Medical School in the North-west

Private Members' Business – in the Northern Ireland Assembly at 11:00 am on 29th November 2016.

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Photo of Robin Newton Robin Newton Speaker 11:00 am, 29th November 2016

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 to make a winding-up speech. All other Members who are called to speak will have five minutes.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I beg to move

That this Assembly notes the support of the Minister for the Economy and Minister of Health for the establishment of a medical school in the north-west; acknowledges the positive impact of a medical school on the delivery of medical and health services in the north-west and that it would be one element in the expansion of student numbers and courses at Ulster University at Magee; calls on the Executive to work with Ulster University, the General Medical Council, the Government of Ireland and other stakeholders for the establishment of a medical school in the north-west; and further calls for a Programme for Government commitment to establish this medical school early in this Assembly mandate.

Members will have heard me raise the issue of the establishment of a medical school in the north-west before, and, indeed, it has been raised by others. For some longer-serving Members, the north-west medical school will have taken on almost mythical proportions as it has popped up, disappeared and resurfaced a number of times over many years. In proposing the motion, I call on the Executive to ensure that the medical school becomes a reality soon and does not disappear again.

I believe — well, I certainly hope — that I am pushing at an open door. The motion acknowledges the support for the proposals that I recently received from the Minister of Health and the Minister for the Economy respectively. However — please excuse my paranoia — we have been here before, hearing warm words but seeing no action. That is why it is imperative that the Assembly signals its support and the Executive signal their intent with a concrete commitment.

Ulster University is trying to get the project off the ground. The project will not only have a very positive impact on the delivery of health services in the North but be one element in the long overdue and much-needed expansion of Magee. While it is early days in the process — they are at the first of eight stages with the General Medical Council — Ulster University is showing real ambition to deliver this for Derry, and that is not something that anyone in the Assembly will have heard me say before. It wants to open the doors in September 2019, with the first graduates in 2023. These efforts require and, indeed, deserve the full support of the Assembly.

Why would the Executive not do everything in their power to make this happen? It ticks so many boxes. It is hard to think of an initiative or intervention from the Executive that would be guaranteed to ensure as many positive outcomes for as relatively small a stake.

The vision is the establishment of a graduate-entry medical school that will increase the number of skilled people here who are committed to careers in medicine and healthcare, bolstering an existing workforce that is spread too thinly and worked too hard, particularly in rural areas. Every week, we hear of the struggle to attract people to and retain them in various posts and the inevitable knock-on effect that that is having on patient care, as waiting lists spiral out of control, regardless of how they are computed. Just this morning, we see another report on the A&E department at Altnagelvin and the difficulty that staff shortages are causing it and the patients who attend it.

This is in no way a criticism of our hard-working healthcare staff. They have been failed by poor workforce planning as much as patients have.

Year after year, the Western Trust tops the chart when it comes to money spent on locums and agency staff due to fixed staff shortages. Locums are not low cost. Last year, the trust spent over £11 million on medical locums and is on course, I believe, to exceed even that again this year. This is money that, had we got our workforce planning right, could and would be spent on other services. It would be a welcome boost for someone waiting for a new hip, someone waiting for a mental health diagnosis, someone waiting for a gall bladder operation or a group providing vital services with no funding whatsoever. That figure relates to locums in just the acute sector. It does not include money that is spent trying to plug holes in the great ship of general practice, the captains of which tell us is about to sink.

Dramatically increased workload is one factor that has led to difficulty in recruiting and retaining GPs, and the demographic of those remaining means that urgent action is needed to ensure that numbers do not fall even further, or we will see even more practices collapse.

Evidence suggests that workers are more likely to be retained close to where they are trained. The creation of this school will end up saving our health trusts millions. It is not just going to benefit the Western Trust. Graduates from this medical school will be available to other trusts. There will be more people qualified to fill essential roles across our health service. I think that, currently, about 20% of newly qualified doctors hop on a plane and end up working elsewhere. The beauty of a graduate entry level school is that that is statistically a lot less likely to happen. People starting and qualifying here are likely to be a wee bit older, more likely to have commitments here and less likely to fly off to find themselves and work elsewhere.

It is envisaged that the school would have an enhanced or particular focus in the areas of primary care, general practice and chronic disease management. Those areas will become increasingly important if we are to finally see our healthcare system transformed into one that copes with current demand and is equipped much better for the future.

The new model for healthcare will require a much more interdisciplinary approach — closer working between doctors, allied health professionals (AHP) and nurses. So, ideally, training in the future should be delivered as such. Therefore, I question the logic of Ulster University, which is currently in the process of moving AHP courses like physiotherapy from its campus in Jordanstown to Coleraine. While there appears to be a genuine desire to get this medical school located and situated in Derry, it would, surely, be a much more sensible decision to shift these courses to Magee.

It is essential that the school will have strong links with the community, even more so given Professor Bengoa's recommendations. Further scope for collaboration exists with the new radiotherapy unit at Altnagelvin — itself a powerful symbol of what can be achieved when we look beyond Belfast for solutions to our problems.

The radiotherapy centre is also the product of North/South collaboration. Close working with the South can only add to what a new medical school has to offer. I believe that, just today, representatives from Ulster University are meeting counterparts from Galway to discuss potential opportunities for shared placements and teaching. Cooperation could also open up new opportunities in cross-border healthcare service provision, medical research and economic development.

I referred earlier to Ministers having previously stated their support for this project. Just last week, Derry City and Strabane District Council supported a motion from my party colleague Tina Gardiner on the issue.

There is also clear support from highly respected professional bodies. The BMA recognises the role that a medical school in the region, particularly one that specialises in GP training, will have in helping to address the chronic shortage of GPs in the area. Integral to that equation is the creation of more GP training places, and we welcome the Minister's announcement on that. The Royal College of General Practitioners (RCGP) also indicated, when I asked them recently at the Health Committee, that this proposal is clearly a winner. Looking elsewhere, the establishment of new medical schools creates competition and drives up performance. That is very evident in Wales.

I am conscious that, as my party's health spokesperson, I have spent all this speech so far focussing on the undoubted health-related benefits of the proposal, and it would be remiss of me, as a Foyle MLA, to not touch on the huge economic benefits it would bring. It has long been accepted that the expansion of the university is key to the economic regeneration of the north-west. What needs to be accepted by the Executive is the need to do something about it. Supporting the motion and making this proposal happen will be a clear step in the right direction.

There is research that demonstrates that every £1 spent on a medical school generates £8·50 in the wider economy, and Derry is a city that is in desperate need of a boost like that. The infrastructure windfall from the autumn statement, albeit smaller than we had hoped for, could be used — well, certainly some of it —

Photo of Robin Newton Robin Newton Speaker 11:15 am, 29th November 2016

I ask the Member to conclude his remarks.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

— for the infrastructural work at Magee that is essential for its expansion.

Photo of Gary Middleton Gary Middleton DUP

I welcome the opportunity to speak on the motion. As a Member for Foyle and a constituent who lives in the Western Trust area, I am all too aware of the specific challenges that face our area, not only from a health perspective but from other perspectives as well.

Specifically on the health challenges, we know from our regular briefings with the Western Trust that there are significant budget challenges and difficulties in recruiting and retaining staff in the area. In March, my colleague, the then Health Minister, Simon Hamilton, had an initial meeting with Professor Patrick Nixon from Ulster University, to discuss the proposal to establish a graduate entry medical school in the north-west. At that time, the Minister said that medical locum costs in the Western Trust had trebled in the past three financial years and were projected to be £12·5 million for 2015-16. As the previous contributor said, the medical locum costs for the incoming year are expected to reach £16 million, which is unsustainable. Those significant locum costs are a direct result of being unable to recruit staff and secure them in the trust. That is having a wider impact on the Western Trust through the deficit that is incurred. Of course, the trust is unable to spend the money that is being spent on locums in other priority areas.

A graduate entry medical school in the north-west would go some way to addressing those challenges. Research shows that the majority of people stay to train and work in the place where they study at university. That is what we want to try to help address the issues in the west. When medical staff and doctors are trained, we want them to stay, because that will help address the shortages.

Whilst the medical school will service a much wider area than my constituency, Londonderry is suitably placed, with the newly opened radiotherapy centre, the innovation work that is ongoing with C-TRIC and the outstanding medical courses that already exist in Ulster University at Magee. There are also very strong partnerships with Altnagelvin Area Hospital, and they bode well for any future medical school.

Through our work on the Health Committee, we have heard from various organisations that fully support the proposal. The General Medical Council (GMC), the BMA and the Royal College of General Practitioners have all voiced their support, and there is no doubt that this proposal will help to address the challenges arising from the shortfall in the number of GPs and other issues that face primary care.

The Economy Minister and the Health Minister have already outlined their support for the proposal and its benefits. We have heard from the SDLP and will no doubt hear the Ulster Unionists' view on the medical school. However, I was — no surprise — slightly disappointed this morning that the tone for the debate was set out in the media. The SDLP press office was extremely busy this morning in saying that it is proposing a new medical school for Magee university. It even created a new hashtag, #ConstructiveOpposition. I am sorry, but this is a case of johnny-come-lately rather than constructive opposition.

Photo of Colum Eastwood Colum Eastwood Social Democratic and Labour Party

Johnny-come-lately? I noticed Mr Middleton's Twitter account earlier. Does he not accept that this is an issue that was not decided in the last number of months or weeks? It is an issue that people in Derry have been arguing about and arguing for long before he or I was involved in elected politics.

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Gary Middleton Gary Middleton DUP

I completely agree with the Member. We have not said that we proposed the idea. The idea came from the Ulster University. For you to suggest that it was the SDLP that proposed it is deeply unfair and quite sad in reality.

We will support the motion. We strongly believe in a graduate-entry medical school. I look forward to hearing from other Members, but the commitment that the Executive no doubt will give is that they are focused on delivery rather than on cheap political point-scoring and cheap headlines.

Photo of Caoimhe Archibald Caoimhe Archibald Sinn Féin

I am pleased to contribute to the debate on the motion, which I will be supporting.

Sinn Féin has been to the fore of consistently promoting the expansion of Ulster University at Magee, and the further and higher education offering in the north-west in general. It is a region with huge potential, which we are seeing through developments at Magee, the North West Regional College and the North West Regional Science Park.

A continued focus on development and investment is required to promote the genuine regional balance of our economy that we all want to see. Education and skills are a part of that, and delivering those locally is necessary. The medical school project would very much add to the offering in the north-west and begin to tackle some of the issues in our health service. I will be rehearsing some of what has already been said.

Week in and week out — in our constituency offices, in our engagements with the trust, in the media, and here through questions to the Minister — we hear about long waiting times, staff shortages and difficulties in recruiting staff to the health service. The Minister has outlined her commitment to the reconfiguration of the health service. That reconfiguration needs to be at all levels right from the start of the cycle, and that begins with training of staff.

As a representative of a constituency partly in the Western Trust, I am all too aware of how difficult it is to recruit staff and of the disproportionate cost of locums in the trust area, as Mr Durkan outlined. Spending on locums in the Western Trust doubled between 2011-12 and 2015-16.

There is evidence that medical students and trainees are more likely to stay in the hospitals in which they train. Having a medical school in Derry would therefore have the knock-on effect of encouraging staff to take up positions in the locality and with the surrounding trusts in the longer term. We do mean the longer term, because we are talking several years by the time that the project would be implemented and the first cohort of students would have gone through.

That is how the Minister's plan for reconfiguration of the health service must be viewed. It must be allowed to have an implementation phase. That will be a process to address issues that have developed over decades, and there are no overnight quick fixes. It is a big-picture view that we need to take.

The Minister's plans regarding specialised centres will also begin to redress the imbalance in recruitment ability to some trusts, and it is likely that certain specialisms will be based in different regional hospitals. Those training in specialisms are therefore likely be based in those hospitals in the longer term. Hypothetically, that will have the knock-on effect of retaining staff in the appropriate specialisms in those hospitals.

If we look at the Western Trust as an example of where specialisms are already located, there are urology, radiotherapy and orthopaedics in Altnagelvin. In orthopaedics, in which there are specialisms within specialisms, there is a need for targeted recruitment, and the training of students in the location may help alleviate that, alongside other measures. Likewise, there are also recognised issues for GPs, as has been mentioned, and the Minister has begun to tackle this by increasing GP training places for 2016-17. Having a medical school in the north-west would hopefully attract trainees to practices in that locality and we would then have a better spread of trainees across the North.

There has been huge investment in Altnagelvin over the past few years, and the new radiotherapy unit as a cross-border service is a major development. That investment makes Altnagelvin a centre of excellence and, therefore, an ideal teaching location. The cross-border nature of the new radiotherapy centre needs to be used as the model for future service delivery, and we should look to attract students from the entire west of the country, and further afield, to a medical school there.

As Mr Durkan said, the medical school has the support of professional bodies and there needs to be collaboration with those to move the project forward. There should be further exploration of the cross-border potential of this project and building on our structural infrastructure on an all-Ireland basis in general as we plan for the future. The health service across the island faces great challenges, and we are too small an island not to be looking at how we can collaborate most effectively to deliver for all our people.

Photo of Steve Aiken Steve Aiken UUP 11:30 am, 29th November 2016

I support the motion from our fellow Opposition party for the establishment of a graduate medical school in the west of the Province. We believe that building on Northern Ireland's reputation for teaching medical excellence, as identified by Queen's University's position in the top 30 medical schools in the United Kingdom, will be beneficial in providing greater training opportunities for medical students, who will bring in a much-needed boost in student revenues, as well as strength and depth in our hospitals west of the Bann.

It is also appropriate at this stage to ask the Department of Health and the Department for the Economy to conduct a detailed review of how the HSC, the universities and our excellent life sciences sector — it would be remiss of me not to mention South Antrim in this context — can be brought together to maximise the teaching, research and manufacturing opportunities for all of Northern Ireland: for students, for patients and for our companies. However — I must declare an interest here, as the ex-CEO of a university fundraising organisation — medical schools can be very expensive to set up, to establish their reputations and they need to be properly resourced.

As a party, we welcome the opportunity to improve the provision of university places in the north-west, and, speaking personally, I would be delighted to see Magee expanded. I would also like to see the A6 prioritised to establish communication links there, and for Londonderry to become a global centre of educational excellence. However, we also need the physical and educational infrastructure to make it work.

In supporting the motion, we look forward to having discussions on increasing the opportunity for all medical training, medical teaching, research and manufacturing in Northern Ireland. Maybe, by doing this, we can, at the same time, do something about our shocking waiting lists across the health service.

Photo of Stephen Farry Stephen Farry Alliance

The Alliance Party supports the motion but not without some reservation. We will highlight some points that the proposers need to consider and some issues that they need to clarify.

In principle, we accept the need for a medical school, and it is in that context that we can support the motion. It is worth stressing that recent talk has been about a graduate-entry school, which is of a different nature from a situation where we are talking about undergraduates, with a particular focus on GP training and primary care. That is a particular pressure point in our health service that we are all very much aware of, and the solution lies in a number of interventions, including how we might shift some of the workload off GPs to other aspects of our health service. There are areas where GPs have taken on additional areas of responsibility almost by default, and there are unintended consequences. For example, free prescriptions are universally available, but that ends up with more prescribing being done, as opposed to people maybe talking with pharmacists. There is a host of other distortions in our health service passing burdens on to GPs.

Equally, we need to look at how attractive certain specialities are versus others in the health service and the number of places available. We welcome what the Minister has been saying about the need for more places, and it is in that context that we look to what we can do about expansion in the north-west.

I was pleased that Mr Aiken raised the issue of cost, because it is important that we have this debate in an air of realism and that people address the issue of cost. Hopefully, the Minister will give some indication of what her officials estimate the cost of this to be. We need to look at running costs, capital costs and the location. Are we talking about locating this on the current Magee campus, or are we looking to co-locate with Altnagelvin hospital or somewhere else in the wider city of Derry?

We also need to ask whether the proposers want to take this forward on a stand-alone basis, which may potentially be easier to fund, or whether it will be taken forward as part of the wider business case for the expansion of Magee. In that regard, I should stress that, in my final week as Minister for Employment and Learning, I received the final version of the business case — or what will hopefully be the final version of the business case. I am not entirely sure where the processing of that now lies in the Department for the Economy and the Department of Finance, never mind any formal decision-making by the Executive and decisions on funding.

The wider context is that we need to look to what is happening in higher education and the potential expansion of the sector. I can clearly state that I want to see the expansion of the university at Magee. I fully understand and appreciate the relevance to the city, the hurt that has been felt over 50 years because of decisions that were taken — quite in error, in my opinion — and the potential now for the transformation of the city for that investment. That is all taken as read.

We also have to appreciate that the expansion of Magee was not a formal commitment in the previous Programme for Government. People think it was: it was not. During the last mandate, we managed to expand Magee by several hundred places — about 650, to be accurate — and we have commenced the construction of the new £10 million teaching block, but this remains a long way short of the 10,000 additional places that people are looking for in the One Plan and, more recently, the strategy group under the city council in partnership with the university.

We have to be realistic before we can talk about expanding our higher education sector. I appreciate that medical school funding may be an issue for the Department of Health in isolation of some of the wider issues, but we have to recognise that we currently have a £55 million deficit in higher education. Before we can talk about expansion, we need to fix the hole first and make sure that the foundations are solid. When we published the Big Conversation paper in March this year, we talked about not just addressing the funding shortfall but looking to expand the number of places available in Northern Ireland in line with the needs identified in the skills barometer. Obviously, Magee can capture some of that, but more and more capital investment will be required to make this a reality.

Photo of Robin Newton Robin Newton Speaker

I ask the Member to conclude his remarks.

Photo of Stephen Farry Stephen Farry Alliance

The costs are significant. There is between £30 million and £40 million per year in running costs, and potentially several hundred million pounds of capital. It is important that Members are aware of that in terms of the full aspirations for expansion of the university in the north-west.

Photo of Trevor Clarke Trevor Clarke DUP

I rise to support the motion. I find it difficult following on from my colleague, who is from a constituency in the north-west. He covered the points reasonably well.

The motion uses the words "notes the support". The SDLP, in its opening remarks, said that this issue has been about for a number of years. I want to put it on the record that I note that this was not down in an Opposition debate, because it probably would have been an embarrassment for the SDLP and its Opposition partners not bringing this forward when they held the portfolio for Health. I am happy to take an intervention if they want to clarify that that is why it was not tabled on an Opposition day.

That aside, it is right and just that the people in the north-west have the services there. As my colleague outlined, it is well known that, if people are educated in an area, they are more likely to stay. We are all too aware of the issues in Health, and that is not diminishing the difficulties that the Minister faces in the years ahead in addressing that. That is addressing a legacy issue, and it will not be done overnight. The will has been there. My colleague mentioned the Economy Minister and, indeed, previous comments from the current Health Minister about these places in the north-west. We all agree that that would go some way to supporting that. I have nothing more to say, other than that I welcome and support the motion.

Photo of Michaela Boyle Michaela Boyle Sinn Féin

I welcome the opportunity to speak on the motion. First, I take the opportunity to congratulate all those involved in the new £50 million radiotherapy centre in the Western Trust as it opens its doors to the public for the first phase of admissions. This unique cross-border centre of excellence, with a complement of over 200 staff across a range of specialisms and expertise, will provide much-needed cancer care to many people from across these islands. It is just one example of what can be achieved when we put our shoulder to the wheel, with both Governments on the island working collaboratively and people not using it as a party political football.

The proposal to establish a graduate entry medical school in the north-west is, as has been said, at a very early stage, but we need to build on existing support for the school to be built west of the Bann. The Magee campus at Ulster University and Altnagelvin Area Hospital are already leading the way as centres of excellence for medical research and education. We need to build on that.

We are very aware of how much the Western Health and Social Care Trust spends on medical locums to cover the north-west. It has the biggest spend on locums, partly given its geographical location and the cost of travel and accommodation, but we continue to be the biggest losers in this regard. There are difficulties in attracting and retaining GPs and consultants in the north-west; there is no denying that. There is a revised induction and refresher scheme for GPs not currently practising in the North of Ireland to return to practising here. I welcome that approach, which goes some way to addressing the gaps here. I am keen to hear from the Minister on how it is progressing.

The establishment of a medical school in Derry will attract many young students from here, across these islands and further afield. Training home-grown young people here on our doorstep can be justified by the statistics and data provided by the BMA. Dr Tom Black, at the Health Committee in October, stated that we have over 1,200 GPs, or 950 whole-time equivalents, delivering the service, which is many fewer GPs per head of population than we had in the 1950s. That, he said, was an "extraordinary assertion", because the demand for GPs is rising as people live longer. We have a successful health service, but success creates more demand, and we feel that more in the Western Trust than in any other trust area. We need to bring forward incentives for GPs and others to live and work here.

I, too, listened to Mr Durkan on the radio earlier, when he stated that this would be a game-changer for the north-west. I agree, but he said it would be for the city. He has to think methodically: this goes beyond the city of Derry. It will work for the people of Coleraine, Limavady and, indeed, my area, Strabane.

Of course, this is not just about GPs. As mentioned earlier, we need more allied health professionals to work alongside our GPs, as not everyone going into a GP practice needs to see a GP. They need a physiotherapist, nurse, chiropodist or podiatrist. All of these people in primary care play an important role in reducing the pressures on GPs.

I welcome the work that has been done by our Minister to date. Significant challenges lie ahead for her and her Department in the transformation of services. The Minister is all too aware of the problems and challenges west of the Bann, and I know that she is committed to tackling them. As I said, proposals for the graduate entry medical school are at an early stage, but I urge the Minister and her Department to bring forward a business case as soon as possible. I support the motion.

Photo of Thomas Buchanan Thomas Buchanan DUP

I welcome the opportunity to speak in the debate. The concept of a medical school in the north-west based on the University of Ulster campus at Magee College, Londonderry has been in the melting pot for some considerable time. It is not something that the SDLP has dreamed up and put out today as its proposal. Over the past few mandates of the Assembly, the issue has been brought to the fore on numerous occasions —

Photo of Thomas Buchanan Thomas Buchanan DUP

— through questions for written answer, private Members' motions and, indeed, in the respective Committees, where the university has put forward its proposals. I give way.

Photo of Colum Eastwood Colum Eastwood Social Democratic and Labour Party 11:45 am, 29th November 2016

I thank the Member for giving way. Does he agree with us that the issue has been around for a long time and needs to be resolved, or does he agree with his colleague Mr Middleton that this was a proposal by his party colleague — last March, I think that was it, Mr Middleton?

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Thomas Buchanan Thomas Buchanan DUP

Thank you. The proposal has been put forward by the University of Ulster and not by any individual or party. For the SDLP to come out this morning and say that it is its proposal is misleading to say the least. To reinforce what my colleague said, on 24 March this year, my colleague Simon Hamilton, the then Health Minister, kick-started the process again when he met the University of Ulster's vice chancellor, Professor Patrick Nixon, to discuss the proposals for establishing a graduate-entry medical school in the north-west, which, I have no doubt, has the support of all the people in the Chamber today.

Moving forward, however, the development of those proposals and making them a reality is essential for stabilising our health and social care services not only in the north-west but in the entire south-west quarter of Northern Ireland. The Western Health and Social Care Trust is under severe pressure due to its dependence on medical and dental locums to meet demand at an unsustainable cost of £12·9 million, and the development of the proposed new medical school would help to address this ongoing issue while reducing the cost of locums. Although the Western Health and Social Care Trust has faced many difficulties in seeking to recruit medical staff west of the Bann, it has been proven — this has been said today — that medical graduates are more likely to seek employment closest to where they are educated. The development of a medical school would provide the platform that would attract and retain skilled people in the medical profession, especially from the entire north-west and south-west quarter of Northern Ireland. This in turn is good not only for the university and the Western Health and Social Care Trust but for our economy, skills development and the overall health and well-being of our citizens.

Ulster University and the Western Trust have been recognised as centres of excellence, and we must continue to build on this success and turn the west of the Bann into a magnet for medical students, doctors and staff to study, work and live.

Across the entire Western Health and Social Care Trust area — with Altnagelvin and its new cancer centre, the new South West Acute Hospital in Enniskillen and the new local enhanced hospital in Omagh — we have the platform and structure of excellence in place to attract highly skilled professionals in the medical field to train and work in this area.

The new South West Acute Hospital is one of the most modern and finest hospitals in Northern Ireland and is the envy of many other areas, but it must be properly staffed with sufficient medical professionals to allow it to deliver to its full potential for all its patients. The medical school will improve the recruitment and retention of medical professionals not only in the north-west but in the entire south-west quarter of Northern Ireland and the entire region, taking in the triangle model for the delivery of health by the Western Trust, which includes Altnagelvin, the South West Acute Hospital and the new hospital in Omagh. It is something that will deliver not only for the north-west, as we heard today, but for the entire south-west quarter of Northern Ireland, where the trust has the same difficulties in seeking to bring in medical professionals to work in the area.

We look forward to further discussions on making the university's proposals a reality in the area for the development of health professionals in the trust area and for the good of the people, the economy and health delivery in the Western Health and Social Care Trust area.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I welcome the opportunity to speak in support of the motion as the Ulster Unionist Party health spokesperson. It is an important issue. Educating sufficient numbers of doctors is essential in ensuring that enough are entering the profession locally. It is widely recognised that our health service workforce is not in a good or sustainable shape. In fact, there has been a total absence of workforce planning in Northern Ireland. That is now directly contributing to many of the pressures currently being experienced.

I am sure that many Members are acutely aware of the scale of vacancies across the local health and social care trusts. I have said this before, and I will say it again: a long-term vacant post, whether it is for a doctor, a nurse or an allied health professional, is about as much use as no post at all. The Department and successive Ministers have regularly gone to great efforts to boast of the number of nursing posts created, but they are loath to tell us that there are 920 posts currently vacant. Before we even consider today's issue of a new medical school in the north-west, the Department needs to be a bit more transparent in telling us what exactly the workforce needs are, including what demands there would be for recruitment from a large number of medical school graduates through, for example, Magee, if that were the case. I know from talking to my colleague Rosemary Barton MLA that there are chronic medical staff shortages in much of the Western Health and Social Care Trust. The pressures are particularly acute in general practice, with a frightening amount of County Fermanagh being on the brink of having no GP cover at all.

It would be remiss of me not to mention the particular situation in Portadown. Minister, you will be aware that we received further contact from a GP this morning. There is a very serious scenario unfolding there with a large number of doctors leaving in very quick order. That has left some of the practices looking over a precipice. I am aware that people are talking about managed dispersal. That is probably as impersonal and clinically cold in reality as it sounds. Minister, I would be happy to facilitate a meeting between you and local GPs in the town if you agree to meet them.

That is indicative of what happens when we do not properly workforce plan. Today's debate could possibly go some way towards fulfilling a need. However, increasing a number of medical school places, whether through a new school at Magee or anywhere else, would do absolutely nothing to soothe the current pressures unless it is accompanied directly by an increase in the number of medical training places. That is the crux of the issue: it does not matter how many people we educate through the universities; it all comes down to how many fully qualified doctors a new school at Magee could help to deliver. Of course, with Altnagelvin, the school would have a perfectly reasonable training ground on its doorstep. However, I suggest to the two Departments and Ulster University that, in their early assessments of whether a school would be viable, they should be ambitious about how they could deliver those training places. For instance, could the South West Acute Hospital, which is a facility that has some problems with recruiting and retaining a sufficient number of doctors, link formally to ensure that doctors are more proactively being sent to train and, hopefully, settle in areas where real demand exists? That is just one option; I am sure that there are many more.

I wish the Minister well for her future engagement with Ulster University on this issue.

Photo of Raymond McCartney Raymond McCartney Sinn Féin

I support the motion. I think that, right across the Assembly this morning, everybody is in support of the motion, notwithstanding that there are some issues about who was the first to propose this. They say that success has many mothers and fathers; we might need an expansion of the maternity ward in Altnagelvin hospital to cater for everybody who is going to claim success.

That aside, it is fair to say that, over a long number of years, the expansion of the campus at Magee has been very much part of the politics of the north-west; indeed, Stephen Farry, in fairness, talked about it. We all know the need for the expansion not just in the numbers of courses and students but in ways that will add to the strength of the university and wider. Obviously, that is in conjunction with the development of the A5 and the A6 and all other aspects. For us, it is about trying to address decades of uneven development. I acknowledge the fact that even Steve Aiken acknowledged the need for the development of the A6.

For representatives for Foyle and the north-west it is good to see that people are starting to see this and support it, and, hopefully, we will see some movement forward. It has to be acknowledged that the Minister for the Economy and the Minister of Health, who is obviously a party colleague, have also expressed their support for the medical school. You can place the medical school in that wider context, but, as an idea in its own right, it has its strengths. Therefore, on that alone, Ulster University has approached this in the right manner. It sees this as a project that will have to go through the rigour of business cases etc. The approach that it has taken, in particular the appointment of a full-time senior person in the university — Professor Hugh McKenna — to take it forward, is a good signal of its intent. It will not leave any gaps. This is not just some sort of concept. It is, perhaps, easy to say that we need a medical school, but the university will ensure that it has a rigorous case that is well presented. As a party, we met and had the presentation from the university. Last Friday, at the Unity of Purpose meeting, Gary Middleton and Mark H Durkan also got a version of that presentation from Hugh McKenna. The intentions and the desire but also the solidity of the case are being well made.

The innovation around this is the idea that it will be a postgraduate-entry school. The university, in presenting that, gave all the pluses around that and said clearly that one of the things, particularly at postgraduate entry in medical schools and in other courses, from experiences elsewhere, is the idea of what they call the 20:20 rule — people stay within 20 miles of where they were educated for 20 years. That is a big plus. If you add to that — people have already alluded to it — the fact that the Western Trust has a large bill for locums that is predicted to grow and with the focus and the emphasis being put on GPs, we can see how the business case will be improved by the fact that we will have postgraduate entry with a focus on general practice and filling that gap. That is how we should go forward with this.

Another emphasis that has to put on this is that it sends a signal with the right case well presented by the university. We have seen recently a change in the direction and the leadership of the university. The university, for the first time, is starting to realise, that, if it sends out the right signal when it, along with the rest of us, talks about the expansion of the university and the need and desire for a medical school, it must present it in such a way that the case will be made. Stephen Farry alluded to some of the problems in the past around this. There will be no gaps and no holes, and that is why it is important.

Photo of Robin Newton Robin Newton Speaker

Will the Member conclude his remarks?

Photo of Raymond McCartney Raymond McCartney Sinn Féin

I welcome the tone of the motion and the widespread support, give or take who was the first to say it. I will say it: Sinn Féin was the first.

Photo of Gerry Mullan Gerry Mullan Social Democratic and Labour Party

I welcome the opportunity to participate in today's debate. I will say at the outset that the focus of the debate should be on the best outcomes that we can achieve for our long-suffering constituents rather than on getting into party politics with disingenuous remarks towards other Members taking part in the debate.

It would be remiss of me, in the context of the debate, not to express my appreciation for the many health service staff who are doing a tremendous job in some of the most difficult and intolerable situations. It is no easy feat for them, and it is incumbent on the Assembly to do all that it can to alleviate the pressures that they are currently facing.

It is very concerning to read in 'The Irish News' today of a Regulation and Quality Improvement Authority (RQIA) report into Altnagelvin Hospital, which states that staff morale is low and that staff do not feel supported and valued. That cannot continue, nor can the current pressures. The Assembly really needs to act. Training more staff could go some way towards alleviating the pressures that staff are currently facing.

There have been many great developments in the Western Trust over recent years, such as the building of the South West Acute Hospital in Fermanagh, the new Tyrone and Fermanagh Hospital in Omagh and the substantial redevelopment of the Gransha site in Derry. In recent days, as other Members said, the new radiotherapy unit at Altnagelvin Hospital was opened. All those are positive developments and evidence of progress — progress that could and must be supported by the establishment of a dedicated medical school for the north-west. In that context, I welcome the Ulster University's proposal to establish a medical school in the north-west that would focus on graduates and GP training places.

However, to reduce vacancy rates in the trust area permanently, we need to set our sights higher, as there exists the possibility of training undergraduate medical students in future by utilising the Altnagelvin hospital and South West Acute Hospital sites. It is my belief that, if we are to accommodate future demand for services that are currently struggling not only in the Western Trust but throughout the North, we need to set our ambitions high.

The Western Trust has suffered for many years as a result of not being able to attract enough staff, whether doctors, nurses, midwives or others. That has resulted in significant gaps in the trust's current workforce. Many of our rural GP practices are facing extinction because of a chronic lack of available doctors and an ageing workforce, all of which has had and will continue to have an impact on patient care and outcomes in many communities. Waiting lists for GPs are growing, and we have already witnessed the gradual erosion of rural out-of-hours services in the west. The establishment of a dedicated medical school would go some way to alleviating those pressures and improving patient outcomes.

Those issues remain concerning, and I and the SDLP believe that much more medical staff recruitment can be gained if we have a stand-alone medical school for the north-west and indeed for the whole of the North. In looking at the potential for a new medical school, we need to look at costs. We are facing substantial pressures on the health service because of the failure of various reform initiatives, such as Transforming Your Care. In the last five years, the Western Trust has spent an unprecedented £54 million on locum and agency staff, not to mention current expenditure on bank staff. It is hugely concerning that only Belfast, which has a higher population density, has spent more on temporary staffing than the Western Trust. This question has to be asked: under the current financial arrangements, are trusts happier to employ staff on a temporary basis rather than to commit to full-time staff?

I will welcome the Minister's views on the issue and on whether she believes that the current financial arrangements and block grant funding for the health service are adding to the growing bills for temporary staff. I urge support for the motion.

Photo of Paula Bradshaw Paula Bradshaw Alliance 12:00 pm, 29th November 2016

I thank the SDLP for bringing forward the motion. As my colleague Stephen Farry said, we will not be opposing the motion, as we see no harm in investigating the potential for a medical school in the north-west. I put on record that we concur with what has been said here today about the crisis in the GP sector, not least in the west and north-west of the Province. However, we want to put on record some of our concerns about the proposal. It is, of course, very easy to present an idea like this to the Assembly, but once it has been costed and detailed sometimes the case ceases to be as clear-cut. It is, of course, one thing to support the establishment of a medical school in principle, but it is another to support it once the full business case has been explored.

It is unclear what precisely the proposal is. There is a reference in the motion to the expansion of Magee to include a postgraduate school for GPs. There is also a reference to a medical school ie a replication of what already exists at Queens, and that is quite a different thing. There is merit in the proposal for medical training at Magee, but what we want to hear from the parties proposing such motions is not just why the project is on their wish list but exactly how it will be delivered and funded, for an overall medical school would not be feasible.

Of course, funding is not the only issue. There are 34 medical schools in the UK. That means that, on average, there should be precisely one in Northern Ireland, which is exactly what we have. We need to be clear that, even with the proposed rise in the number of GPs to be trained, there is not enough to justify a second general medical school in Northern Ireland. In fact, for a medical school in the north-west to be justified, places would have to be taken from the existing school at Queen's. Maybe representatives in the north-west would support that, but I wonder whether the MP for South Belfast, in which Queen's is situated, would be quite so delighted.

We also have to consider whether the proposal fits with the thrust of the ongoing transformation process to which, I understand, the proposers have pledged support. This process includes regionalisation and thus centralisation of specialised services, and many will see medical training as a specialised service. Thus splitting it would run directly contrary to what is proposed here. The idea is to place all the available expertise at a single accessible site. Are we already beginning to see some parties being tempted to put local interests first? I want to hear some clarity on this if that is not the case.

In fact, this strikes me as a much longer-term project than the proposers indicate. Interestingly, it is perhaps one with a cross-border dimension. Is there a long-term case for a medical school in the west of Ireland with GP training at Magee but other courses elsewhere? Perhaps such a course sharing expertise and facilities may be much more financially viable, and may, in fact, contribute to expansion at Magee. However, it is a complex project, requiring greater cross-border agreement on regulations and qualifications than is currently in place. However, we cannot deny that that would take some time.

I do not wish to suggest that such a proposal is not possible, and I hope that I have shown that we could and should look at alternative means of achieving it. I am by no means anti-north-west, having lived in Eglinton on the outskirts of Derry for many years, and I understand the difficulties, the prejudice and disadvantage that people in that area have felt for many years. However, we cannot pretend that this is likely in the short term. It is one thing to support something in principle; it is quite another to deliver on it when purse strings are already stretched by the need to invest in reform while funding services in urgent need, such as tackling waiting lists, which are also crying out for intervention. Let us see a detailed business case for a cross-border school as part of the overall transformation process with a focus on the best possible outcomes for both patient and medic.

Photo of Eamonn McCann Eamonn McCann People Before Profit Alliance

There is no shortage of candidates to have been the first person ever to come up with this idea. It was not I who was the first person, for a starter, nor any party associated with me. The first time I ever heard the idea of a medical school at Magee mentioned was by somebody who is not a political associate or friend of mine, but it was by John Hume at least 25 years ago. There may have been somebody before 25 years ago that I am not aware of or others might have followed on, but John Hume of the SDLP was the first person who ever brought it up in my presence, and that was a long time ago, but not as long as I have been on the road about the University issue.

I was 20 when the University for Derry campaign was founded. I was outside this Building, along with a wide range of people from Derry and the wider north-west at that time, looking for a university. Here we are once again; here we go again. I am not saying that we are back at the beginning. I unequivocally welcome the idea which has been pledged of a medical school or a postgraduate medical school at Magee. I want to put that on record, lest anybody say that I am being begrudging and not welcoming of it. I accept the good intentions of everybody.

On the university's own figures and on the figures that we are talking about here, there would be 500 extra places at Magee if this promised project goes forward. An extra 500 places is absolutely to be welcomed, but it is a long way short of the university of 10,000 students that we were repeatedly promised, both by this place and the university itself. If that is gone and the target has been abandoned — it is not hardly mentioned here as a target at all — let people stand up and tell us, "We can't deliver what we promised". At the moment, those pledges are still on the table for a 10,000-strong student body; we are far from that.

In the last five years, Magee has lost courses in arts, computers and engineering, and life and health sciences have been closed entirely. Most ominous of all, the International Conflict and Research Institute (Incore), which is acknowledged everywhere as a world leader in conflict resolution, has been unceremoniously shifted to Belfast by way of the Maze. It was moved out of Derry, the idea being that it would be relocated as a peace centre on the Maze site. When that did not work out, it was shifted to Belfast. It is as simple as this: we want it back. It should be in Magee. Where better for a conflict resolution institution than in Magee? Where better for an expanding centre of culture generally than in Derry at Magee?

I jotted down a few of the names that came to mind when we look at the cultural richness of Derry, which should surround any university. A university should not be isolated from the cultural life of the community. Derry is the home of Colmcille, Docwra, Amelia Earhart, Seamus Heaney, Seamus Deane, Jennifer Johnston, Gay McIntyre, Brian Friel, Josef Locke, John O'Neill, SOAK, Joanna Fagan, Dame Cecil Alexander, Dave Duggan, Felicity McCall, Abby Oliveira and the Turner-nominated Willie Doherty. Those are just the ones that came to my mind as I sat here.

Photo of Danny Kennedy Danny Kennedy Deputy Speaker

Will the Member accept that most of those illustrious people whom he has named are now dead?

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Eamonn McCann Eamonn McCann People Before Profit Alliance

Well, actually, quite a number of them are not dead. How dare you bury them before their time, Mr Kennedy. I hope that that is not to do with the fact that they are associated with my home town, as it is easier to try to get rid of them. Gay McIntyre is not dead. Seamus Deane is not dead. John O'Neill is not dead. SOAK — Bridie Monds-Watson — is not dead. Joanna Fagan is not dead. Dave Duggan is not dead. Abby Oliveira is not dead. Willie Doherty, one of the most acknowledged sculptors on these islands, lives around the corner from me. Willie Doherty is certainly not dead; in fact, he was not dead the night before last, I can tell you. There are all those people.

What I am saying really is that a university of 10,000 students would be very happy in Derry. If those people were to come in, at least 1,000 jobs — good jobs by our standards — would come to Derry as well. They would be very happy in Derry.

I am not being cynical, but once bitten, twice shy. I have been bitten over and over again and am deeply cynical. I recall the fact that we have recently closed the law school at Magee, which we had been promised for years, and which opened eight years ago. It has now gone. So I am wee bit cynical. I will believe it when we see it; I want to see it. I encourage everybody to keep working on it. If this does not work out, we will have to look elsewhere for an expanded third education institution in Derry, whether it is transatlantic, cross-border, social enterprise or whatever. If the University of Ulster does not deliver, that does not mean that the campaign is going to go away.

This, too, is a legacy issue. It is part of the legacy of sectarian discrimination against Derry under the old Stormont Parliament. It is a legacy issue that has to be remedied in the same way as all the others. Let us do it, and, as I say, if this pledge does not work out, the game is not over.

Photo of Robin Newton Robin Newton Speaker

Minister, you have up to 15 minutes.

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

I start by welcoming the debate that we have had today. I thank Members for their contributions throughout the debate, particularly those on the positive impact made day and daily by health and social care staff in the course of their work. All Members realise that our healthcare system must change so that it can meet the challenges that we will face in the future. There is also a desire to engage creatively and positively in addressing those challenges. That is the correct approach. As I explained in 'Health and Wellbeing 2026: Delivering Together', which sets out my vision for the transformation of health and social care, we all have a responsibility to work together to ensure that we develop a system that delivers better health outcomes for people and which is sustainable into the future. Accordingly, I view the comments registered in the Chamber today and, indeed, the proposal for a medical school in the north-west, as positive.

At the outset, I want again to pay tribute to the dedication and commitment of all our front-line staff, who play a vital role in the delivery of high-quality care to our population across all sectors and settings. I cannot stress enough how greatly I value and appreciate the work that our medical staff do in the face of increased demands and the unique contribution that they make to the lives of patients, clients, and families daily.

The underlying issue that the proposal for a medical school seeks to address is the need to ensure a sustainable supply of well-trained doctors to serve in primary care and secondary care, particularly in the north-west of this island. I share the concern expressed by Members about the challenge of medical recruitment to these services and wish to assure the Chamber of my commitment to resolve and address those issues.

I fully recognise the current challenges that we have in attracting junior doctors to fill all the medical training positions that we have available across the North. It is troubling that medical graduates from Queen's University are not taking up all the 267 foundation posts available. Furthermore, and increasingly, foundation doctors are not progressing into speciality training programmes. In 2015, for example, only 150 of our output of 250 foundation doctors entered speciality training. The reasons for that noticeable trend, which is by no means unique to here, are multifactorial and will require persistence if we are to address them. I consider that effective workforce engagement and planning are key enablers to securing the needed transformation of Health and Social Care (HSC).

My Department is working closely with the North’s Medical and Dental Training Agency to ensure that all medical trainees across the HSC are valued and supported appropriately and that they are provided with up-to-date, high-quality medical training. I know that that is being reinforced by action by local medical management in the individual employing trusts. The key will be to make the HSC an employer of choice, and I am committed to ensuring that a workforce strategy to give substance to that objective is developed by May 2017. I also support the work of officials from my Department and the Health and Social Care Board, in close liaison with local GPs, to ensure that people living in south-east Fermanagh continue to have access to high-quality, sustainable and resilient GP services.

The motion raises the specific question of whether an additional medical school in the north-west could help to fill the current vacancies in junior doctor positions and the challenges of recruiting to GP practices in some of our deeper rural localities. I think that a medical school in the north-west has the potential to do that. It is noticeable, if not exceptional, for example, for healthcare systems across these islands, that about 80% of medical students graduating in the North go on to pursue a career in HSC here. That testifies to the value of the medical careers offered. However, it perhaps also demonstrates that there is a desire among many of our young people to serve the communities in which they have grown up and with which they have deep roots and empathy. A north-west medical school has the potential to tap into that.

That said, the next generation is likely to be the most mobile workforce yet, and the highly regarded doctors whom we train here will be much in demand, particularly across the English-speaking world. That requires us to engage purposively with our future medical graduates to ensure that we harness their skills for the benefit of the HSC in the future. Notwithstanding the real potential that a north-west medical college presents, the proposal is at an early stage and will take time to develop.

The strategic outline case submitted by the University of Ulster is a first and early attempt to assess the financial implications for my Department. The proposal explains some, but by no means all, of the investment that a completely new school would require. Initial predictions of capital costs for the Department for the Economy are in the region of £20 million, and the annual revenue pressure for my Department is placed at around £17 million. However, that assessment needs to be reviewed rigorously. Much further work will be required to understand the extent of the future medical workforce need and the likely costs, including additional costs, that would be incurred in any corresponding expansion of postgraduate training, particularly at foundation level. My officials will work with the University of Ulster to take forward that analysis and make sure that we complete all that work.

Of course, consideration will also have to be given to the challenges associated with establishing a new medical school and placing it on a sustainable footing. We must not shy away from those challenges. The recruitment of suitably trained clinical academic staff will be challenging. The regulatory and accountability challenges of setting up training programmes, which, under the proposal, will stretch across two professional regulatory regimes, should also be recognised and will take time to work through.

I believe, however, that we can overcome such challenges. A lot of potential could be realised for the people of the north-west, and I am committed to working with the university and the Department for the Economy and other Departments to taking it forward.

Mr Speaker

Photo of Carla Lockhart Carla Lockhart DUP 12:15 pm, 29th November 2016

I thank the Minister for giving way. I welcome her very positive remarks about the north-west, but I encourage her today to take note of the issues that are unfolding in the Portadown area. I know that I may be stretching this, but I really feel that it is imperative that you as Minister recognise the great need there and that that is addressed within the overall health reform.

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

I thank the Member for her intervention. You may be stretching it, but all politics is local. You and Jo-Anne Dobson have raised the issue, and I assure you that I am acutely aware of the issues that are unfolding in Portadown and have asked for an update this morning on all that is being done. There are locums in place, but we need to get to a stage at which we have a sustainable health service there and people feel confident in it. I assure you that we are doing everything that we can.

I hope that it is evident from my comments that I see considerable potential in a north-west medical school. I would like the issue to be explored further, and, as I outlined, a number of issues need to be considered in the time ahead as a way of advancing the proposals further.

Central to the consideration of this important issue is my transformation agenda. Last month, I launched my vision for the transformation of health and social care. We are about to embark on an ambitious transformation journey that will radically change the way in which we plan and deliver health and social care. As I have said, under the transformation process, I am committed to investing in the HSC workforce. Our staff are the greatest asset, and I recognise that they are under pressure. Over the last number of months. I have witnessed the outstanding work of all the staff, not least our medical staff and the positive impact that they have on people’s lives. The compassion and dedication of our staff continues to astound me. I am, therefore, committed to developing a workforce strategy early in 2017 and a range of other immediate actions to start to address some critical workforce challenges.

There will be a new approach to learning and team working. I want all those working in Health and Social Care to feel able to effect change and improvement in care rather than concentrating power at the top. We need greater collective clinical and professional leadership throughout the HSC, supported by skilled and able managers. That is why I have also asked my officials to develop a system-wide HSC leadership strategy to be produced by next summer. Resources will be invested to support staff and leaders to develop the necessary skills and behaviours that will be crucial as we move forward.

I anticipate that the transformation process will lead to a revision of the structure of services across the North and the development of regional programmes of care, which will deliver better outcomes for individuals. These are significant factors that we will need to consider carefully when assessing future medical workforce needs, the associated medical education requirements and how best we will deliver them.

In conclusion, I welcome the concept of a north-west medical school. I very much welcome this opportunity to focus attention on our undergraduate medical provision. I am committed to exploring the feasibility of the proposal and ensuring that we train the right number of future doctors to meet the needs of a transformed health and social care system that delivers better outcomes for all our population.

Photo of Robin Newton Robin Newton Speaker

I call Mr Colum Eastwood to wind up the debate on the motion. The Member will have up to 10 minutes.

Photo of Colum Eastwood Colum Eastwood Social Democratic and Labour Party

Thank you, Mr Speaker. I will try not to wind it up too much.

I am very grateful for the support from around the Chamber for our motion, which states that we note:

"the support of the Minister for the Economy and the Minister of Health".

This was not about political point-scoring; this was about putting a very important issue on the agenda. I will say again that I very much welcome the Minister's support today. This is a hugely important issue, and we do not want to play political football — whatever you want to call it — with it. It is unfortunate that a couple of Members decided to drag this down. One minute, the Opposition are being too negative, and then we come up with a very positive motion, and one of the people who called us too negative named his own Minister and singled him out for praise, but that is not good enough either. I am not sure what we have to do, but we will continue to raise the issues that are important to our constituents.

Mr Middleton was at a meeting — unfortunately, I could not make it, but my colleague Mr Durkan was there — last week when the University of Ulster said that it was delighted at the fact that the motion was coming before the House. I think that people are happy that we are addressing these issues. I do not want to get into the issue of who said what first, but Mr McCann is right. It was John Hume who first proposed this. Regardless of all that, that was 25 years ago, and we are still here without a medical school and with a chronic underfunding of our university sector, particularly Magee university.

Mr Durkan well outlined the case for a medical school at Magee. It is absolutely clear that it is not sustainable for the Western Trust to continue to fund locums at the value at which we are doing it. I think that, this year, the amount that the Western Trust will spend on locums will be up to £16 million. It is a fairly simple argument to make, in my view, that we could save an enormous amount of money whilst helping the economy by investing in a graduate medical school at Magee. Mr McCartney made this point, and it is a point that I have made many times.

If someone goes to a university, it is very likely that they will settle down and stay within 20 miles of that university. In fact, 80% of people who leave Derry or Belfast and go to Manchester or Liverpool end up living within 20 miles of that area. Obviously, we can all understand how that works. People settle down, get a job and stay there. We are losing that to our economy. We are losing over 30% of our young people who are going to university at age 18. They head away out of Northern Ireland, and we are losing that to our economy, to our society and to our families. I do not think that that is a way that we should order our society.

Many parts of our economy need to be turned around, particularly in places in my constituency, and, if we are serious about doing that, we cannot rely on just one fiscal lever. If we think that corporation tax is going to solve all our problems and that continuing to disinvest in our university sector is going to solve all our problems, we are barking up the wrong tree.

I have figures in front of me from the health service in the South. In the Twenty-six Counties, a shortage of GPs of between 493 and 1,380 is predicted. Why can we not address that shortage by training people in Derry? Many people across the Chamber have said that we have a GP shortage here. We know that. We have a huge GP shortage right across this island. This is a fantastic opportunity, and, as Mr Durkan said, the university is already working with people in Galway and in Limerick to try to make this a cross-border entity. Why not meet the need that we have right across this island for GPs? I think that Derry would be the ideal place to do that.

We cannot have a discussion about any kind of investment at Magee without recognising, as Mr McCann has, that this has been a 50-year struggle. We have not been very successful at meeting the promise that was asked for by the people who marched to this place over 50 years ago. That was over 50 years ago, Mr Speaker. This is not about us complaining about something that happened 50 years ago. This is about us being outraged that it has not been resolved.

I note that some people might say that this is about local interest. It is about local interest, but there was nobody in south Belfast jumping up and down when Queen's got places that it did not even ask for. Nobody talked about local interest then. It is about local interest, but, every single day, I will fight for the local interest that has been denied to people in my constituency and people west of the Bann, and others in the Chamber will do the same. It has been a disgrace that we still do not have a decent road to Derry, a decent road from Dublin to Derry or a decent university at the right size, 10,000 places, for Derry. It is a disgrace that that still has not happened, and we welcome any support that we can get around the Chamber for that.

We will not be distracted by people telling us that this is about a little local interest; this is much, much bigger than that. It is about righting an historic wrong that should have been righted many years ago. We will do anything that we can to support Ulster University and the work that Professor McKenna is doing to bring forward this proposal.

Let me be clear. Mr McCann asked about the commitment to 10,000 places. We are still committed to it, and I hope that other people are as well. This medical school would be a fantastic addition, if we could get it through, but that is all it is. We are not giving up on the campaign to finally and once and for all fund a decent-sized university at Magee in Derry. People in Derry will not accept anything less.

Question accordingly agreed to. Resolved:

That this Assembly notes the support of the Minister for the Economy and Minister of Health for the establishment of a medical school in the north-west; acknowledges the positive impact of a medical school on the delivery of medical and health services in the north-west and that it would be one element in the expansion of student numbers and courses at Ulster University at Magee; calls on the Executive to work with Ulster University, the General Medical Council, the Government of Ireland and other stakeholders for the establishment of a medical school in the north-west; and further calls for a Programme for Government commitment to establish this medical school early in this Assembly mandate.