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 —