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.