other essential areas are so poor? On the face of it, given what is being spent, we should have the best public services in the world. However, we do not. There has been a systematic and long-term failure of strategic direction from direct rule Ministers, and subsequent mismanagement, which has resulted in cumbersome, bureaucratic systems that do not deliver the services that people need. Non-delivery of essential services would not be tolerated in the private sector — heads would roll and companies would go out of business. In public services, non-delivery of services has been followed by inaction and more of the same. Under direct rule, questions were answered with excuses. However, that was then; this is now. 12.15 pm The review of public administration (RPA) needs to be completed as soon as possible. Health Service management must be given the flexibility, authority and control required to make the necessary changes. More staff need to be employed on front-line services, and they should be given the backup that they need. In the Civil Service and public sector, the mantra should be: if you are not serving a citizen; you had better be serving someone who is. We can no longer accept that the weak and vulnerable in our society are provided with desperately inadequate services. The people of Northern Ireland do not want to hear lectures about finance and cost; they want efficiency and value for money. Furthermore, public servants want to work in an efficient system that clearly delivers for the people. I recently became aware of an early years centre in Ballynahinch, which is a centre of excellence for communications, particularly for children, and others, who have communication difficulties. It is good that such an organisation exists, and I draw the Minister’s attention to it. The centre is literally a one-stop shop and it has addressed some of the difficulties that have been ongoing in the Department. The people who attend the early years centre have severe language and communication difficulties. One of centre’s outputs is that 71% of those children who attended the centre during their early years are now in mainstream schools. It is important that children who are statemented become involved in mainstream education and feel equal to others. As well as providing specialist support for children, the I CAN early years centre in Ballynahinch is a centre of excellence locally, regionally and nationally and provides outreach support and training for early years facilities across the South Eastern Education and Library Board. If that project is the model of good practice, we must ensure that it continues and that its sustainability is maintained. The support provided at the centre should be rolled out across Northern Ireland to allow all children to have equal access to it. Children cannot wait any longer, and they cannot wait for RPA to be concluded before the services that they need are delivered. People are aware that, in the short term, there will be an overspend pending rationalisation under RPA. However, they would rather make that investment now because they know that our children are worth it. They are also aware of the long-term social and economic costs of not making that investment now. Immediate action must be taken to provide better front-line services. We already know what must be done. We need more speech and language therapists in place. We must get our children the help that they need, and we must get it done now. In the recommendations from NICCY’s ‘Overview Report of Speech and Language Therapy Provision in Northern Ireland 2004/05’, the late Children’s Commissioner Nigel Williams stated that the Secretary of State for Northern Ireland: “should ensure that children’s right to speech and language therapy is accepted and prioritised by relevant Government Departments and Commissioners and Providers of Service.” The report’s most important recommendation is a fundamental concern for parents — joined-up thinking: “The Ministers for Health and Education should make this right a reality by ensuring that policy, planning and service commissioning at a strategic level is strengthened to allow a child centered approach to be developed which meets children’s speech, language, communication… needs.” That is a crucial issue for many people across Northern Ireland, some 21,000 of whom require access to speech and language therapy, and that is not currently being achieved. Parents who are now becoming part of the campaign do not want other people to suffer the same difficulties that their own children have experienced, such as delays in communication skills and delays in accessing adequate services. I hope that the Minister has good news to deliver today. To deal with this issue effectively, joined-up thinking is required between the health authorities and the bodies that statement children — initially education and library boards. That must be done as a matter of urgency. I commend the motion to the House. Mr Easton: I welcome the opportunity to discuss the motion. As with many other issues that we consider, the Assembly must take the provision of speech and language therapy seriously. Although such therapy is a particular specialism, it shares with other health services the same traits of long waiting lists and lack of resources. Speech and language therapists undoubtedly undertake a much-needed and vital role, but the current resources for the service cannot meet the demand. That means that children and young people are losing out on a most basic right to communicate effectively. Given the pressure that has been put on our Assembly and Executive to distribute finances accordingly to help to maintain services such as SLT, I urge the Executive and the Minister of Health, Social Services and Public Safety to consider carefully the funding for speech and language therapy. Frustration at the current situation is shared not only by the families of children and young people who are in need of SLT but by the professionals who want to provide the best possible service. For the best results, such children need regular sessions with a speech therapist. Families should not be left waiting for inexcusable lengths of time. The therapy needs to be administered effectively and consistently over time. SLT involves constant attention and it requires the freedom to be able to adapt the situation to suit individual needs. A report from the Northern Ireland Commissioner for Children and Young People highlighted that more than 2,000 children await an initial SLT assessment and that some 3,400 who had already been assessed await the commencement of their programmes. Those findings cannot be ignored, nor can the needs of our children and young people. We must find efficient ways in which to improve the situation. Can we further encourage collaboration between trusts and universities throughout Northern Ireland so that we reap the benefits of having experienced and trained staff who can move into speech and language therapy? How can we reduce waiting lists? We cannot judge demand on huge budgets without a strategic plan for implementation. We must consider that issue before throwing money at the problem and then failing to see long-term improvements. SLT must meet the distinctive needs of all those who require the service, including, for example, autistic children and young people. Such children should not have to go through years of their life without the necessary support to communicate in the best possible way. In too many cases, resources are just not available. No one questions the quality of the therapy that is provided, but we need to consider how we can improve and support the service. We readily acknowledge the importance of SLT and call for further work to be done to shed light on autism and to resource SLT. I support the motion. Mrs O’Neill: Go raibh maith agat, a LeasCheann Comhairle. I suggest that, although inequalities in provision exist throughout the various trust areas, there is a shortfall in provision across the North. That is not the fault of, or as a direct result of, speech and language therapists, who do a great job in difficult circumstances. As a mother of two small children, I know only too well the stress and anxiety that all parents face when their child is ill or requires treatment. That some children must wait for more than three years is appalling. Speech and language therapy is a vital service that about 10% of all children in the Six Counties require, yet access to the service and the time that a child must wait are, by and large, determined by the postcode lottery that Pat Ramsey mentioned. Those children who are most vulnerable and most in need usually face the longest waiting times. Speech and language therapy is an important service that could be enhanced in many ways with a straightforward injection of cash from the Department. We need to train and employ more speech and language therapists to meet our higher levels of need. SLT is not a so-called soft service. During a recent debate, the Minister told us that mental-health services for children were seen as the poor relation, but I believe that children’s services in general have had a raw deal. Let us send a clear message from today’s debate that all services that children and young people require will be properly resourced and that we will listen to the concerns of those who are most aware of where need exists. A recent report from the Northern Ireland Commissioner for Children and Young People highlighted: “The overall lack of action at a strategic and or policy level as regards the concerns raised by NICCY, professionals in the field and parents/carers.” Those concerns have been ignored to date, but let us change that from today. Let us listen to those who are well aware of the services and needs in this area. Without proper access to speech and language therapy, many of our children are being condemned to a life of poor educational achievement. That results in poor employment prospects, poor social skills development, low self-esteem and emotional and behavioural problems. Early intervention by speech and language therapists can help to prevent many of those problems and increase the life chances of many children. Undoubtedly, that would be cost-effective in the long term. As a mother, I have focused on the positive impact that speech and language therapy can have on children. However, many other people could benefit from an enhanced speech and language therapy service — those with communication difficulties, post-stroke sufferers, young offenders and people with mental-health problems. The ability to communicate, which all Members take for granted, is being denied to many people by failures to invest in speech and language therapy. We must end that situation today. For that reason, I support the motion. Go raibh maith agat. Rev Dr Robert Coulter: I congratulate the hon Members who tabled the motion. The issue of speech and language therapy impacts heavily on many people across our land. I am chairman of the board of a special school, so I know that such therapy can have a good impact on children who receive it. The Royal College of Speech and Language Therapists reckons that Northern Ireland has 57,000 preschool children who have speech, language and communication needs. As many as 5,500 of those children will have problems that persist into later life and require specialist help. Such figures underline the importance of today’s debate. This is a significant disability, and it may contribute to other social problems, including the cycle of social exclusion, alienation and offending. That is why the problem should be considered in the round and the funding of services should be examined in the proper context, which includes consideration of how much it costs society in Northern Ireland not to act on this issue. How much does society lose through not dealing with the problem more effectively than it does at present? The Assembly should commission empirical research and a scoping exercise that defines the true extent of the problem. Those should be followed by an evaluation of what would happen if the present levels of speech, language and communication needs were allowed to continue unabated. That would produce a proper context for action. It is probably short-sighted to consider the provision of an adequate response to speech, language and communication needs as simply being another item in the health or education budgets. If early intervention could alleviate the problems suffered by young offenders that in turn have led to their offending behaviour, surely a case could be made for Budget savings to be set aside for those offenders. Members have mentioned the uneven level of care throughout the Province, and that issue must be addressed. The phrase “postcode lottery” has been used again and again, and it is also relevant to this argument. There have been sub-regional differences in waiting times for referral, the availability of sufficient therapy posts, the procedures for assessing referrals, the provision of assistants to help the specialists and differing care packages. A rational and even approach is needed across Northern Ireland to address shortfalls in different geographical regions and areas of provision. The importance of early intervention and, conversely, the dangers of late intervention are well documented. Those dangers include: developmental disadvantage; damage to social skills and employment prospects; educational underachievement; emotional problems; and behavioural problems. All those dangers must figure in the downside costs of inaction, which must be balanced against the actual costs of improving the service to meet professionally led standards of adequacy. The net cost can then be understood, and the relatively small amount of that net cost will ultimately justify this much-needed reassessed public investment in this important service. 12.30 pm What worries me most is that, currently, there are no speech and language therapy services for children and adolescents with mental-health problems and for young offenders, and there is only limited provision for patients suffering from brain injuries, cancer, voice conditions, and strokes, and for secondary-school children and children with Asperger’s syndrome. All of that is a reproach to us. We must look not only at the net cost approach that I have outlined, but at better, more innovative ways of spending the current budget. I support the motion. Mr Lunn: I welcome the motion; it raises a significant issue. However, the motion does not indicate where the “adequate and equitable resources” it calls for are to come from. As Dr Coulter rightly says, debate around the issue suffers from a lack of statistics. The scale of the problem is indicated primarily by concerns raised by health professionals, rather than bare statistics. The figures indicate that this time last year, of 17,000 children requiring speech and language therapy, approximately 15,000 were receiving it. That means that nearly 15% of children who needed the therapy were not receiving it. Overall, approximately 3,500 children and adults who have been assessed and require treatment are still awaiting it. Those are the figures that the Alliance Party has researched. I did not understand the figure that Dr Coulter gave of 57,000 pre-school children in need of speech and language treatment. As Mr Ramsey said, the evidence suggests that there is a postcode lottery, which is also the case for many other services. The trend for patients going from assessment to provision is declining in some areas. The gap is typically a few months, but in some locations there is a wait of up to two years between being assessed as requiring therapy and actually receiving it. That is particularly unacceptable for children. It is intolerable that a six-year-old child should have to wait until he is eight to receive treatment. We need to be cautious that our attempts to provide an equitable service do not result in a reduction of the level of provision in high performing areas. The task is to bring every trust area up to the standard of the best, not to equalise the level of treatment to an average. Our objective of speeding up access to therapy should not lead to any reduction in the quality of the therapy provided. Requirements can differ significantly, so it is not enough to illustrate the issue with mere statistics. Resources and financial support also require some thought. Fewer speech and language therapists qualify than are needed. I would like to know what the position is across the whole of the UK, and Ireland. Anecdotally, it seems that Northern Ireland’s school-leavers are going elsewhere to train. If that is the case, why is it so? Is there any way of encouraging them back? Discussion on this issue has focused on the regional task force. However, the electorate has already become a bit fed up with “government by review”, and “government by task force”. Executive action is required via cross-cutting policies to ensure all of the following: that finances are available; that enough therapists become qualified; that the public is properly informed about the availability of speech and language therapy assessment and provision; that underperforming trusts are brought up to the level of the highest performers; and that children requiring therapy are identified as soon as possible. We welcome the motion as it stands, as a great start. The Executive now faces the challenges of finding where the inequalities in speech and language therapy exist, clarifying exactly what equitable resources are needed, and locating adequate funding. The determination to waste money on segregated services brings a high cost for other areas; the Executive has four years to examine that. Nevertheless, the Alliance Party supports the motion. Mrs I Robinson: I congratulate the hon Members for proposing the motion. As the DUP health spokesperson I had the privilege, just over a year ago, of hosting a reception in the Long Gallery to celebrate the diamond jubilee of the Royal College of Speech and Language Therapists. Those individuals make a hugely important contribution to healthcare in our Province. As with all the allied health professionals, there are stringent resource limitations on what staff can achieve. Retention of people undergoing training has been a problem, and I am encouraged to see that the numbers of new speech and language therapists commencing work in the Province is growing gradually — that is to be welcomed. Significant financial incentives have been attracting newly trained professionals to practice elsewhere; and they cannot be blamed for following that course, because people outside the Province appear to value their exemplary credentials more than we do. I am not sure of the current figure, but recently there were 20 vacancies in Northern Ireland. It has always been difficult to obtain from Ministers precise figures for the waiting times of those seeking speech and language assessment or treatment. Ministers have only been able to provide the length of waits experienced by those who received an initial assessment in the previous quarter. A cynic might conclude that that situation could be useful to the Department in limiting negative media headlines. It cannot be difficult to obtain the waiting list for assessment or treatment across the Province, and the point was referred to in NICCY’s follow-up report in 2006, which states: “There continues to be great difficulty accessing information uniformly across Trusts. It would appear that information … critical to effective service planning is not yet routinely collated analysed, or easily accessible. The urgent need to address this deficiency cannot be over-stated.” I appeal to the Minister to address the problem urgently. Precise numbers must be obtained so that proper resource planning can be put into effect. There have been marked disparities in different parts of the Province. Waiting times are not the staff’s fault: they do as much as can reasonably be expected. Unlike other disciplines, waiting list figures for speech and language therapy encompass adults and children. Long waits are particularly significant for children, as many of them are at an important stage in their development. Vacancies and pressures on special schools also pose particular difficulties. I am aware of great problems at Torbank School, which is in my own constituency, and I wish to highlight the need for an urgent look at that school’s needs. One third of young people with special educational needs is statemented with speech and language needs. In order to improve that situation, the Department of Health, Social Services and Public Safety and the Department of Education must work together in a close and cohesive format. In 2002, the comprehensive review of the speech and language therapy workforce highlighted the need for more posts and to encourage trained staff to remain in the Province. A year ago there were 314·4 whole-time equivalent speech and language therapists in the Province, as well as another six full-time and 22 part-time support staff. The workforce is overwhelmingly female: there are only two full-time and one part-time male therapists. The NICCY follow-up report states that more than 2,000 individuals were awaiting assessment with approximately 3,500 who had been assessed but were waiting for their treatment to start. Across Northern Ireland, over 15,500 patients were receiving treatment, which meant that to provide treatment for all those who need it the capacity of the service would have to increase by more than one third. Recently, 11 out of the 14 health trusts reported having inadequate financial resources for speech and language therapists. Many were also concerned about limited clerical and administrative staff and ineffective appointment systems. I support the motion. Mr McKay: Go raibh maith agat, a LeasCheann Comhairle. I thank the SDLP Members who tabled the motion, which I support. Sinn Féin recognises the important role that speech and language therapists and support workers play in the lives of many people with communication, eating, drinking and swallowing problems. Speech and language therapists provide an essential service in the Health Service for both children and adults. Not only do they assist and work with people with communication difficulties but they help to instil confidence in those people to express themselves to the best of their ability. There is clearly inadequate and inequitable service provision in the sector across the Six Counties. That needs to be acted on urgently. The Commissioner for Children and Young People’s follow-up review of speech and language therapy services for children and young people for 2005-06 showed that, from available information, 5,457 children and young people were awaiting assessment and/or speech and language therapy. For assessments, the review states: “the maximum wait stated by any Trust for community settings was just over 10 months”. The figure was even worse for waiting times for therapy. The maximum waiting time recorded between assessment and therapy was 24 months — two years. That was recorded in the former Homefirst Community Health and Social Services Trust area, which takes in part of my constituency of North Antrim. The geographical inequity in the service is extraordinary. Waiting times for assessment last year ranged from three weeks in one trust area to five months in another. Waiting times from referral to therapy range from 15 weeks to 29 months. Last year, 11 of the 14 trusts identified: “inadequate financial resources and/or speech and language therapists” as reasons for the failure to meet need. The recognised shortage of speech and language therapists is caused by recruitment and retention problems, and that means that many clients, particularly children, experience severe delays in accessing therapy. Sinn Féin calls on the Minister to make the service more equitable across the board and to end the postcode lottery that currently exists in the sector. There is a pressing need to ensure that appropriate financial resources and more speech and language therapists are provided. The need that exists for speech and language therapists looks set to grow even more. That is why the Minister should approach the problem with a degree of urgency in order to get it addressed now. There is greater need for speech and language therapy intervention for a number of reasons. People live longer, and many now live longer after cancer treatment. People with dementia or who have suffered a stroke — conditions that affect communication — need assistance. Problems such as autism and learning difficulty are more widely recognised. Improvements in neonatal care mean that survival rates for preterm babies with developmental problems such as cerebral palsy is increasing. Children are losing out on vital treatment, and that is simply not good enough. If the opportunity is missed for children and young people to avail themselves of speech and language therapy services, that could have a huge effect on their development. The longer that it is left, the more difficult it will be to address some of those difficulties. Go raibh maith agat. Mr Simpson: I also congratulate Pat Ramsey and Dominic Bradley on their motion. A recent review of speech and language therapy services by the Commissioner for Children and Young People showed that some 20,000 children require, or currently receive, speech and language therapy services in the Province. The findings of the then Children’s Commissioner, Nigel Williams, were shocking. In some trust areas, children and young people were forced to wait for up to 18 months to two years to be assessed by a speech and language therapist. A clear inequality exists in waiting times from the date of the referral to the first assessment. The whereabouts of a child or a young person in Northern Ireland seems to determine how long he or she must wait for speech and language therapy. I know that from experience in my constituency. Waiting times for pupils at Ceara School in Lurgan, for example, are much longer than those for pupils at Donard School in Banbridge. I have nothing but admiration for the dedication and work of the diligent staff at all those schools in Upper Bann, especially the principal of Ceara School, Dr Peter Cunningham, and Mrs Freda Wylie at Donard School, who will be retiring next Tuesday after many years at the school. Those years of dedication must be commended. 12.45 pm We asked direct rule Ministers for details on how many patients and young people were awaiting speech and language therapy appointments and the duration of those waits, but we were told that the statistics were not available; they were not kept. That is not good enough. To plan for the future, we must know how many individuals require services, but we are merely provided with general information on the duration of wait experienced by those who have been treated in the previous quarter. For instance, 18 months ago, more than 650 individuals in the southern health area received initial speech and language therapy assessments; 255 had waited more than three months, and 30 had waited over six months. Many of those requiring treatment are young children, and such waits for therapy can have a major impact on their development. The Commissioner for Children and Young People’s report of 2005 made several recommendations. It called for the establishment of a regional task force to address the postcode lottery that exists in service provision and an agreed maximum waiting time for assessment and therapy. A follow-up review by the Office of the Commissioner for Children and Young People took place in 2006, which identified that some trusts had made positive improvements. However, that was not universal across the Province, and there was evidence that some waiting lists for assessment and therapy had increased — for instance, the number of children awaiting assessment in the Sperrin Lakeland Health and Social Care Trust had increased by 28·3%. Eventually in 2006, direct rule Minister Lord Rooker announced that the task force recommended by the Commissioner for Children and Young People would be established. The task force met for the first time last year, but, to date, it has not published a report. Even though some investment has been announced, it does not address the postcode lottery or the ability of principals of special schools to access services directly for pupils. Many children in Northern Ireland need access to, and suitable provision of, speech and language therapy. The current allocation of resources, structures of service delivery and lack of interest on the part of the Government in addressing that means that children and young people who have speech and language difficulties are being denied their basic rights. Government officials tell us that there are not enough therapists because they drop out from their courses, or because there is no funding or insufficient funding available for them — or a mixture of all three. Perhaps the Minister will tell the House why that is so. I support the motion. Mr McCallister: Approximately 2·5 million people in the UK have communication problems. Speech, language and communication difficulties are the most common disabilities presenting in early childhood. This year, the Education Select Committee at Westminster acknowledged that as the number of children with special needs rises, so does the incidence of communication problems. The statistics relating to children with special needs demonstrate the extent of the problem in this country: up to 90% of children with learning disabilities have speech and language difficulties; approximately 80% of those who have severe learning disabilities do not acquire effective speech; 62% of children with mental-health disorders have speech and language difficulties; and 5% to 8% of preschool children with speech, language or communication problems and 10% of school-age children have communication problems. Furthermore, over one third of stroke sufferers have persisting speech, language and communication problems; more than three quarters of the people who have mental-health disorders have communication difficulties; and almost two thirds of young offenders have speech and language impairment or communication needs. Unfortunately, the list goes on. Speech and language therapists provide an invaluable service in Northern Ireland, so there are serious risks to patients if speech and language therapists are not availed of, or applied for, when needed. Children with delay and communication difficulties are an exceptionally high-risk group with high rates of later developmental disadvantages. Difficulties can arise with social skills and behavioural and emotional problems, which can lead to poor employment prospects. One third of children with communication problems, if untreated, will go on to develop mental illness, which will result in involvement in criminal activity in over 50% of cases. The importance of the service that speech and language therapists provide is realised when we examine the extent of the need for their services in Northern Ireland. Statistics provided by the health trusts reveal that over 15,000 children and young people are currently receiving speech and language therapy in Northern Ireland, while a further 2,000 are awaiting assessment for therapy. Those individuals can experience delays of up to 24 months between assessment and receipt of therapy. Average delays range from, at best, two and a half weeks to, at worst, 9 months. That is clearly unacceptable, given the identified need of those children and young people. When considered together, those figures reveal that well over 5,000 children and young people are still awaiting assessment and/or therapy. Up to 21,000 children and young people, therefore, require access to speech and language therapy in Northern Ireland. The Assembly must act to address this inadequate provision. The facts and figures speak for themselves. I unconditionally support the motion and commend its proposer. Mr Beggs: I declare an interest in this matter as a member of the New Horizon Sure Start committee, which operates in Carrickfergus and Larne and is a potential recipient of funding to address the speech and language therapy needs of children in the area. Much is made in education debates of the large number of young people leaving school with limited literacy and numeracy skills. The Royal College of Speech and Language Therapists advises that in Northern Ireland there may be as many as 57,000 preschool children with speech, language and communication skill needs. If a child at preschool stage or at school has such a need and it is not addressed, how can we expect him or her to realise their full potential? How can a teacher cross that barrier and communicate effectively with the child? Likewise, how can the child connect with the teacher or have his or her queries answered? This is a major problem that ultimately affects the education of young children. It also affects their social lives as they try to mix with others, even in their own homes. Other Members have commented on the Northern Ireland Commissioner for Children and Young People’s report on speech and language therapy provision for 2004-05 and his follow-up report, which was launched last March. The follow-up report showed that 2,055 children and young people were waiting for assessment. Yes, it was a 17·4% drop on the previous figure, but does that simply reflect an increase in the number of children and young people who had been assessed but had yet to receive therapy? Children and young people must go through a number of lists before they start to receive the treatment that they need. The report showed that 3,402 people in Northern Ireland were waiting to start therapy. As others have said, children and young people faced a delay of up to 24 months in the former Homefirst Community Health and Social Services Trust area, which covers my constituency of East Antrim — including Larne, Carrickfergus and part of Newtownabbey. That is unacceptable; it is ruining young people’s potential, and that gross inequality must be addressed. Yet, we are told that, in other areas, the delay between assessment and receipt of therapy can be as little as two and a half weeks. Why should children and young people in my area be exposed to such a postcode lottery defect? Why is there such gross inequality in Northern Ireland? It is unfair, and it is ruining their potential in life. Worringly, the NICCY report on speech and language therapy provision showed that, compared with previous years, more trusts complained of inadequate financial resources, a shortage of speech and language therapists, a lack of administrative support and lengthening waiting lists. It was clear that by March 2006, when the report was published, that that situation was worsening. Other Members mentioned the regional task force that was set up in March 2006 by Lord Rooker, the then Minister with responsibility for children and young people, to review speech and language therapy services. Who are the members of that task force and how often has it met? I am led to believe that it has met once, but a lack of clarity exists. Given the new structures in place in Northern Ireland, to whom does that regional task force report? It is important that those questions are answered and that ministerial responsibility is assumed, so that progress can be made and lessons can be learned that will improve the lives of children and young people in Northern Ireland. When are we going to hear of any recommendations by the regional task force? When will it produce a report? One of my constituents had been on a waiting list for 13 months, only to receive a 20-minute assessment from a locum who did not have the notes from previous assessments that other professionals had conducted. As a result of intervention, my constituent has commenced an eight-week therapy course, but what happens then? What ongoing support is available? Difficulties such as those that I have described cannot be cured in eight weeks. Those problems must be solved, and I hope that the Minister of Health, Social Services and Public Safety will help to solve them and improve the defects in the system. We must improve our young people’s lives. Mr Deputy Speaker: Order. Members will know that the Business Committee has arranged to meet immediately upon the lunchtime suspension. I propose therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The sitting was suspended at 12.57 pm. On resuming (Mr Deputy Speaker [Mr Dallat] in the Chair) — 2.00 pm Mr Deputy Speaker: The sitting is resumed. We shall continue the debate on the provision of speech and language therapy. The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I thank Mr Ramsey for bringing this important issue to the House. I am aware that he has raised it with the Department on several occasions with regard to his constituency of Foyle. I acknowledge the problems that there have been with the provision of speech and language therapy, particularly with regard to the excessive and unacceptable waiting times for assessment and treatment. I assure the House that I am focused on the issue, and improvements will be seen in the near future. I want to outline some of the initiatives that the Department is considering. I recognise that the ability to communicate gives children and young people the capacity to participate fully in society. Without the correct assistance, children who have communication difficulties are likely to experience significant long-term educational, economic, social and health ill-effects. That is why I am keen to ensure that everyone who needs speech and language therapy has access to the appropriate services. My Department has been working in close partnership with the Department of Education to ensure that children and young people receive the therapy that meets their needs and, consequently, improves their life chances. That type of co-ordinated partnership between Government and agencies is recognised by all who are involved in speech and language therapy provision as the most effective way forward for the planning, commissioning and delivery of services. An increasing number of children and young people who have speech, language and communication difficulties are seeking help from the health and social services and early education organisations in Northern Ireland. Many of those children also have complex needs and medical conditions that are associated with those needs. Recent national research shows that approximately 10% of school-age children have communication problems and up to 90% of children who have learning disabilities have speech and communication difficulties. The fundamental service review of special education, which reported in March 2003, showed that the number of schoolchildren who have special educational needs increased by 70% between 1991 and 2001. Those statistics show that pressure on speech and language therapy services throughout Northern Ireland has increased. My Department is working towards tackling that need. The former Northern Ireland Commissioner for Children and Young People recommended the establishment of a regional speech and language therapy task force, and that was established in September 2006. The commissioner produced two reports, one in 2004-05 and the other in 2005-06. The reports identified gaps in service provision and highlighted inequity in waiting times for assessment and resultant therapy across Northern Ireland. The task force comprises service users and a wide spectrum of people who are responsible for the policy and delivery of speech and language therapy. Its role is to review the provision of speech and language therapy in Northern Ireland. Working groups have been set up to investigate the key issues that were raised in both the commissioner’s reports. The task force will produce an action plan and will report its findings in December 2007 after a period of consultation. Part of the reason for the delay in the task force’s work is the death of its chairperson, Dr Pamela Hannigan, on 2 March 2007. The task force usually meets every month, but has not done so for the past three months. I expect that a new chairperson will take up position in June. Pamela Hannigan was the driving force behind the task force. The task force, and indeed the sector, has clearly lost a very important champion. It was anticipated that the task force would report in June, but it will now report to me in December, though subgroups have continued, and will continue, to meet. The task force will report after consultation with me in December 2007. It will focus on reducing waiting lists across Northern Ireland. In response to the NICCY reports, all health and social care trusts have agreed new access targets from 25 May 2007, including targets for speech and language therapy. The new targets will comprise maximum waiting times for access to services, assessment and treatment of 26 weeks by March 2008, falling to 13 weeks by March 2009. The trusts have already started work on implementation plans to meet the targets, which are a requirement of the trusts in an effort to address assessment and waiting times. As well as the task force and the new waiting-list targets, I confirm that significant additional funding has been provided for speech and language therapy. Research demonstrates that early identification and intervention are essential to support the optimum physical, cognitive and social development of children with speech, language and communication difficulties. Early access to speech and language therapy for children in education can significantly improve academic ability and employability in later life. In recognition of the importance of such early intervention, the children and young people’s funding package, announced in March 2006, amounted to £4 million to set up nine early-intervention multidisciplinary teams to work in extended school and other early years settings. Those teams are being recruited in the five health and social care trusts, and they will include speech and language therapists who will help to provide early assessments and interventions. A working group has also been established, comprising members from the trusts, my Department and the Department of Education, to ensure that the teams are effective and make the most of available resources. I also confirm that an additional £1 million has been made available for speech and language therapy through the children and young people’s funding package, which will come on line in mid-2007: and, to address Mr Ramsey’s point, that money will not just be for children in special needs schools. The additional resources will be used to drive down further the length of time that children and young people have to wait for assessment and therapy. Recognising the need for additional speech and language therapists to meet increasing demand, my Department has provided funding for the training of additional therapists in the University of Ulster. The cost of training a speech and language therapy student for three years is in the region of £30,000. The Department normally commissions 30 places for training, but from 2001 funding was provided for an additional 10 student places, and that was increased in 2003 to an additional 15 places. There are currently 110 students in place. Those initiatives are being implemented by the Department to try to address the problems that we all understand and accept exist. Mr Ramsey referred to examples of good working practice. The Western Health and Social Care Trust area, which includes the former Sperrin Lakeland Trust, introduced a care aims model in October 2005. That was a radical redesign of the service, which enabled assessment and treatment to take place at the same time, and it has reduced waiting times for treatment in the area from what could have been up to 17 months to zero. Currently there are no waiting lists for treatment in that area. It is anticipated that that good practice will be replicated in the Foyle area where similar results are hoped for. The Department wants to try to address the unacceptable waiting lists in Mr Ramsey’s area. The introduction of speech and language therapy assistants in many trust areas is another example of good practice. The assistants free the therapists from routine tasks, enabling them to devote more time to assessments and interventions. Following an assessment by a speech and language therapist, assistants can often deliver programmes to children with special needs in both special and mainstream schools. The introduction of that mix of skills has had a significant impact on service delivery. Speech and language therapists provide advice to teachers and classroom assistants on measures that they can take to incorporate therapy into lessons. The two ongoing pilot projects being run by Sure Start in the Down and Lisburn area of the new Eastern Health and Social Care Trust demonstrate the benefits of that. The projects involve teachers and classroom assistants providing basic therapy while trained therapists provide support, but are free to concentrate on children with more complex needs. Owing to the success of those projects to date, the trust is considering introducing similar schemes in all its nursery schools. I recognise the success of other initiatives in helping to improve the provision of speech and language therapy in Northern Ireland. The success has been achieved through working in partnership, the importance of which cannot be underestimated in helping to deliver integrated and planned services at an operational level. Other examples of good practice in Northern Ireland demonstrate effective and co-ordinated planning approaches. Those include the language and learning project in the Northern Health and Social Care Trust area and the wraparound scheme operated by the Southern Health and Social Services Board. Those projects identified significantly improved social, health and educational outcomes for children when services are provided through a high-quality multi-agency approach. The task force also investigated evidence of good practice in other areas of the UK, such as Scotland and Wales, which it will use to inform its thinking when producing its report. It will examine ways of mainstreaming good practice to include the delivery of speech and language therapy services in Northern Ireland. The Department of Health, Social Services and Public Safety and the Department of Education will jointly consider the task force’s recommendations to determine the way forward for the provision of speech and language therapy. My Department will continue to work in close partnership with other Departments, the statutory sector and the voluntary and community sector to ensure that the most appropriate speech and language therapy services are available to all who require access to them across Northern Ireland. I am committed to improving service provision, and I look forward to reading the recommendations of the task force in December 2007. I intend to demonstrate that I am not satisfied with past or current service provision and to ensure future equality of access throughout Northern Ireland. In consultation with others, I will give the matter the focus required to ensure a satisfactory outcome for those requiring speech and language therapy services. Mr D Bradley: Go raibh maith agat, a LeasCheann Comhairle. Tá áthas orm achoimriú a dhéanamh ar an mhéid a dúradh sa díospóireacht go dtí seo. I am pleased to make the winding-up speech on today’s debate. As Members have said, language is vital to all aspects of development throughout life. Therefore, the provision of proper speech and language services is vital. Members’ contributions to the debate reflect their concern to ensure that such services are available to all those who need them, without undue delay. My colleague Mr Ramsey highlighted the situation in the Western Health Board area. He said that: “over half the children who required assessment or speech therapy in the Western Health and Social Services Board area could not access those services.” 2.15 pm He also mentioned, as did other Members, the findings of the NICCY report, which concluded that there is a postcode lottery. In other words, the area in which a person lives has a huge bearing on the expected wait for assessment and treatment — something that was also mentioned by Mrs O’Neill, Rev Robert Coulter, Mr Lunn, Mr McKay, Mr Beggs and Mr Simpson. The postcode lottery is a major theme that has emerged from the debate and one that, I am sure, the Minister will heed. He has outlined some of the measures that he is undertaking to alleviate the situation. Mr Ramsey also mentioned one of the core problems in proper service provision — the difficulty in recruiting and retaining staff. He underlined the need to get the resources to where they are needed — that is, on the front line. Mrs Robinson, and other Members, mentioned the fact that trained speech and language therapists find it more rewarding to work in other jurisdictions because the remuneration for their expertise and work is greater. That is something that the Minister will have to take on board as well. Mr Easton stated that current resources do not meet demand. He referred to the frustration shared by children who are waiting on services and the therapists who are waiting to provide those services. Members have heard that 2,000 children are awaiting assessment, according to the NICCY report. Mrs O’Neill mentioned the shortfalls across Northern Ireland with waiting times of up to three years. She suggested a straightforward injection of cash and added that the debate should send out a clear message that proper resources for children and young people services should be made available. Rev Robert Coulter mentioned a figure of 57,000 preschool children with speech and language needs. That is an alarming statistic. He mentioned that 5,500 of those young people continue to have communication difficulties throughout their lives and talked about the impact that those difficulties have on their lives — about the social exclusion. He asked how much more it would cost not to act to remedy the situation. He called for research into the causes of the problem and the most effective ways of dealing with it. He also mentioned the necessity to evaluate the impact of any action that is taken. Rev Robert Coulter underlined the need for early intervention, referring to its benefits and the difficulties caused by late intervention. He also referred to the uneven level of care throughout Northern Ireland, and once again the postcode lottery was mentioned. Mrs Robinson highlighted the fact that there are now more speech and language therapists in Northern Ireland than there were previously, and the Minister outlined some of the steps that have been taken to ensure that that is the case. However, there remain 20 vacancies to be filled. That points to the need to make the work of speech and language therapists, and the reward for it, more attractive than it is at present. We need more therapists, and we need to retain them in the service. Several Members referred to the difficulties that they have had in the past, and more recently, in obtaining information and statistics about waiting lists and the service in general. The NICCY report called for information to be co-ordinated in a more useful way so that it is easily available to those who require it. David Simpson referred to that issue, on which I hope the Minister will take action. It is important that the information that is required from Government Departments by public representatives and experts in the field is readily available. Daithí McKay underlined the unevenness of provision across Northern Ireland, referring to the effect that a lack of intervention can have on children’s development, on their employment prospects, and on their educational development. The ability to communicate is important; it affects every aspect of a person’s life. Therefore, I emphasise, once more, the need for early intervention. I am grateful to the Minister for attending the debate and for listening carefully to the points that were raised by Members. He outlined in some detail the action that is being taken by his Department to remedy the situation. I am aware that the Minister has been in the Chamber for quite a number of debates — he is possibly close to holding the record for debates attended by a Minister — and we appreciate his presence. He has acknowledged the difficulties in the system at the moment with waiting times, which he said were unacceptable, and he informed the House that his Department is focused on alleviating that situation. The Minister acknowledged that help with communication and speech difficulties offers children the capacity to participate fully in their education, and he said that he will take action to ensure access to appropriate services. He cited some examples of good practice. I wish to add to those examples by praising the work that is being done by the education and library boards. Speech therapists work with primary 1 teachers in the classroom to deal with speech and communication problems on the spot. That is an excellent example of early intervention, and it also helps to build the capacity of the primary 1 teacher to recognise and identify difficulties, and to intervene and deal with them. The Minister outlined quite a few measures that are being taken by his Department, and I am sure that all Members will join me in welcoming those. However, we also look forward to the task force beginning its work again, following some difficult circumstances, which we all acknowledge. We look forward to the task force reporting to the Minister and contributing to the dissemination of good practice. Mr Deputy Speaker: Please bring your remarks to a close. Mr D Bradley: Thank you, Mr Deputy Speaker. Question put and agreed to. Resolved: That this Assembly notes the inequalities in the provision of speech and language therapy throughout Northern Ireland, and calls on the Executive to provide adequate and equitable resources and financial support. (Mr Deputy Speaker [Mr McClarty] in the Chair) Mr Deputy Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes for the winding-up speech. All other Members will have five minutes. Mrs M Bradley: I beg to move That this Assembly calls upon the Office of the First Minister and Deputy First Minister to prioritise, as a matter of urgency, the appointment of a Commissioner for Older People, as previously supported by the Transitional Assembly. I await the wrath of the Minister of Finance and Personnel for proposing the motion. However, our older people’s welfare is worth more than a few columns in local newspapers, so I make no apology. I remind the Minister that his party tabled the same motion in the Transitional Assembly less than six months ago, and I want to see it expedited today. That motion received cross-party support, so I hope for no less now. Why does Northern Ireland need a commissioner for older people? It needs one because our population is ageing, with older people fast becoming the largest population sector in Northern Ireland. The 2001 census recorded that 296,000 people of pensionable age were living in Northern Ireland. That amounted to 16% of the population. As that census was taken six years ago, those figures will have increased. Furthermore, by 2017, it is projected that 22% of the population will be aged 60 and over, a figure that is expected to increase to 30% by 2036. In my constituency of Foyle, more than 13% are pensioners. The majority of those people face daily problems without having a champion to turn to who could insist on legislative changes, or even ensure that current legislation is being adhered to properly. A commissioner could act independently, while working with the relevant authorities. There would be none of the conflict of interest that could arise if a civil or public servant were charged with the responsibility. We should not forget the Trojan work that agencies such as Help the Aged and Age Concern, to mention but two, have done to champion the rights of older people. Their work has been invaluable, but because such agencies lack legislative authority, they are restricted in what they can do. What has the Department been doing to help older people in Northern Ireland? The publication in 2005 of a strategy titled ‘Ageing in an Inclusive Society: Promoting the Social Inclusion of Older People’ has yet to make any significant impact. To my knowledge, we are still waiting on a community safety strategy for older people, yet our counterparts in Wales — to be followed by Scotland — have appointed a Commissioner for Older People. The Secretary of State, Peter Hain, was instrumental in delivering that post for Wales. However, I presume that he was too busy appeasing political agendas to be bothered with ensuring a decent human-rights provision for the older people of Northern Ireland. Pensioner poverty is increasing, although the state pension is not. Fuel poverty, and its effects on older people, cannot be ignored. Of the homes that suffer from fuel poverty, 44% are occupied by those of retirement age and above. I am particularly pleased that the Minister for Social Development has deemed the issue of fuel poverty to be one of her key priorities. Deaths of older people are obviously more common in the colder months: in 2004-05, 1,280 deaths were cold-related, with the vast majority of those older people. The numbers increase each year, mainly due to the effects of fuel poverty. Problems of isolation and a lack of community care are other factors. Unfortunately, the number of deaths will continue to rise until a Department with legislative powers to make genuine changes comes into being. Of the £7·5 million of additional resources to tackle fuel poverty in the Chancellor of the Exchequer’s pre-Budget statement, a meagre £1·2 million is for the devolved regions. That is something that a commissioner for older people, acting in conjunction with the Minister of Health, Social Services and Public Safety, could investigate and use to bring pressure to bear on the Assembly. 2.30 pm Members may do all that we can — we can debate all sorts of issues pertaining to older people — but we still leave the Chamber having had little effect on the issues that affect their lives. A commissioner would have the teeth to bring forward the desired effect. The steady progress of the children’s commissioner since the initial appointment in 2003 is proof of that for all to see. Children make up 30% of the population; that was deemed high enough to justify the appointment of a commissioner. The percentage of older people is fast approaching that figure. Members must get their act together and provide that section of the community with the funding necessary to appoint a champion with the legislative powers to see that those people are not only heard but, more importantly, valued. In less than 20 years, demographic changes will dictate that policies and programmes will have to reflect the needs of an ever-ageing society. Just because people get older does not mean that they become part of a throwaway society in which they are the commodity that is dumped. Humans are non-recyclable; we each have one chance at life. In the early years, the majority of us can depend on parents and family to take care of us. However, in later years, older people are pushed aside, pushed about, abused and tortured by those who are charged with the responsibility of looking after them. A commissioner could help to eradicate that type of activity. Elder abuse is an unpublicised crime, and it could be made less frequent with the proper legislation. If older people had an appropriate person or Department to confide in, things would eventually change. Discrimination is frequently highlighted in all aspects of daily life. However, there is much less outrage about ageism, which is considered less of a priority among employers. Free travel is an example of how females of pension age are denied their rights. Although in receipt of a state pension, they must wait until age 65 to avail of the concessionary travel scheme. That restricts the activities of females who are in good enough health and want to avail of the scheme to travel widely. Yet, they must stand by, demoralised and disenfranchised by a Government policy that makes no sense. Wales has got it right. The Welsh Assembly has listened, considered and delivered. Its strategy reflects the United Nations Principles for Older Persons, which promote positive images of ageing and give older members of society a true voice. The role of the Commissioner for Older People in Wales is not simply that of a caretaker, but rather of an active agent with the power to establish and review policy and to empower those who feel vulnerable or lack the confidence to stand up for themselves. That Members are concentrating on older people and the associated challenges does not mean that we are dismissive of the issues and difficulties that affect other sections of society. However, if Members can get it right for one part of society, then the entire society will benefit. Older people are more likely to vote, and it is likely that a substantial percentage of each Member’s votes come from them. Clearly, older people want their voices to be heard and expect some action based on what they say. Existing Government policies are neither sufficient nor effective. The same statements and strategies are referred to in news reports, but that must change. Members know the drill by now. We were put here to make changes — to make life better for all sections of all the communities in Northern Ireland. I urge Members to give the motion their full support. In the words of one of Derry’s famous sons: “Things can only get better.” Older people have rights too. Mr Easton: We are all familiar with the concept of commissioners — persons who are appointed at various levels to oversee aspects of governmental administration — in global and European contexts, and in the various parts of the United Kingdom. Those commissioners deal with areas as diverse as international human rights, refugees, facets of European policy, racial equality, the protection of children, sustainable government and data protection. The Northern Ireland Human Rights Commission ensures that citizens receive equal, full and firm protection in law. The Commissioner for Complaints in the office of the Northern Ireland Ombudsman is charged, as part of his brief, with investigating injustices that are due to maladministration in government. The Independent Monitoring Commission is charged with helping to promote the establishment of stable and inclusive government in a peaceful Northern Ireland. It reports on paramilitary activity, the so-called normalisation process and complaints made by one party against another party or parties in the Executive level of Government. The appointments in Northern Ireland of a Commissioner for Children and Young People and of an Interim Commissioner for Victims and Survivors have been warmly welcomed, and the sterling work that they have done to date is widely acknowledged. However, there have been times when people may have felt that appointed commissioners have failed to operate fairly and effectively in the way that they approached their work or dealt with a particular matter. The Patten Commission on policing would, for most unionists, be at the top of that list. There are times when we might feel that we are overburdened with commissions and commissioners but, by and large, the outcome of their work has been to the benefit of the majority of the community. Health and personal care for the elderly has already been the focus of Members’ attention today, and I welcome the action that has been proposed in those areas. However, there will always be specific areas of community life where we cannot depend entirely on the bureaucratic structure to operate with sensitivity to the needs of people in an efficient and effective way. In such cases, there are great advantages in appointing a person who is charged with the responsibility for the oversight of a specific area of public life to ensure the maximum benefits for a particular section of the community. For that reason, I commend to the Assembly the appointment of a commissioner with responsibility for the elderly — if that is the politically correct term for those who need special attention just as urgently as other groups in our community. There was a time when life expectancy was much shorter, and when those who lived their allotted threescore years and 10 were fewer in number. Those who lived another decade were considered to have been specially blessed. Many people today regard getting older as getting better and, in that context, our First Minister is an inspiration to us all. For many people like him, turning 60, 70 or 80 is just another milestone along the road in a busy and healthy life. However, we are all aware that a considerable proportion of older people do not enjoy good health, or live in suitable accommodation or have sufficient income or resources to meet the needs of daily living. They may also lack the ability or understanding to access the benefits system. There are many older folk who lack independence and who have problems with loneliness and isolation, and with employment and pension issues. Some have no access to, or ability to cope with, the technology that benefits many in our society today. They have problems with mobility, tax and inheritance matters, and many other issues. That mature section of our community is made up of people who have, through thick and thin, held this Province together over the past 40 years of the Troubles. Their lives were blighted by terrorism and instability, yet, they often do not arrive in the safe harbour that they might reasonably expect to find. Instead, they find themselves in a stormy and often unfamiliar world that is difficult for them to understand. We owe older people a great debt of gratitude. They have paid their dues to our society and to this Province. They deserve our special attention. I support the proposal to appoint a special commissioner to protect the rights and interests of elderly people. Mr Brady: Go raibh maith agat, a LeasCheann Comhairle. I welcome the motion. Over the period 1996 to 2036, it is estimated that the percentage of the population here aged 65 or over will almost double from 13% to 24%. Some 41% of older people here feel that they are treated differently from people in the general population because of their age. Of those people, 76% feel that they are treated worse than the general population because of their age. Research by the Human Rights Commission in 2001 found that it is difficult to provide evidence that discrimination on the grounds of age happens on a systematic basis, but that fear exists among older people. According to the commission, the extent of discrimination tends to be hidden because of an absence of research, especially in relation to the healthcare system. Practical consideration must be given to planning for the future needs of a growing older population. Older people are increasingly marginalized or treated as less than equal citizens. They are on the move through organisations such as Age Concern and Help the Aged. Campaigns by these organisations and others have moved the issues affecting older people from the periphery to the centre of the political debate. They have recognised that negative attitudes to ageing across the island have prevented the development of the policies and structures needed to address poverty, ill health and isolation. Surely it is an indictment of Government policy that approximately 200 older people die each year from cold-related illness. Thousands more suffer from the indifference of a cold society. Older people must be brought in from the cold, both figuratively and literally. We must support and actively pursue the political and legislative changes necessary to establish a decent standard of living, full access to services and the rights of older people to participate fully in the lives of their communities. We must have a fundamental review of the standard of living of older people, including pension provision and fuel poverty. Creating the conditions for an equal society means recognising that many diverse groups need enhanced protection. It should be recognised that older people have made a lifetime contribution to society. Unfortunately, the standard of living of many of our older people does not meet their needs or reflect the contribution that they made. It is vital that mechanisms are developed to value properly and recognise the contribution of older people to society. We must support older people in realising their vital role in our communities, and we must stop paying lip service to the rights of older people and appoint the commissioner as a matter of urgency. Go raibh maith agat. Mr Kennedy: I join others in congratulating Mrs Bradley, the Member for Foyle, for ensuring that the issue of appointing a commissioner for older people is kept high on the Assembly’s agenda. Members will be acutely aware of the need for action to improve the way in which society treats older people. Many older people know the benefit of good health and good support from their families; they have the capacity to avail of local services and enjoy a fulfilled old age; and they continue to make a major contribution to their community. Unfortunately, this is not so for too many older people. We have all come across appalling examples of crimes against the elderly and incidents of neglect and abuse in our constituencies. Behind the high-profile examples are tens of thousands of older people who are afflicted by poor health, poverty and isolation. We live in an ageing society. By 2013, almost a quarter of the population will be of pensionable age. With this in mind, and the fact that many of us will soon fall into the category of older people — I am not looking at anyone in particular — surely now is the time for a new approach to older people’s issues. We can already see what the new approach might look like. Organisations such as Help the Aged and Age Concern have done much to draw our attention to the good practice that exists across the whole range of issues of importance to older people. There are many good inter-generational projects in schools and communities, which help to inform young people about the contribution of older people to society and which seek to counter the potential for older people to become isolated. 2.45 pm There are excellent examples of action to improve the health and well-being of older people by encouraging them to continue to be physically active and providing insulation to help them reduce fuel costs. While there are many examples of such good practice, there are still major gaps in our approach to supporting older people, and we need a new approach. The Office of the First Minister and the Deputy First Minister — and I am pleased to see both Ministers in the Chamber — has produced an older people’s strategy ‘Ageing in an Inclusive Society’. The Committee of the Centre, which has not yet been renamed, and of which I have the honour to be Chairman, has not yet had the opportunity to consider that strategy. I do not presume to know the views of my Committee colleagues on the issue. My impressions of the strategy are that it articulates successfully many of the issues that need to be addressed if we are to achieve a better quality of life for older people and to ensure dignity and respect for the most vulnerable older people. The progress made to outlaw age discrimination in employment since the launch of the strategy is particularly welcome. However, the strategy noticeably stops short of recommending the establishment of a commissioner for older people. My view, and that of the Ulster Unionist Party, is that such a commissioner should be established as soon as possible. That would enable the cause of older people in health and education to be championed. We are in an age of lifelong learning, and there are recreational interests, libraries and sporting facilities to be considered. Our counterparts in the National Assembly for Wales and the Scottish Parliament are already making progress. The key functions of a commissioner would be to promote awareness and understanding of the rights and interests of older people; to review the current policies and laws in so far as they affect older people; and to help promote best practice in the services being provided. There is no need to create a bureaucratic empire or a new Department costing a fortune. The Office of the First Minister and the Deputy First Minister is perfectly capable of managing the detail. The First Minister is in a unique position to judge the value of such an appointment. I support the motion. Mr McCarthy: “If this Assembly is to be of any use to the people of Northern Ireland, it must provide a fair deal to our senior citizens.” Where have we heard that sentence before? Our senior citizens are proud and independent people. They have served their country well and must be protected during their retirement. During the previous Northern Ireland Assembly, I had the pleasure of chairing a cross-party group working on the concerns and problems of senior citizens. It was called the age sector reference group, and it brought senior citizens from all corners of Northern Ireland to Parliament Buildings on a regular basis to discuss their needs and ways of overcoming their problems. I take the opportunity of thanking those dedicated people: they are still campaigning, and it is obvious that they have not yet solved all their problems. I hope that when the Assembly is fully working and operational, a similar group will carry on where they left off. However, the group is not happy about the dithering in the Assembly last week — by the DUP in particular — on free personal care. It annoys me enormously when I hear of senior citizens being denied millions of pounds in benefits, to which they are entitled, through no fault of their own. They go without just because the system is cumbersome, and they are put off by having to fill in forms. A method must be devised, through social security, where all senior citizens are made aware of their entitlements and, if necessary, given help to receive all that is due to them. Like Members who spoke previously, I pay tribute to the efforts of Age Concern, Help the Aged, Advice Northern Ireland, citizens advice bureaux throughout Northern Ireland and groups of all sorts for assisting elderly people. Society must never accept that an elderly person must choose between eating and heating. The age sector reference group fought age discrimination and won. Our slogan, “Never on the scrap heap” at 60 for women and 65 for men is now, I am glad to say, history. I am glad to say that people now have the choice of working for as long as they see fit. Senior citizens have been the targets of robbers, muggers and gangsters. Everyone has a duty to support the police in catching the culprits, who ought to be dealt with severely. There are many ways in which to help senior citizens. When we have a commissioner or overseer who is solely responsible for senior citizens’ welfare, this country will be able to say that it looks after the elderly well. Many issues that affect the elderly justify the appointment of a full-time commissioner. Last year, the Transitional Assembly discussed proposals to appoint a commissioner for older people. I hope that the DUP will not treat this important subject as a political football again, in the same way that it has treated free personal care for the elderly. In February 2001, in the House, support for free personal care — Lord Morrow: On a point of order, Mr Deputy Speaker. Is it in order for a Member to continually misrepresent others and to say things that are not factual or truthful? I ask the Member to be more explicit and detailed. It is all very well for him to say that the DUP has hindered and obstructed this proposal, but it has done no such thing. My party has been to the fore in challenging the issues that the Member is addressing, and I ask him to recognise that. Mr Deputy Speaker: I am afraid that that is all part of the cut and thrust of Assembly debate, Lord Morrow. Unless the Member is actually telling a lie, there is nothing that the Chair can do about it. Mr McCarthy: If the cap fits, wear it — that is what I say. I ask Members to recall February 2001, when everyone in the Chamber supported free personal care. When Members had no power to implement that provision, they supported it. In June 2002, however, when they had the power, they reneged on that support. In June 2007, they are still dithering on free personal care. Let us open that up to the public. The debate has gone beyond the need to create the post of commissioner for older people. We must implement that without delay and have no more dithering. My colleague mentioned the duplication of services. When the Alliance Party advocates the appointment of a commissioner for older people, we mean just that: a commissioner who will work alongside the already existing excellent voluntary bodies. Mr Deputy Speaker: I ask the Member to bring his remarks to a close. Mr McCarthy: I support the motion and look forward to its early implementation. Mr Ross: I support the motion. My party has long supported the call for the appointment of a commissioner for older people. Indeed, it was one of the pledges in our last manifesto. I therefore congratulate the Member on tabling the motion. The DUP can be proud of its record on delivering for senior citizens. In the previous Assembly, the DUP pioneered the warm homes scheme and our Minister delivered free transport for the over-65s, enabling senior citizens to travel around the country and get on with their everyday lives. The population is ageing, and people are living longer than ever before. It is therefore a huge challenge to provide healthcare and benefits and to ensure that older people can continue to live full and active lives. I am following with interest the new pop sensation The Zimmers, which claims to be the oldest band in the world and which seems to be heading for a high position in the UK charts with its cover of The Who’s classic ‘My Generation’. In its own unique way, it is highlighting many of the issues that the older generation faces. The band originated in a BBC ‘Power to the People’ documentary by Tim Samuels, who travelled around Britain investigating the feelings of isolation and imprisonment that the elderly suffer. For many older people, life can be a real struggle. Many face poverty and hardship. No pensioner in Northern Ireland today should have to choose between food, home heating and the clothes on their back. Many older people are fearful of leaving their homes. Almost daily, we hear of another attack on or robbery of a pensioner. Those found guilty of such attacks should face the stiffest of sentences for their sickening crimes. Rising global fuel prices and the knock-on effect of that on fuel costs in Northern Ireland are also a real concern for the elderly. Rises in the cost of home-heating oil, gas and petrol hit the most vulnerable sections of our community the hardest. The warm homes scheme is a key instrument for tackling fuel poverty, and it is concerning that my constituency of East Antrim is among the worst areas for take-up of that scheme. Another, often hidden, problem in society is that of elder abuse. That abuse can take many forms and happens when an elderly man or woman is intentionally or unintentionally harmed, mistreated or neglected by someone whom he or she should be able to trust. That abuse can be physical, financial, sexual, verbal or emotional, or comprise acts of neglect. It is important that those who are abused can speak up and seek help from a trusted friend, relative or healthcare professional. We have already heard of the excellent work carried out by Help the Aged, Age Concern, Action on Elder Abuse, social services, hospitals and the police. Health issues are of crucial importance. Dementia affects many relatives of people who are in the Chamber. It is estimated that 11% of people aged over 65 will have dementia by 2015, and it is imperative that we tackle that problem and ensure that the needs of those who suffer from dementia are promoted. Creating more residential and nursing home places, ensuring that elderly patients are afforded the appropriate environment in which to receive care, and improving respite provision are of paramount importance. We should also recognise the enormous contribution of carers in our society. Some 6 million people throughout the UK, including many in East Antrim and the rest of Northern Ireland, provide unpaid help and support to relatives, friends or partners who could not otherwise manage because of frailties, illness or disability. Many of those carers are unknown to statutory agencies and other organisations that could provide support and services. It is important that the work of carers is recognised, and support is given to them to live a full life themselves, by providing them with the help that they need. It is important that older people are able to continue to be active participants in society without being excluded in any way. That is why we on the DUP Benches believe that a commissioner for the elderly can act as a champion for the cause of older people and ensure that issues affecting them are kept high on the list of priorities for the Executive. There are so many areas on which a commissioner could represent the interests of our elderly population. I support the motion. Mr F McCann: Go raibh maith agat, a LeasCheann Comhairle. Once again, Members are debating a motion concerning people in our society who suffer from wide-ranging forms of discrimination due to their age. How many times have we said that, if we had the power, we would work to ensure a strong voice for older people? How many debates or discussions have we had during which we told one another, or those representing the older generation, that, if only we had the power, the situation would be different? That time is now, folks. I commend the Members who proposed the motion. Unlike last week’s motion on free personal care, which Sinn Féin supported, the proposed measures would not cost £20 million or £30 million to implement. All Members should put our hands in the air in support of the rights of older people, and, by our actions, set ourselves on a course to begin that process. We have an opportunity to take that step today, and to send out a message that every party in the House stands for better protection for those to whom we owe our very existence: those who nurtured us and took care of our ills; who provided for us in our growing years; those whom we love, but also, if we are honest, those whom we have ignored or are less tolerant with, because they do not respond as quickly as we would expect; and those who are overlooked when they seek a job. How many times have we witnessed older people being ignored or abused by those who should have known better, and said nothing? How many times have we, in our own communities, spent time with older people who, unfortunately, fell prey to the beaters and intimidators who robbed, wrecked and abused them, and who, because of their age, were unable to defend themselves? [Interruption.] Obviously, someone from the DUP finds this funny. How many times have we responded to attacks on older people, only for the matter to be moved off our radars until the next attack happens? Older people are not asking for something outrageous or that is beyond our power. They are not asking for something that we would not demand for ourselves. They are asking for equality and they are seeking respect. They are asking us to show leadership and to initiate a series of measures that can proactively tackle the many problems that face older people. Let us agree that that cause would be better served by establishing a commissioner for older people, and let us look towards stronger legislation to tackle the many inequalities faced by older people. Let us also examine the establishment of an all-party working group, the terms of which would be time bound, to produce recommendations for dealing with those problems. Let us examine the various organisations that are under our jurisdiction to see whether they can stand the test of age proofing. We should all remember that, in a few short years, we will reap the benefits of what we sow in the House today. Go raibh maith agat. 3.00 pm Mr Deputy Speaker: Once again, I remind Members that the use of mobile phones in the Chamber is prohibited. I suggest that the standard of debate this afternoon does not require Members to set their mobile phones for an alarm call. Mr McCausland: The welfare and well-being of older people is an important issue for any civilised and compassionate society. I am pleased, therefore, that the motion has been tabled; it is a good motion, and it has been a good debate. I believe that the motion will have all-party support. Therefore, it was disappointing that Mr McCarthy sought to introduce such a sour and divisive note into the discussion. Mr Kennedy: He should apologise to Mr McCausland. Mr McCausland: I can assure Mr Kennedy that I am not that sensitive. However, I do have an interest in people being accurate and truthful. I refer to the example of the Commissioner for Children and Young People. That appointment has amply demonstrated the value that a commissioner can have in addressing the particular needs, concerns and rights of people in a sector of our society. That has been a very successful commission and office. The same benefits should be accrued by older folk who would benefit from a commissioner for older people. Having seen the benefits to younger people of such an appointment for younger people, and drawing the conclusion that a commissioner would be of equal benefit to older citizens, we must see this as an equality issue. We live in a society in which there is much talk about equality and the equality agenda. The rights of older people to fair and equal treatment are already embedded in that equality agenda. It is also a human rights issue, and the proposer mentioned the UN principles for older people. We must recognise the tremendous work that is done across Northern Ireland in each of our constituencies by local, province-wide and UK-national organisations that represent the interests of senior citizens. In my constituency, the north Belfast senior citizens’ forum does tremendous work: it provides a network for senior citizens and gives them opportunities and access that many of them would not otherwise have. I am pleased to say that there is also now a west Belfast senior citizens’ forum. Not long ago, over a period of months, and with the support of Belfast City Council’s good relations fund, the link centre in North Belfast sponsored a major consultation with senior citizens groups across the constituency and that culminated in a impressive event in the Great Hall in the City Hall. The views of the people who were consulted and the views of politicians were brought together and a report was presented. It was impressive to see the wide range of senior citizens’ groups that were represented that day and how articulate and forthright many of them were in presenting their views. Research by such groups, as well as by Age Concern, Help the Aged and those who represent the interests of carers, has helped to identify many issues that must be addressed. Some of the issues are: social care, health care, transport, income, opportunities for education and employment, and the pertinent issue of the safety and security of senior citizens, not only in their homes, but in the streets. Many older people have much to contribute to society, through the family network and in other ways. As we seek to enhance their rights and increase their opportunities, we benefit not only the senior citizens, but society as a whole. In that process, there is a valuable and important role for a commissioner for older people. I, therefore, support the motion. Rev Dr Robert Coulter: I congratulate Mrs Bradley, a Member from the Foyle constituency, for bringing this motion to the House. However, I must say that the motion has raised some problems for me. For example, do I need to declare an interest? Some Members: Hear, hear. Rev Dr Robert Coulter: On the other hand, should the First Minister or I decide to apply for the post, does our presence today bar us from making that application? Perhaps a man of your perspicacity could give us your wisdom on that, Mr Deputy Speaker. Mr Kennedy: Definitely, yes. [Laughter.] Mr McNarry: That is a challenge. Rev Dr Robert Coulter: In considering the motion, I tried to quantify the impact of the issue. Some of the figures that my research yielded are slightly different to those that have already been given. The figures that I found show that Northern Ireland has 275,000 people of pensionable age, which is 16% of the total population. That figure is set to rise to 24% of the population by 2013, only six years from now. In assimilating that figure, the conclusion is that one in four or a quarter of the population is aged over 60. That would suggest that we need a specially appointed commissioner to look after their interests. The office of the Northern Ireland Commissioner for Children and Young People was created to look after the interests of children. In fact, a former Member of this House, Patricia Lewsley, now fills that position — very ably, I might add. The 2001 census told us that, at that time, there were 298,054 children in Northern Ireland under the age of 16. That is 17·68% of the total population. That figure is remarkably close to the 275,000 people of pensionable age, and it is lower than the 2013 figure for people of pensionable age. I would contend, therefore, that if Northern Ireland has a Children’s Commissioner for 17·68% of the population, it could surely have an older people’s commissioner for 16% of the population. Setting aside the numeric argument, which is incontestable, are there any special circumstances pertaining to older people that merit the special protection that a commissioner for older people might afford them? My conclusion is that there most certainly are. Nearly one in three people of pensionable age lives alone, and half of all people of pensionable age identify loneliness as a major problem. One in every five of older people in Northern Ireland lives in poverty, and half of fuel-poor householders here are aged over 60. However, the number of older persons in receipt of home help has decreased by 11% from 1998. It is believed that, at any one time, 5% of older people are at risk of abuse, and one quarter of those who abuse them are their sons and daughters. Two thirds of people over the age of 65 think that older workers are discriminated against in job recruitment, a feeling, I might add, that in many cases is born from bitter experience. Ageism, in all its forms, is deeply contemptible. Therefore, the House should support the motion. Often, ageism is nothing more than the naked ambition and self-interest of younger people who want to sweep older people away as if they are of no account and have nothing to offer. To them, youth is nothing more than a mantra to paper over their own self-interest. They are so self-centred and narrow-minded that they disregard the wealth of experience that older people can offer. There is much more that I could say, but I am reminded, especially, of a young doctor of my acquaintance who was working in one of the most exclusive and affluent areas of one of our great cities. She called to see an old lady, who had — Mr Deputy Speaker: I ask you to draw your remarks to a close. Rev Dr Robert Coulter: I support the motion. Mr McNarry: That was quite an interesting story. [Laughter.] A Member: What happened next? Rev Dr Robert Coulter: I will tell you again. [Laughter.] Mr Deputy Speaker: Members will have to find out the end of the story at another time. Mr Dallat: I welcome the motion, but I too regret that the first mandate of the Assembly, before its suspension, did not proceed with the issue. At that time, the need for such an appointment was recognised, and it would have gone ahead after the appointment of the Commissioner for Children and Young People, but, sadly, that did not happen. Much time has been wasted, and many older people have had to survive — or die — without the protection of such an advocate. It was mentioned earlier that it has been left to the voluntary sector — Age Concern, Help the Aged, St Vincent de Paul, the Salvation Army, and so on — to help out. It is clear, from consideration of the Welsh model, that the major issues have been set out. There is clearly an opportunity to use that model, update it and change it as the priorities change with life. Why should there be a commissioner for older people? Hardly a day passes that we do not hear of issues relating to older people that are embarrassing and even shameful. That should not happen in a modern democracy that has put so much emphasis on equality issues. Being equally poor and equally discriminated against is not, of course, a reason for doing nothing. Neither is it good enough to make an appointment and leave the future to the new appointee. Attitudes across society must change — in families, in neighbourhoods, across the range of public services and especially in health provision, in education, in jobs, in housing, and so on. What are the benefits of having a commissioner for older people? They are endless. The prospects of a long and healthy life for older people are much greater if those people are cherished as important individuals in society, encouraged to remain active and made to feel that they still contribute to society in a positive way. That would mean that fewer older people would be forced into costly residential care at an early age, more of them would remain free from strokes and heart disease, and we would have a better society. A healthier society appreciates its older people, does not experience high levels of brutal attacks on elderly people, forms positive relationships with them, checks on their well-being and learns from their lifetime experiences. That already happens in many regions, especially in rural areas. However, it is hit or miss and is not universal. The appointment of a commissioner is vital in order to rebuild good practices that were widespread in the past but have somehow been forgotten in this modern rat race that has focused on the material aspects of life while overlooking the most cherished gift that we have — our older people. In the past, Governments have not been good to older people. They forced them to live on derisory pensions, gave them poor housing and overlooked issues such as hypothermia, isolation, fear of dying in poverty and, for many years, begrudged them free travel. There are many other issues. In recent times, the issue of free transport has been addressed, and warm homes schemes have been introduced. Although there has been some recognition of other issues, they are still far from being resolved. Sales of emergency drums of heating oil are on the increase, and there is no need for me to tell Members who the main customers are. As the second mandate of the Assembly finds its feet and begins to pick up the pieces of a neglected past, everyone should identify with those who were forced to live through the Troubles, complained little and are now at a stage in their lives when they could benefit from a commissioner. Let us begin. I support the motion and I congratulate my colleague Mary Bradley, who has championed this cause for many years. 3.15 pm Mr G Robinson: I commend Mrs Bradley for proposing the motion. As the issue has been debated on the Floor of the House before, I hope that the support that Members previously expressed will be evident again today. Many older people are extremely able to speak for themselves — we all have constituents who raise the profile of issues that affect older people and who campaign on their behalf — but that is not the whole picture. There is no doubt that older people are among the most vulnerable in our society. They are more likely to live on low incomes and about half of Northern Ireland’s elderly live on less than £10,000 per year. As a result, many older people live in fuel poverty, as was highlighted in the House recently. Older people are also more likely to suffer from a long-standing illness and be entitled to benefits but, unfortunately, many do not take up the benefits to which they are entitled. Those facts outline some of the reasons why we need a commissioner for older people in Northern Ireland, but we can also draw on our experience of having the Northern Ireland Commissioner for Children and Young People. We should also look to Scotland and Wales, where people have already taken the initiative. A commissioner for older people could increase awareness of the interests of older people, promote opportunities and reduce levels of discrimination against older people. The role could help us all to value the contribution that older people have given to society and — far more importantly — highlight the role that they still play. A key role for any commissioner should be to monitor the work of the Assembly and to review how it affects older people. A commissioner would also provide the ability to fight individual cases and act as an advocate on people’s behalf. Such a role would provide direct empowerment to older people, who have hitherto been able to turn to their elected representatives but have not had a direct voice. I hope that Members will support the motion. The DUP is rightly proud of its record in this area. From delivering free transport for older people to pioneering the warm homes scheme, we can point to many achievements. However, the job does not stop there. I fully support the call that has been made, both today and previously, to introduce a commissioner who can provide a voice for older people throughout Northern Ireland. In conclusion, I commend the work that Help the Aged, Age Concern and other agencies have done to make life a little more comfortable for our elderly citizens. I support the motion. Mr B McCrea: I will start by thanking a number of people. In particular, I thank Mr McCarthy for introducing some vitality into the debate — Mr McCarthy: Not vitality but truth. Mr B McCrea: It is good to see that he is still paying attention. I also thank the Rev Dr Robert Coulter for his comments. I can tell him that ageism is an issue that the Ulster Unionist Party takes very seriously. It is fair to say that we have checked for ageism and we have not found any sign of it as yet, but we will keep the matter under review, as it is a serious issue. One issue that has come across is that the proportion of people who are elderly will rise from 16% to 24%. Those numbers are quite startling, as they mean that one person in four will be of pensionable age. However, the fact is that we are all living longer. As we heard from the Minister of Health, Social Services and Public Safety earlier, the very significant advances that we have made in enabling people to live longer is one of the real successes of our society. Of course, in those additional years people need some help when concerns arise with health or with other issues. We need to understand the unprecedented challenges that such people face and how we might go some way towards alleviating them. In February, during the run-up to the recent election, when we were all going round knocking on doors, like plenty of other people I was struck by the number of people who, after 6.00 pm when it became dark, would not open their door— Mr McCarthy: When they saw who it was. Mr B McCrea: I am pleased to see that Kieran McCarthy is still alive. I was also struck, when delivering leaflets, by the number of houses that had a letterbox to the side. Why? Kids put firecrackers through their letterboxes. It is disgraceful that elderly people keep money in kitchen drawers so that they have ready cash to hand over to burglars if their homes are broken into. That is awful: in what kind of society are we living? Fear is not the only problem. Eighty thousand people live on their own, and loneliness is an issue. The distance that elderly people live from public transport is also an issue. Members mentioned abuse, which manifests itself in many forms: it might be an elderly person doing too much babysitting, or it might be a 65-year-old person looking after an 85-year-old relative. The Rev Dr Robert Coulter did not get a chance to finish the story that a doctor had told him. He wanted to tell Members the story, so I will finish it now. The doctor told him about an old lady who had had a distinguished career. She had been wealthy but had been left on her own, suffering from dementia. Her daughter had robbed and abandoned her, leaving her without a penny. The daughter had obtained power of attorney, cleared out her mother’s bank accounts and put the house in which her mother was still living up for sale. That sort of thing goes on. Twenty-two per cent of old people live in poverty. However, one statistic confuses me: 49% of old people live on an annual income of less than £10,000, which means that almost one half of the elderly population lives on less than £10,000 a year, but those people are not considered to be living in poverty. That is outrageous. Inflation for elderly people is almost 50% higher than the headline inflation rate. Many people think that young people are most likely to get into debt. However, it is actually elderly people who get into debt. There is much that we can do. We need one independent person to look after elderly people because the many issues concerning them cut across several areas. Such a person could champion the rights of elderly people and could ensure that all Departments, not only internal champions, looked after them. All Members, including Kieran McCarthy, should support the motion unanimously. The Deputy First Minister (Mr M McGuinness): Go raibh maith agat, a LeasCheann Comhairle. I am pleased to address the Assembly on the matter of older people, and in particular on how best to deal effectively, champion and promote issues that impact directly on them. I thank Mary Bradley for tabling this important motion. The Office of the First Minister and the Deputy Minister appointed junior Ministers whose responsibility is to co-ordinate policy for older people, across Government and in the Executive, thereby ensuring that older people’s needs are championed at every level of the decision-making process. Mary Bradley referred to the demographic ageing of society. That represents one of the major challenges of the twenty-first century, as fertility levels have fallen and longevity has increased, with older people living longer and healthier lives. Technology has altered employment patterns — combined with changes in age structure and health, the experience and meaning of old age has been transformed. As Mary Bradley said, statistics show that the population is getting older: between 2001 and 2041, it is anticipated that the number of people here will increase from 1·689 million to 1·723 million. Over the same period, the number of people of pensionable age will increase from about 259,000 to 495,000, which means that, over the next 40 years, the number of people in this group will almost double. By 2030, one quarter of the population of the developed world will be over 65 years of age, and almost one half of the population of western Europe will be over 50 years of age. Such a demographic change brings not only challenges but rich opportunities to harness the experience, expertise and creativity of older people. The fact that people are living longer and healthier lives is a cause for celebration, not least because it reflects the success of our health and care services. However, despite that, it is of serious concern that too many older people suffer financial hardship, or live lonely and isolated lives, often in fear of their personal safety. The debate has produced a clear consensus that urgent action is needed to improve the lives of those older people who are most at risk and most vulnerable. Mary Bradley highlighted elder abuse and discrimination. In her view, current Government policies are not sufficient. Alex Easton mentioned the work of various commissions and their contribution to the political process. Mickey Brady talked about marginalisation and the need to literally bring older people in from the cold. He also mentioned the contributions that older people have made to our society during their lifetimes. Danny Kennedy rightly addressed crime against the elderly. He mentioned that some Members might fall into that category. He looked at me when he made that comment; I should remind him that he is not too far behind me. However, he also paid a compliment to the Office of the First Minister and the Deputy First Minister by saying that he thinks that we are well capable of dealing with the issues raised today. Kieran McCarthy thanked people who campaign on behalf of the elderly, and I am pleased to see that some of them are visiting the Building today. He spoke about the need for everyone to support old people, particularly those old people who are abused in their own homes and who are subjected to criminal activities. He also drew attention to the importance of apprehending those responsible and supporting the police. I wholeheartedly endorse that sentiment. Alistair Ross talked about The Zimmers — I am glad that he was not looking at me at the time. Several Members highlighted the contribution of the First Minister to the Assembly. Given the work that has been achieved over the last number of weeks, that is deserved praise. The contribution that carers make to old people is crucial. Alastair Ross touched on that when he talked about the exclusion of older people. Fra McCann mentioned the need for a strong voice for older people and the need for all of us to support their rights. Nelson McCausland spoke of the value and success of the Commissioner for Children and Young People. He said that the motion is a matter of equality and human rights. He also talked about the importance of consultation with groups who are involved with older people. Rev Dr Coulter asked whether he should declare an interest in the debate — every Member of the Assembly needs to declare an interest on this issue. John Dallat talked about attitudes across society and the need for those attitudes to change. He also mentioned the importance of neighbours and keeping in contact with older people. George Robinson and Basil McCrea also made important contributions to the debate. I recently visited a house not far from my home where three people in their mid-70s, two brothers and a sister, had their house broken into, were abused in their own home, and had a considerable sum of money stolen from them. I acknowledge the positive work of Help the Aged, Age Concern, the Society of St Vincent de Paul and others who work on behalf of older people. Many Members also praised the work of those vital organisations. The needs of older people are all too apparent. Mr Shannon: Does the Minister also condemn an attack that took place yesterday on an elderly resident of Ballywalter, who was robbed in broad daylight in the middle of the street? That is an example of the society that we are living in. The Deputy First Minister: I wholeheartedly condemn it, and I urge anyone with any information about that incident, or any other incident where older people are abused, to pass it on to the police. 3.30 pm There are too many reports of disgraceful attacks on older people and burglaries in their homes, where they have a right to be safe and secure. That is apparent through the extensive body of research, which shows not only the difficulties that older people face in accessing services such as transport, but also the loneliness and lack of support they experience, particularly those in single pensioner households. The research also shows that needs become particularly acute for those who are over 75 years of age, and those concerns are reflected in what older people have to say. There were 14 workshops held here recently as part of the development of the action plan on social inclusion. The Get Heard project made it clear that older people wanted to see an end to age discrimination, and increased availability of better jobs for older workers, including more support for part-time workers. I am happy to say that some of those concerns have begun to be addressed. For example, last October new legislation was introduced to prohibit unjustified age discrimination in the workplace, which created important new rights and responsibilities for all employees and businesses here. People are living longer, healthier lives, and it is essential that the talents of older workers do not go to waste. They must have the opportunity to continue working if they want to do so. Age regulations will accelerate a culture change in the workplace and will impact on every aspect of the employment relationship from recruitment to retirement. Age regulations also represent a very positive addition to the current body of anti-discrimination law and will make a practical difference to many people. However, legislation alone is not enough. Progressive policies are also required that will identify the barriers and problems faced by old people in their daily lives and remove those barriers while keeping to, and being guided by, the United Nations Principles for Older Persons. The previous devolved Administration established an interdepartmental and inter-sectoral working group to develop a strategy and an action plan to improve the lives of older people. That work was completed during suspension, and it falls to the Assembly to ensure that the strategy and action plan are fit for purpose as a matter of priority. The first action plan to deliver the objectives of the current older people’s strategy and progress report has been published. It covers many important areas of public service including housing, transport and community safety. Specific examples of the positive actions include the all-island free travel scheme for older people; a benefit uptake programme aimed at ensuring that older people receive all the benefits to which they are entitled; and a fuel poverty strategy, which aims to eradicate fuel poverty in all vulnerable households by 2010. Later this year, the Executive will consider and agree on a future action plan for older people. It is evident that there is much support in the Chamber for establishing an independent office of commissioner for older people. Such an office exists in Wales but not in Ireland, England or Scotland, and we therefore intend to examine the previous Administration’s Ageing in an Inclusive Society strategy, with a view to ensuring that the commitments therein reflect the views and priorities of the new Executive. The case for a commissioner for older people will be discussed with Ministerial colleagues and the Executive, and proposals will be brought forward. Our proposals will look at how best to champion the needs of older people and the costs and benefits of different options. Ultimately, our proposals must be those that are most likely to deliver the positive outcomes that our older people deserve. Mr Kennedy: Will the Minister give way? The Deputy First Minister: I have just finished, but I will give way and I will answer. Mr Kennedy: I seek the Minister’s assurance that the Committee of the First Minister and Deputy First Minister will have full access to any new proposals and any consultation exercise. The Deputy First Minister: We are fully committed to working closely and in harmony with the Member’s Committee. Mrs M Bradley: I thank all who took part in this worthwhile debate. I will attempt to touch on what everyone said without delaying proceedings, as I am conscious that there is more work to do. Alex Easton took part in the debate and talked about the illnesses that older people have to contend with and how they often feel left out. Mickey Brady mentioned the contribution that older people make to society and said he would like them brought in from the cold. Danny Kennedy talked about neglect, abuse and ill health and how it was time for a new approach. Kieran McCarthy said we should have a fair deal for older people, including cold-weather payments. Alastair Ross talked of crime against the elderly, fuel costs and health issues such as dementia. Fra McCann talked of attacks on older people and the motion on free personal care for the elderly that my colleague Carmel Hanna moved in the Assembly last week. Fra McCann also said that older people feel undervalued. It is important that we carry through what we do agree for our older people today and do not just talk about it. Nelson McCausland mentioned the value that a commissioner could have and how that is an equality issue — perhaps even a human rights one. Rev Robert Coulter said that we need a commissioner and gave us some percentages. He pointed out the value of the Children’s Commissioner and how the same could happen for our older people. He did start to tell us what sounded like a very good story, but unfortunately he did not get to finish it — so, perhaps some other time, Dr Coulter. John Dallat said that older people could either survive or die and said that the Welsh model might be useful to us. He said that we should all be ashamed of the attacks that take place on older people, and he too supported a commissioner. George Robinson also supported a commissioner. He said that there are many older people who cannot speak for themselves and that a commissioner would help them greatly. Basil McCrea talked about the elderly being afraid to open their doors. We all know that is true from our own areas, where they have five and six bolts on their doors. God bless them — I do not think that people could get in to them if there was a fire. I hope I have left no one out. The Minister himself spoke then, and I welcome his saying that he will look at the situation and at the need for a commissioner. After all the years in which this has been talked about, the facts and figures show why we should have a commissioner for the elderly. I urge the Minister to do this sooner rather than later. I thank Members for their contributions. I hope we can all look forward to the day when the elderly get their commissioner and feel valued and safe in their homes. We will all have played a part in that. Some Members: Hear, hear. Question put and agreed to. Resolved: That this Assembly calls upon the Office of the First and Deputy First Minister to prioritise, as a matter of urgency, the appointment of a Commissioner for Older People, as previously supported by the Transitional Assembly. Mr Shannon: I beg to move That this Assembly notes the grave threat to rural communities with the closure of up to two hundred Post Offices in Northern Ireland, and calls upon the Office of First Minister and Deputy First Minister to use their office to support the retention of Post Offices by advocating the use of Post Office services for governmental and council business as far as is practicable. Hit wusnae sae lang sine at we met in this chammer an’ taaked aboot the ill daeins agin oor Poastal Service an hoo needfu’ hit wus tae houl oantae es monie poast offaices es cud bae kep’. Well the situation bes the saime noo – gif hit isnae a baager hannlin- bit thair bes a bag differ. Instead o’ a “Pretend ‘Semmelie” es yin member cried hit in the las’ debate aboot this issue in Janwerry aa the tim’ o’ the Transitional ‘Semmelie, we ir noo a devolved ‘Semmelie at bes fit tae maak a differ an’ pley a baag pairt no onie tae houl oantae oor Poast Offaices bit tae mak’ thaim betther. It was not so long ago that Members met in the Chamber and discussed the attack on our postal service and the necessity of retaining as many post offices as possible. The situation today is the same, if not worse, but there is a major difference. This is not a “pretend Assembly”, as one Member called the Transitional Assembly during the debate on post office closures in January; this is a devolved Assembly that can make a difference and play a major part in the retention of our post offices and their enhancement. The bare essentials remain as they were: it is planned that up to 200 post offices will be shut. That is the crux of the matter, and problems arising from that are especially evident in rural communities, which continually and consistently bear the brunt of the Labour Government’s machinations. The closure of rural schools because they are supposed to be not viable; draft planning policy statement 14 (PPS 14) will prevent growth and the retention of family units; higher petrol prices make the now necessary daily journeys into town for necessities more expensive; and little support is given to the agriculture sector. Ultimately, the Labour Government has attacked the culture and diversity of country life. Furthermore, the closure of the local post office often leads to the closure of a local shop that often doubles up as a post office and which cannot survive alone; or of a shop next door to the post office that has lost business because customers will now use the shops beside the post office in the bigger towns. The new arrangements will be great for town businesses — most of which are thriving — but not so great for village life, which centres round the small businesses that are the core of the village. It has been estimated that 82% of small businesses will be adversely affected by the post office closures, and 15% of them attribute the success of their business to the presence of the post office. The knock-on effect of the post office closures will be the closure of a further 50% of rural businesses. Make no mistake: the closure of post offices is part of the incessant attacks on rural life by those who do not understand or will not try to understand how anything outside the city looks or works. My constituents who live around the Ards Peninsula or in Lisbane, Killinchy and Ballygowan consider the post office to be an invaluable part of the village, and for many it is a connection to services that they would otherwise have no access to. Some elderly people are holding on to their independence for as long as possible before succumbing to the institutionalised nursing or residential homes that have previously been debated in the Chamber, but the removal of the post office from their locality is making that even more difficult. They will no longer have the superb network of local post offices where the staff know and remember their customers’ names, where they will notice if wee Mrs Jones has not collected her pension and check that she is OK. The already busy staff in the main post offices do not have the time to register who or who has not been in. That, along with the added costs of travelling by bus or having to make unnecessary car journeys, will not only adversely affect the financial part of pensioners’ lives — which is already a delicate balance in many cases — but will add to their vulnerability. They face an arduous bus journey, feel less safe in a town where no one knows them, and, understandably, they will feel more alone and vulnerable in the sea of bodies that they meet. Jack McCullough of the National Pensioners’ Association has spoken of the detrimental effect that post office closures will have on the confidence of the community’s elderly sector. Age Concern has said that more than 95% of elderly people consider the post office to be their lifeline into the community — and as the previous debate was about the elderly, that is particularly pertinent. If it becomes the case that their nearest post office is 10 miles away — or further — that lifeline is stretched to the limit. It is not only elderly people who will be affected by the post office closures, so will the disabled and restricted. The closures will mean that those people will have to travel in special kneeling buses or costly private taxis to collect their benefits, or they will have to, unwillingly, give up more of their independence and assign power of attorney to someone else to collect their pensions when they have always been able to do so themselves. The Royal National Institute for the Blind (RNIB) said that the post office closures will affect the blind and partially sighted particularly hard, and that it will leave them even more financially and socially excluded. The closures will also effect those whose ability to get into the main towns is restricted by our often unreliable and, sometimes, restrictive public transport system, which is not helped by the poor state of our country roads. Members could carry on if their wages were late, but that is not the case for most of the elderly or the disabled people who live from pension day to pension day and from benefit day to benefit day. 3.45 pm Mr Donaldson: Will the Member join me in commending the National Federation of SubPostmasters (NFSP) — in particular, its Northern Ireland branch — on its excellent work to promote the benefits of post offices? The NFSP campaigns not only for the retention of its service and businesses but for the retention of a service that is an inherent part of the whole community — especially for the elderly, as the Member has said. Mr Shannon: I thank the Member for his intervention, and I agree with everything that he has said. The people whom we represent tell us the same story. For an elderly person, a two-day delay in collecting a pension can lead to a choice between heating the house and buying food, or even living that wee bit longer. Isolation is also a problem for young mothers with small children. Access to the village shop and other amenities is important, as it provides them with a chance to pop into the village to collect their child benefit, or simply to interact with adults instead of children. Those issues must be grasped. People who want to pop in to lift an extra tenner to put on their electricity card now must pay an extra £1·25 for doing so, because cash machines that charge users are becoming more common in our villages. That cost must be levied, but, nonetheless, it is an extra cost. Only 4% of villages have a bank, whereas 60% have a post office. A large number of closures will mean that reliance on those types of cash machines will be greater, and those who cannot afford to shoulder a greater financial burden will acutely feel the financial ramifications. More than 4·3 million people have a Post Office card account (POCA), but that will no longer be so handy for lifting money. Subsequently, use of that account will become more limited, and thereby less attractive, so the Post Office will lose more business. From an environmental perspective, added journeys to another post office can never be a good thing. All those extra pressures will prove too much for many people. My colleague Mr Donaldson has mentioned the National Federation of SubPostmasters’ campaign. The Federation of Small Businesses (FSB) has stated that 86% of small firms send their mail through the Post Office. That includes 69% of their invoices. Those firms will now have to factor in the financial cost of the journey to a main post office and the cost to their business in lost working hours. Those are clear problems. First and foremost, we must be adamant in our refusal to phase out the use of POCAs for current Government transactions. Furthermore, the Post Office should once again have responsibility for social security payments, using modern chip-and-pin methods. That would enhance the Post Office service, while making the system more efficient — the current banking system is riddled with problems and inaccuracies. Encouraging large numbers of people to use post offices again would show the modern and efficient systems available in the local post office to greater advantage. It would also encourage new business, as customers could avail themselves of services of which they were not previously aware. It is important that customers realise that they can tax their car at the post office. Members should cast their minds back to a few years ago, when tax-renewal forms had to be sent to Coleraine. I thought of another suggestion when in the Ards Borough Council building the other day. The secretary and the receptionist were both very busy. One was answering the phone, the other was dealing with dog licences, and, all the while, a queue of people was building up behind them. It struck me that some of that work could be shifted to local post offices. Why not let the post offices deal with dog licences? How much longer will those queues be when super-councils are introduced under the review of public administration (RPA)? Members will undoubtedly highlight other ways in which the Office of First Minister and the Deputy First Minister can help the post offices and how it has within its grasp the ability to change the future of post offices in Northern Ireland. The crux of the matter is that the imminent closure of some 200 post offices will adversely affect many in our Province. OFMDFM and the rest of the Assembly must step up to the mark and back a service that has the potential to flourish and to benefit all in the Province, should it be given the opportunity to do so. I urge Members to support the motion. Mr D Bradley: I beg to move the following amendment: After “rural” insert “and urban”; and leave out all after the second “Minister” and insert “to formulate an effective strategy on a cross-departmental basis to maximise the use of postal services by government departments.” Go raibh míle maith agat, a LeasCheann Comhairle. Tá áthas orm an leasú seo ar an rún a mholadh. The purpose of my amendment is to ensure the inclusion of urban post offices in the motion and to ensure that the Office of the First Minister and the Deputy First Minister consider the formulation of an effective strategy to maximise the use of Post Office services by Government Departments. When I last spoke in the House about the threat faced by post offices, I highlighted the need to retain Post Office card accounts to help ensure their continued viability. I welcome the news that the Government are to proceed with the successor to the card account and to extend the social network payment until 2010. However, it is essential that the successor to the card account remains a Post Office product with a full migration of current account holders over to the new version. The new card must be complemented by a comprehensive Post Office banking offer with full access to all major High Street banks at Post Office counters. Unfortunately, the Government have not seen fit to extend their own use of the sub-post office network to deliver key services. Even Post Office Ltd itself has not chosen to deliver a full range of banking services and other products to the network. Mr A Maginness: Members should know that the Minister for Social Development has sought advice on retaining and extending the Post Office card account so that it can be used for the delivery of benefits in the future. Furthermore, the use of the card account as a delivery mechanism does not interfere with the parity rule endorsed by this House. Benefits can therefore be obtained at full value even though the system of delivery is separate from that used in Great Britain. Mr D Bradley: I thank Mr Maginness for his intervention. I recognise the commitment of the Minister for Social Development to facilitating benefit payments through the Post Office network in Northern Ireland. The news of the closure of 2,500 post offices in the UK as a whole, with 200 of them in Northern Ireland, is a huge blow to the network, even though compensation will be made available to the people affected by those closures. Nevertheless, local communities will be left to pick up the pieces. Earlier today the Assembly debated the rights of older people. A report published by Age Concern on the post office closures stated that 99% of older people in rural areas consider the local post office to be a lifeline. Many older rural dwellers feel isolated; the report showed that 56% of people over 60 living in the countryside fear that post office closures will leave them feeling even more isolated. Seventy three per cent of those older people surveyed believed that if Post Office services in their area were to be discontinued, they would be unable to access any similar services that might be provided. These are hard facts; once again, they underline the value of our local post offices. The closure of post offices will create problems for disadvantaged residents who need cash for basic groceries — money that they previously had access to in the post office. Elderly and disabled people and anyone with restricted mobility, such as mothers with young children, will face problems travelling to branches that are further away, especially those who have to depend on public transport, which can be unreliable in rural areas. The closure of a local post office can cause the loss of independence and community spirit for residents with damaging repercussions for local shops and businesses. As I mentioned earlier, the amendment includes urban post offices because it is not only rural post offices that are threatened. The New Economics Foundation’s report, ‘The Last Post’, states that there are significant knock-on effects for businesses, community groups and local people when an urban post office closes. One out of six urban post office closures took place in deprived areas where their role is particularly valuable and where a large number of people depend on them to access pensions and benefits through the Post Office card account. The Westminster Government must review their proposals. What is needed is not further closures but adequate investment in a suite of banking services, improved business services, payment for the social and economic service that is provided by non-commercial offices, as well as investment grants for refurbishment and modernisation of offices. The motion, as amended, demands more than just action from the Westminster Government, although that is important. It also calls on the Government of Northern Ireland to take resolute action to maximise the use of Post Office services by Government Departments. Before restoration, Members often called on direct rule Ministers to address particular issues. Now, the Assembly has its own Ministers who have the opportunity to take action on its behalf. I hope that they will do so. I am sure that all Members in the Chamber will agree that the post office is a key element of the local community, whether it is urban or rural. To close a post office is to take away from the identity of the community and to rob it of vital services, from which it may never recover. I hope that the House will support the motion as amended and that the Executive will take appropriate action in support of the Post Office network. Go raibh maith agat. Mr Deputy Speaker: I call Mr Paul Maskey. I remind Members that this will be Mr Maskey’s maiden speech in the Assembly. As Members are aware, it is the convention that such a speech be made without interruption. Mr P Maskey: Go raibh maith agat, a LeasCheann Comhairle. No pressure, then. I am glad that I have the opportunity to say a few words on the motion and want to thank the Members who brought it before the House. The closure of 200 post offices does not only affect the rural community; it has an adverse effect on the urban community as well, although perhaps not to the same level. According to Advice NI’s response to the Post Office network consultation, the number of Post Office branches in the North of Ireland is 540: 30% of them, around 160 offices, are in urban communities, and 70%, around 380 offices, are in rural communities. Therefore, almost a third of post offices are in an urban setting. The Government have yet to say where the closures will take place, so many could be in urban areas. The local post office is, and should always be, at the heart and soul of local communities, particularly those that are in rural and disadvantaged urban areas. The closure of those post offices will be the death knell for many villages and towns, when the magnet that draws people together will be no more. The Assembly can discuss neighbourhood renewal, building up communities and creating a strong infrastructure that will enable communities to modernise; however, the British Government want to pull the very heart out of those communities. For many older people and, indeed, young parents who do not have access to a car a visit to the post office can be a major ordeal. In many cases, the service is being located further and further away from their doorsteps. Many people whom I represent in West Belfast simply cannot afford to pay to travel to the nearest post office and will be disadvantaged when they must cover the cost of public or private transport to get them there and back. I am particularly concerned about what the adverse effect will be on communities when many pensioners will lose their gathering place and that essential service is removed. Many senior citizens use the post office as a meeting place. For some, it is the sole reason that they have ventured outdoors. 4.00 pm Therefore the removal of that service would be a great injustice. The Post Office network is in its current state because of deliberate British Government policy. If that essential community service is to survive, a U-turn in that policy is required. When the payment of benefits moved from payment books to electronic accounts, post offices lost out dramatically as the Government encouraged recipients to have their benefits paid into bank accounts. The loss to convenience stores of NIE (Northern Ireland Electricity) power cards, saving stamps for TV licences and other pre-payment cards was another blow to the network. Therefore the Office of the First Minister and the Deputy First Minister (OFMDFM) and the councils should adopt a proactive approach by advocating that Departments use post offices. I support the motion and the amendment. Go raibh maith agat. Mr Kennedy: I thank the Members who tabled this important motion. I accept that the closure of post offices is probably a reserved matter and still the preserve of the Government at Westminster. However, even at this early stage of the debate, Members have heard about the importance of the issue and the strength of feeling that clearly exists about the retention of urban and rural post offices. The wider argument about rural communities illustrates ongoing concern for their future. The Labour Administration appear to be intent on forcing people to live in towns and urbanised areas, effectively abandoning the countryside. I share the views of the Ulster Farmers’ Union (UFU) and its president, Mr Kenneth Sharkey, on the reduction of services that are available to the rural community. Healthcare services are being centralised, and Members need only read the Bain Report to see the uncertain future that is being mapped out for rural schools. There is a reduction in the provision of emergency services in rural areas, not least in my constituency of Newry and Armagh. There is a great need for ambulance services in south Armagh, but they are not provided. The planning process is in gridlock. The introduction of PPS 14 and new area plan proposals combine to wreak havoc in its administration. There is a reduced policing service in rural areas. Indeed, it appears that we live in a country in which criminals break into police stations and in which members of the Policing Board are known to the police in all kinds of ways. All the above are hammer blows to the rural community, but one of the principal blows is the scaling down of local post offices. As Members heard earlier, the rural community generally has an ageing population. As older people are perhaps not as electronically minded as young people and may not have email, internet shopping or banking facilities close to hand, they rely heavily on post offices to provide banking facilities. Yet, increasingly, many services are being withdrawn, forcing people to have their benefits paid into newly opened bank accounts and to pay their electricity and phone bills by banking transfer. One by one, services that are critical to the viability of post offices have been taken away, leaving the post offices in an almost impossible position. The Government’s policy may have merit in other parts of the United Kingdom, but in Northern Ireland it creates conditions whereby the rural community is being hopelessly abandoned. Just as people came to regret the criminal destruction of the local railway network in the 1960s, there will be regret if the killing-off of rural post offices is allowed. I support the motion. Mr McQuillan: The motion concerns an issue that will impact on every constituency in Northern Ireland. The potential closure of approximately 200 post offices across the Province will have alarming consequences for the whole community. Rural communities, in particular, are likely to be affected. I hardly need to remind the House about the way in which our rural communities have been adversely affected by a wide range of damaging factors in recent times. Those factors include the general decline of agriculture that has resulted in many people leaving the farming industry for good; having to deal with the consequences of foot-and-mouth disease; BSE, and a planning system that pays scant regard to the need to preserve and populate the rural communities — something that has been exacerbated by the introduction of the famous PPS 14 by direct rule Ministers. Lack of housing is driving more people away from their home communities, resulting in a fall in pupil numbers in rural schools and inevitably leading to school closures. Other factors include poor public transport, the commercial life of rural towns, and villages being constantly challenged by large supermarkets and out-of-town shopping centres. That is the backcloth to the latest Government proposals that could lead to the closure of 200 post offices, largely in rural communities. Therefore, it is little wonder that many people see the proposal as the final act in removing the heart from our towns and villages. Of course, we all recognise that the post office is a business and must operate in a commercial environment: no one denies that. Modernisation and change in the way of operating are essential to all businesses in the twenty-first century. However, the post office means so much more to a community than the mere measurement of commercial value in pounds and pence. The social value that it brings to the community is much greater than that. Earlier in the year, Postwatch Northern Ireland carried out a survey on people’s attitudes in rural areas to a number of issues regarding local post offices. The findings were revealing. Seventy-three per cent of those surveyed used the local post office at least once a week — that figure rose to 88% among those aged 55 and over. More than one third got cash from the post office — that figure rose to 58% among those aged 55 and over. Ninety-four per cent regarded local post offices as important to their daily lives, and 73% lived within a mile of the post office that they used most often. Those figures underline the vital role that local post offices play in the lives of those living in rural communities and emphasise the need to ensure their retention. Of course, the question is: how can that be achieved? Some way must be found to quantify the social value of post offices in commercial terms. Who will pay for the social element, and through what mechanism? I am convinced that central and local government in Northern Ireland have a key role to play in helping to support the retention of post offices. I support the call for an urgent and innovative programme of action to be drawn up by the Executive. That programme should identify ways in which local services could be contracted to post offices under service level agreements. For example, dog licences and other charges due to local councils could be paid at post offices. For a fee, post offices could be used as public-information points for tourism and other services. The Civil Service must be encouraged to think outside the box if the conditions are to be created whereby the retention of post offices can be justified. I hope Members will send a strong message back to our rural constituencies that we recognise the immense difficulties that people face and that we are determined to begin the long haul back to revitalising our rural towns, villages and hamlets. The post office is vital to the aim of retaining the heart of each community. Innovative, proactive measures can be identified to achieve that. I urge the Executive to put this urgently needed programme of action into place. Fine words are not enough. We need to show that further decline is not inevitable. Rather, the saving of the post office could kick-start the beginning of better days for our rural communities. I support the motion. Mr Boylan: Go raibh maith agat, a LeasCheann Comhairle. For the record, I declare an interest as a former employee of the postal service. I welcome the motion and the amendment and I thank the Members for proposing them. The loss of up to 200 post offices in the Six Counties will have a devastating effect on rural and urban communities and areas of social disadvantage. According to the published criteria for identifying closures, rural communities are the most vulnerable; the proposals by the British Government will hit them hardest. It is vital that the social importance of the Post Office network in rural communities is highlighted, and I welcome the opportunity that the motion presents us to do that. The rural post office is not just a central part of the community; it is an essential link, particularly for older people. Rural post offices provide a lifeline to thousands of older people who would otherwise be isolated. In many areas of social disadvantage, the post office provides a lifeline for people struggling on benefits. The apparent determination of the British Government to undermine the future of the Post Office network is a disgrace. The decisions to withdraw services such as TV licence payments and the Post Office card accounts that people use to draw pensions and other benefit payments have had a devastating impact on the viability of the Post Office network. In its previous incarnation, the Assembly made clear its support for the Post Office network. The proposal of the motion, namely the retention of post offices by advocating the use of their services for governmental and council business, is both feasible and practical. I believe that there is scope for the new Executive to respond imaginatively to the threat in a way that supports and enhances the Post Office network and supports rural and disadvantaged communities. The implementation of the proposals in the motion will be a positive start. Go raibh maith agat. Mrs I Robinson: The Assembly has already heard that across the United Kingdom, the Post Office network has been losing millions of pounds over the last seven years. Even a Government subsidy of £150 million could not stop the rot. Alistair Darling, the Secretary of State for Trade and Industry, indicated that as part of the latest phase of rationalisation, up to 200 post offices across Northern Ireland face closure and that the Government subsidy would be withdrawn by 2008. That development places a considerable number of local post offices in a precarious position, given that of the 8,000 rural post offices across the UK, only 1,500 make any money. Inevitably, the pressure of Government policy will now come to bear on rural post offices, which are less productive than their urban counterparts. Although value for taxpayers’ money is important, the Government — in its haste to stem the losses that the Post Office is sustaining — has lost its objectivity and abandoned a fundamental commitment to provide maximum possible public access to Post Office services. One trend that is profoundly unhelpful to the maintenance of the network is the removal of services from post offices. Revenue from the services that have been withdrawn has fallen by a whopping £168 million in the past year, which serves only to compound the problems faced by sub-postmasters across the country. One particular example is the plan to remove the Post Office card account. Across the UK, including Northern Ireland, 4.3 million people use their Post Office card accounts to access benefit payments, yet moves are already afoot to wind the system up. That completely disregards the wishes of customers to use the service and ignores the implications for local post offices. As other Members have stressed, post offices are a lifeline for local communities, particularly in rural areas where closures will have shattering social and economic effects. The latest announcement of a further raft of closures is totally unacceptable. It is also economically short-sighted, as any finances saved by the closures will inevitably result in a dip in productivity by local small businesses, which will ultimately lead to a loss of revenue. That view is supported by a survey that was carried out by the Federation of Small Businesses, which found that 82% of the owners of small firms were of the opinion that the closure of their local post offices would adversely affect their businesses. Although the economic impact of widespread closures is undeniable, the repercussions are infinitely more serious for the future cohesion of local communities and the confidence that they require to survive. 4.15 pm The independent monitoring organisation Postwatch commissioned research that was published in January 2007 and which paints a clear picture of how greatly local communities value post office services. Of those surveyed, 21% were retired, seven out of 10 used a post office at least once a week, and 82% were very or extremely satisfied with the service. The most important aspect of that survey may be the responses on the level of importance that people attach to their local post offices. Some 94% of people believe that the post office is important to them, and 78% stated that it is extremely or very important. Most pertinently, that figure rises to 92% of people aged 55 or over, and 83% of females who were surveyed believed their local post office to be extremely or very important. I could go on, ad infinitum, about the importance of those responses, but it is clear that post offices play a central role in the lives of rural communities. To date, the closure of rural post offices has had a profound impact on communities, and has hit the most vulnerable in society — elderly people, the disabled and those with mobility problems — particularly hard. I support the motion. Mr McCallister: I, along with party colleagues, welcome the motion and thank Mr Shannon for raising this important matter in the Chamber. As my colleague Mr Kennedy pointed out, the closure of post offices is another attack on rural communities by the Labour Government. Members have considered the problems of rural communities in various Assembly debates. I represent a large rural constituency, and I live and work in a rural community. Therefore, I know at first hand of the effects of those problems on rural areas. With the Assembly up and running, Members can move more speedily on a proper rural-proofing agenda in which there are in-built protections for rural schools, hospitals and transport, which are all linked effectively. Mr D Bradley: I accept what the Member has said about rural communities, and how post office closures will impact on them, but does the Member not believe that urban communities and those who suffer the greatest deprivation will also be severely affected? Mr McCallister: I have no difficulty or issue in accepting that, and I will speak shortly about the amendment that Mr Bradley has tabled. There are difficulties with the distances that people must travel to access Post Office services, and earlier, in the debate on a commissioner for older people, Members heard that 80,000 people live on their own. That ties in with what Mr Bradley said about urban areas. There is an important social aspect to rural post offices and the services that they provide to local residents. The Post Office must attract as much business and interest as possible, and other Members have spoken of the range of services that it must offer. There are additional actions that Government Departments can take. The full-time and part-time employment that post offices offer to hard-pressed rural communities is important. I have no difficulty with the rural/urban context in which your amendment is set, Mr Bradley. Notwithstanding Mrs Robinson’s valid point that the greatest threat is to rural post offices, we should not ignore the urban ones. I urge caution on the second part of the amendment, which ties in Departments. Have you considered some of the cost implications of that? Bearing in mind that it is not a devolved matter, and there is no money set aside in the block grant, you must consider carefully before you bind Departments, including that of your colleague the Minister for Social Development — Mr Deputy Speaker: I remind the Member to address the Chair, not an individual Member. Mr McCallister: I apologise, Mr Deputy Speaker. Notwithstanding that point about the risks of Departments being tied into financing things, and the cost implications of that for the Departments and for the Assembly, I have no issue with supporting this worthwhile motion. Post offices play a huge part in rural communities, so I support the motion. Mr Dallat: I support the motion and the amendment. If the post office issue is not addressed, Postman Pat will be gone forever — and I do not mean the cartoon. Useful debates took place in the previous Assembly. It is not new to suggest that Departments could play a vital role in sustaining post offices. Members may wish to know that a pilot scheme was envisaged for Coleraine, and officials from the Office of the First Minister and the Deputy First Minister addressed the borough council on that issue. Unfortunately, other matters took precedence. The Assembly was suspended, and more and more post offices have closed in the meantime. Most closures have happened in rural areas, but there have been some in suburban areas also. That has inflicted some financial hazard on people, if we take into account the cost of taking taxis into city centres, and so on. We must not underestimate the loss to our friends in urban and suburban areas. Long debates have taken place at Westminster, and so-called solutions have been found, all of which have failed to recognise the unique role that the post office plays in the lives of people in Northern Ireland — and in the Republic of Ireland. Sadly, because of partition, we do not have the level of discussion that could take place to come up with a shared solution for both North and South. The problems relating to the future of the post offices are exactly the same in the North and the South. We are compelled to work to a model that was designed for large urban areas in Britain. For example, we must send our complaints to Glasgow. That may be fine for Celtic or Rangers supporters, but, for those of us who depend on the post office, it would be nice to have somewhere more convenient to lodge our complaints. Post offices cannot survive as agents of Government services alone. There must be investment in new technology and an extension of the range of services provided. For example, in small towns where there is no police station, post offices could deal with routine police matters, such as reporting lost property or processing documents and other matters for follow-up later. It is only an idea; do not panic. The post office could be a communications centre for Internet services. It could also extend its range of services in other commercial operations. Given political will and commitment, there is no reason why post offices should disappear. In Northern Ireland there are unique opportunities to retain post offices for the payment of Government benefits to customers. Members have already mentioned that. Unfortunately, Government Departments have shown a remarkable lack of interest in the seriousness of losing our post offices. I would like to shout from the rooftops to our 11 Government Departments and other agencies to make a concerted effort to embrace the uniqueness of the Post Office and give it the oxygen of life, which it urgently needs. We can stand idly by; we can choose to do nothing and allow the post offices to die a slow and painful death. Then it will be the turn of banks in rural areas, and some day, sooner rather than later, we will find that there are no shops in our rural towns and villages — no anything — and it will be too late. Is that what we want for the next generation? I think not. It should be remembered that 40% of small towns and villages in Britain now have no post office, bank, butcher or baker — no anything. Out of this debate should arise a plan or strategy to enable action to speak louder than words. Let us talk to our neighbours in the South and share our concerns and our solutions. Let us put an end to the scandal whereby a letter from Derry takes a week to be delivered to Muff, three miles down the road. Let us find a common solution to a common problem: how to save our post offices. Let the action begin. I support the motion, although I hope that it will be amended. Mr Armstrong: The motion relates to the vital importance of our rural communities. I am sure that Members realise that rural communities have become increasingly threatened in recent years. As Mr Bradley has said, while urban post offices are also under threat, the main problem lies in rural communities. The rural way of life has been under threat in various ways for some time. The farming industry is the backbone of the rural community, and I scarcely need to dwell on the difficulties that agriculture has faced in the last ten years. They include falling prices, BSE and foot-and-mouth disease. Farmers, and industries situated in rural areas, have faced all these pressures. Soaring house prices also have a serious effect on rural communities. They make it almost impossible for people — particularly young people — to find accommodation in the villages where their families have lived for generations. Members should not forget that, in the midst of this already critical situation, our esteemed direct rule Ministers saw fit to impose Planning Policy Statement 14, which has had a serious effect on rural communities. To add to these factors, and largely as a result of them, many rural communities have seen enrolments in local schools decline. Many rural schools are now threatened with closure, just as post offices are. Such schools are the bedrock of our communities. I could go on, but I trust that I have shown that rural communities are already dealing with a range of problems and challenges. On top of all that, we now face the problem of losing almost 200 post offices in Northern Ireland, most of them situated in rural areas. That is not acceptable. Rural post offices are a vital part of the fabric of rural life and must remain open. Last month the Federation of Small Businesses (FSB) said that: “Post Offices are a life line for local communities particularly in rural areas and their closure would have a devastating effect on local economies and their spending patterns. The loss of post offices will have an immeasurable impact throughout the effected communities … This action is completely unacceptable and very short-sighted.” The FSB points out that, in addition to the many individuals who will be greatly inconvenienced by these closures, 82% of small businesses reported that the closure of local post offices would have an adverse effect on them. Like the rural community, post offices have been under threat for some time, as various functions have been gradually taken from them, making them even more difficult to operate. I have no hesitation in calling on the First Minister and the Deputy First Minister to use their powers to support the retention of our post offices. 4.30 pm The First Minister (Rev Dr Ian Paisley): Members are well aware that the Post Office is the primary responsibility of the Department of Trade and Industry. Decisions on the future of the Post Office network are not ones, unfortunately, that we can make. Perhaps it is fortunate that someone else will make those decisions, but we would like to be able to make them. If we were making the decisions, we would do our best to save the post office system, but that is beyond us. However, we must have a strategy to impress on the Secretary of State for Trade and Industry the very strong feelings of the people of Northern Ireland. Today’s debate has amply demonstrated the concerns our communities have about the future of the Post Office network. Many people, particularly the most vulnerable in our society, depend on the post offices and the service they deliver. They are part of their life and well-being. The Post Office is about more than delivering mail, although that is critical. It is about managing finances, paying bills, buying stationery and goods in a friendly local shop and accessing important forms for a wide range of Government services. Those services are important to the community, especially to the aged and those who need help filling in forms in a world that has gone wild for form filling. In the House of Commons recently, the Secretary of State for Trade and Industry, Alistair Darling, announced his proposals for the future of the network. I pay tribute to the fact that he approached the Northern Ireland Members of Parliament, and we put to him matters that gave us concern. We are concerned about the plan that he has for Northern Ireland post offices, and we must be given that plan in good time. However, we do not know what that plan is. I asked Mr Darling for the number of post offices, and he could not give me the number. I asked him where those post offices were, and he said that he did not know. I told Mr Darling that he did not know where “A hog hill” is, but I know that it is called “Ahoghill”. That is the ignorance of the people who are handling some of the affairs of Northern Ireland. Immediately the plan for the future of the Post Office network is available, Members of the House should study it carefully, list their objections and put them forcibly to the Government. The Office of the First Minister and the Deputy First Minister (OFMDFM) played an important role in co-ordinating the views of all Departments on the Department of Trade and Industry’s plans as they were being developed. Indeed, the Government’s acknowledgement of the social role of post offices reflects the strong representations that have been made. Mr Darling said that he wants to give the devolved Administrations a greater say in shaping the network of the future, and we certainly want to have a say, because we had no say in the past. We note the amendment calling for cross-departmental strategies to maximise the use of post offices by Departments. We will certainly continue to work with the other Northern Ireland Departments, particularly with those with a direct interest in the Post Office, such as the Department of Agriculture and Rural Development and the Department for Social Development. The potential of post offices to deliver public services can form part of that work. In response to Mr Shannon, Mr Dominic Bradley and Mr Alban Maginness, I say that OFMDFM understands that the Social Security Agency remains committed to allowing people to access their pensions or benefits in cash at post offices if they choose to do so. However, OFMDFM has received legal advice that states that EU procurement law prevents the extension of the Post Office card account contract with Post Office Ltd. Instead, there must be a transparent procurement exercise allowing all contenders, including post offices, to express an interest. Those matters must be fully ventilated, and we must know what the answers are in law. However, we must be realistic about what can be achieved. In the past, a number of exercises considered additional services that could be offered, including pensions and car tax. Those exercises demonstrated that the range of services capable of generating income was limited, particularly where post offices are located in sparsely populated areas. Furthermore, Departments cannot simply allocate major commercial undertakings to outside bodies, including the Post Office, without appropriate and transparent public procurement procedures, nor would it be possible for OFMDFM to direct them to do so. However, there are other potential developments to which we can look forward. For example, the UK Government is now looking towards expanding the role of the Post Office as a provider of personal financial services. It must also be for post offices themselves to consider other services that they could offer in order to help their customers. The aim of OFMDFM must be to help lay the foundations of a viable and stable network of post offices that will protect and support the well-being of those people most in need of the services that they offer. I assure the House that we will seek to play a full part in that work and that OFMDFM will work with everyone who has an interest. For that reason, I am happy to support the motion. Mr D Bradley: Go raibh míle maith agat, a LeasCheann Comhairle. Tá an-áthas orm achoimriú a dhéanamh ar na hargóintí a rinneadh anseo inniu ar son an leasaithe. I am pleased to make the winding-up speech on the amendment. Various arguments have been made in support of the amendment from both sides of the House. There were minor differences, but there is a general air of agreement with different emphases here and there. That is a good thing, as it indicates a degree of unity. The Member for West Belfast Mr Maskey outlined the need for the protection of urban post offices. That is a crucial aspect of the amendment. He underlined the fact that the older population in urban areas depend on post offices and said that, in many cases, the post office was a lifeline for them, as it is for many people in rural areas. Mr Boylan, a previous employee of the Post Office, has some experience of the issues on the ground. He highlighted the devastating effect that post office closures would have in rural areas. He said that the conditions governing closure indicate that rural areas would be hit the hardest, and I accept that point. Mr Boylan also mentioned the fact that areas of social disadvantage will suffer the most, and I agree with him on that point. In fact, it will be the people who depend most on post offices and need them most, both in rural and urban communities, who will be hit hardest by closures. My colleague Mr Dallat mentioned the previous OFMDFM strategy, when officers and staff from that office advocated, in various rural outreach settings, the use of post office services at local councils, etc. Mr Dallat also suggested that post offices could, in this modern age of communication, become centres for Internet use. He further suggested that certain aspects of policing services, such as clerical work, could be delegated to post offices. He called for Departments to make full use of postal services, and for the Assembly to work in close harmony with the Republic of Ireland to find common solutions to the problems that post offices are facing. In my speech, I outlined some of the services that are needed to bolster up our post offices for future viability. These included a full suite of banking services to be available in post offices. I also mentioned the need for present Post Office card account holders to be transferred to the new accounts that are available. There is also a dire need for much investment in the Post Office estate and for full training for sub-postmasters. Recently, I spoke to some rural sub-postmasters who emphasised the need for linkages between post offices and the high street banks. I appreciate the commitment from the Minister for Social Development, who investigated the possibility of delivering benefits through the Northern Ireland postal network. I hope that her investigations meet with success. I also appreciate the commitment from the First Minister to do all in his power to ensure that post offices survive. I realise that this is not a devolved matter, but there is much that can be done through OFMDFM to support the post offices. My amendment is in no way aimed at negating the motion; rather, I sought to include the urban communities in the debate. They should be included because they will suffer too. The second part of my amendment was meant to strengthen the motion. Mr Deputy Speaker: The Member should draw his remarks to a close. Lord Morrow: I welcome the debate and thank all those who have contributed — it has been positive and constructive. The sad reality is that some 2,500 post offices, both urban and rural, are earmarked for closure across the United Kingdom. I listened carefully to the First Minister. He made it clear, and rightly so, that the responsibility on the future of post offices does not lie with OFMDFM. I suspect that if it did, a better outcome could be expected. However, the sad reality is that the responsibility lies elsewhere. I hope that Mr Bradley, having listened to the debate, will now withdraw his amendment. I suspect that he will, as he is normally quite reasonable. I would not want him to change now, and I am sure that he does not want to change either. [Laughter.] Therefore, I hope that the House will unite in favour of the motion that has been well debated and deliberated on. I hope that everyone will take cognisance of that. I hope, too, that we will see maintained in Northern Ireland a network of post offices that serves both urban and rural communities. We have heard much today, and rightly so, about the elderly — we had a good debate on the commissioner for older people — but any closures in the Post Office network will affect the elderly most. It is in rural communities that the impact of closures will be felt most severely. It has been said that the post office is the heartbeat of a rural community and I believe that to be true. Many things are delivered through the local post office. In rural communities in particular, people look to their post office. Rural post offices deliver a superb service. They have become part of the infrastructure of rural Northern Ireland, but we are now on the verge — the very edge — of seeing all of that change. I will not say much more lest I detract from what has already been said — I have five or six foolscap pages remaining in my speech, but much of it has already been delivered — so I say simply that the House should unite on maintaining our rural and urban Post Office network. To those who would use this opportunity to score political points, I say that today is not the time and there will be plenty of other such opportunities in future. Today, Members should put their community first by uniting on the motion, which I commend to the House. Question, That the amendment be made, put and agreed to. Main Question, as amended, put and agreed to. Resolved: That this Assembly notes the grave threat to rural and urban communities with the closure of up to two hundred Post Offices in Northern Ireland, and calls upon the Office of First Minister and Deputy First Minister to formulate an effective strategy on a cross-departmental basis to maximise the use of postal services by government departments. Adjourned at 4.47 pm.
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