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Loss of Nursing Posts

Private Members’ Business – in the Northern Ireland Assembly at 5:00 pm on 20th April 2009.

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Photo of John Dallat John Dallat Social Democratic and Labour Party 5:00 pm, 20th April 2009

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 in which to propose and 10 minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes. One amendment has been selected and published on the Marshalled List. The proposer of the amendment will have 10 minutes in which to propose and five minutes in which to make a winding-up speech.

Photo of Iris Robinson Iris Robinson DUP

I beg to move

That this Assembly calls on the Minister of Health, Social Services and Public Safety to reject plans to cut 722 nursing posts, given his pledge to the Assembly to make efficiencies rather than cuts, and to re-direct resources towards front line patient services.

The amendment seems to ignore the fact that the efficiency targets are demanded by the Treasury and are non-negotiable, even if we wish to make special dispensations. Efficiency savings are supposed to be about doing things better, not about getting rid of key facilities. Waste, bureaucracy and poor performance have to be tackled.

Unfortunately, the Minister’s response to the need to meet efficiency targets has been to punish the community by enforcing stringent cuts on front line services and attempting to palm the blame off on other people. Recent events have shown that Mr McGimpsey’s smoke and mirrors routine of trying to claim credit for all that is good about his Department’s performance, while trying to blame everyone else for controversial or unpopular decisions, has run its course. It is of no further use, and the Minister stands before us exposed as lacking the imagination or determination to deliver, in a real and meaningful way, on the efficiency agenda. The Health Minister can no longer have his cake and eat it.

A Department that spends millions of pounds on travel expenses should not be threatening to put older people out of their homes; a Department that wastes millions of pounds on bonuses and artwork should not be threatening more than 700 nurses with the axe; and a Department whose postage costs £7 million is not beyond efficiency savings.

I saw a recent press release from a Member making disparaging comments about our call for efficiencies in that area. That is exactly the sort of closed-mindedness that I am talking about. If we do not start looking for efficiencies in this bloated bureaucracy, it will inevitably lead to the cuts in front line services that the Minister has put forward.

The Minister hailed the budgetary allocation awarded to his Department as a great success. Members will remember that debate, because prior to that the Minister had washed his hands of accepting the Budget allocations in the first round. He made great play over not having his fingerprints on the allocation in the first round.

On 22 January 2008, when the final Budget had been agreed by all the Ministers of the four parties, Mr McGimpsey said in a press statement:

“The final budget allocation is a good news story for the Health Service. … in light of the financial circumstances facing the Executive, I believe it is the best outcome possible.”

He puffed out his chest and claimed that he had done a great job. Indeed, his party colleagues slapped him on the back for his claim to have gained extra money. That being the case, they cannot now adopt the position claiming that health should be immune from the need for efficiencies, or that more than 700 nurses need to be axed because of spending plans forced on the Minister by malevolent outsiders. Either the Minister got a good deal or he did not. He cannot have it both ways.

Recent history has shown that Mr McGimpsey has undergone a remarkable, rapid transformation from the Bevanite, cradle-to-the-grave, Minister — and every other cliché he has deployed to describe himself — to the Minister for cuts. Gone is the man who welcomed the president of the Irish Congress of Trade Unions to his party conference; to be replaced by axe-man McGimpsey, cutting away at our front line health services.

On 2 May 2008, he said —

Photo of Roy Beggs Roy Beggs UUP

Will the Member give way?

Photo of Iris Robinson Iris Robinson DUP

No, I will not.

On 2 May 2008, he said:

“To start to make cuts is not what people voted us in to do”.

Just a couple of months ago, on 2 February, he was adamant:

“No cuts will be made to front line services.” — [Offical Report, Vol 37, No 3, p154, col 1].

How did we get to this point? We are here because the Minister is trapped in headline-chasing mode, which is doing the people whom he should be working for a disservice.

The sole determining factor in whether an issue becomes “top priority” for the Health Minister appears to be whether he is speaking to a group of people with an interest in the subject, or whether it is receiving specific media attention at the time. For example, take eating disorders. The DUP, in common with other parties in the House, consistently states that there is a need to improve the care available for people who suffer from eating disorders such as anorexia and bulimia. We all exhorted the Minister to do more to help those who were suffering owing to a lack of provision, but we were repeatedly given the brush-off.

The only thing that managed to elicit a response from the Minister of Health, Social Services and Public Safety on that issue was his overriding desire to avoid negative publicity. Only when the BBC started to ask questions did the Minister announce the creation of a tiny unit. The Minister, speaking on the radio, suggested at one point that we could have one dedicated bed in each trust area. How on earth would that contribute to the development of an effective state-of-the-art service? It would not even touch on the problem.

We have seen that pattern from Mr McGimpsey before. He is, of course, perfectly happy to claim the credit for initiatives, such as free prescriptions, yet he tries to blame other people for his decision to axe 700 nursing posts and to close residential homes for the elderly as part of his programme of cuts — a programme that the House, including Members from his own party, has rejected.

Since he became Minister, Michael McGimpsey has stated in his press utterances that no fewer than five subjects are his top priority: suicide prevention; healthier lifestyles; improving access to mental-health care; high-quality health facilities; and health provision in the south-west. That is government by press release, lacking in strategic vision, or capacity —

Photo of Jimmy Spratt Jimmy Spratt DUP 5:15 pm, 20th April 2009

He does not like other people doing that.

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order. All remarks must be made through the Chair.

Photo of Iris Robinson Iris Robinson DUP

— for new or fresh thinking.

Mr McGimpsey, it seems, is more interested in chasing headlines and in building up his media profile than in tackling the serious issues in our Health Service. Instead of describing an issue as a top priority every time the media ask questions — [Interruption.]

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order. There appears to be a problem. I wish to make it clear to everybody that remarks must be made through the Chair.

Photo of Iris Robinson Iris Robinson DUP

I will repeat the last part, because it is important. Mr McGimpsey, it seems, is more interested in chasing headlines and in building up his own media profile than in tackling the serious issues in our Health Service. Instead of describing an issue as a top priority every time the media ask questions, Mr McGimpsey would do better to spend his time devising serious policies that are designed to improve all healthcare fields in Northern Ireland.

It is an off-the-cuff suggestion, but if the Minister would like to sit with me in an accident and emergency facility, in any hospital in Northern Ireland, on any given day or evening, I would be happy to sit with him and let him observe exactly what sort of crisis our Health Service is in. A reduction in the number of nurses and professionals on the floor of those A&E units does not bear thinking about — A&E units can barely manage as it is.

I throw down that challenge to the Minister: any day or night, at any time, I will sit with him in the accident and emergency unit of his choice, in order to let him see what pressures our Health Service front line staff are under. I support the motion.

Photo of John Dallat John Dallat Social Democratic and Labour Party

Before I call Mr McCallister to speak, I repeat that all remarks will be made through the Chair, and I insist that the debate be conducted in that manner.

Photo of John McCallister John McCallister UUP

I beg to move the following amendment: Leave out all after “Safety” and insert

“to review proposals from health and social care trusts to reduce nursing posts, including requesting from the Executive that the Department of Health, Social Services and Public Safety is exempt from the comprehensive spending review efficiency savings process thereby devoting more resources towards front line patient services.”

This debate is essentially about the DUP’s political priorities. Some people in the DUP would rather play politics with our Health Service than maintain a consistent or credible position that has the best interests of the Health Service and the people of Northern Ireland at its heart.

Since the draft Budget was debated in late 2007, the proposer of the motion and some of her colleagues have done nothing but attack the Minister of Health, Social Services and Public Safety on every possible occasion, not with the interests of the Health Service in mind, but in an attempt to discredit a Minister who is, despite their sniping, actually delivering.

Some Members:

Hear, hear.

Photo of John McCallister John McCallister UUP

As the record will show, that is much to the DUP’s shame.

There is a significant gap between the size of the health budget in Northern Ireland and that in England. Even the DUP made that clear in 2005 when its manifesto called for a 20% rise in health spending. However, the DUP did not deliver anywhere near that level of increase when it got into a position of power. At the end of the current CSR period, that gap will be somewhere in the region of £600 million, but despite that huge gap, the DUP is silent on the issue.

Indeed, the proposals in the previous Finance Minister’s original Budget would have made the situation even worse. Thankfully, the Health Minister, along with thousands of people who work in the Health Service, fought for, and won, extra resources, despite the aggressive opposition to that from Mrs Robinson and some of her colleagues.

Some Members:

Hear, hear.

Photo of John McCallister John McCallister UUP

Due to the extra money that was secured, the Health Minister has been able to announce a series of new measures, such as initiatives to deal with cervical cancer and provide breast screening and extra cardiac operations, to name but a few. Ultimately, that money will save lives, yet some people in the DUP oppose the Minister getting a single penny extra; they really should be ashamed of themselves.

As everyone knows, the DUP wholeheartedly —

Photo of Alex Easton Alex Easton DUP

Will the Member give way?

Photo of John McCallister John McCallister UUP

No one in the DUP ever gives way to me.

Photo of Alex Easton Alex Easton DUP

I promise that I will.

Photo of John McCallister John McCallister UUP

Can you believe a DUP promise? [Laughter.]

As everyone knows, the DUP wholeheartedly supported efficiency savings. In case some on the DUP Benches have forgotten, every single DUP Assembly Member marched through the lobby in support of efficiency savings. The DUP’s pathetic attempt to now distance itself from any efficiency-saving proposals smacks of crass political hypocrisy.

Some Members:

Hear, hear.

Photo of John McCallister John McCallister UUP

The DUP not only supported efficiency savings, it advocated reform. In the ‘News Letter’ on 28 November 2007, Mrs Robinson stated:

“In order to continue defending almost half the budget being directed to just one sector with any credibility, we must be able to point to radical reform and modernisation.”

Once again, the DUP’s glowing sentiments appear to be at odds with the record of what it actually did.

Some in the DUP have opposed the Minister when he has attempted to meet the Executive’s targets. When he introduced radical reforms and modernisation programmes, there was DUP opposition that was led by Mrs Robinson, who sniped from the sidelines and opposed the most progressive parts of the Health and Social Care (Reform) Bill when it was proceeding through the House.

I must question whether some people in the DUP are serious about health and ask whether, when bringing pointless motions to the Floor of the House, they really have the welfare of the people of Northern Ireland at heart. We hear nothing in such motions about Peter Robinson emphasising the importance of efficiency savings; nor do we hear anything about efficiency savings in DUP-led Departments or about the waste of resources that is, in many instances, emanating from those Departments.

Photo of John McCallister John McCallister UUP

Perhaps even worse than that is the DUP’s opposition to Northern Ireland’s new Public Health Agency. That is a radical initiative that the rest of the UK and Europe is watching with interest; however, what did our heroes in the DUP do about it? They predictably, but no less disgracefully, opposed the new agency in both the Committee and the House. Where was Mrs Robinson’s call for radical form?

Photo of Lord Maurice Morrow Lord Maurice Morrow DUP

I suspect that the Member is in support of the amendment. [Laughter.] Does he recall that when the health budget was uplifted to in excess of 50% of the overall Budget for running Northern Ireland, the Minister categorically stated that he was very happy and content and that he had fought a good fight to obtain a budget of that size? Will Mr McCallister take that into account in his comments?

Photo of John McCallister John McCallister UUP

I am more than happy to comment on that, because it touches on what Mrs Robinson said earlier. The Minister was stating the fact that it was a better settlement than that which the DUP wanted him to be given. Indeed, for months, the DUP campaigned against a single penny extra being given to the Minister of Health and his Department.

When the DUP was in opposition, before devolution, it wanted a 20% increase and was critical of increases as small as 9%. However, when it reached a position where it could do something about the funding of the National Health Service in Northern Ireland, it dramatically failed to do anything. The Minister and Members on this side of the House agreed that the uplift was very welcome, in comparison with what every DUP Member wanted the Health Service to be run on. That is my simple answer.

Members also had to sit through the spectacle of the DUP attempting to defend smoking advertisements at points of sale. Those advertisements predominantly affect children and have the potential to place a great financial burden on the Health Service in Northern Ireland. The Ulster Unionist Party will not be lectured by a party whose record on health has been completely discredited.

The proposal to reduce the number of nursing posts is simply a proposal. Many of the trusts’ proposals have just arrived on the Minister’s desk, and no final decisions have been taken. My party fully understands the concerns expressed on this issue. The Minister will examine those proposals closely before taking any final decisions. I was grateful to the Minister for his recent decisions regarding Skeagh House and Slieve Roe House.

However, if the amendment were passed today and agreed by the Executive, that would mean that such a proposal would not have to be implemented in the current CSR period, which will allow proper time for real change to take place. If the DUP is serious about what it says, it will have no problem in supporting the amendment. If it does not want efficiency savings and does not deal with the consequences of what it has proposed and agreed to, it must reverse its position.

Let me be clear: Ulster Unionist Party Members are not against efficiency savings. We believe in an efficient and effective Health Service, but we have concerns about the size and pace of some of the changes that are required in such a short period. Having listened to those on the front line, including UNISON and the RCN, we know that our amendment has the support of front line health workers.

If Members support the amendment, they will charge the Minister with reviewing the proposals and making a case for exemption in the current CSR period. I appeal to all Members to listen to our health workers and to support the amendment, thus allowing proper time for real and meaningful change. After all, when it comes to health, we are dealing with individuals’ lives.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I support the motion, which is closely linked to the motion tabled by the Committee for Health, Social Services and Public Safety and debated in February, which called on the Minister to ensure that efficiency savings did not impact on front line services. In that debate, all the arguments were well rehearsed about the impact that proposals would have on front line services, particularly in relation to job losses, closure of residential homes and lack of domiciliary care. The Minister was left in no doubt about Members’ concerns.

Today’s motion focuses on the loss of nursing posts based on the trusts’ current best estimate, which is that 722 nursing posts will be lost. In a briefing paper supplied by the Royal College of Nursing, it is clear that the RCN supports the reform and modernisation of health and social care services. However, it is also clear that much work remains to be done by the trusts to build the confidence of the public and the healthcare workforce in the new health and social care services. The manner in which the trusts have progressed the proposals and consulted has been fragmented and confused to say the least.

In Committee, we examined how the savings are to be made and how they are likely to impact on front line services. We received evidence from a combined delegation of trade unions, who told the Committee that there was a severe lack of information for its members. We raised that issue with the Minister and with the trusts. In fact, in a previous debate in the House, the Minister recognised that that was a problem and told us that it would be rectified. However, that has obviously not happened, because we are debating the issue again.

In its briefing paper, the RCN states that it is still not aware of the details on the loss of nursing posts and where they will occur, and it has absolutely no idea of a time frame. That is totally unacceptable, and I call on the Minister for clarity on those matters.

The UUP’s amendment is, I believe, an attempt to protect its Minister. The UUP fails to recognise that the CSR proposals are a British Treasury-driven initiative. We are not masters of our own economic destiny. If Members had voted for the motion that was tabled by my party colleague Mitchel McLaughlin, which called for more fiscal autonomy for the Assembly, perhaps we would be in a different situation.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

No, I have only a short time left.

The Health Department has a unique arrangement with DFP, which allows it first call on money made available at each monitoring round. We all welcome that. To go down the route of making the Health Department exempt from the CSR process sounds great, idyllic and the best thing to do. However, that would have a knock-on effect on other Departments. All Ministers struggle to meet the CSR demands and all Ministers have targets to meet. We all need to realise where we are. The amendment would have an impact on the other Departments. Where would we take the money from? Should we take it from social housing or from education? We would have to take it from another public service. That would be a hard decision, and one that the Executive would have to make.

We need Michael McGimpsey, the Minister of Health, to step up and do the job that he has been appointed to do. In an earlier debate in February on efficiency savings in the Health Service, he made it clear that he has the final say in all those matters. The trust proposals come to the Minister for his approval, and he said:

“If formal consultations do not produce a clear position, cuts will simply not get through.” — [Official Report, Vol 37, No 6, p316, col 1].

On that basis, I urge the Minister to examine in detail the proposals that are being put forward by the trusts, and to reject any measures that will result in cuts in nursing posts, as that would have a direct impact on front line services. I support the motion.

Photo of Carmel Hanna Carmel Hanna Social Democratic and Labour Party

The SDLP is sympathetic to the spirit of the amendment, but it believes that no Department can be totally exempt from efficiency savings. However, there should be no cuts to front line services. I have sympathy with the Minister in trying to balance a budget for such a demand-driven service, but I believe that the proposers of the motion are engaged in a bit of a cynical exercise. Rather than point-scoring, I would like to have heard some proposals for savings from the Chairperson of the Health Committee that would ensure that there will be no reduction in nursing posts, which is what the motion is about. Have the proposers of the motion asked their colleague the Minister of Finance and Personnel whether he has reviewed his comprehensive spending review policy with regard to the impact on employment and services? Indeed, do they have any suggestions for saving resources?

There is a fundamental contradiction between the loss of nursing jobs and the stated aim of the comprehensive spending review to free up resources to reinforce front line services. Speaking as someone who was a nurse for all too many years, there is nothing more front line than a nurse at the bedside of a desperately ill patient, or a nurse in the community who is an essential member of a primary care team.

I recognise that the reform and modernisation of health and social services is a never-ending and ongoing challenge. We support the Minister’s intent and his commitment towards an ever-greater focus on positive public-health promotion. It is not just about treating the consequences of ill health, it is about appropriate care in the community.

We recognise that the comprehensive spending review efficiency targets have been imposed on the Health Minister in an arbitrary fashion. The SDLP also recognises that given that the health budget accounts for almost half of Executive spending, there must be greater efficiency and enhanced productivity in the Health Service.

The trusts must put in place robust workforce development plans to ensure that registered nurses are adequately trained for the new service delivery that is expected of them. The planned cuts and redeployment of staff will have significant training and professional regulatory implications.

Nurses cannot be treated like pieces on a chessboard: a nurse cannot be taken out of an acute ward and shifted into community nursing without appropriate training, induction and support, or into mental-health nursing without statutory post-registration induction, education and support. Adjustments will certainly be required in the clinical mix among doctors, registered nurses, allied health professionals and care assistants. However, the casualization of nursing skills, which occurred so disastrously in the Thatcher era, cannot be repeated. So much was lost, and we are still trying to regain that ground.

The Royal College of Nursing has produced credible evidence to show that the critical role of the ward sister and other nurse managers is being undermined by the proposals. In some hospitals, ward managers are being asked to work across too many wards and too many locations. When that happens, the role of nursing ward managers as clinical leaders and patient advocates is undermined.

There is a continuing reduction of specialist nursing posts and a tendency to place inappropriate and unpaid leadership responsibilities on band 5 and 6 registered nurses, particularly on night duty staff. Senior nursing posts should be created in every acute hospital, which might convince nurses that their concerns are being listened to.

All changes must, of course, keep section 75 in mind. Any changes must be implemented with equality, integrity and probity, and, at all times, they must put patients’ interests first. The bottom line is that there should be absolutely no reduction in front line services and in nursing posts, as has been stated in the motion.

Photo of Kieran McCarthy Kieran McCarthy Alliance

The Alliance Party members will not, and cannot, support policies initiated by the Executive or the Minister to cut the number of front line nursing staff. Despite repeated denials by the Health Minister, that will be the end result. We will support the motion and oppose the amendment, because we do not believe that cutting front line positions is necessary to attain the efficiency-saving targets as outlined.

The Minister was correct when he said that his baseline budget was inadequate. We agreed with that, but he is wrong to try to suggest that cuts in front line provision are necessary to operate within that budget. By playing politics with front line staffing positions, the Minister is only harming the case that he made for a higher budget, which we supported at the time. We appeal to the Minister and the Executive to halt the process and to stop immediately the loss of over 700 nursing jobs throughout Northern Ireland.

Any person who has been in hospital for any reason must have seen at first hand that all the nursing staff are completely overworked, almost to the point of exhaustion. The Health Service needs more qualified nurses to carry out the duties that they are expected to perform in the interests of the patients whom they serve.

Of course the Alliance Party wants efficiencies and savings to be made across all health provisions and in all Departments.

Photo of Danny Kennedy Danny Kennedy UUP

Tell us. Where are they?

Photo of Kieran McCarthy Kieran McCarthy Alliance

Listen. Give us a chance.

We accept the many advances in the administration of health techniques in almost every aspect. We also acknowledge the increase in demands on the Health Service; again, that is despite all the preventative measures that have been taken and despite people’s having been educated to look after their own health. Where there is demand, in our opinion, it is incumbent on Government to provide — as our own Health Minister has said repeatedly — a world-class Health Service. That cannot be achieved by reducing the number of nursing staff by over 700.

In preparation for the debate, I expect that all Members will have had the opportunity to read the comments of the Royal College of Nursing for Northern Ireland, which has been mentioned already. It has made many comments, among which is that nurses are at the front line in delivering care to patients and that the reduction of their number by 700 will have a disastrous effect on their professional ability to deliver the first-class service to which we all aspire.

The reduction of 700 nursing posts cannot be delivered by voluntary retirements or by what is called “natural wastage”. The consultation process was confused and fragmented. The RCN, as the authority for the nursing profession in Northern Ireland, must be listened to and worked with in order to ensure that bad decisions are avoided before it is too late.

Photo of Tom Elliott Tom Elliott UUP

Will the Member give way?

Photo of Kieran McCarthy Kieran McCarthy Alliance

No, I am racing on here.

Recently, increased costs to the Health Service have been revealed — [Interruption.] Listen, chaps.

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order. Some Members appear to have forgotten my earlier pronouncement that all remarks must be made through the Chair. Continue, Mr McCarthy.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Recently, the vastly increased cost to the Health Service of hefty compensation claims due to medical negligence has been revealed. How does that occur? If that is the case at present, what could it be in the future when the number of nursing staff is reduced by around 720? That places even more responsibility on fewer staff. Is that not a recipe for even more mistakes and more compensation claims to be made?

What about the extra cost to the Health Service of having to rely more on agency staff? The director of the RCN said recently on that issue that you cannot get much more front line than a nurse and that the college is greatly concerned about the impact that the reduction in nursing posts will have on patient care.

Photo of Kieran McCarthy Kieran McCarthy Alliance

No. Nurses want to provide good care to patients.

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member must draw his remarks to a close.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Did a Member want me to give way? [Laughter.]

My party is concerned that the loss of those 700 jobs will have a detrimental effect on care throughout the community.

Photo of Thomas Buchanan Thomas Buchanan DUP

In rising to support the motion, I make it clear from the outset that my party will neither give credence to nor support the amendment. It is one of the most ludicrous and ill-thought-out amendments that I have ever seen brought to the Floor of the House. It contradicts everything that the Minister has said previously.

Of course, that is nothing new from a party for which “delivery” is not a word in its vocabulary. To suggest, as the amendment does, that the Minister should review health trusts’ proposals to reduce nursing posts rather than reject totally plans to cut 722 nursing jobs, as is demanded by my party’s motion, beggars belief. The Assembly now has clear evidence that that party speaks with a forked tongue: it sings from two entirely different hymn sheets.

I remind the Minister and his party that he has, on several occasions, given his pledge, both to the Health Committee and on the Floor of the House, that efficiency savings in his Department would not affect front line services. On 10 February 2009, the Minister reiterated his position in the House when he said:

“Let me make it clear — efficiency savings are not cuts. That is why, when I became Minister, I considered, and threw out, what had been proposed under direct rule”. — [Official Report, Vol 37, No 6, p315, col 2].

If the Minister is true to his word, he will have no alternative but to reject outright any plans to cut 722 nursing posts. The message from nursing staff in hospitals across Northern Ireland is crystal clear — they are already overstretched and under pressure. All Members will agree that nurses provide front line services to patients at bedsides or in the community. Therefore, the suggestion of reviewing the trusts’ proposals to reduce those front line staff flies in the face of any previous commitments or promises that the Minister gave to the House.

Photo of Alex Easton Alex Easton DUP 5:45 pm, 20th April 2009

The Minister also said:

“The final budget allocation is a good news story for the Health Service.”

The Ulster Unionist Party says that it does not have enough money, yet, at the time, the Minister announced that he was happy with the Budget. Is that not a contradiction?

Photo of Thomas Buchanan Thomas Buchanan DUP

I thank the Member for his input; there is ambiguity in the Ulster Unionist Party’s stance. The Minister must come clean and outline his true position on those issues to the House.

The second part of the amendment calls for the Department of Health, Social Services and Public Safety to be exempt from the comprehensive spending review efficiency-savings process thereby devoting more resources towards front line patient services. I remind the Minister and Members from the Ulster Unionist Party that the comprehensive spending review was not plucked out of thin air or dreamed up by a member of the Executive. It was handed down by the Treasury as a mechanism to reduce over-bureaucracy in Departments in order to enable them to operate more efficiently, enhance productivity and free up resources for reinvestment into front line services.

Photo of Iris Robinson Iris Robinson DUP

I thank the Member for giving way. As the Member will be aware, despite the fact that the comprehensive spending review was Treasury orientated, the Executive agreed that if the Department of Health realised — or bettered — the 3% savings, it would retain those extra moneys. No other Department received such benefits.

Photo of Thomas Buchanan Thomas Buchanan DUP

The Member is correct; no other Department was afforded that benefit. The Minister said that the additional funding will:

“save lives and transform the lives of thousands more.”

He said that without those efficiencies the Department would be unable to deliver all the new service developments around cancer, mental-health and learning disabilities, because the efficiencies are paying for those developments.

On the one hand, the Minister says that the efficiencies will pay for those new services; on the other, his party says that the Health Department should not be part of the comprehensive spending review. One part of the party does not know what the other part is doing. Moreover, it should be noted that other Departments must rebid for any efficiencies from the pot. As the honourable Member Mrs Robinson said, the efficiencies in the Health Department return directly to that Department to be reinvested in front line services.

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member must draw his remarks to a close.

Photo of Thomas Buchanan Thomas Buchanan DUP

I support the motion.

Photo of Claire McGill Claire McGill Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I welcome the debate. My party colleague Michelle O’Neill outlined our position on the motion and the amendment. The debate raises the profile of nurses’ significance in society and highlights how Members value their work.

However, there is some ambiguity about the figure of 722 jobs. It would be valuable if there were some clarity about where that number came from in the first instance, and whether those 722 posts will disappear completely.

The Minister has said on occasion that these are not cuts. Other Members have referred to that. I am prepared to accept that what the Minister has said is the truth — that these are not cuts; they are changes to front line services. However, the point is that we need to know whether the changes to the front line services will enhance the service, or will change it in such a way that patient safety and health would be adversely affected. I am prepared to accept what the Minister has said, but there is ambiguity, and we need some clarity on that.

In the briefing from the RCN, which has already been mentioned, reference is made to the Minister’s comments of October 2008. The briefing states that the RCN generally supports the direction of travel of the modernisation. We all do. Perhaps I should not generalise in that way, but many of us accept the modernisation. As the spokesperson for the RCN said on another occasion, we are not against change for the sake of being against change, but we do need to establish exactly what the effect will be, whether these truly are efficiency savings, and exactly what the situation will be in the ward.

The RCN briefing made the point that there are issues related to training. If a nurse, for example, has to shift from one particular area of work to another, when and how will that training take place? I spoke with a representative of the Western Health and Social Care Trust this morning, and raised that issue. I am not sure that the way in which that will happen — moving from one area of work to another — has been sorted out. There has to be some type of time frame for that. I would welcome clarification on that from the Minister.

My understanding is that 350 nursing posts are under consideration in the Western Trust area. That was mentioned at a meeting of the Health Committee when Mr Easton raised the issue with Elaine Way. The issue of reinvestment was raised, which will involve 216 posts in the Western Trust, leaving 134 posts unfilled. I am keen to know where those 134 posts will go. I understand from a report produced by the Regulation and Quality Improvement Authority (RQIA) in relation to clostridium difficile and nursing shortages in the Northern Health and Social Care Trust that there is a direct link between nursing shortages and infection. I would welcome some clarity about those 134 posts. Will we notice that gap in the Western Trust? My reading of the issue is that that has not been managed in a uniform manner across the trusts. When I spoke to the representative of the Western Trust today, I got some reassurance on how it was being managed. We in the west will be keen to follow that up.

Before finishing, a LeasCheann Comhairle, I want to state, as have other Members, that we value the work that nurses do. We do not want to put them under extra pressure. There is not enough money for everything. The Minister himself has said — and I could not agree more — that there have been years of underfunding here. As the Minister said, that is unacceptable. The difference between here and England amounts to £600 million —

Photo of Claire McGill Claire McGill Sinn Féin

I welcome today’s debate. Go raibh maith agat, a LeasCheann Comhairle.

Photo of Edwin Poots Edwin Poots DUP

Here we go again with the Ulster Unionists. If one had taken out the references to the DUP from Mr McCallister’s speech, it would have been reduced in content by around one third. He made the usual cry of give us more money and we can do the job. He should not take on the job of rocket scientist, because anyone could claim that if they were given more money, they could do a better job.

We want to see the Minister do a good job with the money that he has, and cutting 722 nursing jobs does not represent doing a good job.

My wife is a nurse, so I should declare an interest. It is not that the proposed cuts will have a personal consequence for me, but they will have a consequence for the thousands of people who benefit from the service that Health Service nurses provide.

Mr McGimpsey has yet to challenge the Appleby Report. I want to hear today whether he will say that the Appleby Report is not fit for purpose. Professor John Appleby said that Health Service productivity in Northern Ireland was 17·4% less than that in the rest of the UK. As a consequence of that, it was determined that £280 million of savings were there to be made. If the Ulster Unionists are going to challenge that, and say that the Appleby Report is not up to scratch and that they want to take it apart piece by piece, I want to hear them do that. They have not done that to date.

Photo of Edwin Poots Edwin Poots DUP

I am happy to give way. Let us hear what the Member has to say about the Appleby Report.

Photo of John McCallister John McCallister UUP

Will the Member also accept that one of the key elements of the Appleby Report was to do with public health, and the need to engage the population and urge them to look after their health better by tackling drinking, obesity and all those problems that lead to huge health inequalities? However, that lot voted against the Appleby Report in the Committee for Health, Social Services and Public Safety and in the Chamber.

Photo of Basil McCrea Basil McCrea UUP

And smoking.

Photo of John McCallister John McCallister UUP

Smoking as well. The DUP supported that. If we are to debate the Appleby Report, let us debate it all.

Photo of Edwin Poots Edwin Poots DUP

It appears that Mr McCallister’s answer to all this is to create another quango that will cost more taxpayers’ money. Over the past 10 years, although the health budget has doubled, we have seen administration and management costs rise by 33%. The money has gone not to the front line but to administration. That is where Mr McGimpsey must start looking, because that is what efficiency savings are about. They are not about cutting nursing jobs or services for senior citizens —

Photo of Danny Kennedy Danny Kennedy UUP

Will the Member give way?

Photo of Edwin Poots Edwin Poots DUP

Yes, in a minute.

It is about tackling the difficult issue of administration and management costs. [Interruption.]

I will give way to Mr Kennedy now.

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order, please. Let us restore order in the Chamber. I am keen that everyone be present for the vote, but one or two Members’ participation in it is looking a bit dodgy. I ask all Members to make their remarks through the Chair.

Photo of Danny Kennedy Danny Kennedy UUP

I thank the Member for giving way. At least we now have clarity on the DUP’s position. Apparently it wants to protect the 722 nursing jobs. It is doubtful whether the party is under pressure to do so, but the DUP effectively wants to sack hundreds of Health Service employees. Will the Member confirm that that is his party’s position?

Photo of Edwin Poots Edwin Poots DUP

I thank Mr Kennedy for his intervention. That is why I like to give way to the Ulster Unionist Party. He does not want to do away with administrative positions, which are of no help to people in the front line, but he wants to sack the nurses. Let us get that message out. This is what the deputy leader of the Ulster Unionist Party is saying today: sack the nurses and keep the pen-pushers in their jobs. That may be the price that the Ulster Unionist Party is prepared to pay, but it is not the price that the DUP is prepared to pay, nor is it the price that Members from the other parties are prepared to pay.

Over the period in question, Mr McGimpsey’s Department will get a 3·8% increase each year. The Health Service is not being cut; it is receiving increases above inflation whether Mr McGimpsey likes it or not. The efficiency savings that should be made would be ploughed back into the Health Service.

Photo of Basil McCrea Basil McCrea UUP

Will the Member give way?

Photo of Edwin Poots Edwin Poots DUP

Yes; I always welcome the opportunity to give way to Basil McCrea.

Photo of Basil McCrea Basil McCrea UUP

Does the Member agree with the statement that Mrs Iris Robinson made in the House of Commons, in which she described the direct rule health budget increase of 9% as insufficient? Does he agree with her when he says that Northern Ireland has suffered years of underinvestment? Does he agree with her when she says that to get up to the same funding levels as England, we need a 20% increase? Does he agree with those statements? Will he support our Minister in getting more money for our people and our Health Service?

Photo of Edwin Poots Edwin Poots DUP

Basil McCrea called me “Mr Angry” earlier, but he does anger even better. We must tackle issues such as bed blocking and those consultants who use hospital facilities to operate semi-private services in the Health Service.

We do not need to be endangering the lives of expectant mothers by closing maternity units such as the one in Basil McCrea’s Lagan Valley constituency. I put it on the record today that the Royal Victoria Hospital, Antrim Area Hospital and Craigavon Area Hospital are not fit to cope with additional births.

If Mr McGimpsey proceeds with his plan, he will be putting the lives of expectant mothers and their children at risk as a consequence. We need to tackle those issues. Mr McGimpsey is pleased to tell the public that he can provide more money for Herceptin, free prescriptions and IVF. I am happy with all of those decisions — however, I am not happy if they are taken on the back of sacking nurses and doing away with 722 nursing posts. The Ulster Unionist Party may be proud of that, but I am wholly opposed to it. [Interruption.]

Photo of John Dallat John Dallat Social Democratic and Labour Party 6:00 pm, 20th April 2009

Order. The Deputy Speaker is allowed to be heard. The business on the Order Paper has not been disposed of by 6.00 pm. In accordance with Standing Order 10(3), I will allow business to continue until 7.00 pm or until business is completed. Again, I hope that all Members will still be here for that.

Photo of Samuel Gardiner Samuel Gardiner UUP

Political distrust is a very unpleasant commodity. The political distrust that lies behind a whole string of DUP motions in the Assembly is clear for the entire electorate to see. For the DUP Finance Minister to impose 3% efficiency savings on the Health Service here and then for Mrs Robinson, the DUP Chairperson of the Committee for Health, Social Services and Public Safety, to lead a series of debates criticising the Health Minister when he tries to implement those efficiency savings is a deeply cynical thing to do.

This is playing political games with difficult decisions that affect people’s lives and only demonstrates the failure of partnership Government, rather than the efficient discharge of the scrutiny function rightly placed with the Assembly Committees. Bringing endless political point-scoring debates to the Floor of the Assembly — with the name of Chairperson of the Committee for Health, Social Services and Public Safety appended to them — fatally undermines the partnership that should exist between the Committee and the Minister; a partnership that is designed to procure the best results for patients and users of the Health Service.

Unfortunately, such petty political point-scoring is what we in the other parties have come to expect from the so-called lead party of Government. To the ordinary voter, of whom I am one, it simply looks like a political set-up or game — cut the Minister’s money and then criticise him every time he tries to make efficiencies.

Frankly, the scale of the problems that face us in the Budget, public spending, job protection and creation are so great that this kind of political distrust that the DUP indulges in is deeply damaging to the whole process and credibility of government here. It is about as far away from statesmanship, and giving real and responsible leadership, as one can get. This is coming from a party that is playing politics when real leadership is needed, a party that has failed to recognise what even the dogs in the street know — that there is a hole in the Executive’s finances that the DUP Finance Minister has failed to deal with for the past seven months.

That is why I strongly support the amendment that my honourable friend John McCallister proposed today. It reflects the realities of the situation in the Health Service, and not the ‘Through the Looking-Glass’ events that the Chairperson of the Committee for Health, Social Services and Public Safety presented.

There have been years of underfunding in health and social care, and there is already a £600 million funding gap between Northern Ireland and England. We need almost £300 million per annum to make our services match those delivered in England and another £300 million to match the investment that those services will receive this year and next.

Photo of Iris Robinson Iris Robinson DUP

Will the Member give way?

Photo of Samuel Gardiner Samuel Gardiner UUP

No, thank you.

Instead, the reality is that the DUP, using its voting strength in the Executive, has imposed savings on the Health Minister of £700 million over three years. That masks the total failure of the DUP, when it entered Government through its close partnership with Sinn Féin, to negotiate a peace dividend from the United Kingdom Government. The DUP said that it would not enter Government without such funding, but it did. It was only because the Health Minister fought for extra funding that he was able to secure a significant increase in available resources over the comprehensive spending review period.

Without that extra funding, there would have been no development of services such as the introduction of bowel-cancer screening, which will save up to 70 lives a year; an additional 700 heart operations and procedures each year; the introduction of the human papilloma virus (HPV) vaccination against cervical cancer, which kills around 40 women each year; remote monitoring for up to 5,000 patients, and an addition of 200 units in respect of community —

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member must draw his remarks to a close.

Photo of Samuel Gardiner Samuel Gardiner UUP

Let the DUP proposers of today’s original motion tell that to the electorate.

Photo of Samuel Gardiner Samuel Gardiner UUP

I support the motion. [Interruption.] Correction: I support the amendment.

Photo of Tommy Gallagher Tommy Gallagher Social Democratic and Labour Party

I acknowledge the commitment and professionalism of our nursing staff across Northern Ireland. They are, as I have said, true professionals. They are the people who make sure that patients are treated with care, compassion and dignity, whether in their home, in a community setting, in primary care, or in hospital, as is often the case.

It is a disgrace that we are now in a situation whereby more than 700 nursing posts are to be lost. Whether the UUP wants to blame the DUP, or the DUP wants to blame the UUP, this matter is so serious that it needs to be sorted out between the Health Minister and the Finance Minister, because they both have a responsibility from which they cannot escape.

Despite the fact that nurses are such a key group of workers, we know that when these proposals were taken forward by the trusts, there was very little real, meaningful and true consultation with the nurses on the ground. That has only added to the frustration that many of them currently feel.

The Western Health and Social Care Trust, as Claire McGill has mentioned, will lose more than 130 posts, and we have been told by the health authorities — at a number of different levels — that that will be taken care of through natural wastage. We are asked to believe that it will be all right. The reality is that I have had nurses come to me in recent months — well-trained, highly-qualified nurses, some of them at intensive-care level, and many of them young — who have had notification in writing that their contracts are coming to an end. They do not know what the future holds for them.

Instead of cutting nursing jobs, we should be challenged by the task of finding some alternative means of employing them, if it comes to that. I agree with the Chairperson of the Health Committee that there are areas of need. She referred to eating disorders, and I agree that the level of care for people with eating disorders across Northern Ireland is appalling.

With regard to mental health, the situation is perhaps slightly better, but there is a great deal of room for improvement.

If some of those nurses are now to leave our hospitals, there must be appropriate and well-resourced training so that they can move into other settings, because, at the end of the day, they are the people who will take the pressure off the Health Service ― the primary-care and secondary-care sectors in particular ― and will, with appropriate treatment, screen out many patients before they get to other levels. Therefore, we need more resources if the worst comes to the worst here with regard to working in hospitals.

We have arrived at this point because some Members voted for the Budget, which contained the comprehensive spending review measures; unfortunately, we are now living with the consequences. I notice that the Deputy Chairperson of the Health Committee described the efficiency savings as British-inspired. Yes, it is a Gordon Brown initiative and in that sense it is British-inspired, but it is here because that British-inspired initiative was voted through by Sinn Féin. Therefore it is time that we all look at the Budget afresh.

Photo of Michael McGimpsey Michael McGimpsey UUP

I am grateful for the opportunity to respond to this debate, not least because it once again highlights the major challenges faced in delivering millions of pounds in efficiency savings.

As I have said many times, all Northern Ireland Departments must achieve £790 million of efficiency savings by March 2011; for my Department, that equates to some £344 million by 2010-11. That is £700 million over three years, which is a huge task.

Members are aware of trusts’ proposals ― and I emphasise that they are proposals ― to achieve the necessary efficiency savings: proposals that have been the subject of considerable public concern. The motion calls on me to reject plans to cut more than 700 nursing posts; it suggests that those proposals are cuts and not efficiencies.

In our drive towards changing the way in which health and social-care services are provided, nurses will play a vital role in delivering more care in the community: that is what the population wants. I am committed to investing in the front line, but we need to realise that the front line is moving into the community. I have demonstrated that by providing extra funding for the management of chronic diseases, reform of mental-health and learning-disability services, and more community services for our growing elderly population.

Therefore, I welcome this debate on the vital contribution of the nursing profession. However, how sad it is once again to witness attempts by some in the DUP to use the debate as yet another political point-scoring exercise ― that, in spite of the fact that the decision to make efficiency savings was made by the Executive and all parties, including the DUP.

I have to ask: is that selective memory loss or just an unwillingness to wake up and face the stark reality that achieving efficiency savings is a major and difficult task for the Health Service. It is hypocrisy of the highest order for the same people who are asking for efficiency savings to criticise me when I try to make them. Such actions highlight yet again how some are prepared to play politics with the Health Service at any cost.

Let us be absolutely clear: a DUP Finance Minister proposed the efficiency-savings process, and the DUP enthusiastically supported it at the Executive and in the Assembly: the comprehensive spending review process has the fingerprints of the DUP all over it.

I am confident that the direction of change for services for older people, for mental-health care, for hospital services and for health and social care is change for the better. However, I have concerns about the speed and scale of that change.

Just look at the responses to the public consultations on the trusts’ proposals that generated such widespread political debate, media coverage and campaigns. The huge response to those proposals stands in stark contrast to the eerie silence on proposals from other Departments, and it reflects how valued and essential health and social care services are to the public. I have always said that health and social care services must be more efficient and effective in how we use our limited resources. Today, patients access services of the highest quality more quickly than ever.

Health continues to lead the way in the reform demanded under the review of public administration (RPA). The RPA will result in a reduction of almost 1,700 managerial and administrative staff, and it has already seen the number of senior executives fall from 180 to 65. In total, the RPA will bring about £53 million in savings every year.

Although it has taken some time for Members to waken up to the impact of achieving £700 million in savings, I am delighted that the penny has finally dropped. I only wish that their concerns had been raised when I was battling to secure extra moneys for vital services as part of the Budget settlement. Let me remind the Assembly what was said at that time: the Chairperson of the Committee for Health, Social Services and Public Safety insisted that I should accept the Budget as originally proposed. She was so committed to the cause that she even got herself thrown out of the House over it. Indeed, she even claimed that, in a bid to save money, the Mater Hospital should shut, and the new hospital for Downpatrick should be mothballed. At a time of economic recession, can anyone explain to me why I would want to get rid of 1,300 jobs in the Mater Hospital, including almost 600 nursing posts?

In addition, Mrs Robinson’s colleagues said that it was outrageous for me to request more resources over and above the draft Budget, and they claimed that there was a significant element of farce about my battle to increase funding for health. Let me tell the DUP that there is no farce in putting patients first and ensuring that more money is devoted to health. The DUP’s inherent failure to recognise that the demand for health services is rising and urgent investment is required is the only farce around.

When will some Members on the DUP Benches waken up to the fact that their Minister controls the purse strings? Instead of scaremongering and sniping from the sidelines, why do they not talk to their Minister about getting more money for the Health Service? Have any of them even raised it with their Minister of Finance and Personnel? No, they have not.

I welcome calls to exempt the Health Service from efficiency savings. We have to provide 3% efficiency savings on the block grant, but there is no law that says that it has to be by Department. The Department of Health, Social Services and Public Safety has the largest share of the Budget, but it also has the greatest need. Our population is continuing to grow, we have an increasingly elderly population, and expectations for improvements in health and social care are rising. That means that we need to make the most of our limited funds, and we are doing that.

Trusts already have proposals to deliver £140 million of savings a year from increased productivity, including reductions in absenteeism, reduced energy costs and agency spend. That is in addition to the £53 million already being achieved through reduced management costs under the RPA. To think that we are ignoring such potential savings is naive in the extreme.

The motion is about the reduction in the number of nursing posts. Health and social care is delivered by people, and almost two thirds of our spend is on staff costs. It is also naive to assume that efficiency savings of that magnitude can be achieved by simply tinkering with the system. People who make such claims need to live in the real world. We cannot achieve efficiencies of that scale without their having an impact on how our staff deliver services to meet ever-changing needs. However, over the past 12 months, I have worked closely with trade unions, the Royal Colleges and trust management to minimise the impact on staff. That is because nursing is fundamental to high-quality healthcare.

Nurses deliver care across all settings and to all patients. Shifting our focus from providing care in the acute sector to providing it to people in their own communities means that there will be fewer staff delivering hospital services. It also involves nurses bringing their skills and expertise to treat and care for people in their own homes

I am determined to protect the welfare of staff who serve with commitment and professionalism, and that is why I have made it clear that I do not expect compulsory redundancies. I am also committed to maintaining the number of nursing students, and I have invested an extra £2·2 million to providing support to students in the clinical areas. I have addressed shortages of midwives by increasing the number of midwifery students and making more resources available to increase capacity.

However, the debate should not simply be about the number of nurses. Indeed, and instead, our focus should be on what is required to deliver an effective service and what is required to deliver safe and good-quality care. If we are reducing our reliance on hospital beds and are making better use of support staff and focusing on preventative care, we must be prepared to adjust the workforce numbers to match the work that is required.

The Appleby Report made it clear that there was real scope to deliver hospital services that improve the quality of care and allow us to target resources to those most in need. My Department is ensuring that that happens, and that is largely what we are talking about now. In fact, all of the Appleby recommendations are under way or have been implemented. However, Professor Appleby also considered that Northern Ireland required uplifts of 4·3% each year in the funding of health and social care in order to meet increasing levels of needs, rather than the 1·2% that was granted by the Executive —

Photo of Michael McGimpsey Michael McGimpsey UUP

No; the 3.8% refers to the National Health Service in England — you were referring to the wrong Health Service, Mr Poots. [Laughter.]

Professor Appleby therefore recommended that there must be some way around the implications of the Barnett formula in relation to health and social care if the assessed funding requirement was to be delivered. How unfortunate that that was the only recommendation from the Appleby Report that has been ignored. The uplift that was provided to health and social care was only around one quarter of what Professor Appleby recommended as necessary. Therefore, some Members from the DUP must go out and quote from the Appleby Report, so that they will ensure that that recommendation is implemented. The one recommendation from the Appleby Report that is not being implemented is the financial one; that is, the one that I have just talked about.

I must ask why it has taken so long for some Members to grasp the fact that the Health Service needs enough money to meet the ever-growing demands of the public. I make no apologies for fighting hard and against considerable opposition in attempting to secure extra funding as part of the Budget settlement —

Photo of Michael McGimpsey Michael McGimpsey UUP

That extra money ensured that I was able to introduce essential service developments such as bowel cancer screening and an extension to breast screening programmes, to name but a few of those developments that will transform, and save, lives.

It is true that described the final Budget settlement as being as good as it could get at that time; however, I also said that it is still not enough, and I will continue to fight for more.

At a time of recession, when so many people are struggling with financial pressures and unemployment is rising, the demands on our Health Service will increase. Now is the time for investment. Without adequate funding, how else can we address the years of historic underfunding of our health and social care systems? How else can we begin to close the £600 million funding gap between Northern Ireland and England? How else can we ensure that people in Northern Ireland have the same access to health-care as is the case in the rest of the UK?

Let me make it absolutely clear: I am not arguing that the Health Service should not be attempting to make efficiency savings. Rather, given that the needs of my Department are so much greater, I ask why we are being asked to do so much in such a short period of time. We simply cannot give anymore; there is no slack in the system. Indeed, Dr William McCrea recently sent me a letter in relation to this matter, in which he asked me to apprise him of the extent of the proposed cuts. Furthermore, he expressed his support for the views of his constituents in asking that the National Health Service be exempt from the Executive’s comprehensive spending review. [Interruption.] That is a letter from a sincere individual who is not playing politics. The date on the letter is 30 March 2009.

Why do the sick and needy have to pay for years of underfunding of our Health Service? After all, when it comes to health, we are dealing with people’s lives. It is time for everyone to face up to their responsibilities. It is not as if I have not warned everyone of the difficulties that the Health Service faces in trying to make those efficiency savings.

Yes; in respect of our capacity, we are managing at the moment. However, we are at our limit. If we are to continue to protect the quality of care that is provided, we cannot give any more — we must get real. The debate is not just about numbers of nurses; it is about the healthcare of our current population and that of future generations. I would like more time to deliver those changes, but I do not have it.

As Minister, I am determined to do the right thing, to reform and to modernise in order to deliver the services that people need. Those are the criteria against which I will consider these proposals. I will also consider the remarks made by Members today.

Some Members:

Hear, hear.

Photo of Basil McCrea Basil McCrea UUP

Mr Poots referred to his family connections in the nursing profession. He knows that I also have family connections, because they nurse together. He knows that my partner’s sister is a nurse and that my brother-in-law is a nurse. He knows that we on these Benches hold the nursing profession in the highest possible honour.

Mr Poots also knows — because others have spoken about the stress that nurses find themselves under in the National Health Service — the amount of work and responsibility that falls to them, which is why I fully support the Minister’s quest for additional resources to look after the heroines and heroes in our Health Service who need it most. Let no one be in any doubt that we in the Ulster Unionist Party absolutely and fundamentally support the nursing profession.

Some Members:

Hear, hear.

Photo of Basil McCrea Basil McCrea UUP

I congratulate the DUP on its ability to play clever politics, to be sleekit, to take something and to turn it round, and to use the motion in order to play on people’s fears. I acknowledge the DUP’s ability to pour poison and invective on those who are standing up and fighting for the people of Northern Ireland and for the Health Service, as the Minister is expected to.

I also admire the DUP’s ability to rewrite history. I admire the fact that somebody said — and I am happy to take an intervention, if anybody wants to tell me where this text came from:

“Northern Ireland has suffered from relative underfunding for decades…more than 20% extra spending per capita on health care is required to achieve the same level of service as in England.”

Who said that? The DUP manifesto in 2005 did.

“The Health Service in Northern Ireland has suffered from long-term under-funding relative to the rest of the UK.”

Who said that? The DUP manifesto in 2007 did.

In March 2005, describing the direct rule health budget increase of 9% as insufficient, who said the following?

“The extra money does not allow for any new service development. Proposed allocations will not even allow trusts to stand still. In fact they are being forced to withdraw services.”

Photo of Basil McCrea Basil McCrea UUP

Iris Robinson; that is correct. Now, the DUP is turning round and saying, “by the way, live within your means.”

That is rank hypocrisy. In fact, it is not just hypocrisy; it is duplicitous double-talk from a party that is duping the people of Northern Ireland. When it comes to health, I look at the DUP’s partners in crime on the Sinn Féin Benches, and I must say that, while I acknowledge its right to be in Government, I despair of that party’s ability. This idea about — [Interruption.]

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order.

For the benefit of all Members, including those who have recently arrived in the Chamber, I asked that all remarks be made through the Chair. I intend to see out the debate in that way.

Photo of Iris Robinson Iris Robinson DUP

I thank the Member for giving way. First, the speech that you quoted was from me. I was arguing in the House of Commons

A Member:

Through the Chair.

Photo of John Dallat John Dallat Social Democratic and Labour Party

I think that a Member was suggesting that you speak through the Chair, Mrs Robinson.

Photo of Iris Robinson Iris Robinson DUP

I am sorry — I will try. I was speaking in the House of Commons. Of course, one makes the case when fighting in the House of Commons when one does not have an Administration in Northern Ireland. That is what my speech was about.

On the subject of manifestos, I remind the honourable gentleman that it was his party that said that it would not enter into government with Sinn Féin/IRA unless and until guns were handed in. [Interruption.]

There is a difference: we got the guns. If we are talking about manifesto promises, that party is the biggest hypocrite.

Photo of Basil McCrea Basil McCrea UUP

I thank Mrs Iris Robinson for her excellent intervention. It demonstrated duplicity, doubletalk and rewriting of history, among all the other invective. Sinn Féin keeps saying that it will increase taxes, but who will pay those taxes?

Photo of Basil McCrea Basil McCrea UUP

OK, perhaps Sinn Fein does not want to increase taxes. However, that party demands fiscal responsibility, so if it wants more money for the Health Service, it will have to fight for it.

I listened to the Alliance Party come out with more motherhood and apple pie and promises of how it would make cuts. However, not one example was given. All I hear is political immaturity. It is time for people to get — [Interruption.]

It is not often that I cannot command the Floor, but the Alliance Party is doing its best to prevent me from doing so. When it comes to the issue, we, as 108 MLAs, will collectively have to start making tough decisions. It is absolutely appropriate that when cuts of 3% across the board must be made, there will have to be change. Members need to recognise that.

I conclude by rejecting the terrible position that the DUP has taken.

Photo of John Dallat John Dallat Social Democratic and Labour Party

The Member should draw his remarks to a close.

Photo of Basil McCrea Basil McCrea UUP

I commend the Minister of Health for fighting for all the people of Northern Ireland, and for fighting, as he should do, for our Health Service.

Photo of Alex Easton Alex Easton DUP

The House will consider little of more importance than the subject that is under discussion. The Minister of Health, Social Services and Public Safety would do well to listen. Trusts’ potential loss of 722 nursing posts will, if not reversed, mark a seismic mistake of ministerial folly.

Our National Health Service is world-renowned for its expertise. Many in the House, me included, can testify to its surgical and medical expertise. At the core of the service stands the distinguished profession of nursing, which is a vocation. Many of our nurses have distinguished themselves by the care that they give. They deserve to be treated fairly, and they deserve the respect that is due to them. We all know that many nurses — including my sister, who is a nurse in Lagan Valley Hospital — go above and beyond the call of duty in their commitment to their patients. I am at a loss to fathom how 722 nursing posts can be axed without a critical negative impact on front line services.

The Northern Ireland director of the highly respected Royal College of Nursing has already informed us that, if 722 posts are cut, patient care will be damaged and further strain will be placed on an already pressurised workforce. Proposals to cut the number of nursing-ward or team managers, to force them to work across multiple locations and to downgrade their roles are unacceptable threats to patient care and client safety. Those proposals must be revoked.

A report by the Regulation and Quality Improvement Authority suggests that the loss of the nursing posts will cause an increase in healthcare-acquired infections. The RQIA report contains powerful messages about how inadequate nurse staffing levels contributed to the spread of infections, yet the five trusts wish to add to that danger by doing away with 722 nursing positions.

That eloquent analysis places none of us in any doubt about what the motion is about: protecting front line services and enhancing, not damaging, patient care. Does the Minister think that he knows better than the Royal College of Nursing? Does he expect the House to believe that he knows better than the men and women who daily provide services in an increasingly pressurised workplace?

The Minister’s logic that one can cut 722 posts and not hinder front line services defies reality. I challenge him to go to hospitals, treatment rooms and homes in which district nursing services are being provided to witness for himself the pressures that nurses are under and to appreciate the fact that many nurses are regularly working unpaid overtime. The Health Service has many demands, but, frankly, the Minister’s cutting of 722 nursing posts will only add to the problems faced on the front line — it has no part to play in solving those problems.

I have asked the Minister to direct his attention towards areas that can contribute to the solution and increase productivity, and I make no apology for reiterating that. Every time they are mentioned, he seems to pooh-pooh them. I said that he must address the level of non-attendances at outpatient clinics, which stands at 196,000 — he has not done so. I said that he must address some of the 14,000 cancelled clinics — he has not done so. I said that he must address the alarming cost of medical negligence claims, which amount to £14 million — he has not done so. Furthermore, he must address the £6 million cost of independent sector providers, and whether it is really necessary to pay management consultant fees of more than £100 million. Consider the £40 million cost of employing agency staff: if one is getting rid of nurses, it does not make sense to re-employ them as agency staff at twice the price. Strategically, the Minister is in error in his belief that cutting 722 nursing positions will not detrimentally impact on front line services.

Photo of Iris Robinson Iris Robinson DUP

Would he also add to that lengthy list the fact that —

Some Members:

Through the Chair; that is a conversation.

Photo of Iris Robinson Iris Robinson DUP

I cannot keep my eyes from that end of the room. [Laughter.] Dream on.

The Minister should also take cognisance of the amount of money that is spent each year on locums. Last year, I believe that they cost almost £700,000.

Photo of Alex Easton Alex Easton DUP

I take on board the points raised by the Member, and there are plenty more statistics that we can read out if the Minister wants us to do so.

Better front line nursing cannot be achieved with fewer nurses. Consider the pressure that they are under already. Put simply, this is not rocket science. I suggest that the Minister takes a reality check. Do not take my word for it; take the words of nurses:

“the proposals will damage patient care and place further strain on an already pressurised nursing workforce.”

The loss of 722 nurses will damage front line services. The Minister should remember — to use a metaphor — that he will do what it says on the tin. He said efficiencies, not cuts; he said resources would be directed towards front line services —

Photo of Alex Easton Alex Easton DUP

No, you would not do it for me, so tough.

On close examination, the amendment reads:

“to review proposals from health and social care trusts to reduce nursing posts”.

The amendment does not guarantee those nursing jobs; it only seeks a review. Furthermore, it asks the Executive to accept:

“that the Department of Health, Social Services and Public Safety is exempt from the comprehensive spending review”.

Is the Ulster Unionist Party asking us to break the law and go against the directive from Westminster, which we had no choice but to accept? What is equally amazing is that the Ulster Unionist Party is asking us to go against its own Health Minister, who supported the Budget in the Executive, stating that he was satisfied with the Budget and that it was a good day for health in Northern Ireland.

Even if we were legally allowed to exempt the health budget from the comprehensive spending review, what would that mean? It would mean that all the efficiency savings identified by the Minister would not have happened and that all the extra money he was given would not have been given. It would mean that the Minister would not get first refusal on the first £20 million handed back, which amounts to an extra £60 million over three years. No other Department gets that extra money, and failing to get it would mean that the Minister would not have been able to announce all those new services, including free prescriptions.

Those new services came about as a result of record investment and the size of the budget that the Minister got, and that would not have happened if the Department of Health, Social Services and Public Safety had been exempt from the comprehensive spending review. Before the Northern Ireland Assembly was up and running, the health budget was £3·982 billion. By the end of the three-year Budget period, it will be £4·491 billion, which is £500 million more for health — a record investment in health in Northern Ireland.

The amendment from Tweedledum and Tweedledee is a smokescreen; it cannot be done. If it could be done, the other Departments would have to find savings to make up for the shortfall; DSD would have to stop benefits, and there would be no money for community groups; DARD would have no money for grants for farmers; DRD would have no money to repair roads; DEL would have to close colleges — I am sure that the Ulster Unionist Party would not want their Minister to have to do that — and DCAL would have to stop money for community events.

In tabling the amendment, the UUP has shown itself to be financially inept and financially unstable. It is no wonder that the Ulster Unionist Party is in so much debt and almost broke. When one looks at the state of the finances that Basil McCrea received from the Assembly, one will see that he had to fire some of his own staff because of his financial ineptitude. Let us get real; let us save the nursing jobs.

I will try to get through some of the points that were raised during the debate. On the one hand, Sammy Gardiner praised the extra money, but, on the other, he wanted to do away with the extra money by doing away with the comprehensive spending review. I would be glad to see him coming through the Lobbies with us to support the motion.

Tommy Gallagher said that the Health Minister should speak to the Minister of Finance and Personnel. However, I submitted a question for written answer in which I asked whether the Health Minister had raised the subject of efficiency savings on nursing and residential care homes, and I was informed that he has not even raised it in the Executive; he has not even bothered to do so. That shows you what the Minister thinks of nursing jobs and residential homes. He has not even bothered to raise the issue at the Executive.

Minister McGimpsey complained about all the parties supporting the comprehensive spending review, which he supported. It is a pity that the Minister was not concerned enough about the nursing positions to raise them at the Executive.

I did not take any notes on Basil McCrea’s contribution, because I do not think that he was talking about health.

John McCallister said that the DUP was opposed to the new health agency. When debating the Health and Social Care (Reform) Bill, DUP members did not oppose a new health agency; we wanted to keep it within the new regional board.

Photo of John McCallister John McCallister UUP

They voted against it.

Photo of Alex Easton Alex Easton DUP

No, they did not. Mr McCallister needs to tell the truth to the people of Northern Ireland, because that is not true. Members can check the record.

Photo of Basil McCrea Basil McCrea UUP

On a point of order, Mr Deputy Speaker. I think that I heard the Member say that Mr McCallister has to tell the truth. I ask him to withdraw those comments.

Photo of John Dallat John Dallat Social Democratic and Labour Party

I was already on my feet to do exactly that.

Photo of Alex Easton Alex Easton DUP

DUP members were accused of voting against the health promotion agency during debates on the Health and Social Care (Reform) Bill, but we did not. Therefore, Mr McCallister did not provide the truth. [Interruption.]

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order. I need to hear the explanation from the Member.

Photo of Alex Easton Alex Easton DUP

Mr McCallister stated that the DUP voted against the new health agency. We did not vote against the new health agency, so what he said was inaccurate; it is not true. Mr Deputy Speaker, you can check the Hansard report, and you will see that the DUP did not vote against it. I will not be apologising.

Some Members:

Hear, hear.

Photo of Danny Kennedy Danny Kennedy UUP

On a point of order, Mr Deputy Speaker. Following the debate and once the Hansard report is published, I ask you to reflect on what was said by Mr Easton and decide whether his comments were parliamentary.

Photo of John Dallat John Dallat Social Democratic and Labour Party

I will refer the matter to the Speaker, who will make the decision.

Photo of Naomi Long Naomi Long Alliance

Further to that point of order, Mr Deputy Speaker. It would be helpful to have clarification, because, if I heard Mr Easton correctly, he asked Mr McCallister to tell the truth. That is not necessarily an accusation that he was doing anything otherwise.

Photo of John Dallat John Dallat Social Democratic and Labour Party

That is precisely why I have decided to refer the matter to the Speaker, who will be the final arbitrator.

Photo of Alex Easton Alex Easton DUP

I am happy to await the Speaker’s ruling.

Michelle O’Neill supported the motion and called on the Minister for more clarification on the plans and to step up and do his job. Kieran McCarthy said that the Minister was playing politics with nursing job cuts and called for them to be stopped.

Tom Buchanan said that the UUP was speaking with forked tongue. I am not sure whether it was the Conservatives speaking or the UUP, so he is correct on that. Claire McGill wanted to know about the confusion and ambiguity from the Minister on efficiencies in savings in front line services.

Edwin Poots said that the lives of expectant mothers and, potentially, those of their babies were at risk because of the trusts’ proposals for maternity services. The Chairperson of the Health Committee, Iris Robinson, talked about the smokescreens and mirrors that the Minister —

Photo of Alex Easton Alex Easton DUP

The Committee Chairperson also said that there are not enough nurses in accident and emergency units. Furthermore, she challenged the Minister to go with her to see that that is the case.

I support the motion.

Question put, That the amendment be made.

The Assembly divided: Ayes 9; Noes 51.

AYES

Mr Armstrong, Mr Beggs, Mr Elliott, Mr Gardiner, Mr Kennedy, Mr McCallister, Mr B McCrea, Mr McFarland, Ms Purvis.

Tellers for the Ayes: Mr Gardiner and Mr McCallister.

NOES

Mr Boylan, Mr D Bradley, Mrs M Bradley, Mr Brady, Mr Bresland, Mr Brolly, Lord Browne, Mr Buchanan, Mr Burns, Mr Butler, Mr Campbell, Mr T Clarke, Mr Craig, Mr Dodds, Mr Donaldson, Mr Durkan, Mr Easton, Dr Farry, Mrs Foster, Mr Hamilton, Mrs Hanna, Mr Irwin, Mrs Long, Mr A Maginness, Mr A Maskey, Mr P Maskey, Mr F McCann, Ms J McCann, Mr McCarthy, Mr McCausland, Mr I McCrea, Dr McDonnell, Mrs McGill, Mr McGlone, Miss McIlveen, Mr McKay, Mr Moutray, Ms Ní Chuilín, Mr O’Loan, Mrs O’Neill, Mr Poots, Mr P Ramsey, Mr G Robinson, Mrs I Robinson, Mr P Robinson, Mr Ross, Mr Shannon, Mr Simpson, Mr Spratt, Mr Storey, Mr Weir.

Tellers for the Noes: Mr Buchanan and Mr Easton.

Question accordingly negatived.

Main Question put and agreed to.

Resolved:

That this Assembly calls on the Minister of Health, Social Services and Public Safety to reject plans to cut 722 nursing posts, given his pledge to the Assembly to make efficiencies rather than cuts, and to re-direct resources towards front line patient services.

Adjourned at 6.58 pm.