Debate resumed on motion:

That this Assembly expresses its frustration at the lack of progress on transforming the social care system since the 'Power to People' report was published in 2017; notes that workforce shortages, care home capacity constraints and long delays to access community care packages are leaving too many people without the high-quality services they need, when they need them; welcomes the contribution of front-line staff, providers and community and voluntary sector bodies in the work of the social care collaborative forum; and calls on the Minister of Health to bring forward the key policy development priorities from that collaborative forum without delay, including the health and social care workforce strategy 2026, revised care standards for nursing homes, review of the carers’ strategy 2006 and residential care home minimum standards. — [Miss McAllister.]

Which amendment was:

Insert after "when they need them;": "is concerned that current charging arrangements for adult social care in Northern Ireland are unfair and inconsistent; believes the Department of Health should explore the potential benefits of independent price regulation within the care sector;" — [Mrs Dodds.]

I welcome the chance to talk about one of the most important issues facing Northern Ireland: the future of social care. There is no doubt that the system that we have is far from perfect. In fact, with still rapidly growing demand being increased by a rapidly ageing population, it is imperative that we take action now to get ahead of that while we can. Thankfully, when looking at the 48 proposals for reform that were revealed as part of the 2022 public consultation, I was glad to see the emphasis that is being placed on increasing not only the quantity of social care but the quality.

Without our social care workers, we simply would not have any provision. That is why our social care workforce is and remains one of the most important groups of all. That workforce allows our older people to remain at home. For those who cannot, social care workers are essential in supporting them to live well with their non-clinical needs. Any one of us who has had family members receive that care will have seen at first hand just how tirelessly our social care staff work day and night to provide quality care to many of the most vulnerable. That is especially true in constituencies such as mine, Fermanagh and South Tyrone. Every day huge numbers of people are assisted, regardless of whether they live in towns or at the bottom of any of our long and meandering farm lanes.

Of course, there is also a very important crossover between working in health and working in social care. Without the providers and workforce that we have, our hospitals simply could not or would not function. Whilst patient flow through our hospitals is often a problem, the situation would be even worse were it not for our social care system, which often goes above and beyond. That is why I very much support the key proposals to improve pay and terms and conditions for the social care workforce.

Yet, none of us, I am sure, are oblivious to the remaining challenges that are weighing down the sector. That is why I was glad that, earlier this year, a further cash injection was made. Unfortunately, however, despite the growing demand for social care, the Health budget that was agreed earlier this year fell far short of the recognised levels of need. Nevertheless, I absolutely recognise that the solutions are not dependent solely on funding.

We know that some aspects of the current system do not work in the way that we need them to. To address that, we need to look more widely at how social care is organised, commissioned, delivered and led. In addition, I especially welcome the previous consultation's focus on including greater powers to regulate and inspect independent sector providers of care. Every year, the role of independent sector provision becomes more important. Those powers must be seen not as a detriment to that provision but as something that works in the interests of everyone, including service users, providers and, fundamentally, those who pay for the service, be that individuals, families or the state.

I return to the fundamental issue of the workforce, because, without it, we would have nothing. That is why that issue is so important for the long-term sustainability of the sector and why it has to be tackled. I hope that the House sends a unanimous message today that social care is a good, rewarding and incredibly important career. I look forward to seeing reforms in the time ahead that further strengthen and stabilise our social care workforce and the sector as a whole.

I thank the Members who tabled the motion. I support the motion and the amendment.

We know the problems that face countless families across the North who are being failed by the current social care system. It is overstretched and underfunded. The issues affect everyone from our elderly and the most vulnerable to the workers who care for them. It has been seven years since the 'Power to People' report was commissioned, and we still face the same challenges: persistent workforce shortages, care home capacity constraints and long waits for community care packages. Those issues were only made worse by the COVID pandemic and the number of people who came out of the caring profession at that time.

In rural areas, such as my constituency of Mid Ulster, the challenges are even more severe. Families wait far too long for care packages, and care workers face travelling long distances and inadequate support. They are not funded to drive those distances or to provide the care that they provide; we know that. The Minister is well aware of that. The Department is looking at all those issues. I attended a meeting with Carers NI and carers from rural communities last week. They told me nothing that, unfortunately, I did not already know as a representative of a rural constituency. We know that the challenges for those in our rural communities are much more difficult.

The Reimagine Children's Collective, which we spoke about this morning, brings together 10 major charities, and it has echoed those concerns in its recent briefing on children's social care. It highlighted all the struggles that we will have without urgent reforms. I note that some commentary in the debate this morning was about collaboration: I absolutely agree with that. We need collaboration across Departments, but we need it mostly with our communities and the community and voluntary sector, because they really can deliver the services at good value. We need to ensure that that collaboration happens.

The amendment also brings an important issue to the forefront: unfair and inconsistent charging for adult social care. In areas such as Mid Ulster, where incomes are often lower and services more difficult to access, those inconsistencies hit families hardest. Independent price regulation is essential to ensure fairness. No family should have to choose between paying for care and other basic necessities.

Additionally, I emphasise the need for early intervention and prevention in both adult and children's care. Again, that point was covered in the debate on the motion this morning. We know that early intervention can make a real difference. I spoke about Sure Start, but many programmes deliver early intervention. I know that tackling health inequalities is a priority for the Minister. We will be able to do that only through early intervention programmes. I look forward to hearing what the Minister will say on that.

The community and voluntary sector, as I said, plays a vital role. We must ensure that it is properly resourced. It is not just about the amount of money that it gets — I know that the sector has made the Minister well aware of that point and that it is being looked at — it is about how the sector is funded and how the groups can work together on funding, instead of doing what we have done for years, where everybody looks at one pot and thinks, "How can I get some out of that?". They want to work together, and we need to fund them in a way that allows them to work together.

We must listen to the people whom we serve. We must listen to the families who are struggling in our rural areas. We must listen to the children and young people who require our services. We need a family charter that is co-designed with young people and parents. That would ensure that families know what to expect from the system and have recourse if standards are not met.

This is about equity, dignity and fairness. Social care reform cannot wait any longer. We have been presented with the tools to address the issues, and we now need to take the issue in hand and work with people such as the Reimagine Children's Collective and others to deliver on that. For our elderly, our carers and our children in Mid Ulster and in rural constituencies across the North, there can be no more delays. We need to work together to create a social care system that reflects the values of fairness and compassion and serves all citizens of the North equally, no matter where they live.

I declare an interest today because I have been a carer for most of my adult life: first, for my brother Michael, who has sadly passed away, and now for my father. My father is in receipt of social care support twice a day.

Care in the community depends on an effective social care system, but, from day one, the problem has been that the need for care in the community was set out and the plans were put in place but there was no preparatory work done to ensure that appropriate care was available in the community to support it.

Today, I want to talk about the older population. Northern Ireland has an older population, and we will see that demographic increase over the next number of years. While people live longer and many are healthier in old age, an increasing number of people are not in good health in their old age and will need support to continue to live at home. Too many have not received chronic pain support; too many have their mobility severely limited because of hip or knee replacement waiting lists; and the number of older people living with life-changing health conditions has increased. Many live in fear, the fear of how much it will cost in their old age, if they need residential care. That is why we will support the DUP amendment to our motion.

I have spoken to many older people who do not believe that their needs are being met by the health service. They feel that they are a problem for the health service. The care that they receive is limited and takes too long to access, and those comments were made specifically in respect of domiciliary care, particularly when the older person lives in a rural area. They have also told me that they apologise regularly to ambulance drivers if they are having to hold up an ambulance, as they see it, outside a hospital while waiting for a bed. That is not good enough. <BR/>According to the Alzheimer's Association, the social care system is not set up properly to deliver care that meets the needs of people, from the association's point of view, with dementia. In fact, many people living with dementia continue to be reliant on the social care system to help manage their symptoms. They will continue to require accessible, high-quality, affordable, personalised care, and it is therefore vital that the current and future care system is fit for purpose. That could be achieved through a fairly paid and sufficiently resourced workforce that is trained to understand the specialist needs associated with old age and dementia.

Social care systems must also recognise the value of unpaid care provided by families and loved ones. Local systems must proactively assess unpaid carers' needs, as per the statutory duty, on, at least, an annual basis and meet those needs through support and access to respite care to allow sufficient breaks from caring. Unpaid carers save the health service an absolute fortune. They prevent the health service from being bankrupt, but the pressure on them is crippling them.

Addressing the current insufficient and fragmented funding model must be a priority, and, as Ms Dillon has just mentioned, that fragmented funding model leads to silo working as opposed to joined-up working. It shifts the responsibility of care to individuals and families to achieve the vision of care in the community.

As a sector, adult social care contributes significantly to the economy in Northern Ireland. It is estimated to be worth around £1 billion, and that is in Northern Ireland. Cost savings are being met on the backs of unpaid carers, and, as others said earlier, a carers register is definitely needed.

I go back to dementia. People living with dementia make up around 60% of the people who draw on care at home in the UK, and 70% of those in residential care live with dementia. People living with or impacted by dementia often face catastrophic care costs. An individual with dementia spends, on average, around £100,000 on care in their lifetime. Therefore, it is important that we have a long-term social care workforce strategy. It should be mandatory for all GPs and care staff to undertake high-quality dementia training that is mapped to the dementia training standards framework or an equivalent standard. That recommendation was also made in the UK's Skills for Care workforce strategy, which was brought out in July 2024.

There needs to be a sustainable funding model for quality personal care that is centred on achieving affordable care for everyone living with dementia and other conditions. There also needs to be improved support for unpaid carers through proactively offered needs assessments and access to appropriate respite care. Today's motion, hopefully, sets out to the Minister the support that there is in the House for an improved social care system.

I call the Minister of Health, Mr Mike Nesbitt, to respond to the debate. Minister, you will have 15 minutes.

Thank you very much, Madam Principal Deputy Speaker. I welcome the opportunity to contribute to the debate. I thank the mover of the motion and the mover of the amendment.

I understand the frustration that many have expressed regarding the pace of reform in our social care system since 'Power to People' was published in 2017. I take this moment to emphasise that progress has been made, particularly in the context of significant external pressures and challenges that have impacted on the pace of reform.

Since the publication of the report, there has been sustained commitment to transforming our social care system. Several initiatives to address the systemic issues identified in the 'Power to People' report have moved forward. First, my predecessor, Robin Swann, consulted on proposals to deliver the vision outlined in 'Power to People'. The public consultation took place during 2022. It set out proposals to address the issues facing social care and to put in place tangible actions to create change that would significantly improve services. The post-consultation report was published last year. That consultation was by no means the end point; rather, it represented the groundwork necessary to ensure that the reform process was both sustainable and transformative in the longer term.

As Members have noted, one of the most significant developments since that consultation has been the establishment of the social care collaborative forum. The forum has provided a vital space to bring together a wide range of stakeholders, including front-line staff, care providers, policymakers, union representatives, regulators, representative bodies and service users. The forum's aim is to develop short-term solutions to alleviate immediate pressures and longer-term strategies for sustainable reform. Through that collaborative effort, key policy development priorities have been identified, and work is under way to address some of the most pressing challenges.

One of the first actions taken forward by the forum was to map the reform of adult social care consultation proposals against the forum work streams to ensure that, where we can, the reforms are delivered. Some of them will be delivered more quickly than others. Some will require legislative change. The vast majority will require additional and sustained investment to ensure that they make the transformational changes envisaged by the 'Power to People' report.

Through the work of the forum in 2023-24, we have implemented early review teams in the trusts, with a view to developing a regional model to monitor and review service users' home care needs and packages of home care, with almost 1,100 home care hours being recovered and allocated to cases of unmet need. We have also implemented improved digital solutions in trusts to more effectively manage the change in home care packages. We have sought to better promote social care as a valuable career choice by delivering the Making a Difference promotional campaign to showcase the value and diversity of social care, which includes the podcast series, 'Care to chat?', video stories showcasing the value of social care and digital posts about social care. Work in 2024-25 will focus on building a sustainable workforce, on improving commissioning and contracting arrangements and on developing improved partnership working.

One of the critical recommendations in 'Power to People' was the urgent need to address the social care workforce crisis, and significant steps have been taken to prioritise that. Although we continue to experience challenges, the sector has been prioritised for funding in recent years. The development of the social care workforce strategy also marks a considerable achievement by laying the foundations for addressing recruitment and retention issues in the sector. The strategy is central to resolving many of the workforce challenges that we face. It sets out a clear path to attract, train and retain the skilled staff necessary to deliver high-quality social care. The strategy focuses not just on immediate recruitment but on long-term development, offering a framework that recognises the importance of ongoing development and career progression for social care staff. Those measures are crucial, given the critical role that the workforce plays in delivering front-line care and in supporting those in need across the health and social care spectrum.

Some Members have said that not enough is being done on delivery and that we continue to consult rather than implement. The implementation of the workforce strategy will commence by the beginning of next year, and I am confident that the strategy will address many of the concerns that Members have raised about recruitment, retention, recognition and, indeed, remuneration. Additionally, initiatives to improve staff well-being and to ensure fair pay are ongoing, and those initiatives will undoubtedly have a positive impact on addressing staff shortages over time.

Work is ongoing through the social care fair work forum to build a case for change that seeks to highlight the potential impacts and benefits to be realised by raising wages in the social care sector to a real living wage. Although significant challenges remain, the collaborative work involving the Department of Health, the social care collaborative forum and workforce representatives has been instrumental in bringing us closer to a more sustainable workforce model. The forum's supporting carers work stream is currently commissioning a regional evaluation of the outcomes of the implementation of the Caring for Carers strategy from 2006. Work is due to begin shortly, and, on completion, my officials will identify relevant learning and key findings to inform the future strategic direction.

Cross-departmental work is also ongoing to consider how we can work collaboratively across government to address the issues identified in 'A New Deal for unpaid carers in Northern Ireland' from 2023. The current 'Care Standards for Nursing Homes' and the 'Residential Care Homes Minimum Standards' documents set out the requirements for registration and inspection of providers by the Regulation and Quality Improvement Authority (RQIA) to ensure that there is a consistency of approach and that residents, families and providers have a clear understanding of the standards that they can expect to receive or provide. People living in nursing homes have specific and sometimes complex needs, which usually arise from their own healthcare requirements. It is therefore important that the standards reflect the most recent developments, guidance, policy and procedures in order to ensure the provision of a safe and effective service with the appropriate quality of care.

I accept that the standards need a comprehensive review to ensure that they are fully reflective of best practice, learning and guidance and that they are relevant to the current environment in which the care sector operates. A working group, chaired by my officials, has been established to undertake a review of those standards. That review will involve ongoing collaboration and engagement with relevant social care stakeholders to ensure that there is clarity between what is considered to be best practice and what will be measured under the inspection frameworks. An initial exercise has been completed to identify potential gaps and revisions that may be necessary. My officials are considering next steps to revise the standards. Those revised standards will require consultation, and Members will have the opportunity to consider them in due course.

Members have also raised the issue of VAT recovery, and, as I have said previously, significant work is under way to consider the nature of that change, any potential operational, legal and regulatory implications and associated resources that may be required to allow for the recovery of VAT by independent care homes in Northern Ireland. A project manager and dedicated legal resources have now been appointed to drive that work forward as part of the wider review of the care homes contract. Legal colleagues have advised that it is not going to be possible to separate the issues of VAT reclamation from the wider review of the contract. Concerns have also been raised about the potential impact on smaller care homes, which may not be in a position to reclaim VAT, and that is being considered as part of the review. Officials also continue to liaise with counterparts in Great Britain, at departmental and local authority level, to gain a better understanding of the implementation and outworking of the VAT reclamation. It is paramount that any changes to the contractual arrangements between trusts and providers be reflected in the HSC care homes contract. The current HSC care homes contract that sets out the terms and conditions under which trusts commission services from care home providers has been in place for several years now and requires substantial revision.

As we move forward, I remain committed to tackling health inequalities and ensuring that social care reform remains a priority. By addressing these iniquities, we can build a system that not only provides high-quality care but does so in a way that is fair and equitable, ensuring that all individuals, regardless of their circumstances, have access to the services that they need when they need them.

My Department annually reviews the regional tariff rate for residents placed in residential care and in nursing home care, and the regional tariff rate is compiled on the basis of a breakdown of the costs of care. The amount that the rates are uplifted by each year takes account of increases to statutory uplifts to the national living wage and a range of other factors. It is important to note that, separate to establishing the regional tariff rate, independent care providers are responsible for setting their own care home fees. Top-up fees, also known as third-party charges, are set by the independent care home providers at a level that they deem to be appropriate to reflect market prices. Neither my Department nor the health and social care trusts have any role in setting or calculating those fees. I do, however, recognise that the tariff rates may not be fully reflective of the true cost of care, and work is under way within the social care collaborative forum to consider how the commissioning and contracting of care home provision across Northern Ireland is currently delivered. Finally, a finance task and finish group has been established within that work stream to review existing finance issues. As part of that work, consideration is being given to the regional tariff, third-party top-up fees and enhanced care rates. The group will also consider the inclusion of clauses provided for enhanced care within the tariff.

Thank you, Minister. I call Alan Robinson to wind up on the amendment. Alan, you have five minutes.

Thank you, Madam Principal Deputy Speaker. This is a very broad topic, so I will keep my comments very broad. It is one of the most important topics in the health structure, and it is a key pillar. How many times have we heard that if you fix social care, you begin to fix the wider health service?

We very much support the thrust of the motion in calling for action to transform our social care system since the 'Power to People' report was published back in 2017, but we were keen to submit an amendment for the reasons that my colleague Diane Dodds outlined. It has been seven long years since the report's 16 proposals were made, but critical issues outlined in that report and others thereafter remain unresolved. The expert advisory panel sought to make the case for transforming the way that the adult care and support system operates by way of 16 proposals, including valuing the professional and strengthening the support available to carers.

Our social care system is the backbone of our society, caring for the elderly, the vulnerable and those in need. However, as the motion states, workforce shortages, limited capacity in care homes and unacceptably long delays in accessing community care packages are leaving too many of our people without the high-quality care services that they need and deserve. It is safe to say that many unpaid carers are at breaking point, with one in four describing their mental health as bad or very bad. Several reports — some refer to review fatigue — state that we cannot continue to allow those gaps to persist.

In light of the ongoing challenges, I want to take a moment to recognise the incredible contributions of our front-line staff providers in community and voluntary sector organisations, particularly those who are unpaid, to whom I have just referred.

The system is under increasing pressure, with demand continuing to rise, which is due, in part, to an ageing population. However, social care is not just about older people; it is about the young man or woman with a learning disability who needs to move from a school setting into adult services; the elderly person who needs a care package to return home; and the person with mental health issues who requires support to move into supported living.

We can all give examples of cases from our constituency offices in which we have had to intervene. No family at the point of despair should have to come to our constituency offices and beg us to intervene. One case that stands out for me is from some years ago when I was a councillor. The daughter of an elderly lady had no respite and was so stressed, so broken and so guilty for feeling the way that she did that she attempted to take her own life. The daughter ended up requiring support, which put further pressure on the health service. That is the circle of despair that I have referred to in previous debates.

I am conscious of time, but I will turn to some of the comments from the debate. The proposer of the motion, Nuala McAllister, said that it was crucial that social care was properly supported. She also said that consultations were being used as mechanisms of delay. My colleague, Diane Dodds, in proposing our amendment, said that over 600 patients had had a needless stay in hospital, which was akin to locking the doors of the Royal Victoria Hospital. She referenced the need for better working conditions for domiciliary carers. The Chair of the Health Committee, Liz Kimmins, said that the unavailability of beds was creating a bottleneck in emergency departments. She said that she had never seen the scale of the challenges that are currently in the system.

Colin McGrath highlighted how the system is in crisis and said that we need action now. Diana Armstrong, whom I very much welcome to her new role, said that the system is far from perfect and that we need to get ahead of the game. Linda Dillon said that we face the same challenges since the 'Power to People' report was commissioned and that no family should have to choose between paying for care and paying for everyday items. Kellie Armstrong talked about her personal circumstances. It adds to the quality of debate in the Chamber when we talk about our own circumstances. She talked about the fear that older people live with and how they see themselves as a burden on the health service.

I thank the Minister for his contributions. He said that he understands the frustration at the pace of reform, and we all share that. He also referenced the importance of partnership working, recruitment and retention, and I thank him for that.

I call Danny Donnelly to conclude and make his winding-up speech on the debate. Danny, you have 10 minutes.

Thank you, Madam Principal Deputy Speaker. I thank all those who spoke in the debate. We can agree that it was a constructive discussion on a very important issue. I will touch on the contributions of other Members shortly.

We have spent much time discussing the many pressures facing our health and social care services, and social care, specifically, is facing unprecedented pressures. That is a consequence of increasing demand and constraints around funding and workforce. Short- and long-term vacancies are increasing across all aspects of social care. One particular concern is the uncertain future facing many workers who have come from EU nations, following the UK's departure from the EU.

Funding shortages remain a significant concern, which provides another example of the unsustainability of our current funding model, as we have discussed on previous occasions in this place. We also need to acknowledge that more people live longer, which, while it is undoubtedly a good thing, increases demand on social care services. We need to adjust how we approach social care to accommodate that. It is estimated that, over the next 20 years, the number of people in Northern Ireland aged 65 and over will grow by nearly 50% and overtake the number of children in Northern Ireland for the first time. To tackle those challenges, we need to see the urgent prioritisation of the recommendations from the social care collaborative forum. That includes maximising capacity by testing new models and rolling out innovative digital solutions.

We also need urgent progress on the social care workforce strategy, the social care career pathways and the continuous learning framework. We must provide specific support to unpaid carers who, along with paid staff, provide an invaluable service to those most in need. The collaborative forum recommended an expanded carers register for Northern Ireland to provide more information for unpaid carers and to help to improve their outcomes. That should involve consideration of the complete review of the 2006 carers' strategy that our motion calls for, ensuring that the strategy's aims and objectives continue to deliver the necessary decisions to improve the lives and conditions of our carers.

Greater research into and investment in supported living are another priority outlined by the collaborative forum. A clear definition is needed, along with clarification of the services provided by HSC and community and voluntary services, with the intention of ensuring an interdependent approach to maximise the planning and delivery of social care services.

All of that must be urgently progressed. Unfortunately, we have not seen such progress from the Department of Health, as has been pointed out. Other Members raised the risk of the Department and the Minister focusing too much on consultation rather than delivery. In some respects, that has been a problem in the work of the Department and the collaborative forum.

I welcome the DUP amendment, which we will support. As other Members and I have outlined, the current funding arrangements are unfair and require urgent review.

I will now move on to Members' comments.

Nuala McAllister proposed the motion, noting that investing in domiciliary and community care is an early intervention action and that our social care workers must be supported. Noting the 2017 'Power to People' report, she said that little has changed since and suggested that consultation is delaying change. She asked, "When will we reach the point of action, and when will people see the benefits?". She mentioned third-party contributions and the impact on families of the outdated guidance. She also highlighted the need for a regional approach to data collection.

Diane Dodds moved the amendment, raising an issue that has come to her constituency office: delayed discharges and appropriate costs of care. She called the number of beds that are out of action for acute care an "obscenity", highlighting the fact that, in March of this year, 628 patients were needlessly in hospital, in some cases for long stays, which is equivalent to one large hospital and one small hospital closing their doors. She said that, if the Government and the powers that be do not value social care, why should anyone else? She also highlighted the potential for a price regulator, noting that families who are trying to pay top-ups are in desperation, and the need to improve carers' career opportunities. She asked the Minister for an update on the ability of independent care homes to reclaim VAT on expenditure in the same way as care homes elsewhere in the UK, which he delivered.

Liz Kimmins, Chair of the Health Committee, noted that the debate was similar to that on children's social care this morning. She referenced a recent visit to Northern Ireland Ambulance Service headquarters, highlighting the bottleneck in the system that results in failure to deliver safe and reliable care. Liz also pointed out that families wait months for care packages, which puts incredible strain on unpaid carers.

Colin McGrath talked about the lack of meaningful progress since the 'Power to People' report in 2017. He highlighted workforce shortages and long waits for support, stating that the system is in crisis and that the work of the social care collaborative forum is vital. He called on the Minister to bring forward key priorities and highlighted vacancy rates in social care. He asked where the new social workers would come from and called for a review of the 2006 carers' strategy.

Diana Armstrong talked about the importance of social care staff to older people and their families and to patient flow in hospitals. She noted that reforms are needed but that solutions are not solely dependent on funding, and she highlighted the importance of regulation of the independent sector.

Linda Dillon noted that the system is overstretched and underfunded and that, again, seven years since 'Power to People', the problems remain and are even worse in rural areas in Northern Ireland like her constituency of Mid Ulster. She highlighted the importance of collaboration in the community and voluntary sector and of a review of how it is funded, saying that independent price regulation is essential.

My colleague Kellie Armstrong gave us her personal history as a carer for her late brother and her father, and, as Alan noted, that strengthened the debate. She said that the population of older people in Northern Ireland who will need support is increasing. People are impacted by spending long times on waiting lists, particularly for things like hips and knees, and they are suffering unnecessarily. She also highlighted the fact that the Alzheimer's Association said that the social care system is not set up to care for people with dementia. She noted that unpaid carers save the health service a fortune but are struggling under extreme stresses and must be supported. She also pointed out that we need a carers register, which came up a few times.

Minister Nesbitt responded by saying that he understands the frustrations with the pace of reform and that the Department has established a social care collaborative forum that works on short-term solutions and long-term strategies. He spoke of the importance of improving social care as a career, and he mentioned the 'Care to chat?' podcast. He talked about how he is working towards our need to get to a sustainable workforce model. He highlighted the importance of ongoing cross-departmental work to support unpaid carers and talked of a review of social care standards that will be consulted on in due course. The Minister stated that social care reform remains a priority for him, and, on tariff rates, he said that work is under way to establish how social care is delivered.

In his winding-up speech, Alan Robinson made quite a statement when he said that, when you fix social care, you begin to fix the entire healthcare system. He talked about unpaid carers being at breaking point — again, that is familiar to most people across the Chamber and recalled the sad case of a constituent who had tried to take her own life.

Before being elected to this place, I worked in the health service as a nurse, and I have seen at first hand the effect of the overcrowding in hospital wards and A&E departments that results when patient flow is reduced. Wards that can be understaffed end up with extra patients being cared for in inappropriate corridor beds, where there is no emergency equipment and little dignity. Healthcare staff are unable to deliver the care that, they know, their patients need, and that causes undue stress and burnout.

A&E departments become so full of patients requiring admission to wards that they cannot take any more, and ambulances end up stacked outside for many hours with paramedics in the back caring for patients for sometimes their whole shift rather than being on the road attending calls. That results in long waits for ambulances in our communities. Members of the Health Committee who visited the Northern Ireland Ambulance Service will have spoken to paramedics. I was impressed by the paramedics' professionalism but concerned to see the extreme pressures on the service.

I will highlight research from the Royal College of Emergency Medicine that suggests that there is strong evidence that, in 2022, 1,434 people died as a result of delays in Northern Ireland's emergency departments. That claim is backed up by evidence in the 'Emergency Medicine Journal' that suggests that, if you are waiting in an emergency room, you have a much higher chance of dying. Those 1,434 excess deaths in 2022 represent a shocking figure, and I am sure that we can all agree on that.

In conclusion, I encourage all Members to support our motion. We need to address the crisis facing our social care services. Everyone deserves the best outcomes, regardless of their background. The policy priorities have been outlined in previous reports and by other Members throughout the debate. We know what needs to be done, and it is time for action from the Department of Health.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to. Resolved:

That this Assembly expresses its frustration at the lack of progress on transforming the social care system since the 'Power to People' report was published in 2017; notes that workforce shortages, care home capacity constraints and long delays to access community care packages are leaving too many people without the high-quality services they need, when they need them; is concerned that current charging arrangements for adult social care in Northern Ireland are unfair and inconsistent; believes the Department of Health should explore the potential benefits of independent price regulation within the care sector; welcomes the contribution of front-line staff, providers and community and voluntary sector bodies in the work of the social care collaborative forum; and calls on the Minister of Health to bring forward the key policy development priorities from that collaborative forum without delay, including the health and social care workforce strategy 2026, revised care standards for nursing homes, review of the carers’ strategy 2006 and residential care home minimum standards.

I ask Members to take their ease.

(Mr Deputy Speaker [Dr Aiken] in the Chair)