Northern Ireland Budget (Anticipation and Adjustments) (No. 2) Bill

Part of the debate – in the House of Commons at 6:07 pm on 5th March 2019.

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Photo of Karin Smyth Karin Smyth Labour, Bristol South 6:07 pm, 5th March 2019

I am grateful to the hon. Gentleman for making that point. I have not been able to visit that project, but I would very much like to. I agree that investing, training and keeping people local is an important and valuable symbol.

I recently visited the stunning new Omagh Hospital and Primary Care Complex, which is part of the Western Health and Social Care Trust. It is doing great work across the area to manage the challenges of rising demand and costs, which all health systems face. Its top issues of concern are the availability of medical staff and the huge amount of money being spent on locums. To ensure cover across Northern Ireland, precious resource is being spread far too thinly. I ask the Minister to tell us whether the Government will direct the Ministry of Justice to support the Lord Chief Justice’s call for funding, and whether he will progress the medical school, which is time-critical.

Some 46% of the Northern Ireland budget is for healthcare, and the history of reports and recommendations is decades-long. Most recently, Professor Bengoa’s report referenced the renowned academic Professor John Appleby, who found that Northern Ireland’s spending is roughly 11.5% higher than in England, but there is roughly an 11.6% higher level of need. The service is broadly funded as well as the rest of the UK, but there are significant disparities. In particular, mental health need is recognised to be about 44% higher than in England, but per capita spending is sometimes 10% to 30% lower. That led to the conclusion that the problem is not the level of funding but how it is being used to deliver services. Today, we are no further forward in addressing that problem. Spending on the acute sector continues to grow. Having a large number of small buildings is expensive and, most importantly, is not fit for the high quality, 21st century care that we should all be expecting across the United Kingdom.

The Bengoa report opens with a quote from the former chief medical officer, Sir Liam Donaldson:

“A proportion of poor quality, unsafe care occurs because local hospital facilities in some parts of Northern Ireland cannot provide the level and standards of care required to meet patients’
needs 24 hours a day”.

What action are the Government taking to address that problem?

The Minister of State and I share a health geography in the south-west. His local hospital is undergoing difficult and controversial changes. He understands the safety issues and the need to make difficult choices about changes to small hospitals and the transformation to different models of care and to greater specialisation at large acute trusts. In his remarks, he needs to reassure people in Northern Ireland, just as we seek to reassure our constituents here in England, about quality of care. He needs to assure us today that the extra money for health is not just covering continuing inefficiencies and deficits, but is doing something to improve services and, above all, that patient safety is paramount.

Previous allocations as part of the confidence and supply money are of course welcomed by people in Northern Ireland, but one-off payments are no way to transform a health system. I recently heard about a preventive cardiology pilot working upstream with GPs. Money for successive years is not known and the trust is expected to continue funding it as part of its mainstream budget. It is not possible to transform healthcare to meet demands in the 21st century on one-off moneys, and it is a very poor use of taxpayers’ money as well as of the staff time spent proposing and developing new bids.

The next greatest area of spending is education, which has dominated today’s debate. As mentioned, the Northern Ireland Affairs Committee has had an informative session on education spending in the last few weeks, and last week again discussed the much reported recommendations to improve education outcomes in Northern Ireland. Sir Robert Salisbury, who gave evidence last week and reported in 2013, told us six years ago that the system was living beyond its means, and he gave the example of the six post-primary schools in Omagh, which has a similar population to his native Nottinghamshire, which has two.

The Education Authority, which has been referenced this afternoon, has a £90 million deficit largely because of special educational needs spending, which has also been addressed this afternoon. Schools are managing very high levels of mental ill health and, sadly, of suicide and self-harm among children, as Jim Shannon highlighted. As I mentioned earlier, the poor funding of mental health services as part of the overall health budget is exacerbating the problem.

There is a large deficit in schools, as Mr Campbell just said, and the budget is an escalating catastrophe. There are also high levels of achievement, as referenced in the Select Committee last week, and what is described as a long tail of underachievement. There are an estimated 60,000 to 70,000 empty desks in Northern Ireland, two teacher training colleges and two separate statutory planning authorities. The Integrated Education Fund, which I have visited recently, has called the system divided and costly.

I hope that the Northern Ireland Affairs Committee report will shine more light on education spending, but many of the calls have been for a Bengoa-type review. As noted, however, we already have a Bengoa review of health, and without the political oversight and will, it will not make the change. The end of the Committee’s session finished on a depressing note, as the Northern Ireland Commissioner for Children and Young People reported that there needed to be an honest conversation about the allocation of funding within the Department of Education but that there was no appetite for that.

We in the Labour party continue to support the need for integrated education as part of the long-term route to reconciliation in Northern Ireland, and I know that the Integrated Education Fund hopes to visit here in the summer to share with Members the work it does and the challenges faced. It would be good to see some of its thoughts put to the Northern Ireland Committee in its final report.

Beneath the figures that we are rushing through tonight—without proper process and security—lies the future of Northern Ireland’s children’s hopes, dreams and aspirations and of the people needing treatment and care from the NHS who now find themselves on record length and totally unacceptable waiting lists. We will of course support the budget tonight, so that public services can continue, but the people of Northern Ireland deserve much better than this.