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Workforce Planning Review

Committee Business – in the Northern Ireland Assembly at 10:30 am on 13th October 2015.

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Photo of Mitchel McLaughlin Mitchel McLaughlin Speaker 10:30 am, 13th October 2015

The first item of business is a motion from the Committee for Health, Social Services and Public Safety on its review of workforce planning. The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer will have 10 minutes in which to propose the motion and 10 minutes in which to make a winding-up speech. All other Members who wish to speak will have five minutes.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

I beg to move

That this Assembly welcomes the Committee for Health, Social Services and Public Safety's review of workforce planning; and calls on the Minister of Health, Social Services and Public Safety to ensure that workforce planning is fully integrated with the implementation of Transforming Your Care.

Go raibh maith agat, a Cheann Comhairle. I welcome the opportunity to take the motion to the Floor of the Assembly today on an important piece of work around staffing requirements and workforce planning in the delivery of health and social care.

Since the publication of Transforming Your Care in December 2011, the Health Committee has carried out extensive scrutiny of various aspects of the policy and the proposals for implementation. We have looked at Transforming Your Care through the lens of health inequalities, learning disability, supported living for older people, outcomes frameworks and, most recently, workforce planning.

Transforming Your Care aspires to place the individual at the centre of health and social care services, with a shift left from hospital-based services to more community-based services. The strategic implementation plan for TYC acknowledges that achieving that shift left will require substantial workforce planning to ensure that the appropriate staff are in place to deliver that new model of care. Therefore, in light of the importance of workforce planning for the implementation of Transforming Your Care, the Committee decided to conduct a review of the workforce planning model in that context. We wanted to find out what level of progress had actually been made on workforce planning at regional and trust levels. We were also very interested in scrutinising some of the original assumptions in relation to workforce planning, specifically the notion that implementation of Transforming Your Care would require a 3% reduction in the overall workforce. The review looked at the difficulties around recruitment and retention of staff and whether those issues were being addressed by the Department at a strategic level. We also examined the Department's approach to involving staff, professional bodies and staff-side organisations in workforce planning and whether that approach has been appropriate or, indeed, effective to date.

In the course of the review, the Committee took evidence from a wide range of professional bodies representing staff across the health and social care sector, the unions, the health and social care trusts, the Department and the regional workforce planning group that it chairs. We also did a videoconference with officials from the Scottish Government, who provided us with very interesting assumptions on workforce planning.

I would like to refer to the situation regarding recruitment and retention of GPs. There have been 18 recommendations as a result of our inquiry. This was highlighted in the evidence from the BMA, and the Committee heard that GPs are increasingly choosing to leave or retire due to unreasonable workloads. The BMA advised that it has no evidence that investment has been shifted from hospital settings to primary care. It pointed out that there has been no additional investment in GP training places to allow for GPs, as a workforce, to take on new work that has traditionally been carried out in secondary care settings, as envisaged by Transforming Your Care. The Committee is deeply concerned that, while a number of successive reviews have recommended an increase in GP training places, this quite simply has not been implemented by the Department. The Committee therefore recommended that the Department implements the recommendation of the most recent review to recruit an additional 15 GP training places.

Secondly, I wish to highlight the Committee's concerns about the projected size of the workforce under Transforming Your Care. Specifically, the Committee wished to scrutinise the Department's original assumption that the implementation of Transforming Your Care would require a 3% reduction in the overall workforce. That assumption was contained in the public consultation document on Transforming Your Care, which clearly stated that a 3% reduction in the workforce, representing 1,620 staff, would be required for implementation. However, during an evidence session with the Department, the Committee was advised that the 3% figure had only been a working assumption at that time. It had been produced by the Health and Social Care Board, and the Department could not provide details of how the figure had been calculated.

The Committee wrote to the Department on two occasions to ask how the 3% figure had been arrived at, but, as yet, has not received a clear answer. The Committee asked again, in a further evidence session with the board itself, and was surprised by the response from board officials that they simply did not know where the figure came from.

When the Committee asked the professional bodies that gave evidence whether a 3% reduction in the workforce was feasible or realistic, the unanimous opinion was that it was neither. In evidence sessions with the Department, it became apparent that not only was the 3% reduction no longer a working assumption but that it was likely that an increase in the workforce would be required. However, the Department was unable to give an estimation of the size of that increase. In correspondence with the Committee, the Department advised:

"Going forward, no overall target for either an increase or decrease is being set for the HSC workforce as that would be arbitrary and would serve no useful purpose."

Given the increasing growth in demand for services over recent years, we welcome the fact that the Department is not working towards a 3% reduction in staffing as a target required to implement Transforming Your Care. However, we find it somewhat surprising that the Department was not able to advise us exactly how and why that figure was ever in a public consultation document on Transforming Your Care.

Given that it is now more than three years since the publication of Transforming Your Care, and the number of workforce reviews that have been carried out, the Committee finds it difficult to understand why the Department is unable to provide a figure for the size of the required workforce. The Committee therefore recommends that the Department produces an estimation of the percentage increase or decrease in the workforce required to implement Transforming Your Care.

Speaking as a constituency MLA, I would say that workforce planning is central to implementing Transforming Your Care. Staff are our most valuable resource. They are the foundation of our health service, and we need to work with them to bring forward the improvements and changes we all want.

This, today, is another sad indictment of the fact that we do have the DUP in the Chamber to listen but we do not have the DUP Minister at his desk, when evidence after evidence tells us that in terms of our staffing requirement we are heading for the rocks. Nor is he at his desk to respond to the clear recommendations that the Committee brings forward today.

I ask the Assembly to support the motion. Go raibh maith agat.

Photo of Fearghal McKinney Fearghal McKinney Social Democratic and Labour Party

As SDLP health spokesperson, I welcome the opportunity to speak on the motion and give my party's support to the review into workforce planning by the Committee for Health, Social Services and Public Safety.

I concur with the remarks of the Chair. I find it ironic that we are discussing workforce planning when the Minister is not at his desk and the Chief Medical Officer is double-jobbing as head of the Belfast Trust. I am disappointed that the Minister is not here.

The health service employs almost 55,000 staff, who are dedicated and professional, and who are working to achieve the highest standards of care for patients in often difficult and stressful circumstances. Their commitment, energy and compassion must receive the highest praise. It is important that we acknowledge that. The pressure they are under is intolerable and the reason for it is systemic failure.

We are here to discuss the key strategic direction of workforce planning in relation to the Transforming Your Care plan. That plan foresaw the strain on the health service, particularly on the expense side, with a growing older population, growing long-term health conditions and a growing need to reach into communities with meaningful health interventions to avoid, as much as possible, people having to go into hospital and essentially racking up big bills.

What did TYC say about workforce planning? Recommendation 79 called for measures to be put in place to ensure that staff are able to work in a manner that supports TYC. Recommendation 95 called for the development of new workforce skills that shifts care towards prevention, self-care and integration to the home. Recommendation 97 called for integration of workforce planning into the commissioning process.

The Committee heard views on these articulated by many substantial representative organisations in the system. The Royal College of General Practitioners said that TYC sets:

"key priorities and performance indicators ... but there has been no outline of how we get to where we want to be ... in two years ... four years and ... six years."

Systemic failure. The unions told the Committee:

"Even though we have asked for it three times, we have not yet seen a breakdown of where the £25 million [for implementing TYC] was spent, how it was spent and where it was applied."

That is the considered view of leading health unions four years into the process. It reinforces the fact that the public have not yet benefited from the implementation of TYC and have scarcely seen its implementation. Worryingly, the BMA advised that it has no evidence that investment has been shifted from hospital settings to primary care. The Royal College of Nursing also pointed out that there has been decline in the number of community nurses over recent years, which similarly seems to be out of step with the direction of shift left under TYC. So, we were getting an absolute chorus of key representative organisations saying the same type of things albeit in slightly different ways.

Photo of Kieran McCarthy Kieran McCarthy Alliance 10:45 am, 13th October 2015

I am grateful to the Member for giving way. Does he agree with me that we are now faced with added pressures in that a new contract is being talked about for our junior doctors, and they are most unhappy about its direction of travel?

Photo of Mitchel McLaughlin Mitchel McLaughlin Speaker

The Member has an extra minute.

Photo of Fearghal McKinney Fearghal McKinney Social Democratic and Labour Party

I thank the Member for his intervention. We have all been receiving correspondence in this regard; I am sure that the Member has too. While it is not within the confines of this discussion, the new terms of that contract would bring about a complete removal of the GP training service, cut junior doctors' pay by 30% or 40% and stretch the working week at a time when there is a shortage of GPs, A & E and psychiatry trainee doctors, which once again underlines the irony here and the fact that there is not proper strategic planning. We, as a party — I am sure that other parties are too — are concerned that the proposed changes will dissuade medical students from going into the profession, or from staying here if they have gone into it, at a time when we need more of them.

The consensus is clear. These views point in only one direction, which is towards a plan that is simply not being implemented. I should know. I have spent the last two years constantly asking questions about its implementation, only to be fobbed off with obfuscation. First, we were given assurances that it was being implemented and that there were targets in the plan. Then, as the questions piled up, the evidence conveniently disappeared. In the end we had the Donaldson review, which basically called it as it was: a failure of leadership, a failure in commissioning and a failure to deliver. It is the workers, the patients and the public who suffer as a result, and they all deserve better.

The response of the Department and the absentee Minister is even more concerning. During the inquiry, the Committee heard that the plan is not so much a plan any more, rather it is a philosophy. We all love to have a philosophy, but, if you do not have some strategic plan to work to, you are going nowhere. The Health Minister, according to himself, has diluted it even further. It is now about the "principles of TYC" and some vague ambition for world-class healthcare. I remind the Minister that the TYC document made one very important point. It said that to fail to plan for the future would lead to unplanned and haphazard change that will not be in the best interests of patients. So it has come to pass.

Photo of Michael McGimpsey Michael McGimpsey UUP

I support the motion on the review of workforce planning and our way forward. I note, as others have, that the Minister is absent, although I will make a prediction here: I think that we are about to see a U-turn, and I have no doubt that the next time that we all stand up to do such a debate, the Minister will be in place and the gag will be off George Robinson, for example, and his party colleagues will be allowed to take part in the debate.

This is an important issue. It is about having the right people in the right place at the right time, with the appropriate skills to address the needs of patients. It is clear that our health service is under enormous stress. We have a plan that we talk about, TYC, Transforming Your Care, which we used to call, in the Department, "shift left" and still sometimes do. That is about moving care increasingly into the community. The principle of moving care into the community was that patients will do better. Patients who are looked after in their own homes will do better, will be happier and will live longer. Their life expectancy will be longer if we can manage to provide that care in the community, as opposed to a hospital setting. The hospital setting has been very much the traditional way that we do things.

The problem, of course, is how you move from one to the other. That needs front-loading and investment. You cannot simply say, "We are not taking them into hospitals. We are keeping them at home," and move staff from hospitals into the community. It cannot work like that. This needs a lot of planning. It needs different skill sets for our staff. The very first thing that you have to do is engage with staff side — BMA, RCN and all the workforce. The representatives must understand what is happening, must not feel that they are being taken by surprise and must feel that they are part of the move. Like others, I was somewhat surprised to discover that the regional planning group excluded staff side and the trade unions. I found that very difficult to understand because, in my time at Health, I had regular engagement with staff side. Sometimes it was quite uncomfortable for me, but we did that on a regular basis. I took the view that, if the trade unions were not on board, whatever you wanted to do would be very difficult.

The big thing that you have in your favour when you are talking to the trade unions is that the health service is essentially their creation, so they want to make it work. They are onside, as are RCN and BMA, so it is not a conflict situation. It is always a situation of partnership. That is the very first thing that I want to see. As we move forward, I want to see re-engagement with staff side, otherwise we will continue in this sort of discussion with the deaf.

We also need to invest in our staff. For example, we talk about planning. The planning is there. The Health and Social Care Board, which I established with a cap of 350 members and no more, is the essential management tool of the health service. When I left there were 335, and it is now over 500, which is an increase of around 40%. When I asked Jim Wells why there was that increase, he said that 70 staff had been recruited specifically for TYC. So we have a TYC workforce in there doing the work. They know what they need to do. They have the plan. I think that they need to share it with us. I am not quite clear that any of us really understand what the plan is. The plan will have benchmarks, not least a time frame.

There are a number of issues here. A much greater burden will fall on general practice and primary care, so the investment needs to be there. We are told, for example, and it is true, that we have the lowest cover as far as GPs per head of population in Northern Ireland as opposed to the other home countries. Also, a percentage of our GPs now are heading towards the end of their career and looking forward to retirement. They need to be replaced. They need that sort of investment. Like many of us, I was shocked to discover that, last year — again, Jim Wells told us — 50 young doctors who graduated from Queen's elected to go and work in Canada and Australia. Each one of those cost the health service £600,000 to train, and away they went. It seems to me that that is a fundamental problem. We have to hold on to our staff. We provide fabulous training. We have the plans, we need the investment and we must hold on to our staff.

Photo of Kieran McCarthy Kieran McCarthy Alliance

As a member of the Health Committee, I fully support the comments made by the Chair and other members who have spoken on this very important issue. Again, however, I express disappointment — indeed, it is shameful — that no Health Minister is present in the Chamber to listen and, more importantly, take action on what is a very important topic. We should be really committed to the pathways outlined in the 'Transforming Your Care' document and backed up by the review commissioned by the Department and delivered by Sir Liam Donaldson.

Our health service is experiencing extreme difficulties, as the permanent secretary reported at the Health Committee last week. Some people say that we are in a crisis; I suggest that the health service, at this time, is in a total and absolute shambles, given the ever-increasing waiting lists. Look at this headline from last week: my constituent has been waiting for two years for hospital treatment — she is one of 373,000. What a shame. Not only that, we have people waiting on vital drugs, and, indeed, there are many other inequalities in our present-day health service, which leave so many people to continue suffering in agony.

This is not what this Assembly is about, and the sooner a Minister gets back to work to overcome the shambles, the better. Let me say loud and clear at this juncture that I, the Alliance Party and everyone in the Chamber have the highest regard for every person engaged in providing our community with an excellent health service, from cleaners right up to the consultants and the highest in the profession. The problem is this: how do we get our constituents to receive this fantastic treatment within a reasonable time frame?

Our report has been a very useful exercise. It arrived at 18 recommendations in total, which, if implemented, would allow our patients to receive the necessary health provision as and when required. One of our terms of reference was:

"To examine the Department’s approach to involving staff, professional bodies and staff side organisations on workforce planning in support of the implementation of Transforming Your Care".

We had nine evidence sessions, and we are grateful to all the witnesses who appeared and for the written submissions received, which resulted in the Committee coming up with the recommendations that I mentioned. I take this opportunity to thank the Committee staff for the work that they did in helping us to produce this report.

One disappointing outcome was the delay in the publishing of the work of the regional workforce planning group. That group started work in August 2012, and its report was only published in April this year. One could be forgiven for questioning why there was such a delay and wondering what opportunities may have been missed.

One of the key outputs of the group is the regional workforce planning framework, which is described as:

"key to moving forward, as it sets out the respective roles of the Department, of the HSCB and the Public Health Agency (PHA) as commissioners, and of the trusts."

Our Committee expressed concern that the RWPG had not been as inclusive as it should have been, thereby missing out on the views of experienced people, such as the Royal College of Nursing, trade unions, the allied health professionals and others.

We recommend that our Health Department asks the board to produce an annual workforce plan as part of its annual commissioning plan and also to consider taking a longer-term approach to workforce planning, rather than the proposed five years.

The Transforming Your Care pathway, now regarded not so much as a plan but as an ethos, has been running for a number of years, from 2011. It would appear that money has not been transferred to places where it ought to go, thus the slowdown and perhaps stoppage in the workings of Transforming Your Care, giving us the shambles that we are presently experiencing.

Workforce planning must surely be an essential component in making best use of all the staff within our Health Department. I believe that our Health Committee has done an excellent job in producing this report. I sincerely hope that, despite having no Minister at the helm — at this time, indeed, we simply do not know who is actually in charge of the Department — progress will be made on behalf of all our constituents who are presently ill or on a waiting list.

Photo of Mitchel McLaughlin Mitchel McLaughlin Speaker

The Member's time is almost up.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Staff are the backbone of our health service and are central to delivering the best. They must continue to play a pivotal role. I have every confidence that staff —

Photo of Mitchel McLaughlin Mitchel McLaughlin Speaker 11:00 am, 13th October 2015

Thank you. I call Mr Daithí McKay. Your time is long up.

Photo of Daithí McKay Daithí McKay Sinn Féin

Go raibh maith agat, a Cheann Comhairle. I speak in support of the motion, obviously. It is ridiculous that we find ourselves once again addressing an empty chair across the way. I see that Mr Robinson is the sole representative of the DUP today; perhaps he would like to sit in the Minister's chair, so that we can have some semblance of a real debate and a response from the other side of the House. This is getting beyond ridiculous.

(Mr Principal Deputy Speaker [Mr Newton] in the Chair)

A Phríomh Leas-Chathaoirligh, having just come on to the Health Committee, I am not across the full work of the report, but the importance of workforce planning to productivity, better outcomes, better health outputs and, indeed, the improved health of staff within the health service itself is clear to anyone. From the Committee recommendations it is clear that there are a number of serious concerns that the Department needs to address in terms of Transforming Your Care. These include, for example, the number of GP training places, which has not been implemented by the Department. The Committee is recommending that the Department implement the recommendation of the most recent review to provide an additional 15 GP training places.

The Committee is also concerned that the regional initiatives on normative nurse staffing have not been completed or implemented and by the potential impact that this may have on patient safety. It also recommends that the Department consider how primary care services can be reconfigured across a range of health and social care professionals to deal with the increasing demand for GP appointments.

Recommendation 21 is interesting. As the Chair has already stated, it calls on the Department to produce an estimate of the size of the workforce that will result from Transforming Your Care. This should really be a given. It is surprising that the Department, at this stage of Transforming Your Care, has not carried out this very basic exercise. There are also some real concerns about how the VES (voluntary exit scheme) is being carried out. Such a sizeable movement of staff needs to be a core part of the workforce planning group's work. These need to be strategically aligned urgently to mitigate negative impacts on service delivery.

There also needs to be a common understanding of what TYC is. Is it an ethos? Is it a realisable objective? There seem to me to be a lot of mixed views among stakeholders responding to the Committee. In the Committee's view, the approach to Transforming Your Care of not working to a measurable, costed plan raises key concerns and questions in terms of monitoring, governance and funding. How can an organisation work towards key objectives if there is not a shared view on what they actually are? There is no certainty about what the specific aims and objectives actually are. These are some fundamental basics lacking here, in my view.

There is no doubting the potential in Transforming Your Care. There is no doubting the benefits that there are to be gained. In a situation like this, we need clear leadership and we need clear direction. That would instil confidence in the workforce about where the health service is going and when and, until we get that, we will continue to have all sorts of problems.

It goes without saying that we need a Minister in post to give that leadership and direction. Again, we have a situation where we do not have someone at the helm to respond to the needs of our communities and our workers. This is people's health; this is people's lives; this is a crucial issue for the people whom we represent. Mr Hamilton should really step aside if he is not going to do the job. A lot of people out on the street and around the country would tell you that they would get sacked on the spot if they were not to turn up to work on a Monday or Tuesday morning, as the Minister has been doing for the past few weeks. Of course, Ministers are responsible for billion-pound budgets, so it is a reasonable point made by people that Ministers responsible for those kind of things should be just as accountable as anybody else working in our society.

I have just noticed this morning that it has been noted that the Enterprise Minister is still at work. You have a situation where the Enterprise Minister has been at work, officially, for the past four days, and the Health Minister has not. I do not know what the priorities are within the DUP, but it is becoming increasingly clear that the Department of Health is not a number-one priority. There seem to be concerns that the Enterprise Minister needs to be in post to do his job and to sign off on certain things, but it is not as important that the Health Minister be in post.

Photo of Robin Newton Robin Newton DUP

I ask the Member to conclude his remarks.

Photo of Kieran McCarthy Kieran McCarthy Alliance

I thank the Member for giving way. Does he agree that it is disappointing to hear the present Minister — I do not know whether he is present or not — dismissing the fact that, because he was not there, progress in the health service would not be affected in any way?

Photo of Robin Newton Robin Newton DUP

The Member has an extra minute.

Photo of Daithí McKay Daithí McKay Sinn Féin

The Member makes a very important point. Some will argue that the Health Minister has one of the most important jobs full stop. Making the argument that it is perfectly acceptable for that post to be left vacant for a few weeks or a few months is absolutely ridiculous.

If the Minister does not want to do his job, let somebody else do it. Let somebody else from the party or someone else in the Assembly do it. There are plenty of capable people across all parties here who should take up the mantle if he is not going to do it, because this is people's health that we are dealing with. The DUP may be more concerned about wind turbines and wind energy at the moment —

Photo of Robin Newton Robin Newton DUP

I ask the Member to conclude his remarks.

Photo of Daithí McKay Daithí McKay Sinn Féin

— but it should be more concerned about hospitals and waiting lists.

Photo of Rosaleen McCorley Rosaleen McCorley Sinn Féin

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. Cuirim fáilte roimh an rún seo inniu, agus aontaím le gach rud atá ráite ag na daoine eile. I welcome the debate today and agree with everything said so far by other Members.

TYC was brought forward as a new policy direction for the delivery of health services by the then Minister in 2011. At that time, it was anticipated that £83 million was to be spent and that the shift left would move services from hospitals to community settings in what was seen as a positive move to reflect the changing needs of our population. Agus d’aontaigh muid uilig go raibh athrú de dhíth. We all agreed that change was needed.

The reality is that our health service is constantly under pressure and often in crisis. We live in the context of a growing ageing population; an increase in long-term illness; a constantly growing demand on hospitals and services; a continual drive for greater productivity and value for money; and a workforce that is changing in profile all the time. TYC was heralded as the right direction to take. It was always a requirement that, given such a major change in how services were to be delivered, there would be significant implications for staff in terms of training, work location, job profile and skill sets.

In that context, the Committee agreed to undertake a review of workforce planning to support the implementation of TYC, taking evidence from a wide range of stakeholders. D’fhoghlaim muid cuid mhaith ó na daoine siúd, ach is cúis díomá é an dul chun cinn go dtí seo. We learned a lot from those stakeholders, including that progress to date has been disappointing. The evidence given to the Committee shows that there is a lack of clarity in the planning timetable for implementation. There were failings in the communication between the Department and staff bodies. The regional workforce planning group was set up in 2012, but we learned that, by April 2015, all it had succeeded in doing was producing a planning framework. At a time when we would have expected to have seen many changes bedded in, it seemed an unnecessary delay to be still at the planning framework stage.

A couple of years ago, the Minister said:

"my aim is to have a health and social care system that is safe, resilient and sustainable into the future. For that to be the case, it is essential that we take decisions that will ensure that our services are fit for purpose for the challenges that lie ahead. To achieve that vision, we need to look at how we can improve our health and social care and, in so doing, reshape how we interact with all those who use our services." — [Official Report, Bound Volume 78, p95, col 1].

Cad é a tharla ó dúradh sin? What has happened since that was said? The allied health professionals and the Association of Social Workers told us that they were unsure whether new service models were even being planned for their workforce as part of TYC. Further to that, there was no clear picture of whether a new model operating in one trust area would happen across all trust areas. To illustrate this, the allied health professionals said that, under TYC, some trusts have introduced a practice that enables paramedics to assess, treat and discharge. That is a positive development, but it does not apply across the North as a whole, and they do not know whether it is planned to be so in the future.

Similarly, the BMA advised that it has no evidence that investment has been shifted from hospital settings to primary care. The Royal College of Nursing pointed out that there had been a decline in the number of community nurses over recent years, which seems to be out of step with the shift left under TYC.

During the review, we also heard from trade unions that represent healthcare staff in relation to the impact of the shift left on the workforce. They told us that most organisations were not aware of how that had affected staff on the ground. Having been told earlier by the Department that £25 million had been spent to date on TYC, the trade unions further stated:

"Even though we have asked for it three times, we have not yet seen a breakdown of where the £25 million was spent, how it was spent and where it was applied."

Níl aon bhriseadh síos go fóill ar an chaiteachas go dtí an pointe seo. There is no breakdown yet on what has been spent to date.

We also know that there is a looming GP crisis if steps are not taken soon to address very serious concerns. Our GPs are the valued first point of contact for most of us in the health service, yet we have the lowest number of GPs per head of population here compared with other regions. It is the oldest GP workforce, with 24% over the age of 55 —

Photo of Robin Newton Robin Newton DUP

I ask the Member to conclude her remarks.

Photo of Rosaleen McCorley Rosaleen McCorley Sinn Féin

— and we have an ageing practice nurse population.

Finally, I would like to refer to the recommendations of Claire Keatinge, the Commissioner for Older People —

Photo of Robin Newton Robin Newton DUP

The Member's time is up.

Photo of Rosaleen McCorley Rosaleen McCorley Sinn Féin

— which are still sitting on the Minister's desk a year after they were recommended.

Photo of Robin Newton Robin Newton DUP

The Member's time is up. I call Ms Jo-Anne Dobson.

Photo of Rosaleen McCorley Rosaleen McCorley Sinn Féin

I call on the Minister to immediately get back to work and implement the workforce review.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I also welcome the opportunity to speak on this issue. Unfortunately, however, as my colleague Michael McGimpsey said, it appears that Mr Hamilton once again has decided that he has better things to do than to be held to account by the Health Committee. Of course, this is the same Mr Hamilton who thought it appropriate four weeks ago to neglect the plight of the 373,000 people waiting for a first outpatient appointment, a diagnostic test or an inpatient treatment at hospital. Then, last week, he failed again to respond to the Ulster Unionist debate on cancer and the SDLP motion on autism. So, today, it has come as no surprise that he thinks it is acceptable to avoid some of the most pressing issues facing his staff across the health service.

The Assembly has spent considerable hours discussing Transforming Your Care. Much of the debate has been constructive, although some of the rest has been less so. Few people will object to the overall objective of the plan, not least in ensuring that Northern Ireland's health and social care system meets patients' needs well into the future. Unfortunately, however, the initial report also made a number of errors. Its comments regarding 50% of statutory care homes were unnecessary and utterly took away from the value of it. Of course, the decision by some of the health trusts to equate the phrase, "at least 50%", to effectively mean 100% was totally disingenuous and caused very real hurt. I well remember meeting scared and frightened care home residents in my constituency, so I think that policymakers need to be much more sensitive when formulating their words.

Of course, aside from that, the implementation of TYC has been completely bungled. As was highlighted in the Committee, the Department could not even give a proper answer on how the £25 million, so far, had been spent. My party has always warned that seeking to move in excess of £80 million from secondary to primary care, at a time of growing pressures, was always unlikely. The Department effectively left the future of TYC at the mercy of monitoring rounds.

Members, demand is changing. As recently revealed by the Northern Ireland Statistics and Research Agency (NISRA), the number of people aged 85 and over has grown by over 1,000 each year in the last decade. During that time, the population aged 85 and over increased by 41% — six times faster than the population aged under 85. Whilst that is very welcome, it ultimately has an impact on the health service as it adapts to supporting more people with chronic conditions for longer.

However, the Department is failing even to plan for the present, let alone the future. There are serious staff shortages across our GP service, with many over 55 set to retire next year in radiology and emergency medicine, to name just a few. If people cannot see their GP on time, many of them will be forced to attend A&E, which, in turn, will cause further delays there. That led to our recommendation for the Department to prioritise the recruitment of an additional 50 GP training places.

So TYC was broadly heading in the right direction, albeit with those few issues that my party would like changed, but it was never given the attention that it deserves. The last number of Ministers have referred to it in high-level terms only, as if it was a convenient strategy to use as a fig leaf when they were challenged on what they were doing in regard to the growing problems across our health service. I hope that the Department will read the Committee's report, but if it is not followed up with action then, ultimately, it has been a waste of our time, a waste of their time and a waste of time for the staff and organisations that contributed so openly to it.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin 11:15 am, 13th October 2015

Go raibh maith agat, a Cheann Comhairle. I first want to thank the Members for their contributions today. Suffice to say that all of the Members who spoke reflected on the fact that we have an absentee Health Minister. Particularly in the hugely important and very human remit that is health, it is nothing short of a disgrace that, when we are debating critical issues like workforce planning, we have no one to act, listen and respond accordingly.

First of all, I want to refer to a number of Members' comments. Fearghal McKinney highlighted the lack of strategic planning in relation to Transforming Your Care, its implementation and its investment, and referred to the clear consensus that we were actually moving towards a plan that was not being implemented.

Michael McGimpsey said that the system does, of course, need a lot of planning and that part of that engagement has to be proper and meaningful engagement with staff. He specifically referred to the regional planning group, which had excluded the staff side, and called for immediate and proper re-engagement with the staff side.

Kieran McCarthy talked about the extreme difficulties that the health service was experiencing, and said that what is happening in our health service is actually a shambles. He stressed the need for staff involvement in workforce planning.

Daithí McKay is surprised that the Department has not carried out an estimate of workforce requirement. That is a critical piece of learning that has come from the review and the need for a common understanding around Transforming your Care. He questioned whether it was a policy direction or simply an ethos. There was no certainty on what the objectives were. He said that, if the Minister does not want to do his job, he should simply step aside.

Rosie McCorley talked about the reality of the health service, which is currently under extreme pressure. Again, there is a lack of clarity on the way forward. All that had been produced over the period of years was the planning framework. She questioned why so much more had not been implemented.

Jo-Anne Dobson referred to the fact that, given the last number of weeks and our in-out Minister, it is no surprise that the former former Health Minister finds it acceptable not to turn up today and respond to the needs of our staff. She also questioned the 50% target for closure of residential homes that was contained in Transforming Your Care and the fact that the report needs to be followed up by actions.

I just want to refer to another few points in terms of the review. As many have stated, the review contained 18 recommendations, and much has been said in relation to GPs. Critical to that, however, is the entire primary care workforce. As my colleague Rosie McCorley said, that means addressing issues around allied health professionals and, indeed, front-line community and district nursing. We heard very specific evidence from the BMA and the college of GPs. They certainly threw into question the Department's commitment to the goal of Transforming Your Care in terms of leadership.

Both organisations — we should not lose sight of this — referred to a crisis in general practice that cannot be ignored. The BMA and the college of GPs highlighted their concern — again, some Members mentioned this — around the number of GPs. The college said:

"we have the lowest number of GPs per head of ... population ... the oldest GP workforce, with 24% of our GPs over the age of 55; and an ageing practice nurse population."

It went on to refer to the:

"three workforce reviews since 2006, with each highlighting the need to increase the number of GPs."

I suggest that those concerns have, quite simply, fallen on deaf ears.

In conclusion, I thank the Committee members and the staff and researchers for their very robust work on the inquiry and recommendations. Three years into Transforming Your Care, the very benchmark of the delivery of TYC, namely our staffing requirement, is not yet resolved. It is simply not good enough that while, over the last three years, 1,620 staff posts were under threat, now, in the last number of months, we have been told that that was simply a working assumption.

Photo of Kieran McCarthy Kieran McCarthy Alliance

I am very grateful to the Member for giving way. We all recognise the problems that she is indicating. You will know that the junior doctors are facing an immense plight: their contracts are up for renewal, and there are proposals, as Fearghal McKinney said, to reduce their pay. What would you, as Chairperson of the Committee, say in view of the fact that we have just conducted this very important inquiry about workforce planning? Where are we going if that junior doctor contract is allowed to go ahead in the way that they are talking about across the water?

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

I thank the Member for his intervention. He is absolutely right. The very clear message is that, at a time when we need to be supporting primary care, which means addressing issues like recruitment and retention, it seems that the most vulnerable end of the system is being targeted. It is a sad indictment that we do not have a Health Minister at his desk to ensure that those changes to contracts are not implemented here and that we protect the rights and entitlements in the contracts of junior doctors.

In conclusion, our health service needs radical reform. That view is not just from me or the Health Committee and most members on it. It has been well documented by many sectors, including professional and staff sectors. The system is complex and overly bureaucratic and it lacks accountability. We need a Minister, for workforce planning and many other issues, to deliver that blueprint. We need a Minister for health, not a Minister for half an hour.

Question put and agreed to. Resolved:

That this Assembly welcomes the Committee for Health, Social Services and Public Safety's review of workforce planning; and calls on the Minister of Health, Social Services and Public Safety to ensure that workforce planning is fully integrated with the implementation of Transforming Your Care.