Northern Ireland Assembly, 21 January 2002
53 contributions from 23 members. The official report.
Assembly: Health, Social Services and Public Safety Committee
Assembly: Environment Committee
Care in the Community
Tommy Gallagher (Social Democratic and Labour Party, Fermanagh and South Tyrone)
I beg to move
That this Assembly notes the increasing difficulties facing those who have to rely on community care packages and calls on the Minister of Health, Social Services and Public Safety to take action to remedy this situation.
If the mark of a civilised society is the way in which we care for our sick, elderly, disabled people or people with mental health problems, clearly we here have some way to go. A key component of our Health Service is what goes on under the heading community care. I have tabled the motion because there are glaring problems with that provision. When we examine what is happening on the ground, we see that community care is something of a misnomer.
At the moment, practically every trust is reporting that it cannot meet the needs of those who require home help and other forms of domiciliary care. In many instances the community care budgets ran out some time ago. In my area, the Sperrin Lakeland Trust reports that it needs an additional £700,000 to provide for the assessed needs of the sick and the elderly.
In many cases, the only way in which home help services can be found for new patients is by cutting back on the home help hours of existing patients. Every week, cases are reported to my constituency office and, I am sure, to the offices of other Members of the Assembly, which show that the level of community care is inadequate. I know of a 90-year-old man being looked after in his home by his 80-year-old wife. They receive only two hours of home help a week. Money is so scarce in the system that the sick and the old are being asked by some trusts to use their own pensions and benefits to pay for community care packages.
I am not suggesting that the state of community care — and it is in a sorry state — is the fault of the Minister of Health, Social Services and Public Safety. In Britain during the 1990s, expenditure on health and personal social services rose by 57%, while in Northern Ireland it rose by 35%. That shows how our Health Service was short-changed under direct rule. That was the difference in funding during the 1990s, and from reports in the media we know that the Health Service in Britain is breaking down. We need to have that historical underfunding put right and made good, and to do that we require the combined efforts of the Treasury, the Executive and the Minister of Health, Social Services and Public Safety.
At Executive level, finding the resources to meet the pressing demand for additional domiciliary care and day-care packages must be made a priority. However, the crisis in community care is not solely about funding. There are steps that the Minister can and must take. The administration of the Health Service has to be streamlined, and the current unwieldy structures have to be sorted out, because they are contributing to the shambolic community care provision. The Health Service needs less bureaucracy and more efficiency, which is something that the Minister and her Department must tackle now.
The inability to deliver meaningful care packages impacts directly on other budgets and contributes directly to bed blocking and spending inefficiencies in the Health Service. People in hospitals are suffering. People are waiting for heart surgery, joint replacements and for fractures to be dealt with. Youngsters are waiting to have their tonsils removed, while their education and health suffer. The list is growing. We have cases of patients, particularly elderly people, being kept in hospital at a cost of up to £900 a week, and no clinical reason is given. The explanation is that no money is apparently available in the home help service to keep people in the comfort of their homes.
Why does this happen? There is clear mismanagement when £100 or £150 a week cannot be found for the home help service, and £900 is spent instead. That is being caused by our crazy maze of health trusts.
Places in nursing homes for those who are unable to return home cost between £300 and £350 a week, but no money is available to provide them. In one case, a lady was kept in hospital for eight weeks solely because no money was available to fund a place for her in a residential nursing home. If that one bed had been available during an eight-week period, how many more people could have been treated?
Community care provision is also vital for cancer patients. There are 8,500 new cancer patients in Northern Ireland every year, and increasing numbers — up to 90% — are being looked after in the community, in accordance with medical recommendations. In some areas the demand for palliative care packages has increased rapidly. The social work department in one of Northern Ireland’s four cancer units reported recently that it receives an additional 17 referrals every month. The good news is that the number of cancer patients who make a full recovery is on the increase, but there is a serious shortage of skilled staff to deliver palliative care. The level of that care is patchy across the North, and in some areas the voluntary sector is too heavily relied upon. The voluntary agencies do outstanding work, and we are all aware of examples of that, but that sector cannot be expected to do everything.
The Alzheimer’s Disease Society recently issued a report on community care support for people who suffer from dementia. In Northern Ireland, 20,000 people, many of whom are under the age of 65, suffer from dementia. That report advises that, in many cases, although carers felt that they needed more support, they were experiencing cutbacks. Seven out of 10 carers had to contend with regular sleep disturbances, yet help is rarely available during the night; the availability of such provision varies according to where the carer lives. That encapsulates the inconsistent approach by our health authorities to community care.
One of the most damning messages of that report is that many of the carers surveyed said that they found it difficult to obtain information from social services bodies. Many described the procedure as a battle. It is wrong that people who are trying to care at home for a family member with a distressing illness should have to battle to get information. The point was made in the last couple of weeks at a meeting of the Committee for Health, Social Services and Public Safety when members heard the case of a carer who had to look after two members of his family in distressing circumstances. That carer experienced great difficulty in getting any information from the system.
These responses sum up what many feel is wrong about the way in which healthcare is provided — it is no longer the service that it should be. It has become, from the carers’ point of view, a system that they do not understand. Putting aside the fact that money is not forthcoming, there is no excuse for the lack of availability of information for carers. I ask the Minister to take every step necessary to remedy the problem.
Mental healthcare is another important area which, as many Members know, relies heavily on the voluntary sector. The shortage of skilled staff is a serious problem, and mental healthcare also suffers from the problems that affect other areas of healthcare. Recently, I learnt that seven people who were medically fit for discharge were not released from Holywell Hospital because no care packages were available to assist them or their families.
At the other end of the spectrum, some people are released from hospital with little or no domiciliary care available to help them in their home surroundings, which is an important element of the recovery process. The only contact that they have is with the social worker who comes to assess their needs. The social worker can move only those individuals who have no movement onto waiting lists.
Furthermore, there is the question of parity of expenditure. People in rural communities are entitled to the same level of community care and access to services as people in urban areas. There is a disparity of expenditure between health boards and trusts on care programmes for the elderly. Some urban trusts have a greater per capita expenditure on such programmes. For example, in 1999-2000, in the North and West Belfast Health and Social Services Trust area the per capita expenditure figure was £3,200; in the Foyle Trust area the per capita figure was £3,300; but in the Sperrin Lakeland Trust area the figure was £2,700. I will examine those services to check that they have been, or will be, rural proofed to ensure that people who live in rural areas are not being disadvantaged.
I have mentioned only some of the anomalies, inadequacies and inconsistencies of the current community care provision. There are many other examples: stroke patients facing lengthy delays for physiotherapy; people waiting for assessments by occupational therapists for home adaptations; and people waiting for speech therapy — the list goes on.
The Minister was due to receive the preliminary report on care in the community last year. I would like the Minister to announce the outcome of that review. I would also like to see a clear plan of action and a definite management strategy to sort out the mess that carries the misnomer of care in the community.
The inadequacies of the Health Service are having a detrimental effect, not only on the patients and those who care for them, but on the people who work in the service. I want to acknowledge the work that is done by all health workers. In the face of all the difficulties, they endeavour to provide the best possible care.
It is not a matter of simply throwing money at the problem. Undoubtedly, resources are a key element in tackling the growing mess. However, resources must be part of a clearly developed strategy for the whole of the North, not a sticking plaster for the trust that happens to shout loudest about the crisis. If the Minister does not initiate such a strategy quickly, undoubtedly we will face a worse crisis.
John Gorman (UUP, North Down)
Ten Members wish to speak in the debate, for which just over two hours have been set aside. Therefore I ask Members to accept a limit of 10 minutes for their speeches. That limit will not apply to the Minister, or to Mr Gallagher, who will wind up the debate.
Paul Berry (DUP, Newry and Armagh)
I commend Mr Gallagher for raising the important issue of care in the community. The motion reminds us that health provision is not what it should be. While newspaper headlines tell the public about elderly people blocking beds, they do not reveal the human face of those involved.
Recently I had to deal with two constituents who had been admitted to Daisy Hill Hospital. Both were well enough to leave the hospital after having had successful operations and receiving care, but they remained there for 13 weeks. One needed a care in the community package that was not available at that time due to lack of funding. The other needed residential care, which was also unavailable for the same reason. The cost to the Health Service for those 13 weeks runs into many thousands, the vast bulk of which could have been saved had those patients been able to get out of hospital sooner. If it costs a hospital around £1,300 a patient, a week, those two patients were costing Daisy Hill Hospital and the trust £2,600 a week, which adds up to £33,000 over 13 weeks.
These are not unusual cases. The average overstay in some hospitals across Northern Ireland is five weeks. Hospitals are losing a fortune in that area alone. If each of the 150 delayed discharges in December and January were patients who had spent five extra weeks in hospital, each occupying a bed, the cost to the Health Service would be £975,000. That is probably a conservative figure. I suspect that the real cost is around £1,000,000. Had the Department got its act together and applied a holistic approach, it could have saved thousands of pounds every week for care in the community. Those savings could have been used to increase the money paid to the providers of nursing and residential homes, which are closing at an alarming rate. That point does not seem to have registered with the Department, judging by its answers to written questions on this important subject.
While I welcome extra resources for care in the community, that is only part of the problem in the Health Service. The Department seems unable to see the whole picture. There is a problem recruiting and retaining carers and home helps. That has been made acute in places where there are large retail centres close by. Recently I held discussions with the chief executives of two different trusts. They said that they were having a difficult time recruiting carers and people to look after the elderly. In some areas carers are leaving to take up jobs in large shopping centres and retail units where the pay, hours and conditions are better. There is a rising staffing problem, not only in hospitals but also for care in the community. To provide extra resources is good, but if the personnel are not there, we are back to square one.
What is needed is an overall approach by which patients can be discharged into the community or into residential homes on a temporary basis, with resources and staff available to ensure that patients do not end up in hospital unnecessarily, as they do at present. With a clear vision and will it is realistically possible to reduce bed blocking to an acceptable level without the expenditure of huge resources. Savings in one area will more than cover what is paid out in the other.
Until this problem is tackled across the board, piecemeal actions will not resolve it. The longer it remains unresolved, the bigger it will become, until hospitals are no longer physically able to take in any new patients. That is already happening on an infrequent basis. It does not take a genius to realise that at the current rate, it will become a permanent reality. It is important that this issue has been highlighted today. As Mr Gallagher said, it is not about funding or resources alone, but about having a holistic approach to the important issues of care, and carers, in the community.
I commend and support the motion.
Sue Ramsey (Sinn Féin, Belfast West)
Go raibh maith agat. I commend Tommy Gallagher for moving the motion. I agree that we are judged by how we treat the most vulnerable in society. Steps must be taken within the administration of the Health Service. However, similar steps must be taken in the review of public administration. At what stage is that review? The Executive initiated it, but the administrative issue within the Health Service, boards and trusts also needs to be addressed.
I welcome the Minister of Health, Social Services and Public Safety’s announcement of a 1,000 extra community care packages, which was mentioned by the last two Members who spoke. I am glad that the Minister is here to explain the detail of the package.
The last debate before the Christmas recess was on the Health Service, during which my Colleague, John Kelly, and I tabled an amendment that called on the Executive to provide additional money to tackle issues in the Health Service. That was six weeks ago. At what stage are we now? Every party agreed that additional money was needed. Areas that must be targeted include the acute sector, community care, young people and the elderly.
Everyone is aware of problems within the occupational therapy (OT) sector, which often have knock-on effects for community care packages. The Minister’s officials and officials from the Housing Executive held discussions to tackle OT waiting lists. Measures to solve those problems may involve simply installing a handrail, but a patient is unable to leave hospital until that handrail is installed. How have the discussions progressed? We talk about collective responsibility. Those issues may not necessarily be the responsibility of the Minister or her Department; they may be another Department’s responsibility. The issues must be targeted.
Tommy Gallagher said that the Personal Social Services (Amendment) Bill is currently at Committee Stage. I welcome that Bill. The Health Committee is going through it clause by clause. Examination of the Bill highlighted some problems that carers and their families face. Those problems are being targeted, and the Bill should be brought before the Assembly shortly.
As I said, we could debate the motion all day.
John Gorman (UUP, North Down)
I hope not.
Sue Ramsey (Sinn Féin, Belfast West)
I do not suggest for one minute that I will do so or that one problem in the Health Service is more important than any other. The Health Service needs substantial investment. The money must be provided to target the problems.
In a way, the Committee for Health, Social Services and Public Safety pre-empted this debate. Although the Committee supported the Minister’s bids and welcomed the money that was received, it also supported calls for additional money. The Committee, which closely scrutinises those issues, wrote to both the Office of the First Minister and the Deputy First Minister and to the Minister of Finance and Personnel to request an urgent meeting to discuss not only the money that is needed for this year and future years, but for the years of serious underfunding that the Health Service has endured. It is more than ten weeks since that meeting was requested, and it has yet to be timetabled.
Although I welcome the additional money that was announced in previous months, some of that money — if not a large percentage of it — is a one-off.
It does not ensure forward planning or allow a three- year or five-year plan to be implemented. The additional money is a one-off. That needs to be questioned.
This matter is a test for the Executive because the Programme for Government informed us that health, along with other matters, was a priority. We need to do more than talk about it; we must ensure that the money is allocated to, and invested in, that priority. Rather than have announcements of one-off amounts, we should ensure that money is in place for the long term.
I welcome the motion and congratulate Tommy Gallagher for moving it. My party supports it. Go raibh maith agat.
Kieran McCarthy (Alliance, Strangford)
I too thank Tommy Gallagher for raising this vital matter on the Floor of the House. Care in the community is a very worthwhile policy, which has the support of many people. However, sufficient funding is needed to deliver a good, comprehensive community care service. Funding is vital and must be provided. I appreciate the Minister’s presence today to hear our concerns.
Community care should be defined as helping those who cannot manage on their own at home. It means helping such people to live in the community in their homes or, perhaps, in sheltered housing or residential care. Different people need different forms of assistance. A range of services can enable some people to stay in their own homes. That is what they want, and everyone should endeavour to bring that about. For others, a place in sheltered housing or in residential care might be more appropriate.
Care in the community is sometimes thought of as only for people who are being discharged from hospital, but many other people need that extra care at home. It may involve the provision of aids or appliances to assist them at home, meals on wheels, a home help service or perhaps day-care respite. Someone with a learning disability or someone who has suffered a stroke might require care and assistance. The list goes on.
Tribute must be paid to all those who care for our sick or elderly people. It must be said that carers do far more than they are paid to do — and they do it out of love and compassion for the people who are so dependent on outside help.
I appeal to the Minister to ensure that sufficient funding is in place to meet the needs of care in the community throughout Northern Ireland. I support the motion.
Cedric Wilson (NIUP, Strangford)
This is an important debate. In considering an issue which affects the most vulnerable in society — the elderly who are physically or mentally infirm — we need to give serious thought to how we deal with the crisis.
A report last year disclosed the alarming figure of 162 delayed discharges in the Eastern Health Board’s area. Bodies often find innovative ways of publishing statistics and information to hide the true plight. A more accurate definition of "delayed discharges" might therefore be that at the end of September 2001 162 people were "imprisoned in hospital". They were unable to go home because proper care was not available. Families were unable to have their loved ones brought home from hospital and provided with care packages or have them discharged to proper care in residential or private nursing homes.
The situation is even more alarming. A report issued by the boards’ independent health watchdog body has revealed that 333 people are at home waiting for care packages. That is a great indictment of the Department, because Member after Member has referred to the cost of providing care for these patients who are now imprisoned in hospital. I ask Mr Gallagher to check his figures; he mentioned a cost of £900 a week for bed blocking, but I understand that the figure is nearer to £1,500 a week. Of course, that does not include the capital costs that are normally there for private healthcare.
It is a disgrace: those patients who are blocking beds, against their wishes and those of their families, are denying care to hundreds of patients who require it daily and weekly. Various Members have asked for additional funding to be thrown at this, but we are acutely aware that it is unlikely that that would solve the immediate problem because the amount of funding that would be required is not readily available.
Therefore, I challenge the Department to do what it should have done — grasp the nettle and look at how care can be provided within existing funds and budgets. It should use the money to purchase the care required in a way that will provide the maximum amount of care for the greatest number of people. We would all like additional funding, and it is essential that additional funding be found, but the Department has been lacking.
Esmond Birnie (UUP, Belfast South)
I thank the Member for giving way. If I am wrong, I am willing to be corrected. However, I understand that the Member may have a personal interest in this particular industry. Perhaps he should declare it.
Cedric Wilson (NIUP, Strangford)
I will declare it again. I have made it clear on numerous occasions that I have a personal interest in private nursing care. I represent a body that has spent many long hours with the Department, the trusts and the boards in an attempt to resolve the anomaly. I have often pointed out that a crisis was looming in that industry.
The crisis in the private nursing sector was front-page news in the ‘Belfast Telegraph’ and received other media coverage. The Sandown Group, one of the largest providers of care, was recently placed in the hands of the receiver. That must be of concern to the Assembly and the Department. It would be worse if, regardless of the Assembly’s efforts to find money to provide the care that is essential for these elderly, vulnerable people, it was then the case that there was nowhere to place them following their discharge from hospital.
That is a real problem that the Assembly and the Department must consider. Across the United Kingdom, the private sector is suffering as a result of the statistics that I quoted. Patients who have been assigned beds in a private home, and people whose families have selected a home for them, find that the funding is not available for the care. Something is wrong, and that must be obvious even to people without any experience in the fields of healthcare or care in the community. There must be something wrong with how the money in the system is being allocated.
I am sure that many Members are aware of the ridiculous cases of home care packages that are provided at costs of up to £2,000 a week. They deprive other people of services. The main argument is that the situation depends on the way that funding is allocated — on the Department’s budgeting and system of allocating money.
Anyone who looked at the situation in a sane or rational fashion would see that it makes sense to move someone out of a hospital bed, costing up to £1,500 a week, into the private sector or to provide a home care package that costs substantially less.
I appeal to the Department to do a fundamental root-and-branch reappraisal of the way in which care is purchased and provided in the community. Some patients are bed blocking, while others are sitting at home. The Department should examine ways in which it can alleviate this problem.
As elected representatives, we are all aware of the plight of elderly people who have to provide care for their husbands, wives and others who receive no assistance. At a time when we are moving to provide free care at the point of delivery, we start to hear stories of elderly people having to fund their care from their pensions or whatever small savings they have. This is a matter of urgency, and if the Assembly is wise, it will highlight the plight of those who require our help.
John Gorman (UUP, North Down)
All Members have been limited to 10 minutes.
Monica McWilliams (NIWC, Belfast South)
I thank Mr Tommy Gallagher for tabling the motion. It could not have come at a more important time. The serious situation that we face in the Health Service is caused by a combination of the problems in hospitals and community, primary-care services. If we get this right, we can probably find our way through the crisis.
We have seen enormous changes over the years in the way in which illnesses are dealt with. At one time people with tuberculosis were sent to separate facilities. There were cottage hospitals with convalescence and rehabilitation facilities. These have all been closed. People who need rehabilitation treatment or time to convalesce must now stay in hospital. People are moved from hospitals into nursing homes if community care is not available.
If we approached the problem in a different way, we could save a great deal of funding and provide better services, particularly for the elderly and the disabled. We must change the way that we think about health services — we must change their delivery and the culture that surrounds them. To do this, we must take account of a huge rise in the elderly population. Between 1995 and 2025, the number of people over the age of 80 will increase by 50%, and the number of people over the age of 90 will also double. We cannot expect hospitals to deal with an elderly person every time he or she gets a chest infection. When an elderly person becomes ill, the GP is called. If the GP cannot deal with that person, he or she is admitted to hospital.
Having visited several trusts, I am aware that many have recently introduced some innovative schemes, such as intensive home care beds. These enable staff to provide intravenous medicine, carry out blood transfusions and other processes that require complex nursing. The trusts have started some wonderful programmes. The Down Lisburn Health and Social Services Trust, for example, has introduced the Hospital at Home programme and a rehabilitation service for stroke patients called Step Down Care as well as many other interesting services. However, these require 24-hour, seven-days-a-week health and social care services to be in place. The culture of the trusts must change. They must provide nurses in the community.
I was heartened when the South and East Belfast Trust told me that nurses want to work in the community and that it has 60 applications for every community nursing post, while hospitals have problems recruiting nurses. If we were to reorient nursing services to deal with patients and the elderly in the community, we could avoid bed blocking, delayed discharges and trolley waits. Frequent readmissions to hospitals, risks of pressure sores, exposure to infections, institutionalisation, dependence, depression and confusion present major challenges to a system that requires major service redesign. We must change the way in which we deliver services soon. I am heartened that a community care strategy is being reviewed, and I hope that it will be put in place shortly.
We will need a well-balanced supporting infrastructure between the primary healthcare services and the GPs, and that is why, after April, we must get primary care right. We also need a menu of services so that patients can be maintained and rehabilitated and can receive acute care in their homes. We must stop equating acute care with hospitals — acute care can be delivered to patients in their homes in a complex way by integrated teams of physiotherapists, occupational therapists, nurses and doctors working together.
A thriving independent sector is also needed. I am aware that there are problems with the nursing homes. The Sandown Group has recently gone into receivership. There is a problem with the elderly not being able to find places because of fees. However, that is a debate for another day.
I have just read a recent report from the Northern Ireland Ombudsman called ‘Facing the Future’. In it, the Ombudsman says that it is interesting that the nature of the complaints that he has received recently has changed and that the majority of complaints that he now receives concern community healthcare. He says that that is because of the non-provision of community services and the lack of resources. He believes that, although it may not be a matter of maladministration, it clearly is an issue when people who have a statutory right to services, and who have been assessed for those services, are not given them.
Last week, the Committee for Health, Social Services and Public Safety dealt with the Committee Stage of a piece of legislation that, again, introduces a statutory right to care assessments. I told the Committee that there is no point in that legislation being introduced if the services are not then put in place. Otherwise, people will have their needs assessed and be made aware of the services to which they are entitled, but they will then be told that they cannot avail themselves of those services because they do not exist. Tom Frawley tells us that his mailbag is full of complaints about this. Perhaps we would prefer the Northern Ireland Ombudsman — who is also the Assembly Ombudsman — to be dealing with other kinds of complaints, rather than have his mailbag full of complaints about the lack of community care services.
Clearly, a fundamental review is required. We must think about the services that we provide. My vision for the future of the Health Service is that hospitals will deal only with surgery — be it elective or emergency — and that the majority of people, including those suffering from mental illness or disabilities and the frail elderly, will be treated in their homes or by the independent sector in the residential and nursing sector, with respite services also in place.
We cannot go on simply saying that if we close convalescent and rehabilitation services, those services should be provided in hospitals. Hospitals do not have the resources to provide them. However, there are many dedicated professionals who have the necessary skills but are unable to use them, for example, in the mental illness field. A wonderful initiative has been introduced — the Thorn nurse training initiative — but patients who leave psychiatric units to return to the community quickly find themselves back in psychiatric hospitals, because the nurses have not been able to apply their wonderful skills and give the services that psychiatric patients need in the community.
They are intensive and will require significant extra resources. However, in the end, those resources will be more cost efficient.
Alan McFarland (UUP, North Down)
The debate on care in the community is ongoing — in fact, I think that our last debate on it was in October 2001. I welcome Mr Gallagher’s motion today, which will, I hope, continue to highlight the issue.
Many would argue that solving the community care problems is the key to solving the difficulties in the acute hospitals, and Members have referred to that already. New patients referred by primary care cannot get into hospital in the first place because recuperating patients cannot get out. It is interesting that some 43% of community care packages are home care packages. Indeed, 86% of community care packages are for the elderly. Those are all important, particularly the packages for the elderly.
Although the Minister has given money towards home care, residential care is equally important. I understand that statutory homes, in many cases, have closed and are continuing to close. However, the most frightening aspect involves the private sector homes, which, in theory, should take over from the statutory sector to deal with the problem. Private sector homes are now closing because the amount per head that is allocated for looking after patients is not enough. What is the Minister doing about it? This has the potential to be a disaster. Even if money were put in, we would have a mammoth problem if there was nowhere for those patients to go to be looked after physically in the community. The Minister should give some thought to that.
I want to raise the unfairness in the present system of charges for personal and nursing care. In Scotland, free personal and nursing care is to be introduced from April. England and Wales have free nursing care. Is it right that people who spend their lives saving end up in their old age having to pay for their care? People who have paid their taxes, assuming that the NHS would look after them, suddenly now find that that is not the case. Indeed, their homes are at risk. The implications of that are that you should all live life to the full, forget about saving and squander your money, because that way the system will look after you. I am afraid that you just lose it all at the end if you are prudent about your affairs throughout your life. That is a frightening thought for all those who have been prudent. Elderly patients’ houses are at risk, and I understand that there is a deferred payment scheme in England, Scotland and Wales to allow the burden of losing your house to be eased. Does the Minister have any plans to introduce such a system here?
Care in the community is not just about money; it is also about organisation. The Minister should look at the whole issue again with renewed vigour. I support the motion.
Annie Courtney (Social Democratic and Labour Party, Foyle)
I support the motion by my Colleague Mr Gallagher, and I thank him for bringing it to the House today.
In many instances care in the community is assumed to refer to the elderly, but that is only part of the story. Trusts responsible for community care have to ensure that resources are sufficient to meet increasing demands, not only in elderly care but also across a wide range of other services. Chapter 9 of the Hayes Report dealing with primary care states
"our analysis strongly suggested that patients are being treated in hospitals in Northern Ireland who would be treated in the community elsewhere."
We should, therefore, reduce pressure on the acute hospital sector by treating more patients in the community, provided that levels of resources, organisation and motivation in primary care are sufficient.
The Department of Health and Social Service’s consultation paper, ‘Fit for the Future’, presented health and personal social services as a single, integrated service, centred on primary care. ‘Putting it Right’ encouraged general practitioners to work more closely with hospital- based medical teams to extend their skills, thus enabling more services to be developed in the community. For example, minor surgery is now performed at health centres.
‘Building the Way Forward in Primary Care’ points out that close links between primary care and hospital services are essential if people are to receive treatment in the right setting at the right time and if they are to be able to move easily through the health and social care system. General practitioners are effectively the gatekeepers of the wider systems of care, and they have a key role to play in deciding what kind of care, treatment or support is necessary to meet people’s needs.
Equally important is the fact that primary care is often a bridge to back-to-normal health for those who have received more specialist care. Effectiveness in guiding patients in and out of the hospital system is essential if the Health Service is to provide the service for which it was created — appropriate treatment at the appropriate time and free at the point of delivery. When that service fails to deliver, as it currently appears to be doing, there are problems, and we must ask ourselves why.
Health and personal social services are underfunded and have been for decades. However — and this is critical — some figures suggest that the situation has worsened under devolution, despite extra resources. For example, between March 1996 and March 2001 waiting lists jumped by 700%. Trust deficits have more than doubled in the periods 1998-99 and 1999-2000, despite a 7·2% increase in the Budget announced in October 2000 and allocations of £17 million in November 2000, £14·5 million in January 2001 and £18 million in February 2001. The total budget available for 2002-03 will be 37% larger — an increase of £687 million — than when the Minister took office. There is evidence that the Executive and the Assembly are committed to the Health Service, but, I contend, there are arguments about management as well as money.
Resources are only one element, but we have a responsibility to ensure good management and accountability for the way in which they are used. We can all quote instances of patients lying in acute beds waiting for beds in the community, and we must ask why. Usually the reason given is that trust responsible does not have the resources to buy more beds. Nursing homes are closing, and it has already been pointed out that the Sandown Group has gone into receivership. That is sad, because many people depend on nursing homes.
Nursing homes can no longer cope and give adequate care to those who need it. Their allocation is less than £400 a week a patient, yet it costs approximately £1,500 a week to keep a patient in the acute sector. At the end of 2001 the Ulster Hospital had up to 42 beds with delayed discharges, and it is a similar story in all acute hospitals. The Hayes Report stated that 10% to 15% of acute beds were not available because patients were waiting to be transferred to the community.
The last thing that is needed is another review, given that most reviews to date have not been acted on. That point was highlighted in a written answer on 18 January 2001 from the Minister to a question that had been put by my Colleague, Mr Bradley. He had asked her
"to detail (a) the number of reviews that have been initiated by her Department or its agencies since devolution; and (b) the number that were ongoing when she took office".
The Minister replied:
"Since the establishment of the Executive in December 1999 I have initiated six major reviews. My Department has also initiated a further 15 professional reviews/studies. Some 23 reviews/studies have been initiated by HSS boards, trusts and agencies. Fourteen reviews, of which 12 were departmental, were ongoing at December 1999."
There have been many reviews.
There is still a lack of resources, but we must ask how the current money is being spent. For example, how much of the additional £687 million was spent on consultancy fees, public relations and reviews? The audit trail is so poor that there is no way that we can find out. Instead of constantly referring back to underfunding under direct rule, the Minister must accept responsibility for answering those concerns if confidence in the Health Service is not to dissipate completely.
Jim Shannon (DUP, Strangford)
I am encouraged that the motion is being debated today, but it must be stated that it is ridiculous that we are once again pleading on behalf of our needy constituents to the Minister of Health, Social Services and Public Safety to make the Health Service work here.
A week ago, I watched her agree with a television news reporter that the situation was grave. However, she refused to reveal what she and her Department were going to do to improve it. I also noted that she did not take up Dr Maguire’s challenge to experience life on a ward that has not been prepared for her arrival and which is overrun with patients sitting on trolleys because there are no beds available. The Minister does not know what a real ward is like, because she does not make unannounced visits. If she did so, she would see that chief executives do not want to advertise the conditions under which doctors and nurses are suffering day and night. The Minister has certainly not ventured into the Strangford constituency to talk to people who are currently receiving, or waiting for, community care. The Minister for such a failing Department should at least make the effort to look interested.
The lack of adequate funding has overstretched the resources of the whole of the National Health Service. Some elderly and disabled patients are not being allowed home until adequate care facilities become available, and then no community care places are available anyway. Other patients are let out of hospital too early, only to return with complications or to avail of extensive care packages. If there were enough money for the correct and adequate community care packages to address that need, a huge burden would be lifted from the Health Service. Perhaps Sinn Féin can lend a hand now that it is gaining four new office allowances from Westminster.
Recently, the Minister gave the go-ahead for pay rises for chief executives. Has she given any thought to the people in the country? People in my constituency wait for years for hip replacements, and due to the delay they must have community care to help them wash, dress, prepare food and keep their houses clean — the very basics. They were angry to hear that the Government in England have enabled those who have waited more than six months for operations to travel abroad for treatment; some of those patients went to France last week. Is the Minister going to make provision for such facilities here? That would considerably ease the burden on the community care departments, not only in my constituency of Strangford but in the Province as a whole.
The Ulster Community and Hospitals Health and Social Services Trust needs £20 million to sort out the deficiencies in its community care department. The entire Province got £13 million. Is it just me, or is there something lacking in the Department of Health, Social Services and Public Safety? The Department and its Minister do not recognise the daily problems faced by the trusts in the Province and the fact that it is real people whom they are dealing with and not just numbers. We see real people and their problems every day. The amount of money required to help such people is phenomenal, but there is no way around the fact that it is needed. Although the Minister may try to ignore the situation, she cannot.
People in her constituency must also be waiting for community care; their home helps’ time is also being cut back and rearranged to cover the increasing number of people needing care. I would love to know exactly what she says to those people, because I, for one, am fed up listening to the same old platitudes and trying to reassure my constituents that the issue will be addressed in the Assembly. It is being addressed today, but what will the answers be? The situation worsens day by day for many of them.
Each year, the Ulster Community and Hospitals Health and Social Services Trust sets out its targets and goals. With disgust, its representatives told me that they could not achieve those aims because they receive no financial back-up or support. They want to provide the service, but they cannot do so because the money is not forthcoming. They say that they must provide £10,000 for each person who needs care management. Using this figure as a barometer, only 1,300 people across the Province were helped by the release of £13 million to the National Health Service.
If all the money went into the community care department, a minimum number of people would be helped. This means that a great many people are being left in pain and without help or the facilities to help themselves. My constituency is laughingly called "better off", but many of the elderly and disabled are living on the poverty line and need this help to survive each day. It is not a service — it is a necessity. It gives many people the independence and standard of living that should be the bare minimum for anyone in our society. I urge the Minister to look at her Department and realise the hardships that many people face. It reminds me of the workhouses in Dickens’s novels, and people in this country deserve better. They have paid their National Insurance to have this service, and it is failing them miserably day-by-day. I support the motion.
John Kelly (Sinn Féin, Mid Ulster)
Go raibh maith agat, a LeasCheann Comhairle. I too support the motion. I pay tribute to the carers who are working under very difficult circumstances to maintain a service to the elderly. I congratulate the Minister for bringing forward 1,000 extra care packages this year. Sometimes we overlook — for whatever reason, political or otherwise — some of the positive aspects of what is happening in the Health Service.
Jim Shannon’s reference to being disappointed that the Minister did not visit his constituency is a revelation. I wish that he would carry that forward and encourage his Ministers to participate in the Executive to help in this very critical area to deliver a better Health Service to our community.
On the question of the Minister not going to the Downe Hospital, the Committee for Health, Social Services and Public Safety met with doctors and junior doctors before Christmas and agreed that it would visit the Downe Hospital, which it did last week. These sensationalisms do not help the Health Service and are detrimental to its conduct. Indeed, they do not have the agreement of many of the medical practitioners in the Health Service.
People are living longer, and I congratulate and concur with the review of the capitation formula that looks at this issue and attempts to provide funding for our increasingly ageing population. It is easy to make political capital out of the Health Service, and there is too much of that going on. I do not say that because I am a member of the same party as the Minister. I have an example of that. Before Christmas — I see Billy Hutchinson has left the Chamber — I had a case where an 80-year-old woman released from hospital could not get access to a wheelchair to be wheeled down a country lane to get some fresh air. When I rang the local trust, I was told that they did not have wheelchairs. When I probed further, it emerged that there were wheelchairs but that they were not being given out in case the trust ran out of wheelchairs and did not have the funding to provide more.
We have this layer in the Health Service. Certain boards are holding back what they have because they are afraid that for some reason they will not get the funding to provide items such as incontinence pads for old people. In this case it was a wheelchair that the trust had to hand but was not giving out because it was afraid that it would not get funding for other wheelchairs. Then the trusts say that they would welcome complaints to the Department and the Minister. Trusts seem to be determined to direct as many complaints as possible to the Department without making reference to the resources that they already have available for those in the community who need them.
As my Colleague Sue Ramsey said, we could go on and on. In response to Tommy Gallagher’s point about a health strategy, we cannot have one unless the necessary funding is provided. Finance Ministers Gordon Brown and Charlie McCreevy, when they provided the funds for a health service strategy, looked not only to the immediate health crisis, but five years ahead, in an attempt to prevent health service crises from recurring.
Any extra funding that the Minister may receive will still be inadequate to cater for the strategic view that the Health Service needs. That strategy should include the development of provision for the elderly, including pensioners such as you, Mr Deputy Speaker, Rev Robert Coulter and myself.
John Gorman (UUP, North Down)
I have just been advised that I should declare an interest in this matter.
John Kelly (Sinn Féin, Mid Ulster)
Perhaps I should have declared an interest before I started, unlike Cedric Wilson. A collaborative approach among all the political parties and by all medical practitioners is the only way to solve the immediate crisis in the Health Service and to provide a strategy.
Robert Coulter (UUP, North Antrim)
I apologise to the House for being late. I was hosting the Dalriada Doctor-on-Call group in the Long Gallery. I recommend that Members go along for five minutes to hear what representatives of that group have to say.
I thank Mr Gallagher for moving the motion. It is fitting that we should discuss the matter today. The problems that affect the community care sector have already been covered in the speeches that I have heard today. We all know what kind of Health Service we would like. However, we need to discuss not only what we should do to achieve that objective but what we can do in the short term to alleviate at least some of the problems that people face.
At present, I am dealing with the case of an elderly woman in her 80s, who lives alone, and who spent five weeks in hospital recently. When she was discharged, she needed access to oxygen at all times, and she depended on a neighbour for assistance. The hospital did not inform the woman’s GP that she was being sent home. When the patient informed her GP, he contacted the local trust, but it was 48 hours before a community worker visited her. There is something seriously wrong with the management of a system that allows such treatment to occur — that incident happened in the past two weeks.
As the Minister has already said, we could ensure that the first priority for those who are responsible for sending patients home from hospital would be to have at hand the information for the patient’s GP and a list of the patient’s needs, medical or otherwise. It would not take a great amount of money to do that; it would not take a huge amount of administration. We are over-administered with 19 trusts, four boards, five agencies — a plethora of administration. It has also been suggested that we are going to set up four or five more committees in each board area. We need to adopt a sensible approach to what we can do in the short term to rectify the problem. It will not help to apportion blame or to throw money at the situation. Another consultation document will not help either. John Kelly hinted that if all those who are involved could get together to see what we could do in the immediate future, we could act immediately.
We need decisions at every level of community care. I recently realised that Homefirst Community Health & Social Services Trust, which is centred in Ballymena, is the largest community trust in the entire United Kingdom. When we examine the percentages, we see that Homefirst is being castigated because it cannot meet its needs. It covers one fifth of the entire population of Northern Ireland, so is it any wonder that we have problems? We need to focus on money and management. Although we can all say what system we should have, I appeal to the Minister and the Department to get together and stop blaming each other or anyone else. We need to see what we can do and then do it.
Oliver Gibson (DUP, West Tyrone)
Many issues have been eloquently and adequately placed before the Assembly today. Indeed, no one has done that better than Rev Robert Coulter. I make a plea for one aspect because all the other areas have been well covered. In my constituency of West Tyrone the norm is for the family to care for aged relatives. Most Assembly Members welcome the fact that there are still those in the community who care for their elderly relatives. However, it is a punishment for one family member to do that under the present system. If people of working age give up their work to look after their elderly parents, they are reduced, even with income support, to giving 24-hour care on £77 a week. At the same time, they are further punished by having to give up their pension rights. In other words, they cannot receive any additional money. Family members are being punished for looking after their elderly relatives.
Although this is not the direct responsibility of the Minister, I appeal to her to deal with the matter. Through the single equality Bill and section 75 of the Northern Ireland Act 1998 we have raised the expectation that we will give equal treatment, and I presume that that involves pay. We should reward those carers not for 24 hours’ work but for at least eight hours’ work. They do not ask for anything more; it is reasonable that they should be justly rewarded. The expectations that were raised by the lovely glossy magazines on the subject might then be met.
In the past, I presented to the House, in a puritanical fit, a pile of health documents produced in the past five years, and weighing some 17 stone, which were written, published and printed at a cost of millions of pounds. I make a plea this afternoon that, in the extended family care system, those who give up work to look after their kith and kin receive an adequate and fair reward for their input.
Gerry McHugh (Sinn Féin, Fermanagh and South Tyrone)
Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to speak on the issue as someone who is not a member of the Committee for Health, Social Services and Public Safety. Mr Gallagher, who shares my constituency, has raised issues that are also of concern to me and to constituents. The Minister has a difficult job trying to deal with all the issues and to act accordingly. The main problem that affects the health system is the inadequacy of budgets.
Community care is a sensitive but vital issue in rural areas. Mr Gallagher said that we no longer have the service that we should have, which implied that in the past we had a service that we could be proud of. That is not the case. The Thatcher years resulted in 14 years’ destruction of the Health Service. In the 1980s and 1990s the Tory Governments made 3% cuts, year-on-year. Those trying to deal with the cutbacks were told that if they did not run the hospitals, private managers — now known as "roving managers" — would be brought in to do the work for them. I do not think that that approach worked. The Labour Government seem to be taking the same approach by giving money with one hand and taking it away with the other, as is evident from the cutbacks in hospitals, bed shortages, et cetera.
The increased elderly population, particularly in Fermanagh, will create difficulties in the provision of community care. People live longer than before. Although diseases such as tuberculosis no longer affect people, today’s hospitals treat patients for chronic diseases such as strokes, multiple sclerosis, Alzheimer’s disease and drug-related illnesses. There are not enough nurses in our hospitals, and nursing staff are usually rushed off their feet. They do not have enough time to care for patients properly, with the result that staff become sick due to stress and there are twice as many people on the payroll to cover those absences. In addition, winter pressures, which affect older people more than anyone else, create an extra burden.
Those factors create massive pressure for the Minister, and much of that problem is inherited. Is the Department of Health, Social Services and Public Safety looking after the needs of carers? Doctors in areas such as Fermanagh find it difficult to get carers. They get neither time off nor relief from their job. The financial situation of homes creates a further burden.
The Budget did not allocate enough money, and people’s health is suffering. Poor housing is also a factor in ill health. In my constituency of Fermanagh and South Tyrone, 17% of the housing stock is in poor condition. Dampness and inadequate toilet facilities also affect people’s health, particularly stroke patients and those with serious illnesses. I join John Kelly in welcoming the 1,000 care packages announced by the Minister.
There is poor access to hospital day care in rural areas. Since bus passes for pensioners were introduced, elderly people have been told that they cannot take taxis to hospital — they must use the bus. However, in our area there are some routes that have only one bus a week. Even Rural Lift does not allow bus passes to be used.
On the issue of healthcare in border areas, an all-Ireland approach is necessary. North and South could work together, for example, Co-operation and Working Together (CAWT). There are natural hinterlands. Mr Gallagher will know that villages such as Kiltyclogher and other cross-border villages have worked together in the past. They did not look towards Enniskillen and places that are 30 miles away.
Specialists are a massive cost in rural care. Social workers may visit one area or one patient at home. Other workers, such as health visitors and district nurses, have to be paid for their mileage. These are costs that did not occur previously when one general health carer was able to assess a patient’s healthcare needs. That situation could be considered on a cross-border basis, between the Department of Health and Children in the South and the Department of Health, Social Services and Public Safety in the North, in order to create savings and prevent duplication. In some cases, their base could be Letterkenny, which is a hell of a journey from border areas in south Fermanagh.
The Department of Health and Children in the South is trying to do something about it, although it inherited the health system in the 1920s from the British, which has not served the country well. They spent far too long working with the system rather than trying to dispose of it and have something better.
Is specialisation needed, with all its inherent cost? Of course there are issues such as litigation, changing times and skills to be taken into account. In the 1950s a patient undergoing a hernia operation, for example, might have spent four to six weeks recuperating in the hospital, whereas today it is a day procedure. In order to keep up their skills, surgeons now have to perform at least 50 appendix operations a year.
The Minister has also announced a timetable for the establishment of local health and social care groups and the ending of GP fundholding, which has a tremendous impact in my area on delivering care.
Rural proofing is needed in applying the Noble formula in relation to deprivation. Per capita, Fermanagh has £31, in contrast to places like Derry, which has £84 per capita under that formula. What impact will that have across other Departments? Will they follow the Noble formula as a basis? Voluntary groups will discover that they are losing out under this formula.
People in rural areas also face health problems. I am a member of the Committee for Agriculture and Rural Development, and it has been brought to the Committee’s attention that farmers face problems such as stress, depression and even suicide arising from factors such as low income, isolation and a lack of future prospects.
What help or counselling was provided to families or individuals in the wake of the outbreak of foot-and-mouth disease? There was a helpline, but what follow-up help has there been in areas affected by foot-and-mouth disease, such as Newry and Armagh? What impact did the outbreak have on stress levels or the incidence of heart attacks, for example?
I have mentioned issues that involve three Departments. Health is a cross-cutting issue, which involves other Departments besides Ms de Brún’s. Farmers’ families need help, especially if they have not received help with their financial situations. Ms de Brún has inherited the problem, which has been brought about by a lack of adequate finance.
Mr Gibson mentioned the inadequate benefit payments for people who have given up work. Does he not agree that that is an issue for the Minister for Social Development? As I have said, cross-departmental issues are involved.
Go raibh maith agat.
William McCrea (DUP, Mid Ulster)
The debate is timely, although its subject has exercised the Assembly time and again. It is 2002, and the situation is the same as it was in 2001. We rehearse the problems, because that is what we have — a plethora of problems. We had them last year, and we had them the year before. We have had reviews, and we have had consultation documents. We have had reviews of reviews and reviews of consultation documents — but when will the Department and the Minister make decisions? We rehearse the problems in our debates, but decision-making is lacking.
The Minister, as the person who leads the Department, is responsible for overseeing what happens in her Department. Every Department can rightly say that it needs adequate finances, but is that the only answer? Adequate finances have been provided across the water, but it has been like pouring water into a big hole — there has not been the required improvement in services to the public. We can see that happening in our Province. The Assembly has voted considerable amounts of money to the Health Service since devolution. However, when we ask whether we have we seen the corresponding improvements, the answer is "No".
The Minister gave us the age-old statement — which, of course, leans towards the Labour Party — that we should blame the Conservatives. They are blamed for everything, even though they have not been in power for five years. When will the Minister take some responsibility for her Department, instead of blaming everybody else? Blaming everybody else for the problem is a cop-out. The real problem with the Department is that there have been no decisions. There has been no decisiveness at the top of the Administration and at the top of the Department on how to make real changes with the money that has been allocated.
Let us not turn up our noses at the amount of money that was allocated. Certainly, it is insufficient, but, when money is provided, improvements must be seen, and that has not happened.
It is true that we have an increasingly elderly population. It is also true that many of those elderly people feel totally deserted. They feel that politicians and the Administration have let them down. They worked hard, and, with the rest of the people of the United Kingdom, they built a service that was second to none. They were promised that they would be looked after from the cradle to the grave, but they have not received that care. In fact, at the most vulnerable time in their lives, they feel more deserted than ever.
Let us examine community care packages. If we want to know what community care means, we should ask the public. In reality, it means that people are thrown out of hospital into the community. Care packages are promised, but they are not provided. Rev Robert Coulter mentioned a case in his constituency. In my constituency, an 80-year-old lady who needed continual treatment was forced to leave hospital. She was sent home to be cared for by her 86-year-old brother, who was also ill. She was thrust back into the community.
The Assembly has discussed getting people out of hospital and back into community care. I believe in community care — we want to keep people in the community. However, it is not enough to use the verbiage without providing proper care for such people. That is not a criticism of those excellent workers in the Health Service and the community who are trying their utmost. Many are at their wits’ end to know exactly where to go next, and whom to go to next, because such a demand is placed on their time. They cannot cut themselves into a thousand pieces.
We have rehearsed the problems, and that is only right because we must bring this need before the Assembly constantly. The Department and the Minister of Health, Social Services and Public Safety need to take responsibility, because the Assembly cannot rely on the vision that the Minister recently published in the press. There is no vision. There is a verse of scripture, which Mr Coulter will know very well, that says:
"Where there is no vision, the people perish.".
Without a clear vision for the Health Service and community care, people will die. That is what is happening. So many elderly people await operations that I sometimes believe that there are those who almost hope that a person will die before the operation is performed, such is the crisis that the Health Service is in. The reviews and consultation documents are about how to close hospital facilities rather than meet the need in the community.
Some people have been sent to France for operations. I suppose that the next thing is that they will be sent to Russia, because they cannot have operations in Northern Ireland. That is a disgraceful situation that must not be allowed to continue. It is not only due to a lack of money, as one Member pointed out. Need must be targeted, and a vision must be carried through. Real decisions that will make a difference to Northern Ireland’s community care and Health Service need to be taken. My hon Friend Mr Gibson talked about glossy documents. I am fed up looking at glossy documents that tell us how wonderful the provision is. Less should be spent on glossy documents, and more money should be put into getting people the operations and the community care that they need. I assure the House that that would go down much better with the people than documents that tell us what provisions there are for the elderly.
At the start of 2002, many families, as well as many elderly people, feel deserted. The burden is on them. I strongly believe that families have a responsibility for their elderly. That has always been a trait of good Ulster people — they cared for their fathers and mothers and sought to do their best. However, many families are being pushed over the limit; they are being used and abused. Whenever they look for help to enable them to keep their parents at home, they are faced with a blank look and no help at all. Many people in Northern Ireland feel that not only is the Health Service in crisis, and that the community care packages are in a critical situation, but that the Minister of Health, Social Services and Public Safety has no idea what the answer is. That is the worst situation of all. There must be decisive decision-making and a clear vision of where the Health Service is going in the future.
I thank Mr Gallagher for his timely motion. I trust, as the year progresses, that we will see a true change for good in the lives and health of our people.
Bairbre de Brún (Sinn Féin, Belfast West)
Go raibh maith agat, a LeasCheann Comhairle. Ba mhaith liom mo bhuíochas a ghabháil leis an Uasal Gallagher as ucht na nithe tábhachtacha seo a chur faoi bhráid an Tí.
D’éist mé go cúramach leis na pointí fiúntacha a luaigh Comhaltaí le linn na díospóireachta agus is ábhar imní agam é chomh maith na deacrachtaí atá ann ag riar ar an mhéadú atá ag teacht ar éilimh ar phacáistí cúraim phobail.
Is eol do Chomhaltaí gur chuir mé cuid tionscnamh suntasach ar bun i réimse an chúraim phobail le linn na bliana seo caite. Sa bhliain airgeadais reatha leithroinn mé £2 mhilliún sa bhreis go sonrach do sholáthar cúraim phobail le 230 pacáiste breise a chur ar fáil os cionn an mhéid a bhí beartaithe, agus an bhliain airgeadais seo chugainn beidh fáil ar 1,000 pacáiste breise cúraim phobail.
I thank Mr Gallagher for bringing these important issues to the Floor of the House. I have listened carefully to Members’ valuable points and share their concern about the difficulties in meeting the increasing demand for community care packages.
I will try to respond to many of the points. However, that will be difficult at times, as some very sane Members called for a fundamental re-examination of the Health Service on the one hand and for no more reviews on the other. Members also called on me to allocate more money to virtually every sector in health and social services but also to act within my existing budget. There was also a call for greater information to be given on what is available, and in the same debate there was a call for an end to documents and leaflets outlining what is available.
Members are aware of several significant community care initiatives that I have taken in the past year. In the current year, I have allocated an additional £2 million specifically for community care provision to deliver an additional 230 care packages over and above planned provision. Next year will see the introduction of a further 1,000 community care packages. The elderly, as the main users of community care, will gain substantially from that. More people will be cared for at home and in other community settings, and there will be a reduction in delayed discharges from hospital.
The packages will be a mixture of domiciliary and residential care and will go a long way towards easing the difficulties that are experienced by some people in getting access to support services in the community. I stress that I understand the extremely important point that community care is not just about delayed discharges from hospital or preventing people from going into hospital — it is about looking after the whole range of needs of those outside hospital.
Since I came into office, I have initiated five major reviews, as well as a routine quinquennial review of the Mental Health Commission. Members know that very distinct and specific actions have come from those. Comments made by Annie Courtney and Rev William McCrea about the reviews were rather unfortunate. Aside from the routine five-yearly review of the Mental Health Commission, two of the five major reviews were initiated within weeks of my taking office and have resulted in significant actions and benefits.
Following the pressures on health and social services during the outbreak of the flu-like illness in the winter of 1999-2000, two of my first actions as Minister were to ask the Chief Medical Officer to review intensive care provision and the chief inspector of social services to review community care. As a result of detailed information gathered during those reviews, extra intensive care and high-dependency beds were made available in the acute sector — a total of 33 since I came into office.
A total of 230 extra community care packages were provided this year, with 1,000 more to follow in the next financial year. ‘Facing the Future: Building on the lessons of winter 1999/2000’ recommended a comprehensive review of community care policy. I endorsed that recommendation in October 2000. A project board with an independent chairperson was set up to conduct the review — users, providers and carers were represented on it. In July, August and September 2001, extensive consultation took place, which took on board the views of statutory and independent sector providers, voluntary organisations and the health and social care professions. The objective was to identify barriers to the delivery of community care services, to identify good practice in place across the North and to implement recommendations for short-term improvements. From the outset, we have not only sought extra resources in that area but have examined what could be done to improve existing areas, for example, we have sought to build on good practice. I welcome the comments made on major initiatives and on the good practice that has been employed in some trusts. I shall consider the review’s findings.
Although the review is ongoing, action has been taken to identify a range of good practices in place in trusts and, where appropriate, to put similar schemes in other places across the North. People will see that, where improvements can be made quickly, necessary action will be taken.
Those who were in residential and nursing care homes before the introduction of community care in 1993 were given preserved rights to special rates of income support to meet the costs of their care. However, they were not included in the new health and social services care arrangements at that time. Those residents are now being brought into care management arrangements, which, along with the transfer from social security of the related funding, is intended to give help and reassurance. Those people will, for the first time, be subject to an assessment of their needs under the care management arrangements, and, where necessary, those care needs will be met in a more appropriate manner.
The payment of residential allowance to those in independent sector accommodation who receive state assistance with their costs also went unchanged at that time. That created a perverse incentive to place people in care rather than keep them at home. That allowance will end for new residents but remain for those currently in receipt of it, and that will involve a funding transfer from social security. That funding will allow the trusts further flexibility to consider care at home rather than in a residential care setting.
I am aware of the difficulties in recruiting and retaining staff. The poor pay and conditions still experienced by many front-line care workers make it difficult to attract and retain staff. I shall continue to examine the scope available for providing additional funding from my allocation to address that matter.
On the statutory side, staff recruitment is a matter for each trust. I am aware that trusts continue to attempt to recruit staff as the need arises and to address recruitment and retention. Those issues will be addressed by a departmental working party that is currently developing a new health and social services workforce plan.
Another important point raised during the debate concerned delayed discharges. Delayed discharges show the difficulties faced by health and personal social services, especially when there is increased demand on services. The level of delayed discharge can peak during the winter months, but it now proves to be a more persistent feature of the pressure on services all year. We have seen the need to create additional services in the community to allow the earlier discharge of patients who are improving, so that they can be cared for in a proper nursing environment outside hospital. We are moving to address that need with whatever resources become available.
It is also necessary to support primary care with more resources, so that GPs and other primary care professionals can do more to deal with patients in the community and to prevent their being admitted into hospital. The recorded number of patients waiting for care packages in the community stands at over 400 at any time. The Department recognises that it is not simply a matter of solving one aspect of the problem; there must be an integrated and holistic approach, which it is taking.
Health and personal social services have piloted several local projects and schemes to make their community services more responsive. Examples include rapid response nursing, hospital at home, intensive community care and home from hospital schemes that provide intermediate care in the community and prevent inappropriate admissions to hospital. Such step-up and step-down initiatives have developed good practice and demonstrated innovation. The challenge is now to replicate that type of scheme across the North and to provide the necessary funding to ensure that they are successful. That is something that the Department will attempt to do while working within the overall budget.
Health and social services boards and trusts have operational responsibility for the assessment of the need for nursing home and residential care in their areas, and they constantly review the beds available against that assessment.
In some areas there are difficulties with the provision of residential beds in the independent sector. However, I am advised that regionally there does not appear to be a shortfall in the numbers needed. There are three different types of providers of residential care beds: the statutory sector accounts for 36%; the private sector accounts for 43%; and the voluntary sector accounts for 20%. Approximately 95% of nursing home beds are provided by the private sector. The remainder is provided by the voluntary sector.
Several Members mentioned the difficulties faced by people who are involved in running nursing homes in the independent sector. The Department of Health, Social Services and Public Safety examined the fees structure in the independent sector and reported in May 2000. As a result of that report, over the last two years fees were increased by more than the social security uplifts. I fully recognise the contribution that the independent sector makes, and if Mr Cedric Wilson were still present, I would assure him of that. I will continue to explore ways of providing further increases within the available resources.
Several Members asked what the additional 1,000 community care packages would mean. They will prevent inappropriate admissions and speed up the discharge of improving patients. However, they will also provide for the needs of those in the community whom the trusts are trying to help at present. I assure Members that trusts will look at local and individual circumstances in their areas.
When considering the parity of such funding, it is unfortunate if Members quote the funding that is available to bodies such as the North and West Belfast Health and Social Services Trust without making it clear that funding for community and hospital services in that trust area also includes the funding for Muckamore Abbey Hospital. However, there are differences in community care from trust to trust, depending on the specific needs that the boards and trusts must assess.
The cost of keeping people in hospital rather than in the community is a given. The Department knows that, clearly, that must be addressed. However, it is equally clear that the only way in which it could instantly make a massive change — by putting all funding into the community sector — would stop people from receiving treatment in hospital because, in the interim, the hospital’s overheads remain.
Therefore we need a service with the flexibility to make the moves that are needed. During the 1980s and the 1990s, £190 million — in today’s terms — was taken out of both hospital and community sectors. That robbed the service of that flexibility. This measure will save money in the future. We have been working to provide 230 extra packages this year and 1,000 extra packages next year. We will continue to make as much as we can of the available resources in a holistic manner. We hope to be able to make progress in this area.
The money that I have received since I came into office was also mentioned. Five sixths of that money is spent on the rising costs of existing services. People need to look at the extra money in that context. The rest of the money is all that can be used to build up services.
I am keen to ensure that the standard of care and provision is maintained and improved. Not only have we taken immediate action, but the consultation document ‘Best Practice — Best Care’ sets out proposals for a framework for setting standards; securing local accountability for the quality of services delivered; and improving monitoring and regulation.
Many people who receive community care services to manage their lives depend on the care and support of a carer. It is estimated that there are 250,000 carers here and that there is a carer in 18% of households. Carers enable many thousands of vulnerable people who need support to continue to lead independent lives in the community. At the same time, carers reduce the amount of input that social services and other agencies need to make. It is essential that we act positively to protect the interests of carers and foster a climate in which they can continue to care for as long as they wish and are able to.
It is important to state that many carers carry out their roles because they wish to do so. However, we must foster a climate in which they can continue to care for as long as they wish and are able to do so without jeopardising their own health or financial security and without reducing their expectations of a reasonable quality of life. Therefore, in recognition of the role of carers in delivering health and personal social services, I commissioned a strategy for carers in October 2000. Officials have now developed proposals and recommendations, working with, and in close consultation with, the major carers’ organisations and carers themselves, including those mentioned by Members in the debate.
I recently received the report with recommendations for services that will support carers in the valuable work that they do. I join with other Members in commending those who carry out that tremendous caring role. I have made it clear that I want a strategy that will contain practical measures that will make a real difference to carers here. I am determined to make a reality of the strategy. One measure that I have already indicated to the Assembly is my intention to allocate funding breaks for carers in 2002 and 2003.
Members will also be aware that I recently introduced a Bill to the Assembly to give health and social services boards and trusts the power to provide services to carers to improve their health and well-being. We must give the boards and trusts the power to do this. I will also continue to argue for the extra resources that are needed and ensure the provision of those resources when I can.
It would not have been right or proper to introduce a Bill without providing carers with the right to an assessment. The right to an assessment does not alter the trusts’ existing legal responsibilities. As with all services for which people are assessed — whether those are in coronary care, care in a hospital or care in a community setting — we want to be able to provide the services and have the resources to do so at the right level.
Health and social services were given priority in the Executive’s revised Budget for 2002-03, which has enabled the Department to prepare to tackle some of the current serious problems in the community and hospital sectors. There was a proposal to inject additional funding into community care next year, and £4·5 million has been allocated for the introduction of free nursing care from October 2002.
Subject to the necessary legislation being passed through the Assembly, measures to facilitate free nursing care will be carried in the health and personal social services (No 1) Bill, which will be introduced in the Assembly in the coming weeks. I have asked the chief nursing officer to set up a group to examine how the need for nursing care can be assessed professionally and in a manner that can be understood clearly by the public and with a minimum of additional bureaucracy. That group will report to me with recommendations in sufficient time to allow the necessary consultation and to introduce the required legislation to implement the agreed recommendations by October 2002.
The proposals that I have outlined will pave the way for free nursing care in all settings and will relieve some of the financial worries of those cared for in nursing homes. Further improvements have been made to the charging system for care, and the ending of the income support preserved rights scheme will bring around 1,700 existing cases fully into care management, allowing those people’s needs to be assessed for the first time and met in the most appropriate manner. The ending of the residential allowance and the transfer of the related funding will allow trusts more flexibility in considering care at home rather than in residential settings. I have provided funding for an additional 230 care packages this year and a further 1,000 care packages next year. All those proposals are already underpinned by appropriate funding in 2002-03. As additional funding becomes available, I will introduce other measures that are part and parcel of clear plans that I have for the way forward for the service.
A member of the Committee for Health, Social Services and Public Safety stated that Scotland would provide free nursing and personal care from April 2002. That statement is incorrect. Scotland’s latest plans are that that care will be delivered from July 2002, and we shall see how that progresses. It is unfortunate that we have not been able to move as quickly on that issue as others have elsewhere, but we have had to work with the funding that is available to us. I am delighted that we now have the funding to provide free care.
The Executive are currently conducting their own review of the future of public administration structures here. I reiterate that it makes sense to take any review of health service structures forward in the context of the Executive’s stated intention to bring that forward and to examine the outcome of the initial consultation on the acute hospitals review, which also mentions structure. The Executive must decide whether some of those issues are taken forward separately or simultaneously with aspects of the public administration review.
However, I must make two important points. First, administrative and clerical staff carry out a range of duties related directly to patient care, and the provision of support to professional staff means that more professional time can be devoted to patient care. Therefore, administrative and clerical staff clearly play a key role in healthcare provision.
Secondly, no amount of restructuring will provide £190 million, which is today’s equivalent of the amount that was taken out of the health and social services budget in the 1980s and 1990s.
The setting up of the Assembly provided a new beginning. When I came into office, many issues needed to be addressed; Members were aware of that. We can now make progress together on many of those issues: on the one hand, we can take immediate action to deal with immediate problems, while on the other we can draw together the strands of different examinations, initiatives and some initiative reviews to create an overall regional strategy, as I reported to the Assembly and the public. I would welcome the opportunity to engage Members further in this debate.
Tommy Gallagher (Social Democratic and Labour Party, Fermanagh and South Tyrone)
I acknowledge the fact that the Minister was present at the debate for more than two hours, which is a considerable demand on ministerial time. The issue is not the responsibility of one Department only; it involves serious cross-departmental matters, such as transport, housing, culture and leisure, and employment and learning. In addition to housing, Mr McHugh mentioned cross-border issues, which form an important part of improvements to care in the community for those who live adjacent to the border.
All Members’ contributions were well made and highlighted the key points involved. Mr Berry was the first to draw attention to bed blocking. He referred not only to the problem of patients’ having to wait on trolleys in corridors, but to the importance of having places and funding for nursing home beds, which are known as "step-down beds". If trusts had the available resources, they could move people from hospitals to those beds, thus helping to avoid the serious pressures of recent weeks and previous winters.
Respite care, which was mentioned by Mr McCarthy and Ms McWilliams, gives carers a break and eases the demands on them by enabling the person that they are caring for 24 hours a day to stay at a facility for a few days. Carers favour such facilities, but at present our provision is sketchy. Many of the available respite facilities are located far from carers’ and patients’ homes, and that can result in stress for a patient who is moved there. There is considerable dissatisfaction with our respite care provision at present.
Mrs Courtney and Ms McWilliams mentioned primary care. It is an area that I hope will receive more concentrated attention in the coming months and years.
Paul Berry, Alan McFarland and Annie Courtney referred to the closure of nursing homes, and the Minister made it clear that more than £4 million will be available for the provision of nursing care from October 2002. The waiting lists, and their implications that seem to clog up the system, were outlined by Cedric Wilson, among others. Rev William McCrea’s perspective on people who depend on community care was well articulated, and he reminded us how unsatisfactory it is for people to experience shortcomings. It was useful to be reminded how the users of the service feel about it.
One inescapable problem, which was highlighted by John Kelly, was the increasing number of elderly people, which is a trend that is set to continue. Rev Robert Coulter, among others, referred to the breakdown in communications and the difficulties arising from that.
In some instances patients are discharged too early from hospital. Many of them have to return to hospital, and that compounds the problem. Jim Shannon pointed that out. The matter of giving up pensions and benefits was raised by myself and developed by Oliver Gibson. John Kelly said that a strategy is one thing, but the strategy in itself is of no use if we do not have resources to back it up. We cannot argue with that, but at the same time we cannot get hung up on which comes first — the chicken or the egg, the strategy or the money.
In the Health Service we can always take steps to improve the quality of service, and that applies to every other area too. However, we can tackle the unwieldy structures that were referred to and that are a problem in some cases. Many Members gave examples of how we can tackle the inefficiencies and the inconsistencies, as well as the information deficit. I gather, from comments that have been made, that the point has been taken. I hope that we will improve in that regard.
John Kelly (Sinn Féin, Mid Ulster)
Does the Member agree that you cannot have any eggs if you have no chickens?
Tommy Gallagher (Social Democratic and Labour Party, Fermanagh and South Tyrone)
Yes, but I do not want to digress. Suffice it to say that there is room for improvement in every organisation, and we hope that it will be ongoing. There are particular points to which we want priority to be given. The Minister made helpful comments with regard to additional money to improve the situation around high-dependency beds. More people in residential nursing homes will qualify for assessment; that is very helpful too. I did not quite pick up the Minister’s point about the community care review, but I look forward to reading it in Hansard.
I thank all Members for their contributions. It is clear that there is a recognition from everyone that we are not dealing with numbers and lists, but with people. There is a sense that we all share this responsibility.
Question put and agreed to.
Resolved:
That this Assembly notes the increasing difficulties facing those who have to rely on community care packages and calls on the Minister of Health, Social Services and Public Safety to take action to remedy this situation.
Sue Ramsey (Sinn Féin, Belfast West)
On a point of order, Mr Deputy Speaker. Several questions came up during the debate that related to the Office of the First Minister and the Deputy First Minister and the Executive. Will you forward a copy of today’s Hansard to them?
John Gorman (UUP, North Down)
If the questions to the Office of the First Minister and the Deputy First Minister have already been put on the Order Paper, I would not be happy about trying to add to those now. Is that what the Member is suggesting?
Sue Ramsey (Sinn Féin, Belfast West)
No. Several questions were raised today directed to the Office of the First Minister and the Deputy First Minister. Can you ensure that a copy of Hansard is sent to them?
John Gorman (UUP, North Down)
That certainly will be done.
The sitting was suspended at 2.16 pm.
On resuming (Mr Speaker in the Chair) —
Independent commission of inquiry
Monica McWilliams (NIWC, Belfast South)
I beg to move
That this Assembly calls on the UK Government to expedite, as agreed, their provision of all relevant documents and files to the Independent Commission of Inquiry into the 1974 Dublin and Monaghan bombings, which is chaired by the former Irish Supreme Court Judge, Henry Barron.
At approximately 5.30 pm on the afternoon of 17 May 1974 a terrible atrocity took place in the city of Dublin. Another took place later that same evening in Monaghan. Thirty-three people were killed, and over 300 were injured as a result of bomb explosions. A bus strike in Dublin that day meant that there were more pedestrians than usual in the streets when the bombs went off. It may well be understood that the explosions created pandemonium. Inside 90 seconds three bombs exploded in Parnell Street, Talbot Street and South Leinster Street. Ninety minutes later, a further bomb exploded outside a Monaghan pub which, incidentally, was owned by a Protestant family. The suffering and anguish of those families is similar to that of the families of those who died in Omagh, but their experience has been treated quite differently.
Frank Massey, whose 21-year-old daughter died six weeks before her wedding, summed up their feelings. He said:
"We have been treated like lepers."
The families feel betrayed.
Alice O’Brien lost her sister, brother-in-law and two nieces in the Dublin bombings. When researching the background of the bombings, I was moved to learn that those two babies, aged 15 months and seven months, lay unidentified because no one knew until the next day that their parents had also been killed. Alice O’Brien said:
"As families we wish to bring closure to our suffering through knowing the truth. For twenty five years we have endured the costly and unnecessary ordeal of fighting a legal battle to gain access to Garda files. As well as being the innocent victims of an atrocity we have had to endure the ignominy of fighting our own political and police authorities."
That is only the beginning of their story.
Some of us were members of the team that negotiated the Good Friday Agreement. In the agreement we wrote that
"it is essential to acknowledge and address the suffering of the victims of violence as a necessary element of reconciliation."
As a consequence of those words, a victims’ commissioner for Northern Ireland, Sir Kenneth Bloomfield, was appointed. The Republic of Ireland also has a victims’ commissioner, Mr John Wilson. I pay tribute to Mr Wilson, whom I have met often as a result of my work with the families of the disappeared.
John Wilson wrote a report for the Irish Government on the needs of victims and included in it what he had heard from the families of those killed in the Dublin and Monaghan bombings. He requested that the Irish Government do something about it.
In January 2000, the Dublin Government established an Independent Commission of Inquiry into the Dublin and Monaghan Bombings that is now headed by Mr Justice Barron, a former judge of the Supreme Court. In that year, the Taoiseach told the Dáil that he expected a report from the inquiry to be presented to a joint Oireachtas Committee by May. He later informed the Dáil that he expected the report to issue before the summer recess in June 2000. He then said that he expected the report by September 2000. It is now January 2002, and the report has not been completed.
The terms of reference of the independent inquiry were that the facts, circumstances, causes and perpetrators of the bombings be investigated and that the nature, extent and adequacy of the garda investigations, including the co-operation of the relevant authorities in Northern Ireland and the handling of evidence, including the scientific analysis of forensic evidence, also be investigated. Also, the reasons why no prosecutions took place, whether the investigations had been impeded, and if so by whom and to what extent, should be identified, and the issues raised by the Yorkshire Television documentary ‘Hidden Hand: The Forgotten Massacre’ broadcast in 1993 should be considered.
The terms of reference were clear. However, yet again, almost a year has passed since Mr Justice Barron made a formal request to the UK Government to release documents that would enable the inquiry to bring the matter to a conclusion. The Prime Minister met the Taoiseach and agreed to facilitate Mr Justice Barron in his search for the files. Last week, the Secretary of State met Mr Justice Barron and said that police and forensic documents had been handed over. However, Mr Justice Barron still awaits many more documents.
The amount of relevant documentation is a disputed issue. Apparently, the Northern Ireland Office holds 68,000 documents — not including those held by the Ministry of Defence. The Secretary of State said that it has taken a considerable amount of time to go through the documents in order to provide a file for Mr Justice Barron. Quite rightly, the families do not understand why it has taken so long to provide the documents; it has been almost a year. It might have made more sense to provide such an enormous file of documents every month or every two months rather than hand them all over at once. Some people may now argue that the delay in the handover is stalling the inquiry and that, in the absence of the files, Mr Justice Barron may conclude that he cannot carry on with it.
It gives the impression that there is something to hide, and that should not be the case. To date, the garda investigation file remains open. The coroner has stated that he is prepared to reopen the inquests that took place so shortly after the bombings and that were closed so quickly. The families have always wanted a public statutory inquiry, but they have a private independent inquiry in its place. The least that they deserve is for that inquiry to reach its conclusions. The loss of their loved ones seems to have been compounded at every stage, initially by the Irish Government, and now by the UK Government.
There has been an enormous loss of faith in the institutions of the Republic, which, through officials’ actions, omissions and denials, have prevented the full disclosure of events. If people in Northern Ireland know anything about conflict resolution, it is that the least that the victims of the troubles deserve is to know what happened and why — to have the truth and to have closure on terrible events. Those families have not had that, and it is little wonder that they sum up what has happened to them as "a trust betrayed".
I tabled the motion because we should be able to say to those victims, and to all victims who approach us in the Assembly, that they have our unanimous support. I hope that we can take the transcript of today’s debate to the Secretary of State and ask for action to be taken. Perhaps in one month’s time, the file will be available, and Justice Barron will be able to close his inquiry. The Irish Government will have to decide what to do following that.
Donovan McClelland (Social Democratic and Labour Party, South Antrim)
The debate must conclude at 5.00 pm. All Members will be limited to approximately four minutes.
Alban Maginness (Social Democratic and Labour Party, Belfast North)
I thank Ms McWilliams for tabling the motion — it is useful that the matter has been brought to the Floor. The motion should not cause controversy in the House. The UK Government have agreed to co-operate with the Independent Commission of Inquiry into the Dublin and Monaghan Bombings. The problem is that the Government have failed to provide that inquiry with all the information that has been requested. The delay is becoming intolerable. It is appropriate for the House to deal with the matter and to emphasise the necessity for the British Government to make a full and true disclosure as soon as possible.
The issues of transparency, accountability and public confidence are central to the case. We must remember that the Dublin and Monaghan bombings were the worst atrocity in the history of the troubles. Even the terrible atrocity at Omagh was not as great. The inquiry is long overdue and was not initiated lightly by the Irish Government. Many unanswered questions remain. Some 33 people were killed in those appalling attacks, for which no one has yet been charged. There have been persistent allegations that known suspects were not pursued, despite eyewitness identification. We must therefore examine the issues. If possible, we must reassure the families that everything has been done and that suspects have been pursued but not yet brought to justice because of a lack of evidence or another factor.
The issue is not confined to the existence, or otherwise, of adequate evidence to secure convictions, however. It extends to wider issues that concern the procedures that were followed in response to the attacks — from the alleged connections between suspects, the RUC and the UDR to the level of co-operation offered by the RUC to the Garda Síochána. It also concerns the capacity of the UVF, which was clearly responsible for the atrocities, to have carried out such an attack without outside assistance.
There is a real suspicion that they had that assistance, because it is doubtful that they would have had the technical capacity to carry out such an attack at that time.
The families of those killed, and the survivors of those atrocities, are entitled to accurate information on how those events arose, the competency of the investigations that were conducted by the Garda Síochána and the RUC and why no one has ever been prosecuted. The families of the victims of the Dublin and Monaghan bombs have a right to know exactly what happened, just as the families of the Omagh bombing are entitled to know the details of the police investigations.
Some events of our recent history have been of such magnitude that they now represent the core of our conflict — and the Dublin and Monaghan bombings are part of that core. The SDLP wants such representative issues to be examined so that the fresh air of accurate information can bring about the healing process, as Monica McWilliams rightly referred to it, and so that procedures can be established to prevent any recurrence of past wrongdoings. The SDLP believes that if key questions are not adequately answered, that will have a long-term and damaging impact on our efforts to move forward. We therefore support the motion and urge the British Government to fulfil their duty to provide full and accurate disclosure.
Mitchel McLaughlin (Sinn Féin, Foyle)
Go raibh maith agat, a LeasCheann Comhairle. I am grateful to Monica McWilliams for tabling this important motion. I fully endorse her introductory comments and Alban Maginness’s contribution.
Although I fully support the case that has been made, I do not wish to cover old ground. In the context of a conflict resolution process, it is important that we examine the clear evidence relating to many incidents, particularly multiple killings by Loyalist gangs that were later shown to have been penetrated, and sometimes controlled, by RUC Special Branch or British military intelligence. The Dublin and Monaghan bombings are a particularly horrific example of that.
Other examples are easily brought to mind, and the current controversy over the investigation — if it is appropriate to call it that — into the Omagh bombing shows that a hidden hand is at work. Republican, Nationalist and, in particular, Unionist representatives must address that dimension of the "dirty war" in Ireland, because there can never be full reconciliation, closure or peace until that aspect of the troubles is included in the examination of the activities of Republicans and Loyalists. That forms part of society’s understanding of how certain circumstances arose and why they were permitted to continue for so long.
These events happened almost 28 years ago. Since then strenuous efforts have been made to elucidate the inexplicable failure to follow through on available evidence and to examine the precision that had never been demonstrated before or since by the UVF gang that claimed responsibility and which subsequently claimed to have acted on its own. That happened despite evidence from court records at the time, and for a long time afterwards, that the gang had been penetrated by British military intelligence. Why did the authorities in the Twenty-six Counties fail to confront and deal with this suppression of information? Why was the Garda inquiry wound down within three months? It is significant that when the Omagh investigation is scrutinised, exactly the same pattern emerges. First, there is an initial response, when the Government appear to act with authority and urgency and resources are poured into the investigation. Subsequently that turns out to have been a façade, important information has been suppressed and in some instances important evidence has been destroyed. After much propaganda and publicity the investigation is substantially wound down.
In the case of Dublin and Monaghan there is a linkage to the difficulties that are now confronting those who are bringing forward arguments for full accountability and transparency. The answer is to be found in exposing, once and for all, the role of British military intelligence and the RUC Special Branch in the manipulation of those Loyalist death squads over that period of time. Go raibh maith agat.
Maurice Morrow (DUP, Fermanagh and South Tyrone)
I was not going to say anything on the motion, but as I listened to the contributions from some Members, I decided that perhaps I should speak. It is interesting that some Members have stated that the motion should not divide the House and that it is not a motion that is pointing the finger. However, it is also interesting that some Members have stated that Unionists have something to answer for in relation to what happened in Dublin and Monaghan. As a Unionist, I have absolutely nothing to answer for on that.
Politicians of all ilks tell the House that it is time we moved on, that it is time to draw a line under the past and let history be the judge. Of course that is not what is being proposed in the motion, any more than what is being proposed in relation to the inquiry into Bloody Sunday. I do not hear those same people calling for an inquiry into Teebane. I do not hear a cry for an inquiry into the slaughter at the La Mon House Hotel or into the slaughter in Enniskillen in my constituency. I do not hear a great clamour for an inquiry into the atrocity in Omagh, other than its being used as a yardstick and an opportunity to pillory the security forces. I do not hear about an inquiry into Bloody Friday. There have been many acts of slaughter in this Province, yet inquiries are called for only in cases in which Republicans claim that there has been security force collusion. Every opportunity is seized upon to denigrate the forces of law and order and to put them behind the eight ball. I have no doubt that that is what is happening here.
Ms McWilliams stated that she had no political axe to grind on this, that it was simply a matter of getting to the facts. Alban Maginness again referred to security force collusion. According to some Members of the House, every time there is an atrocity such as this, it seems that there must be security force collusion.
We either move on, or we stand still, or we are selective. Some want to turn a blind eye to all the atrocities, but some of them were more heinous than others, as if that is possible. Yet, some of the most heinous atrocities do not seem to be of any consequence. That is something that we on the Unionist side find very hard to understand.
With no disrespect to Prof McWilliams, I have yet to hear her call for an inquiry into Enniskillen, where people were slaughtered while attending a Remembrance Day service. I have yet to hear her talk about Teebane, where Protestant workers were slaughtered on their way home. I have yet to hear her talk in the Assembly about La Mon House Hotel, but maybe I have got it wrong. Maybe she has referred to all the incidents.
The least that the Assembly must ask for is a degree of consistency. Let me make it quite clear that I have no brief whatsoever for those who carry out such atrocities. I do not believe that anybody should be marked out because of his politics. However, I would like to see a degree of consistency and less hypocrisy when Members are speaking here. When I am told that this is another one that is being referred to as part of the dirty war and that this is something that Unionists will have to address, I find that very hard to take, particularly coming from a group that is inextricably linked to the greatest killing machine in the whole of western Europe. That group is not cutting —
Donovan McClelland (Social Democratic and Labour Party, South Antrim)
Mr Morrow, I must be very strict with time.
Maurice Morrow (DUP, Fermanagh and South Tyrone)
That group is not cutting any ice with the Unionist community when it comes out with talk like that.
Kieran McCarthy (Alliance, Strangford)
I thank Prof McWilliams for bringing this important subject to the Floor of the Assembly. I am somewhat disappointed in Dr McCrea. I assure him that I do not regard him as a Unionist who is involved in any of those things. There may be some misapprehension, but I would not go along with that.
I hope that the Assembly supports the motion to help bring about an end to the suffering of the friends and relations of all the innocent people who were slaughtered on that day in both Monaghan and Dublin. Of course, many other people in our community have suffered grievously, and they have yet to see the perpetrators convicted and/or get answers about the circumstances that led to the deaths of their loved ones. I only have to refer to last week, when we remembered the Teebane slaughter. We offer our sympathy to those people who are still looking for justice for that atrocity.
The problem with the atrocities in Dublin and Monaghan is the commitments that were given by our Government some time ago that have not yet been honoured. The Irish Government set up the independent commission of inquiry in January 2000, after pressure from the relatives of those killed and injured, because after so many years no one has been apprehended or brought to justice for perpetrating those horrendous outrages against innocent human beings. Of course, as I have said, that applies equally to all the outrages committed during the last 30 years.
Much has been written about the atrocities in Monaghan and Dublin, and rightly so. Fingers are pointed in many directions, but when the commission was set up, people were hopeful that answers would be forthcoming. At the time, the British Government gave an assurance of co-operation with the commission. Unfortunately, to date little or no co-operation has been forthcoming, and that is why we are discussing this today — in the hope that that will be put right.
The longer the saga continues, the more suspicions and rumours are created, which does nobody any good. We are all aware of the commitments and goodwill that were given by our Government — by Mr Blair, Adam Ingram, John Reid and many others — to help provide information to the commission of inquiry.
So far that commitment has not been honoured. Those gentlemen are hon Members of the British Government, and I urge them to do the decent thing and provide this vital information as soon as possible. We often hear people say that they support the victims of violence. This is a real opportunity to show that actions speak louder than words. Relations between Britain and the whole of Ireland are presently in good standing. I am thankful that, since the start of the all-party discussions that led to the Good Friday Agreement, relations between all the people in these islands have been at an all-time high. Let that continue.
Only this week, relatives yet again expressed deep disappointment at the outcome of a meeting between Mr Reid and Justice Barron. Again John Reid, our Secretary of State, said:
"I will do all I can to see we are as helpful as possible."
While that was a welcome statement, after nearly two years it falls far short of what is now required. All files held by the Government on the atrocities committed on that awful day, 17 May 1974, must now be produced in full to Justice Barron. Only then can the relatives begin to see justice. The Alliance Party fully supports this motion and hopes that our Government will listen to the words of the Assembly.
Cedric Wilson (NIUP, Strangford)
My party would be pleased to support a motion in this House from any party that adheres to the democratic process for an inquiry into any act of terrorism in the United Kingdom or the Irish Republic, if we believed that the purpose of that inquiry was to ascertain the truth and apprehend those responsible for acts of murder and maiming. That would be true whatever group was involved — whether Republican or so-called Loyalist terrorists.
However, having listened to Ms McWilliams, I will say most emphatically that we will not be party to what is clearly a farce. Ms McWilliams had the audacity to inform us about her and her party’s involvement in the Belfast Agreement — an agreement that brought unreconstructed, unrepentant terrorists back onto the streets of the Province to return to their trade. It was a process that did not put terrorists in the dock, in court or in jail but into the Government of Northern Ireland.
As Mr Morrow has pointed out, many events in Northern Ireland require inquiries. I am not just offended by the jurisdiction — by the fact that Ms McWilliams and her Colleagues feel that they should start calling for inquiries into the events that occurred in Dublin and Monaghan. When one reads of those events, one is struck by their similarity to the 30 years of violence and, as some have mentioned, the bloody Fridays that we have had in Northern Ireland. Indeed, every day was a bloody day in Northern Ireland — 365 days of the year, every year for over 30 years.
Ms McWilliams and her Colleagues have suddenly had some attack of conscience on this matter. What I find most offensive is that it is clear that she and her Colleagues, other Members on the opposite side of the House and those who signed up to the Belfast Agreement are now prepared to endorse the latest move by the British Government under the terms of the Weston Park agreement. Those who are currently on the run for acts of terrorism are going to be given an amnesty. If she had anything genuine in her heart on this matter, she would not support that.
There is no point in having an inquiry to find out who organised, assisted and planted the bombs in Monaghan and Dublin if one is not prepared to take the next logical step: once you ascertain who was responsible, you apprehend them and bring them to justice. That is what the people of Northern Ireland and the Republic of Ireland require. Those responsible must to be put in jail, not granted amnesties. I did not vote in this House, as these Members had the absolutely disgusting audacity to do, to put those who front terrorist organisations — "inextricably linked" to terror, to quote the Prime Minister — into positions such as that of Minister of Education and Minister of Health, Social Services and Public Safety in Northern Ireland.
If we are to have public inquiries in Northern Ireland, let us have an inquiry into the activities in the days leading up to Bloody Friday of Mr Gerry Adams, the commander of the Belfast brigade of the IRA, responsible for organising and orchestrating that violence. Let us have an investigation into the activities of Martin McGuinness, that self-proclaimed member of the IRA — and we all know his role in that.
I will return, Mr Deputy Speaker — [Interruption].
Donovan McClelland (Social Democratic and Labour Party, South Antrim)
Mr Wilson, I remind you that you must speak to the motion. You have moved off it substantially. I have given you quite a licence.
Cedric Wilson (NIUP, Strangford)
Ms McWilliams will need to explain to the victims of violence in Northern Ireland and the Republic of Ireland why, when she is calling for this investigation on the one hand, she is saying, with her great experience of South Africa, that all she really wants to know is the truth. She does not want to go any further because that might ruffle a few feathers. It is OK to call for those who orchestrated and organised the bombing of Omagh to be brought to justice, but, we are told, the Sinn Féin Members who are glaring at us from across the Chamber must have immunity so that in the future the Minister of Education cannot be removed from his post and put in jail where he belongs.
Alan McFarland (UUP, North Down)
The Dublin and Monaghan bombings were appalling tragedies, and those responsible should have been brought to justice. However, while there was evidence, the Irish authorities considered that is was not enough to lead to convictions.
I am concerned about the glee with which Sinn Féin approaches these subjects in the House. It sees Brit plots everywhere, and we have another one today. I am concerned about the present one-way traffic of these inquiries, and many Members have also drawn attention to that. Ms McWilliams talked about victims having a right to know what happened. There are over 3,000 victims who have a right to know what happened. The majority were victims of the Provisional IRA.
Where is the clamour by Amnesty International, the Committee on the Administration of Justice, the Human Rights Commission and others who quickly take up these causes? Where is the clamour to investigate the outrages of the past 30 years? We do not hear it. I have warned repeatedly in the House about having a truth commission. If we have learnt anything from South Africa, it is that we should not continue examining the entrails of the last 30 years. People from both communities in Northern Ireland need, and mostly want, to put the conflict behind them. Let us leave this behind us. If we get into 30 years’ worth of murder and mayhem and over 3,000 deaths, with each one being investigated to find out who did it and when, this conflict will never end. We will be at this in another 50 years with accusations across the Floor of the House between the communities about who did what and when. We should put this conflict behind us and let these issues lie.
Monica McWilliams (NIWC, Belfast South)
Let us all be assured that the things that have happened in the past need to be opened up. John Paul Lederach visited Northern Ireland to address victims’ conferences — many of which I attended. He said to remember and to change — he did not say to forget. He said to remember everything that has happened to you, to change and to learn lessons from it to ensure that it does not happen again.
For those Members who are concerned about my moving this motion, every time there have been human rights abuses, currently or in the past, I have asked for them to be investigated. I have especially asked for an investigation for the families of the disappeared. I will continue to work with the families of the disappeared in Northern Ireland to ensure that they get some truth, even if they never get their bodies returned for Christian burial.
The inquiry is already established. This motion is not calling for an inquiry; it is calling for the closure of that inquiry. It is already up and running. Mr McFarland may have questions, as I have, about how many more inquiries we will have.
Rest assured: there will probably be many more inquiries. I hope for Mr Morrow’s sake and for all of our sakes that some day there will be some kind of truth in this country about what happened at La Mon, Teebane, Enniskillen and elsewhere.
All of us who have read ‘Lost Lives’ by McKittrick, Kelters, Feeney and Thornton might be able to establish things that we did not know before. Until I read that book, I did not know that a close friend of mine was tortured before he was murdered in 1974, at exactly the same time as those bombings took place. That was a little bit of truth of which I was unaware. Can we imagine what it must have been like for that person’s mother to read that for the first time? That is what inquiries attempt to do. So many questions remain unanswered that the families, many of whom will be listening to this debate, simply want to know what happened and why.
If there are questions about why the Garda Síochána investigation concluded early, Mr Justice Henry Barron should answer them. If there are questions about the technical capacity of the paramilitaries to carry out the bombings, some of the files might answer them. What was the level, or lack, of co-operation between the Garda Síochána and the then RUC? Was there penetration? That would not be surprising after 30 years of the troubles in Northern Ireland. In order to gather intelligence from those operating against one’s police force, does one not try to infiltrate and penetrate in order to understand them better than they understand themselves? That is what I understand to be a line of military intelligence gathering. Do we not want to ask those questions and always have them answered? The difference is that we expect standards from those in charge of law and order that we might never expect from paramilitaries.
The inquiry is in place, and all that is being asked for is a full and truthful disclosure, and, it is to be hoped, some consistency. I have worked with victims’ organisations such as Families Acting for Innocent Relatives (FAIR), Families Against Crime by Terrorism (FACT) and others. Let no one be under any illusion that they do not disparage the word "truth" any more than the families of the forgotten do. What unites them is that they want disclosure, and they want some truth.
In order to protect ourselves from perpetrators, we have to have retribution. However, in a conflict resolution situation, there must also be some restoration of justice. The least that we can do is give those families a little bit of that.
In this Building last week, pupils from Lagan College presented a play by Paul Goetzee, ‘The Pilgrimage’, in which he wrote that
"Peace is a foreign country when war has been your home for far too long."
Perhaps all that we can do in the Assembly today is vote to give those families a little bit of peace in their lives.
Question put.
The Assembly proceeded to a Division.
John Kelly (Sinn Féin, Mid Ulster)
On a point of order, a LeasCheann Comhairle. What is the ruling when it is obvious that the minority of Assembly Members, in answer to your question, say "No"?
Donovan McClelland (Social Democratic and Labour Party, South Antrim)
Mr Kelly, you know the rules of the Chamber — I hope as well as I do.
John Kelly (Sinn Féin, Mid Ulster)
Well perhaps you could explain them to us.
Donovan McClelland (Social Democratic and Labour Party, South Antrim)
Mr Kelly, I advise you not to be discourteous to the Chair.
The Assembly divided: Ayes 26; Noes 18
Ayes
Alex Attwood, Joe Byrne, Annie Courtney, John Dallat, Mark Durkan, Sean Farren, David Ford, Tommy Gallagher, Carmel Hanna, John Kelly, Patricia Lewsley, Alban Maginness, Kieran McCarthy, Alasdair McDonnell, Barry McElduff, Gerry McHugh, Mitchel McLaughlin, Monica McWilliams, Jane Morrice, Conor Murphy, Mary Nelis, Danny O’Connor, Eamonn ONeill, Sue Ramsey, Brid Rodgers, John Tierney.
Noes
Billy Bell, Wilson Clyde, Fred Cobain, Tom Hamilton, David Hilditch, Roger Hutchinson, James Leslie, Maurice Morrow, Ian Paisley Jnr, Edwin Poots, Iris Robinson, Ken Robinson, Mark Robinson, George Savage, Jim Shannon, Jim Wells, Cedric Wilson, Sammy Wilson.
Question accordingly agreed to.
Resolved:
That this Assembly calls on the UK Government to expedite, as agreed, their provision of all relevant documents and files to the Independent Commission of Inquiry into the 1974 Dublin and Monaghan bombings, which is chaired by the former Irish Supreme Court Judge, Henry Barron.
(Madam Deputy Speaker [Ms Morrice] in the Chair)
Motion made
That the Assembly do now adjourn. — [Madam Deputy Speaker.]
Closure of Factories in Lisnaskea
Tommy Gallagher (Social Democratic and Labour Party, Fermanagh and South Tyrone)
The issues of unemployment and job losses have been discussed in the Chamber before; they will be revisited today. In the constituencies in the west of the Province, unemployment levels are persistently high.
Lisnaskea is the second largest town in Fermanagh; it has a population of 3,500. In the past three years the town has suffered major job losses — there were 70 redundancies when the Adria factory closed, 80 jobs were lost when Fermanagh Creameries shut down, and 196 were lost when the Sir Richard Arkwright textile factory finally closed in July 2001. The loss of those 350 jobs has resulted in hardships for the employees involved, their families and other local people.
Belfast has a population of 352,700. Can Members imagine what would be the impact upon Belfast of 35,270 job losses — one-tenth of the city’s population — over a three-year period? The job losses in Lisnaskea were a severe blow to the town and to the wider Fermanagh community. The wages of employees at the Sir Richard Arkwright factory contributed some £2 million to the local economy each year. In the aftermath of the closures, there were promises of renewed efforts to secure more inward investment to the area. To date, however, there has been no breakthrough in that regard. Those who were made redundant were given some support in the form of help to relocate and retrain. Some were able to find work elsewhere, although many of those jobs were located outside the Lisnaskea area and some were situated across the border.
The unfavourable exchange rate disadvantages those who work in the South but live in Fermanagh and pay their bills and mortgage in sterling. For several years the difference in the exchange rate has created a downward trend in cross-border trade in towns such as Lisnaskea. The effects of that have now been compounded by the job losses.
A more hopeful sign has been the resolute action and attitude of the local community. The local development association has put in place a strategic plan to help small local businesses to grow. It has built small business units, all of which are already occupied. There is a demand for extra workspace, and at least one of the present tenants of one of those units is ready to move to larger premises and to increase his workforce. Conveniently located land is available for that purpose, and locals are formulating a plan to help to finance further developments. Their aim is to retain expanding business in the area and to increase employment. As we know, increased employment, in turn, will bring greater social and economic benefits for that hard-pressed area.
That is one example of the approach referred to by the Minister, Sir Reg Empey, at the time. I note that he is present for the debate. He referred to the development of local business as one way of countering the blows of factory closures in the Fermanagh area. Locally- owned, home-grown businesses are a success story in Fermanagh. However, indigenous industry must be nurtured by Government agencies. Therefore, I call upon the relevant agencies to give assistance to local development initiatives and to facilitate expanding businesses at Lisnaskea so that they can bring their plans to fruition.
We want inward investment in the area, and we are entitled to a level playing field when competing with other areas in Northern Ireland to attract new jobs. The area suffers from some disadvantages. For example, it is far from the bigger airports, and its roads are in a poor state. I repeat my demand that the Department for Regional Development includes the upgrading of Fermanagh roads in its plan. In response to a recent question in the House, the Minister for Regional Development, Mr P Robinson, said that it would help Fermanagh if the roads in neighbouring counties were upgraded. The people of Fermanagh will not be fobbed off with that suggestion. We want the roads in our county to be upgraded so that we have a level playing field for attracting inward investment and helping local businesses.
When the job losses occurred at Lisnaskea last summer, there was a great outpouring of concern about the situation. We must remember that the employees who lost their jobs and their families are living with the consequences. Hence, I proposed this debate, and I ask that the creation of jobs in the area be given all the attention and support that it deserves.
Maurice Morrow (DUP, Fermanagh and South Tyrone)
It is appropriate that the Assembly should discuss this matter at this time, and I thank Mr Gallagher for bringing it to our attention. About 18 months ago, people living in Fermanagh and south Tyrone read headlines in the local papers, such as, "135 Jobs lost in Desmonds closure"; "Staggering loss to Employees" at the closure of Unipork and "Shock turns to anger for cheesemakers out of a job" when a cheese factory announced its closure.
When the Lisnaskea factory closed, I contacted the Minister, Sir Reg Empey. I was impressed by his hands-on approach and his willingness to do all that he could to try to avert the job losses and create better prospects for the future. I attribute no blame to him whatsoever for his best endeavours. It is right that Members should acknowledge that he is present in the House today. He has again shown that he does not take these matters lightly but wants to adopt a hands-on approach.
At that time, around 18 months ago, when there seemed to be a catalogue of announcements, Sir Reg Empey said that the Malton’s closure was another regrettable setback for Fermanagh, one of the regions where the Department of Enterprise, Trade and Investment and its agencies were focusing initiatives to strengthen employment. I look forward to hearing how the Minister has advanced those initiatives since then. It would be appropriate for the Minister to tell the House what the future strategy is for areas like County Fermanagh. We are entitled to be treated like any other part of Northern Ireland. We could be forgiven at times for thinking that we are not treated that way. We will let others be the judge of that.
County Fermanagh is an area of high unemployment. Unless we get investment quickly we could be in a very bad situation. The people of Fermanagh, in areas such as Lisnaskea, are innovative and have made honest endeavours to do things and to stimulate their area. They cannot do it without the support of the Minister and his Department. I call on the Minister to take a particular interest in County Fermanagh and the Lisnaskea area and for his Department to come up with a strategic plan that will directly tackle the recent job losses and, more importantly, stem the flow of redundancies that have come in a glut recently.
I also ask the Minister if he is prepared to consider County Fermanagh for high-tech jobs. Fermanagh suffers more from the lack of that type of investment than any other region in Northern Ireland. I would like to direct the Minister’s attention to that particular type of work to ensure that the job losses do not continue in the days ahead. A proper infrastructure and a strategic plan are needed. I hope that the new Invest Northern Ireland board will divert some of its energy and money to tackling the chronic problem.
Gerry McHugh (Sinn Féin, Fermanagh and South Tyrone)
Go raibh maith agat, a LeasCheann Comhairle. I thank Mr Gallagher for raising this matter nearly a year after the job losses occurred. Not much has changed for those who found themselves out of work in Fermanagh — Lisnaskea in particular, where almost half the total jobs were lost. I have looked at the figures relating to the factories that were closed. We all know which factories lost out. One of the worst cases was Fermanagh Creameries. Food production was something I considered to be fairly high-tech, given the quality of the machinery that was in that factory. I believe that it could have been continued. However, that is not the Minister’s fault, or indeed anyone’s fault. It is one of the things that happen. Members have no say or control over them. However, we must deal with them when trying to represent our areas.
It was a perfectly good factory, which could have produced for years to come. It is now lying idle. Most of its machinery is dilapidated and can no longer work.
Agricultural businesses outnumber other businesses in the county. Although agriculture is important, it is also a weakness because of the great dependence on it. Farming, for example, is an industry in the doldrums. It is difficult to see a future for farming or a way out of the present situation despite the ‘Vision for the Future of the Agri-food Industry’ report from the Department of Agriculture and Rural Development. Of all registered businesses in Fermanagh, 58% are agricultural; the figure for the Six Counties as a whole is 33%. That highlights the area’s rurality and the importance of farming to its economy.
Unemployment figures from the Department of Enterprise, Trade and Investment in 2001 show that 1,767 people were unemployed in Fermanagh: 1,264 male and 503 female. That gives an idea of the effect of job losses on those who expect to find work in the area.
All job losses have dramatically affected the people of Fermanagh. Such job losses are unacceptable. However, it is even more unacceptable to be told that the situation is improving because the number of people claiming jobseeker’s allowance is decreasing. It is not mentioned that the number is decreasing because people are being siphoned off into training schemes, forced to claim other benefits or entering part-time or temporary employment with lower wages.
A recent study by consultants for Fermanagh Economic Task Force highlighted a labour force reserve of 2,829, compared with a Department of Enterprise, Trade and Investment jobless total of 1,766. The Department’s figures do not include those who are not claiming benefit because they work in a temporary or low-paid job, are unemployed, or are unemployed farmers. In addition, unemployment in the farming community is high and continues to undermine our economy’s ability to grow. There is a considerable difference in those figures, which the Minister can perhaps explain.
It is clear that the peripherality of Fermanagh means that the area requires disproportionately more IDB investment and support to attract and retain inward investment and to develop local indigenous businesses — possibly more than anywhere else. IDB assistance in Fermanagh between 1996 and 2000 was 5% of the Northern Irish total. However, only 2·5% of the jobs that were promoted and safeguarded by the IDB were in Fermanagh.
A recent Department of Enterprise, Trade and Investment labour market bulletin recognised that districts in the west, among them Fermanagh and Tyrone, showed the highest concentration of long-term unemployment. In several districts, over 34% of the workforce were long-term unemployed. In Fermanagh, the figure was 38%, while the figures for Derry and Omagh were both 34%.
LEDU has had an impact on the small business sector with its business start programme. Of the 149 people in Fermanagh who completed the programme, 86 went on to start their own businesses — almost double the Northern Irish average. There is a significantly higher percentage of small business starts in Fermanagh in comparison with Northern Ireland as a whole, which proves that starting and establishing small businesses is one of Fermanagh’s strengths rather than attracting larger businesses, as the area does not have a large pool of workers.
Between 1995 and 1999, tourism ranked as the fourth highest generator of money in the local economy. The TSN programme of action is obviously one of the areas of greatest need. The ‘Measures of Deprivation in Northern Ireland’ report by Dr Mike Noble is significant. Perhaps the Minister and other Departments can look at how that will affect Fermanagh.
If all Departments follow suit, the figures show that among the voluntary agencies — even in health — anyone doing anything in Fermanagh is obviously at a disadvantage. The Noble index is unfair, as opposed to our position on the Robson indicator. We are losing a considerable amount of money. The local strategy partnership (LSP) may operate in respect of some of the new money for the new rural programme, and that impact will continue. I do not know what we can do about it, but the impact on Fermanagh will be severe in comparison to that on other areas, including urban areas.
The current population of Fermanagh is 57,000. That will rise to almost 59,000 by 2003 and to 60,000 by 2008. The population of working age will rise from 33,500 to 37,000 by 2008. Therefore, more people will be available either to look for work or to fill jobs provided by outside bodies. The Robson and Noble indicators will be significant, and that is worrying unless figures can be produced to show something different.
Of the 45 Noble indicators, seven domain deprivation measures are combined to produce one overall multiple measure, with income weighted at 25%, employment at 25%, health and disability at 15%, education, skills and training at 15%, geographical access at 10% and social environment and housing at 5%. Seventeen per cent of our housing is unfit. The ranking is very low for something so important, and Fermanagh will fare badly as a result.
Fermanagh’s strength is, as I mentioned earlier, in the small business sector. We have several small but considerable businesses that survive on their own. Whatever profits they make are returned to the business. Through the rural programme, we probably need to start up more small businesses in small villages to provide off-farm jobs. That has been done successfully in parts of County Monaghan.
Our difficulty is that planning policy statement (PPS) 7 permits no commercial development in the countryside. Most of Fermanagh’s villages have no zoned areas for development, and that creates a problem for people who have to travel from places such as Rosslea to Enniskillen to start up a business. They are forced to pay for space that they cannot afford, when quite often they would prefer to start a small business in their own back yards or on their own bits of property. Many of our businesses started that way.
That has not been dealt with. Planning continues to be a severe difficulty for us, and it will continue to be so, even in the new rural development programme. It is for those Departments and Ministers to examine that matter and see what can be done; otherwise the new programmes will be a waste of time.
Businesses are more easily started across the border. There is more incentive from the Industrial Development Agency (IDA). Our problems seem to be greater. More business is permitted in rural areas, and that must change. We must encourage investors, together with small- and medium-sized businesses, into all areas. Small business managers must be persuaded of the benefits of staff training versus looking for capital handouts. That is often their chosen route, and it can be bad value for money. It should be explained to them that training their staff in marketing would gain them more.
The aggregates tax is obviously going to put us in an uncompetitive position. Construction is one of our strengths in Fermanagh, and it is a growth industry. It will become uncompetitive with the introduction of the aggregates tax, and I welcome the stay of execution on that.
Fermanagh and, perhaps, Derry also are without broadband services, information and communication technology (ICT) and the superhighway. Other areas have those facilities. I mentioned the matter to British Telecom officials during a recent presentation, and its representatives said that they would look at that in greater detail. However, it puts Fermanagh at a competitive disadvantage when compared to other areas such as Letterkenny. Those services are important to education, and participation in the ICT industry is something that Fermanagh could gain from.
If my figures are correct, then, according to the Noble report, Fermanagh needs to benefit from rural proofing. That is why we have been arguing for rural proofing of the various departmental policies and the effect they have on rural areas.
The Hayes Report raises other issues, and its implementation would make a big difference to a county that is in dire need of jobs. The Erne Hospital is one of the area’s largest employers and one of our greatest strengths, and we are hoping against hope for success there.
The report from the Department of Agriculture and Rural Development’s vision group can also give benefits. The Executive will need to support their implementation by providing the necessary resources. Without those resources, much of the proposed rural programme will not happen. Agriculture faces a difficult future. Those developments may deliver local jobs, and the Minister of Enterprise, Trade and Investment, and others, should consider them.
I thank the Minister for his consideration of the jobs situation. The job losses that occurred were not his fault, and he was not in a position to do much to prevent them. He did his best, and he worked with everyone, including myself, to try to do everything possible for the people who lost their jobs. Many of those people have had to travel to firms such as Quinn’s, to places across the border and to other areas in search of jobs. Even though some of them have found employment, the fact remains that they have had to travel away from Lisnaskea. That shows that if local jobs were available, the people would be there to do them. Go raibh maith agat.
Reg Empey (UUP, Belfast East)
I welcome the opportunity to respond. The reasons for the debate are apparent, and they have been eloquently addressed by the Members who have spoken.
The substantial reduction in jobs, associated with the closures that have been referred to, is regrettable. However, as Members have accepted, the decisions to cut jobs were taken by the individual companies involved for their own reasons. I do not need to remind anyone of the difficulties that the food-processing and textile sectors in Northern Ireland have faced recently. Lisnaskea and the wider Fermanagh area have not been alone in suffering the effects of changes in the market place.
However, we have been taking action to try to halt the decline in those traditional sectors and to encourage them to become more competitive. Many of the jobs lost were in the textile industry. The Kurt Salmon Associates (KSA) report that we commissioned, and which was published last year, is a clear example of how Government and industry have worked together to identify a way forward for the sector.
There were five themes for sustainable growth in the sector — focusing on branded products; applying e-business and knowledge techniques; the development of strategic alliances between suppliers, customers and centres of excellence; the development of more balanced sourcing of portfolios that include offshore suppliers; and the development of unique and desirable products.
As part of the recommendations of that report, a new industry-led company called Catalyst was established in December 2001. It will provide strong leadership for the sector and continue the work of the report’s implementation team. The IDB will continue to work closely with the sector bodies and individual companies to ensure that the momentum that was built up following the publication of the KSA report is not lost. I wanted to mention that, because some people believe that we have given up on the textile sector. That is not true — it is still a significant employer in Northern Ireland and is well ahead of the national average. Between 13,000 and 14,000 people are employed by the industry, so it is a significant sector by any standards. That does not compensate those in the Fermanagh area who have suffered. Nor does it compensate others in that sector, in areas such as County Antrim and County Down, who find themselves under threat. That sector has been under continuous threat over the past decade.
Work is continuing to replace the jobs lost in Lisnaskea and elsewhere in County Fermanagh. One way of doing that is to attract inward investment. I understand Fermanagh’s concerns that it has not had its fair share of new inward investment in recent years. There has been a significant number of visits to the county. In the last three years, there have been 13 inward investment visits to County Fermanagh. The IDB continues to encourage people to establish businesses there. Telecom and network service sectors have provided the bulk of new inward investment in Northern Ireland. It has been hard to encourage many of those businesses to establish in areas west of the River Bann. County Fermanagh is no exception, but we continue to try. However, despite the fact that the companies are offered incentives to locate in New TSN areas, they have concluded that a large critical mass of skilled people within a limited travel-to-work area is required for their types of business, and it has been difficult to encourage them to establish in certain areas.
The IDB has been working closely with others, particularly with council and community representatives, to establish how we can best market and promote the area to do our best for inward investors. At the end of the day, it is they who make the final decisions.
We have also been collaborating with LEDU on the council-led economic task force, which was established in March 2001 following job losses. The task force has been very important. It comprises representatives from all Department of Enterprise, Trade and Investment agencies, the council and the local community. It is a good example of how local people can respond, and we are ready to help that task force in any way that we can.
Inward investment is not the only solution. Most jobs in Northern Ireland are created by indigenous companies rather than by inward investment. Much has been done to stimulate and help the development of local businesses, enabling them to become more internationally competitive. One of the key priorities identified by the economic task force was the need to support small local businesses to identify and develop potential for growth. To this end, the Department of Enterprise, Trade and Investment has offered financial assistance for the establishment of the Fermanagh growth programme, which is directed specifically at small businesses.
Many companies from the area have participated on international-led trade activities, such as trade missions, trade development visits and exhibitions. They have also made use of tailor-made consultancy from trade advisors in the Middle-Eastern, European and Asian markets. Competitive assessment and improvement methods are also offered to companies in the area, and several have availed of these services. In addition, the IDB’s e-business service helps prepare traditional manufacturing companies to participate in the digital economy by using information and communications technology to protect and enhance their profitability and achieve sustainable growth. Some forward-looking companies have recognised the importance of this and have made use of the service.
Not all has been doom and gloom in the county. While this debate focuses on Lisnaskea, it must be emphasised that there are job opportunities in the wider area. For instance, in December 2000, I was privileged to announce the £2·5 million investment by Belleek Pottery, at a time when traditional companies were under pressure.
So far, that has resulted in the creation of 30 of the 50 jobs that were promised, and I hope to see the speedy conclusion of that expansion. Rye Valley Foods in Enniskillen is another success story: it is investing almost £14 million at its plant, which will ultimately create 130 new jobs in the manufacture of frozen prepared meals for the Irish, British and European retail food service markets.
LEDU also remains active in supporting local industry in the Lisnaskea and Fermanagh area. For example, LEDU has represented my Department on the task force and on the Into the West and Innovation West initiatives. Last year LEDU organised a business growth seminar at which it presented a range of support services available to clients and at which the Fermanagh growth programme was launched. The LEDU western area regional action plan aims to ensure that all small indigenous businesses located within disadvantaged areas of Fermanagh and Tyrone are afforded the opportunity to participate in a range of business development programmes.
Raw unemployment statistics are only one indicator of unemployment levels. Members have pointed out that other issues are involved and that raw statistics cannot be taken on a stand-alone basis. However, they are not insignificant. According to the last set of figures that I have available, some 1,670 people are currently registered on the claimant count. That figure is 100 fewer than Mr McHugh’s figure.
This year’s pattern has similar highs and lows to last year’s. Last August unemployment rose to about 1,900, largely due to the closure of the Sir Richard Arkwright textile factory and the effects of other previously announced redundancies. However, that figure is still marginally below the figure for the same period in the previous year. The subsequent figures show that that pattern is continuing: unemployment is now slightly lower now than it was last year, with a difference of approximately 123. I acknowledge that it is a blunt instrument and that those figures must be viewed alongside other issues. It is true that some people may have moved on to claim other benefits or not sought re-employment. However, many people who lost their jobs last summer have managed to find themselves relocated, many of them in the Enniskillen area. Ironically, several companies complained to me that they could not attract labour and were having difficulties recruiting staff.
So there has been some displacement, and I do not doubt the validity of Members’ anecdotal evidence about people having to find jobs across the border and so forth. However, it has not been all negative, because some people have started their own businesses, having been counselled when they were made redundant. Admittedly, that number may not be large; nevertheless, it is significant as it shows that people have taken the opportunity to move on on their own.
As regards LEDU, if all goes well, we expect approximately five projects to be announced between now and the end of the financial year. Those five projects will create approximately 34 jobs. Although I cannot be specific at this stage, the IDB is negotiating with some companies in the county, and I hope to be able to make some announcements before the end of the financial year. However, on the whole, the small business sector in the county is one of the most vibrant in the west of the Province.
Many people there are actively promoting, expanding and starting businesses. The county is taking up a disproportionate share of the available resources in the west of the Province because there is a good core of businesses there. Clearly, there are people in the county who are anxious to progress. There is leadership from the council, and now a new basis and good analysis in the recent Quinn report. I am hopeful that this will send out a message that, despite all the difficulties, the county still has a vibrant, viable small business sector. Indeed, it is clearly growing, as I have outlined, with the projects that we hope to announce between now and the end of the financial year, and I see no reason why this should not continue.
However, I am aware of the underlying fragility in certain areas. There is disproportionately high dependence on agriculture, and we all know that there are clear difficulties there — difficulties that apply right across the Province and further afield. Those difficulties do not often show up in unemployment statistics. Often self-employed farmers have to take a second job, and they do not necessarily show up as unemployed. At the same time, however, there is a reduction in earnings and therefore less money in the economy.
Foot-and-mouth disease had a disproportionate effect on two of County Fermanagh’s stable industries — tourism and agriculture. There is no doubt that our tourism industry has not yet fully felt the effects of 11 September; there is a long way to go. We know from experience in the Gulf war that it took three to four years for the transatlantic tourist traffic to return to pre-war figures. I see no reason to believe that we shall not face similar time scales. Tourism is re-focusing its emphasis on the European and Great Britain markets to compensate for the shortfall, and, of course, a major drive will be made in the Republic to encourage more visitors. Those areas will be targeted to supplement some of the anticipated losses from long-distance destinations.
I am concerned that we are talking down the economy of County Fermanagh — almost implying that it is on its knees. It is not on its knees. It has suffered a bad period in its history with these losses. However, I am hopeful, as the county has a good community spirit. Many good voluntary organisations are working in close co-operation with the council and the statutory bodies, and there is co-operation between the statutory bodies, which is absolutely critical. Indeed, County Fermanagh is one of the leading examples of this co-operation in Northern Ireland. It is happening at a structured level. Resources are being put into it, and the council is taking a major lead. There is civic leadership in the area to justify support.
There is also a strong small business sector, which we sometimes underestimate. The announcement of one or two extra jobs somewhere in the country does not necessarily make the headlines. The media gives disproportionate coverage to closures, and I have watched this closely over the last couple of years. If one tries to get a good news story on the economy into the press, one may or may not succeed.
The announcement of a closure will have no trouble whatsoever in achieving headlines. However, it will have a detrimental effect on our ability to give confidence to the business community in the county. People who wish to invest money need to have confidence. They are aware of what is going on around them, so if they hear stories of doom and gloom, they are less likely to invest.
Another key issue that was raised during the debate was planning, and my Colleague, the Minister of the Environment, is in the Chamber.
There is a tug of war between the desire to help small businesses to locate in rural areas and the desire to protect the environment, and permanent tension exists between those two objectives. Many people would not want to see ad-hoc or willy-nilly development in rural areas, because that would spoil one of County Fermanagh’s key assets — its beauty. Indeed, that county has a collection of some of the most beautiful landscapes anywhere, and nobody would wish to see that destroyed. Therefore, the Department of the Environment has a huge task in trying to balance the protection of the environment with allowing the economy to grow. We must continue to discuss those tensions, which are reflected in the local community, the district council, communities in the wider county and elsewhere in rural Northern Ireland, because we want to protect our heritage and the environment. However, at the same time, we do not want to stifle economic development.
The tension is reflected throughout the community. It does not have any party political issues attached to it; it is purely a matter of how we see our future. My Department is interested in the matter, but we must be aware of that tension, and we do not want to destroy our heritage. We want to pass on an environment of which our successors can be proud.
Another closely related issue is land and the provision of sites. That has been a live issue in Lisnaskea in particular.
Jane Morrice (NIWC, North Down)
I remind the Minister that thanks to the family-friendly Standing Orders, our cut-off point is 6.00 pm.
Reg Empey (UUP, Belfast East)
I wish to close on the issue of the land. We are negotiating with economic development people in Lisnaskea and await their proposals. I am hopeful that we can achieve a way forward. We are also looking closely at other projects in the county, which could ensure access to sites for industrial development. We want to encourage such development, because Lisnaskea has an excellent record. With several sources of funding, there is the potential to achieve a satisfactory outcome especially given Lisnaskea’s track record of success.
I want Members to be aware that we are far from complacent. I thank Mr Morrow for his comments, but I regret that some of the communications concerned negative news. Nevertheless, the county has much going for it. It is beautiful; it has immense potential in the European Union for expansion of its tourism sector. However, people do not want to sit in a museum. They want to be active participants. They want to see businesses that can provide employment so that their children do not have to leave. Our agencies and Invest Northern Ireland, when that is established in the spring, are determined not to take their eye off the ball in County Fermanagh, and I certainly hope to visit the area in the near future.
Adjourned at 5.59 pm.