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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 —