Northern Ireland Assembly, 17 February 2015

315 contributions from 62 members. The official report.

Ministerial Statement

Jim Wells (DUP, South Down)

Mr Speaker, at the outset, I thank you for your letter regarding my wife's health. It was much appreciated, along with all the messages of support that I have received from Members throughout the House.

My predecessor launched an evaluation of the individual funding request (IFR) process for specialist drugs on 24 September 2014. The evaluation is now complete, and I want to take this opportunity to brief the Assembly on its findings and on how I propose to take the issue forward.

Like the previous Minister, I have heard the concerns raised by cancer patients and survivors, charities, the pharmaceutical industry and, indeed, many colleagues in the Assembly that the current process of providing access to new specialist medicines in Northern Ireland could be strengthened. Before going into the results of the evaluation, I should be clear that, while I absolutely recognise the importance of new drugs to patients, we do need to acknowledge that drug therapies are only one aspect of cancer treatment. Early diagnosis, timely surgery and radiotherapy are of paramount importance in improving patient outcomes, and those are also the treatments that have the potential to lead to actual cures.

In recent years, we have seen significant investment in cancer services in Northern Ireland, and that has led to real improvements in outcomes for patients across a range of cancers. A recent European-wide study has shown that survival rates for lung, breast and prostate cancers in Northern Ireland are the best in the United Kingdom. The improvements that have been made have been brought about through investment in cancer services and by a major refocusing on how the service is delivered. We have established cancer targets, instigated extensive reforms and invested in the staff and infrastructure necessary to bring our cancer services up to the standard expected of a modern high quality health service. We have also been able to provide better access to a wide range of evidence-based treatments, including drugs and radiotherapy. Cancer services have been reorganised in recent years so that professionals with an expertise in treating the most common cancers can be brought together.

Patients who are treated by professionals specialising in cancer and working together as a multidisciplinary team have a better outcome than those not managed by such teams.

Investment in cancer services over the past 10 years has been considerable. It has included: the opening of the Belfast cancer centre in 2006 at a cost of £70 million; additional radiotherapy capacity at the Belfast cancer centre, where two new linear accelerators have been installed at a cost of around £3 million; and a £66 million investment has provided a new radiotherapy unit at the Altnagelvin Hospital, which is planned to open in 2016, by which time the Belfast cancer centre will have reached full capacity. Older Members of the Assembly will remember that, at one stage, that very welcome new facility was cancelled because of an apparent lack of funding. I am glad to say that my predecessor, Edwin Poots, made absolutely certain that funding was found for that much-needed facility, and I have committed myself to providing the funding for the running of it, in conjunction with my colleagues in the Irish Republic.

The improvements have been impressive, but we cannot afford to be complacent. This has all been achieved against a background of increasing demand. The next few statistics that I am about to give you will be quite shocking. Since 2009-10, the number of patients receiving treatment for cancer after an urgent referral has increased by 42·3%. There are approximately 8,500 new cases of cancer diagnosed each year in Northern Ireland and, with an ageing population, that is likely to increase. Indeed, on World Cancer Day, Cancer Research UK announced that, according to its findings, one in two people will be diagnosed with the disease over the course of their lifetime. That is a staggering statistic, but it is also at least partly good news, in that it means that more people are being diagnosed and are surviving longer. Although that is categorically a good thing, it will of course lead to increased pressure on our cancer services.

I move on to the IFR evaluation. The evaluation in the report that I am dealing with this morning was originally intended to test purely whether the IFR process was meeting its objectives. However, its remit was later widened to include additional factors, such as: arrangements for access to specialist drugs in other UK jurisdictions; the early access to medicines scheme (EAMS); the pharmaceutical price regulation scheme (PPRS); and the potential for the reintroduction of prescription charges to finance a specialist drugs fund.

The evaluation report covers each of those areas, and I will outline the findings in a moment, but I want to make it very clear, to the avoidance of all doubt, that I am opposed to the introduction of a cancer drugs fund (CDF) similar to that operating in England. I am opposed to that. There are a number of reasons for that, not the least of which is that specialist drugs are used to treat a large number of serious conditions other than cancer. We should not simply confine our understanding of the situation to cancer alone. As I see it, any solution should therefore address access to specialist drugs for all patients, rather than focusing on one distinct group, to the disadvantage of the rest. Furthermore, there are a large number of new licensed drugs coming onto the market each year. In order to determine which of those new treatments offers the best prospect of improvement over standard therapies, they must be assessed for clinical and cost effectiveness before they are made routinely available. The National Health Service and Health and Social Care (HSC) in Northern Ireland are guided in that process by the National Institute for Health and Care Excellence (NICE), which has an international reputation of excellence in scientific rigour, independence and objectivity.

In its original format, CDF offered no incentive to the pharmaceutical industry to keep prices low and, in fact, introduced a risk that companies could bypass and undermine NICE assessment of new drugs. Indeed, in the aftermath of the well-publicised overspend of £150 million on the CDF, the authorities in England are developing an enhanced link to clinical and cost effectiveness for any drug to be made available through it. The new Scottish system, the new medicines fund, is a more attractive model, offering as it does a new clinical peer-review process and an enhanced role for the patient within that.

However, the Scottish national health service is in a very different financial position to our own and is using receipts from the pharmaceutical price regulation scheme to resource this new fund. The PPRS agreement is a UK-wide arrangement, negotiated between the Department of Health in London and the Association of the British Pharmaceutical Industry (ABPI). The 2014 PPRS was implemented in Northern Ireland on 1 January 2014. At this stage, I cannot be definitive about the scale of the payments Northern Ireland is likely to receive through PPRS. The current financial pressures on the health service also mean that it is not possible to commit to using PPRS receipts solely to fund new medicines. However, I very much welcome the scheme and the positive way in which the ABPI has worked with government to bring it about.

In Northern Ireland, the IFR process was originally set up to provide access to specialist drugs that are not normally commissioned in circumstances in which there is an agreed clinical need. Officials in the trusts and the Health and Social Care Board have worked hard and shown great commitment in making decisions about access to new specialist drugs within the constraints of the existing IFR system. I thank them for this work and emphasise that the changes that I am now proposing are no reflection on their performance; rather, they are about improving the system in which they operate. Having considered the available evidence, I still believe that, with the significant changes that I will now outline, the IFR process can remain an effective mechanism for providing access to specialist drugs for patients in Northern Ireland.

With this in mind, the findings of the evaluation are as follows. First, the existing exceptionality criteria should be amended to remove the reference to 95%. In the course of discussions with stakeholders, the most commonly cited difficulty with the current system has been the 95% exceptionality criteria, whereby clinicians who seek to apply for an IFR must be able to demonstrate that their patient is:

"outside the range of clinical circumstances presented by at least 95% of patients with the same medical condition at the same stage of progression … and is likely to gain significantly more benefit for the intervention".

While it is reasonable to expect clinicians to demonstrate some level of exceptionality, there is a compelling case that the current definition applied in Northern Ireland sets the bar too high. Many groups have contacted me in the last four or five years in my position as Chair of the Committee, Deputy Chair of the Committee and currently as Minister to say that they felt that this is an incredibly high threshold and is very difficult to meet.

The second main recommendation is that the establishment of regional scrutiny committees should be considered to ensure that all IFR applications are subject to regionally consistent clinical input and peer review. At trust level, the scrutiny of IFR applications varies significantly, which may result in some variation in decisions made regionally. The Department also heard anecdotal evidence that this local variability can have the effect of discouraging applications and may have a negative impact on patient confidence through a perceived lack of transparency in the process. To resolve this, the Department proposes to work with the Health and Social Care Board and the trusts to establish one or more regional scrutiny bodies to consider all IFR applications at trust level.

The third recommendation is that the existing IFR guidance should be revised to include greater transparency. Throughout the evaluation process, the team received feedback criticising the alleged lack of openness of the process for patients. The team also found that there was a perceived lack of accessible information on the numbers and detail of unsuccessful applications. As well as reviewing the administrative arrangements, as I mentioned, it would be a worthwhile exercise to review the existing guidance to increase transparency for clinicians and patients in the overall process.

The fourth recommendation is that the Department should establish a specialist medicines fund to meet the costs of administering and maintaining access to specialist drugs.

I suspect that there will be a lot of interest from Members in that recommendation.

Removing the 95% exceptionality criteria and creating one or more regional scrutiny committees will, of course, attract costs, whether due to the increased number of IFR applications or the administrative costs attached. To ensure that the changes are sustainable, I propose the creation of a specialist medicines fund to fully resource the developments and support wider medicines pressures.

To resource the new fund, the recommendation is that the HSC reintroduce charges for prescriptions. I empathise entirely with patients who have undergone trauma and stress related to their treatment, and I want to make certain that they receive the most effective treatment possible for their condition. However, we need to face the fact that my Department does not currently have the finances required to introduce the changes that I have set out in a sustainable manner. The issue is one that I feel passionately about. I want to make sure that the changes happen and that they are sustainable in the long term, but I cannot do it sustainably without finding a source of additional funding.

Prescription charges were abolished in Northern Ireland in April 2010. The cost of providing free prescriptions was found from increased efficiencies in the Department of Health's budget at that time, and no additional funding was sought to support the introduction of that policy. In view of the current financial position, I do not think that it is unreasonable to ask people to contribute to the cost of their prescriptions and to provide a financial foundation for innovative and specialist medicines for the future. I believe that this is an appropriate time to reconsider the provision of free prescriptions in Northern Ireland.

Reintroducing charges for prescriptions is about making funding available for specialist medicines in a secure and sustainable way in the long term. I understand that it will take time to put this into practice, and, in the coming months, I will explore every possible option for making the changes to the IFR process as quickly as possible. I assure Members that once the public have had their say on this important issue, I will bring it to the attention of the Executive as a matter of urgency.

In view of the tremendous interest in the evaluation, I release today the findings of the report for public consultation. The consultation period will run for 12 weeks from today, and my Department will hold a number of consultation events to make sure that everyone’s voice is heard before we finalise these proposals. I look forward to hearing the public’s views, and I also look forward to hearing the views of Members, especially those who sit on the Health Committee, on this important issue.

Maeve McLaughlin (Sinn Féin, Foyle)

Go raibh maith agat, a Cheann Comhairle. I thank the Minister for his statement on a hugely important topic to us all. I welcome his acceptance that the exceptionality clause is set too high. It is a barrier for clinicians, GPs and patients alike. The question is this: what will it be replaced by? I note that the Minister was very specific in his opposition to the cancer drugs fund in England. A view shared by a number of charities is that it is not sustainable.

The Minister talked up the concept of a specialist medicine fund. I think that most people would accept that as a concept. However, will the Minister clarify to the House the current cost of waste in the system, the potential savings from the use of generic drugs and, importantly, the cost of implementing the scheme that he refers to today? If he is convinced that prescription charges are the only answer, maybe he will clarify to the House, given the huge health inequalities, exactly how much people will be expected to pay.

Jim Wells (DUP, South Down)

The Chair asks some very valid questions, which I would expect from the House. First, the model that we are thinking of, which will go out to public consultation, is along the lines of a 30p, 50p or £1·00 charge per prescription per person for everyone. However, because there are so many people with long-term conditions who could not possibly afford to pay that regularly, we are thinking about a season ticket — let us call it that for the sake of argument — costing, we think, although we do not know, about £20·00 or £25·00.

Those are the sorts of figure that are being suggested. We are still working on the model at the moment. Figures will be released for the consultation to work out how much each of the models would produce. That would cover all prescriptions for an entire year. In GB, in England, at the moment, the cost is £26 a quarter. Many people have told me that they would welcome the chance to make some contribution to health-care provision. They feel that it is unfair that people are getting prescriptions entirely for free.

The Chairperson makes a very valid point about wastage. As she knows, the permanent secretary is looking at administrative wastage in the service, with a view to taking out significant savings. I see the administration of what is being proposed costing several hundred thousand pounds rather than several million pounds. There will definitely be costs associated with it. We found that, when we had prescription charges under the old model, we were spending a very large amount of money on enforcement and scrutiny. That was not a good use of resources. In the proposed situation, it would not be a case of having to check prescriptions to see whether a person was entitled to free prescriptions. It would be relatively easy to scrutinise because everyone would be paying.

We have been driving up the rate of our use of generic drugs. I think that the last time that I looked at it, it was at 72%. It is still 72%. Each one percentage point rise saves us £6 million a year. Of course, the difficulty is that we have picked the low-hanging fruit. The result is that it is more and more difficult to increase the level of use, but I certainly want to see that work continue. For instance, the cost of the administration of prescription charges under the old model was £2·5 million a year. That was a drain on resources. We have here an initial set-up cost and administrative costs. Again, we are working on those models. I certainly want to keep cost down to an absolute minimum.

Jim Wells (DUP, South Down)

That is a very important question. Members will not agree to anything that simply fills a black hole in some other part of the health service budget. What we are committing ourselves to is to using the money to help establish the specialist medicines fund to support approved and unapproved medicines. I can guarantee that the additional funding will allow HSC to improve access to unapproved drugs, but some of it may also be required to meet pressures in approved drugs. I will commit myself here to openness and transparency on that. We are more than happy to allow the Health Committee, the cancer charities, and so on, sight of exactly what is coming in and where it is being spent. There has to be absolute openness and transparency, because we are going to ask people to make a small contribution for their prescriptions. If they are handing their 30p, 50p or whatever across the counter, they will want to know that it is being used to help people in need.

One of the most painful experiences that I have had as Health Minister was sitting across the table from Una Crudden on several occasions and her making an impassioned plea for a drug that would help those with ovarian cancer and extend their life. The present system means that we were unable to offer people such as Una hope. I hope and pray that, as a result of the changes, we will be able to look at those people and say that, provided that the local committees are happy that it is an effective treatment being provided, we can offer them that hope. Implicit in what we are doing here is a significant increase in expenditure on specialist medicines. That is why we need the extra money.

More will be spent on those specialist treatments in Northern Ireland, but we cannot have the situation of an open-ended chequebook that has occurred in England, which has run out of control. It still has to have some form of exceptionality test. I will give you an example. I dealt with two drugs yesterday, which I will not name. One of them costs £220,000 per year per patient for four people in Northern Ireland, and the other one costs £252,000 per patient in Northern Ireland. That is the sort of money that we are talking about. Those drugs are often what are called orphan drugs. The costs of development are spread over such a small number of patients that the cost is incredibly high. That is unfortunately where we are moving and is why we need the extra money to fund them.

Last year, we spent an extra £12 million simply funding the NICE-approved drugs that became available automatically. That has eaten up any PPRS income almost entirely. Therefore, we need a fresh source of income so that we can offer hope to those very needy people. I do not want to sit in my room any longer and say to folk that, because of our restrictions and the 95% exceptionality test, we cannot offer them any possible outcome.

Fearghal McKinney (Social Democratic and Labour Party, Belfast South)

The SDLP welcomes the announcement in large part. It is a tribute to the many people who have campaigned against what is a fundamental inequality in that many of these drugs have been available elsewhere in the UK but not here. I welcome, as a point of principle, the fact that the Minister has made a number of announcements. The SDLP will have reservations about tying it to prescription charges, and we will reflect those in any consultation.

In relation to openness and transparency, I note that the Minister has not revealed any details around the PPRS. Will the public not need to be doubly convinced? The PPRS was about making drugs available to people, yet it has been used elsewhere in the system. What practical guarantees can the Minister give today and throughout the process that any concept of a prescription charge will relate to specific cancer and specialist drug provision?

I have one other comment, if I may. The Department is in dispute with pharmacies over moneys, and they find themselves very stretched. Who will collect that? Will they get remunerated for doing so?

Jim Wells (DUP, South Down)

If I was sitting in his chair, I would be asking those exact questions. I am indebted to MLA John McCallister, who asked a question on that subject very recently, albeit that the answer may not yet be available on the website, and so I can answer Mr McKinney's first point specifically. He asked me to outline the quarterly income from the PPRS to the health service budget. In quarter 1, which is from January to March, it was £3·53 million. In quarter 2, it was £3·83 million. These are all 2014 figures. In quarter 3, it was £3·92 million. It does not take a mathematical genius to add that up; I can do it. If you extrapolate that, you are talking about over £12 million. That has been entirely eaten up by the extra £12 million that we have committed to spend to deal with the increase in NICE-licensed and agreed drugs. While all this is going on, NICE is still adjudicating on a series of new treatments. Once NICE agrees with that at a GB level, we are then in a position where we have to implement those treatments. Therefore, the money has been swallowed up. Whilst we welcome the PPRS — it is good news, and I am very happy that ABPI has agreed to it — the reality is that it does not provide us with the new money that we need.

He also raises the issue of wastage, which is a very valid point. Having listened to him talk about that issue in the media, I know that he feels that, at the moment, he is not in a position to sign up to any administrative charges for prescriptions if there is still perceived wastage. We have set the pharmaceutical budget a very stringent target of £20 million of savings next year, and that will be the tool that we will use to eliminate any perceived wastage.

I can say to him that that aspect of our budget has become more and more efficient. When I was Chair of the Health Committee, we spent £400 million a year on community pharmacy. That is now down to £362 million, largely because of a decrease in wastage, but also a greater uptake of generics. I want to satisfy him that we are dealing with this before I would expect him to agree to what we are proposing. This is a different model; this is not going back to prescription charges of £6·40 per script or £8 in England. This is a standard tariff for every man, woman and child in Northern Ireland, with a ceiling for the year of an unspecified figure, which, we hope, is affordable to the entire community.

Jo-Anne Dobson (UUP, Upper Bann)

Minister, I hope that you share my belief that cancer sufferers, including my constituent the late Mr Brian Coburn, should not be focusing on having to pay thousands for treatment in the final few months of life. Minister, you say in this statement that early diagnosis is paramount, and your ministerial target for treating people following an urgent referral for suspected cancer is 95% within 62 days. Last month, we heard that less than two thirds — just 64·5% — of patients were seen within this time. Is there a crisis in cancer waiting times? What are you doing to address that, considering that it affects all types of cancer?

Jim Wells (DUP, South Down)

First, I pay tribute to Mr Coburn. I watched the programme on BBC 1 about cancer at 3 o'clock in the morning in the Royal on my iPad as I was sitting with my wife. I was taken by his comments, which were very legitimate. Mr Coburn had, of course, made an outstanding contribution to the economic life of Upper Bann.

We face huge pressures on cancer referrals at the moment; I accept that. We get periods when we do not meet the target. That is caused, on this occasion, by an increase of 8,500 people per year getting the bad news about their condition. I am somewhat relieved to hear that, despite that pressure, our outcomes for many forms of cancer are excellent by UK standards. That is the benefit of concentrating resources in the Belfast cancer centre at the City Hospital site, where all the experts on the conditions come together to give the best possible treatment. We are working hard and trying our best to get back to the target of 95%. Again, however, this emphasises the need for additional resources for cancer treatment.

If some of those drugs were available, it may be that the outcomes for patients in life enhancement would be better. That would put more pressure on the system, because if people live longer, they have to be treated for longer. I made the very important point in answer to one of my first questions in the Assembly — from Mr Brady in 2014 — that, for the first time ever in Northern Ireland, more people who have been diagnosed with cancer will be alive in 10 years than will have passed away. There was also a very useful question from Mr McKinney, which is in the system, asking for an outline of where those improvements have occurred. For some conditions, like childhood leukaemia and prostate cancer, the outcomes are extremely good in Northern Ireland. However, we have a long way to go, and I need a mechanism to raise additional resources to continue that improvement.

Chris Lyttle (Alliance, Belfast East)

I welcome this overdue action today and pay tribute to all those who have been involved in the campaign for equal access to cancer drugs in Northern Ireland, including Cancer Focus NI. I hope also that this demonstrates a departure for the DUP from political campaigning against responsible, fair revenue-raising as a way of funding essential services. I welcome the leadership that the Minister has shown in that regard.

I would like to scrutinise further his dismissal of a pharmaceutical price regulation scheme as an option. He said in his statement that, at this stage, he cannot be definitive about the scale of payments, and he went on to detail those and, indeed, in his answer to my question, he detailed receipt of around £3 million by the regional Health and Social Care Board in June 2014. I ask the Minister to state again why the pharmaceutical price regulation scheme has not been used for a Northern Ireland cancer drugs fund or a specialist medicines fund as per Scotland and what it is being used for instead of achieving equal access to drugs for cancer patients in Northern Ireland?

Jim Wells (DUP, South Down)

Mr McCallister's question for written answer is dated 18 February, so it is literally hot off the press. No doubt he will use that against me in the local press and say that he was on the ball.

We need to understand that PPRS is based on a refund to the Department based on receipts of drug expenditure undertaken. Therefore, to some extent, it is difficult to predict exactly how much is going to come in. It always comes in retrospectively. We introduced the PPRS in Northern Ireland only on 1 January 2014, so whilst we very much welcome it, it is still in its infancy. The Member needs to understand that that income, which, according to the answer given to Mr McCallister, could be £12 million or £13 million, is in the context of £165 million that I need to find to deal with financial pressures in 2015-16. I made the point that we are already committed to spending £12 million in increased budget for pharmacy simply to take cognisance of decisions that NICE in London made. So, we are not yet in a position to be definitive, but it is pretty clear that we are running fast to keep still. That will not provide us with the additional money that we need to do what we should, which is to offer hope to many cancer patients and other patients. Keep remembering that this is beyond cancer. Other life-threatening conditions in Northern Ireland also require those specialist treatments. I know that he has written to me on several occasions on behalf of his constituents on these issues, as has almost every Member and every MP.

The sums clearly indicate to me that the PPRS is useful, but it is not going to meet our ultimate need. I welcome his support for some form of additional charge for prescriptions. I want the Health Committee and the Assembly to debate the issue and to come to a thought-out view on it. At the end of the day, I am going to need that support because the system that we have here in the Assembly means that things can be stopped very quickly if they do not have cross-party support.

Mitchel McLaughlin (Speaker, South Antrim)

We have just completed the first round of questions. I have quite an extensive list of Members who have their names down. I ask Members to come as quickly as possible to their question and to restrict themselves to one question. That will give us the opportunity to bring in those who are on the list.

Paul Givan (DUP, Lagan Valley)

I welcome the Minister's statement, particularly the news that Northern Ireland has one of the best survival rates for some types of cancer anywhere in the United Kingdom. I commend the Minister for wanting to take forward the issue. I believe that he is with the public on this, who are ahead of some politicians on the reintroduction of prescription charges.

Cancer Research UK has indicated that the cancer drugs fund in England is not financially sustainable and does not sit well with other cost-effective assessments, such as NICE. Will the Minister elaborate on why he believes that the cancer drugs fund established in England is not the best way forward for Northern Ireland?

Jim Wells (DUP, South Down)

We spend £600 million a year on drugs in Northern Ireland, and we spend £27 million on specialist cancer drugs already. I do not want people thinking that we are not already committed to that field. All NICE-approved cancer drugs will be made available to people in Northern Ireland.

The English CDF was established at £200 million a year. There has been a growing consensus throughout England — it was echoed by many of the respondents to the consultation on the individual funding requests (IFR) review — that it is only a short-term fix to a complex problem. It is not sustainable or equitable because it deals only with cancer patients; it does not give hope to those with other conditions. In 2014, it went over budget by £140 million. That is on the basis of a £200 million budget. That indicates the enormous stress that it is under. English authorities are having a rapid review of how they are doing things to make it more sustainable.

We have looked at models in Wales and Scotland. I like to think that what we are proposing takes extracts from all the models to try to bring some form of sustainable model to Northern Ireland. When we go out to consultation on this, if folk feel like we have got it wrong, by all means, please let us know. We are trying to find a system that offers hope to many hundreds of people in Northern Ireland but does not lead to an unsustainable model where we are going to end up having to close the fund because it is running out of control. We feel that we have a fine balance between the various models. I understand that, at the moment, we are spending about £1·9 million a year on these specialist, non-NICE-approved drugs. Our model suggests that that could treble or quadruple under the proposals that I am making this morning. That is a genuine commitment to many people, but there will still be patients in Northern Ireland to whom the committees, after they have looked at the applications, will say no. There will still be situations where the assessment will be either that the drug is not effective or it is not cost-effective. There will still be difficult decisions to make, but much fewer than today.

Rosaleen McCorley (Sinn Féin, Belfast West)

Go raibh maith agat, a Cheann Comhairle. Gabhaim buíochas leis an Aire as a ráiteas agus cuirim fáilte roimh an ráiteas s’aige inniu. I thank the Minister for the statement, which I welcome. The establishment of regional scrutiny committees is a welcome recommendation, because it is about addressing inequalities in the system where local variations may exist. In that context, can he give an assurance that a new regional scrutiny committee coming into being to consider applications for IFR will not incur any unnecessary delay for people requiring treatment?

Jim Wells (DUP, South Down)

The benefit of those new committees is that they will not be bound by the 95% threshold which, we all agree, is so ridiculously high that very few people can avail themselves of it. We will be asking these committees, which will be made up of experts in the field, to move quickly on applications, examine them very carefully and be transparent. Part of the problem at the moment is that many patients are left without any detailed knowledge of why their IFR application was not made.

I also need to emphasise that inherent in what we are doing is that many clinicians who, up to now, have felt it was not worthwhile applying because of the 95% exceptionality criteria will now feel that it is well worth their effort in going through the paperwork to apply. Initially, there is going to be a surge in applications if we go into this model. The committees will meet weekly, which will certainly help the situation, and it will be a much more efficient system. It will also ensure that there is equal access to drugs throughout Northern Ireland, so we will have some consistency. Do not be surprised if the numbers of IFR referrals rise quite significantly in the first few months; that is good news, because that means that clinicians feel that, under what we are suggesting, there is a much more realistic chance of getting the drugs made available and paid for. We will watch that very carefully.

I find this issue very difficult personally, because some of the people whom I have dealt with have passed on even in my short time as Health Minister. I want a system that allows me to look patients straight in the eye and say that we have a lean, fast and efficient system that will give you a decision quickly on your clinician's IFR referral. I will be watching this very carefully to make certain that bureaucracy is kept to a minimum and that we ensure that we can offer hope to these people, who are often at a terribly low stage in their lives.

Jimmy Spratt (DUP, Belfast South)

I thank the Minister for his statement to the House this morning. Given that I benefited from a specialist drug some two and a half years ago from an oncology point of view, I certainly welcome the statement. The Minister is just after saying that the scrutiny committees would have experts in the field. Will he ensure that those experts will be the oncologists, the surgeons and the very dedicated teams that we have that deal with cancer and things such as MS? I welcome the fact that other drugs are included, as well as cancer drugs.

Jim Wells (DUP, South Down)

I thank Mr Spratt for his question and pay tribute to Mr Spratt, Ms Bradley, Mr McMullan, Seán Rogers and others in the Assembly who have gone through that journey of a cancer diagnosis and who have been courageous enough to come forward and make their views known in the Assembly about their personal circumstances. We have all learned a lot from listening to their experiences, and that has been helpful in the improvement of services.

I can absolutely guarantee that this is not going to be a committee made up of administrators or bureaucrats. This will be a committee largely of experts in the field, the oncologists who know what they are talking about and whether a drug treatment or new form of treatment will lead to a real improvement in the condition of the patient.

Sadly, most of these drugs are not life-preserving; they are life-enhancing and increase life expectancy. There are very few treatments that we can say lead to a cure, although Allister Murphy from east Antrim, who came to see me to lobby on this issue, made the point that sometimes that can extend the life of a patient to the point when another drug becomes available. Therefore, it can, on occasion, offer hope.

The committees will be made up of leading clinicians. Oncologists will be an important component because 66% of IFR applications are the result of cancer diagnosis. One committee will be dedicated to oncology and one to other conditions. These are the people at the coalface; experienced clinicians who are European leaders in the treatment of cancer and who will be making the decisions. I would put my trust in them because the evidence would indicate that the cancer centre, particularly under the management of Paddy Johnston and his team, was producing first-rate results for people in terribly difficult circumstances.

Mickey Brady (Sinn Féin, Newry and Armagh)

Go raibh maith agat, a Cheann Comhairle. I, too, welcome the Minister's statement. Minister, obviously you envisage a specialist medicine fund that will include other conditions. Mr Spratt mentioned MS and other chronic and debilitating conditions. The Chair asked about cost. I am not sure if you gave her a figure, so I am just wondering if you have any projected figure at this time for that specialist medicine fund?

Jim Wells (DUP, South Down)

No. We envisage that the cost of running the committees would be relatively small in the overall scheme of things. Remember that we are already spending. For instance, last year we spent £1·5 million on 170 individual funding requests. It is difficult to separate out the cost of the additional expenditure on drugs from the cost of the committees, but I do not see them being a large component of the overall cost.

Going by the Barnett formula as a guide, if we were to implement the cancer drugs fund on the same ratio as the rest of the United Kingdom, it would be between £6 million and £10 million. Our model is being considered specifically for Northern Ireland and is not directly comparable, but we expect the extra cost in drugs to be between £4·8 million and £9·5 million, roughly. Please do not hold me to that because that model has to be refined significantly. That, of course, depends upon at what level the committees agree to funding. It could be up to the higher end.

That is on top of all the other pressures that we are facing in Northern Ireland in health. Unfortunately, there are some difficult decisions to be made in terms of finding the £50 million in savings in the non-health trust element of the budget — that is, the Fire and Rescue Service, the PHA, the BSO etc — and the £165 million in efficiency savings that have to be found within the six trusts. I can tell you that there is some burning of the midnight oil going on within the Department as we work out how to do that. What we simply do not have in that context is the extra £6 million to £9 million required to fund cancer and other drugs on top of the £12 million that we have to find for the NICE-approved drugs.

We are coming through a very difficult phase. I know that Members will say, "Well, what's different now from the decision made by Mr McGimpsey six or seven years ago?" Since then, we have moved on to a totally different financial planet for health in Northern Ireland, and that is the problem. Demand is rising inexorably. When you consider that there has been a 43% increase in referrals for cancer diagnosis since 2009, that gives you an indication of the speed with which this condition is growing in Northern Ireland. One in two means that 54 people in this Chamber will face cancer. That is how frightening it is. Four have faced it already, but there could be another 50. That is where we are going with this disease.

Joe Byrne (Social Democratic and Labour Party, West Tyrone)

I welcome the statement by the Minister. Paragraph 4 states that early diagnosis, timely surgery and radiotherapy are of paramount importance to client outcomes. What advice will the Minister give to a family that has a member who has been diagnosed with cancer and needs surgery but cannot get it under the NHS for at least six months? They could get it next week if they pay £2,000 to a surgeon who works in the NHS but who also does private work.

Jim Wells (DUP, South Down)

That would be an unusual case. It is mostly orthopaedic surgery that is carried out in the private sector. He, from the Western Trust area, can at least tell his constituents that in 2016 there will be a state-of-the-art £66 million facility at Altnagelvin in Londonderry, which will be co-funded by our colleagues in the Irish Republic and will mean that the capacity problems that we have at the City Hospital are somewhat relieved.

That is a commitment that I have made, and Edwin Poots also made it. Others said it could not be done, but the Member will no doubt be invited to the ribbon-cutting of that much-needed facility in a year's time. That offers hope for his constituents in Omagh and Strabane that there is extra capacity.

In the meantime, we are working as hard as we can to relieve the waiting list. If a case is red-flagged — if it is put forward by the oncologist as an urgent case — we will endeavour to see that person within two weeks. I am very interested in the case the Member raised, and I ask him to write to me and quote the difficulties. I am very keen to see why that person has been waiting six months and is looking at the option of private treatment. I would like to check with Western Trust officials and the City Hospital's cancer centre to see why that is happening, because something just is not right about the difficult dilemma his constituent is in. If the Member writes to me, or even emails me today, we will turn that round as quickly as we can.

Roy Beggs (UUP, East Antrim)

I too welcome the Minister's statement and indicate my continuing support for a specialist medicines fund in Northern Ireland similar to that in Scotland. I have concerns about a potential £25 charge, or £1 charge, for those who may have long-term conditions and particularly those who may be living in poverty. Given the recent Northern Ireland Audit Office report into primary care prescribing, which indicated that very significant savings could still be made and that one drug alone — Pregabalin — could be costing an additional £10 million because of oversubscription. The report also found that some GP prescribing rates per patient are twice that of others. Why is he not gaining efficiency savings to fund such a proposal?

Jim Wells (DUP, South Down)

That is a very valid point. First, we are imposing very stringent savings on the budget for 2015-16 to try to deal with those issues. Like everyone else, I am determined to drive down the cost of prescriptions; and we have been successful in the move to generic medicines.

He made the point that I expected to be made at the very start of this debate on the £25 or £20. The consultation, which will be open to all of the public, will have several options, including the "do nothing" option, which would mean that we stay as we are. Various models will be set out, and one of them includes the figure of £25. We want to set it at a figure that is affordable to our community. For most people, £25 for an entire year's supply of drugs, the value of which could be running into tens of thousands of pounds worth of value, is welcome.

My wife is on four or five prescriptions a day, and I am sure that that is running into thousands of pounds per year. Obviously, I could pay the £25, but what I want to hear from the community generally is whether that is acceptable. If we drop it to £15, the fund will be smaller for vital drugs. The difficulty is in getting a model that produces the income in a way that is sustainable in the community. From the various views I have received, a figure of £25 could be seen as a sensible compromise for people who could not possibly afford to pay £1 every time they went into the pharmacist because it would cause real poverty.

That is why the consultation will be so important. What do the public really think about that suggestion? Generally speaking, I find a lot of support in the community. People regularly write to me and say, "Why don't you address this issue?" and, "Why, when I go into the pharmacy, am I not expected to make a small contribution?" Remember that the pound comes nowhere near the cost of the prescription; it is only a tiny fraction of its value. We were paying £6·40 before the end of prescription charges. In England, they pay over £8·00. A season ticket in England costs over £100. Ours will be significantly different. We continue to press on inefficiencies, and it is a long-term situation.

I have seen some of the figures that have been quoted for bespoke designer drugs for specific patients. With the sort of money that is coming down the pipeline for what can be assigned to a particular patient for a specific condition, we will have to develop a model that will mean that we can answer that demand on a long-term basis. Some of those drugs are incredibly effective, but the prices are, quite honestly, frightening, so we need a long-term, sustainable model that we can use to pay for them. I cannot see the health service being in a position, in the foreseeable future, to meet that increasing demand. I know that the Member's constituents in East Antrim will be lobbying him intensely when those drugs become available.

Stewart Dickson (Alliance, East Antrim)

Minister, thank you for your statement. I welcome and recognise your point that you cannot make those changes or make them sustainably without finding a source of additional funding. So I will turn to the additional funding and the suggestion that there may be a £20 or £25 charge. The previous prescription-charging regime was a shambles, and more of the income went on administration than on what the job was supposed to be about: paying for drugs. We are talking about very specialist drugs, and that is very welcome. Will the Minister assure the House that the administration of any future prescription regime will be effective and efficient? From my £25, I expect only a few pence, if even that, to go on administration.

Peter Weir (DUP, North Down)

I thought that that point would have been raised in the second or third question today. As we are guaranteeing total transparency, people will know exactly what is coming in and what is going out. If we are successful, I want to be able to stand here in a year's time and show Members that, if we have brought in £20 million, we were spending £19·5 million or whatever on specific cancer drugs and other drugs. That is why that commitment, which I will also make to the Committee, is so essential. The Member will be able to see the costs.

One interesting model has been suggested, although none of this is concrete. At the moment, we pay pharmacists a small administration charge of about a £1 for every drug that they dispense. One idea is to stop paying that and simply collect the £1 and put it into the kitty. That would eliminate a huge amount of administration. I am sure that that is too simple and that there would be resultant issues. I have spoken to pharmacists about the concept and their overall view of it, and there is general support for it. We do not want a model that will eat up vast amounts of money in administration.

The Member is absolutely right about the old prescription charge. We had communities in Northern Ireland in which 90% of those who walked through the door of the pharmacy got free prescriptions. I find that very hard to believe. That happened even in areas in the Member's constituency, like Carrickfergus, which is not an area of rural poverty and where there are high rates of employment. It always amazed me that practically everybody got free prescriptions.

When I was quite ill, just before the end of the prescription-charging regime, I was asked whether I got free prescriptions. I thought that that was a pretty silly question, but I was invited to sign the back of the form — not that I did. I thought to myself that, if I signed the back of the form and was not entitled to do so, what would the chances be of getting caught. We were spending £2·5 million a year trying to police that, and one of the reasons why I supported Mr McGimpsey when he abolished prescription charges was that I did not see it as an efficient model, as we were spending so much money policing it.

The good thing about a small blanket charge is that there are no problems with enforceability or fraud, because everybody will pay it. People need to get their heads around the fact that there will be people in Northern Ireland who will be paying that small charge for the first time ever. That is understandable.

There is a second issue in that, since the abolition of prescription charges, the numerical demand for prescriptions has risen very significantly. If you put some value on a prescription, albeit quite a small value, people will stop and think whether they really need it and whether they should be demanding it for free when they can buy it across the counter. That aspect is a very minor consideration in the overall scheme. We are trying to purchase essential drugs, not save on demand.

Jim Allister (Traditional Unionist Voice, North Antrim)

I welcome the Minister's return to full operation and wish his wife a continuing and full recovery.

On the issue of potential prescription charges, the Minister seems fairly clear that he is looking for something modest and universal. Does it therefore follow that he emphatically rules out, as I think that he should, means-testing, so that there are no out-of-control administration charges? What assurance is there that, once introduced, these charges will not creep or gallop endlessly upwards?

Jim Wells (DUP, South Down)

That is the third question that I predicted was going to arise.

We have a specific idea of the sort of funding that we need to meet demand. We are working on various models as to how we achieve that. We will definitely not be going down the route of means-testing, I can assure him of that. That would negate the whole issue. Let us be honest: it is quite clear that, under the old scheme, people were getting free prescriptions who were not entitled to them. We have to accept that. If you are the local pharmacist in a community and are faced with someone you have known all your life saying, "I'm entitled", in what position is the pharmacist to contradict that? It is very difficult for the customer/pharmacist relationship. In the consultation, a number of options will be set out for prescription charges and the potential exemptions; in other words, the fee. We are finalising those models, and it is not possible at the moment to give any further detail.

I am very aware that this could be seen as a tax by stealth, which we would gradually crank up. We will have total transparency around how this is operated. Members will know what is needed and what we are doing with it. Of course, the Committee will be consulted regularly as to how it is operating. Even if we did not do that, I know that the present Chair would be constantly badgering us about it anyhow. I do not know who will be Minister by the time this is all up and running, but, for as long as I am there, I certainly will not be using it as a way of funding other aspects of health service budgets. We are certainly not going to use it to plug any black holes, of which there are many, in the health service budgets. It will be very clearly ring-fenced for this purpose. It has to rise, but it will rise because demand for these essential drugs and treatments is rising. It is not rising because we are using it as a way of finding money for other things. In addition to the cancer drugs, other treatments are coming online, which are expensive. I would like to be able to offer people the prospect of those new services as well; for example, vaccines. That is my commitment. I know how the House would react if we tried, by stealth, to use it as simply a fundraising device for health generally.

Steven Agnew (Green, North Down)

I thank the Minister for his statement. I welcome the advances in cancer treatment. As the Minister knows, many of us have been affected by cancer, directly or indirectly. Less than four years ago, I lost a very close friend to it.

The Minister has acknowledged that there will be those who would have been exempt from paying under the old scheme who will now have to pay under this proposal and those of us, like me and him, who can afford to pay more than what is being proposed. Has any consideration been given to a voluntary payment scheme, which would not have the administrative burden of means-testing but would allow those in need to get their prescriptions free of charge?

Jim Wells (DUP, South Down)

We are talking about maybe 50p or £1. We are not talking about going back to the model of £6·40 or, as in GB, over £8. Certainly, in the consultation, I will be interested to hear whether anyone suggests a voluntary approach. The problem is this: what degree of certainty can you achieve with a voluntary approach? We know what we need to meet the demand for these drugs. We will model how that need can be dealt with, given the fact that we have very clear knowledge of the present demand for prescriptions. The problem is that you could end up committing yourself to very substantial expenditure on much-needed drugs and find that the voluntary income comes nowhere near what one would expect or need. Whilst initially it is attractive, I do not see it being realistic.

Equally, once you get into means-testing and the situation where you ask people whether they have the income to pay, previous evidence shows that, unfortunately, the vast majority of people prefer not to pay. What worries me is that people had the opportunity to be open and honest under the old scheme, and, in many communities, the vast majority chose to say that they could not pay for prescriptions.

I have my doubts about whether all of them were in that position. The figures from his constituency were quite remarkable. I am not convinced that over 80% of the people living in North Down were consistently in a position in which they could not afford prescriptions.

John McCallister (UUP, South Down)

I am glad to see the Minister back and wish his wife continued progress in her recovery. I was a little nervous, Mr Speaker, when, as soon as the subject of raising money came up, the Finance Minister rushed down to the Minister's side. I would like an assurance from the Health Minister that health will keep any money raised.

Will the Minister come back with more detailed proposals on how much he thinks that he needs to raise and what an acceptable level of charge is? In many aspects, Mr Givan is right: the public are ahead of the politicians on the need for some level of charging. Will he also look at things like using money from the charge to extend the HPV vaccine programme to young boys?

Jim Wells (DUP, South Down)

I am glad that the Minister of Finance is here with me because I will make absolutely certain that this is additional money. I am certain that the Minister of Finance, even in his darkest hour, would never dream of saying, "The health service is introducing a scheme. The public will take the pain of the small charge and raise £10 million. Therefore, I will reduce the health budget by £10 million to compensate for that". I know that the honourable Member for Strangford is a man of honour and integrity. He would never dream of such a thing, but I remember that additionality was a problem in European funding. This will be extra money, and it will be hypothecated — I was dying for a chance to use that word — in order to secure additional funding.

The Member asked about the amount of money needed. Various models are being postulated. It could be £6 million; it could be £9 million. If I wanted to introduce all the additional services or drugs, including the vaccine that the honourable Member mentioned, it could be up to £24 million or £25 million, but it is a matter for public consultation. The options will be clearly set out, and option 1 will be to do nothing. I will be very interested to hear what the public say on the "do nothing" option, which would mean staying as we are but with no funding for these much-needed treatments.

I welcome the Member's very positive engagement and detect that all Members are at least keeping an open mind. I understand entirely where the Chair of the Health Committee is coming from — I do — and, if I were her, I would be raising the very same points. We have to decide whether our community is ready for this. Will they buy into it? Will they buy into it on the basis that they know that every penny that they put into the till will go towards much-needed treatment for their friends, relatives and, maybe, ultimately, for them?

George Robinson (DUP, East Londonderry)

I thank the Minister for his very welcome statement. How have the numbers of people diagnosed with cancer been changing in Northern Ireland?

Jim Wells (DUP, South Down)

Earlier, I mentioned that the figures are rising very significantly, by 8,500 new diagnoses a year. I do not think that any of us who have not been through that experience — of course, four of our Members have — can understand what a body blow it is for someone to be brought into what is known as "the bad news room". Within the last fortnight, I have been in the "bad news room" twice, so I know exactly what that entails. Individuals sit down with their husband, wife or family and are told, "I'm afraid, Mr Smith or Mr Jones, that the diagnosis is cancer". To this day, that phrase instils fear in the hearts of many. However, I have a friend who has had stomach cancer for 23 years and had a work colleague in Saintfield who has had breast cancer for 19 years. We meet such people regularly. A gentleman in my church was diagnosed with prostate cancer nine years ago and thought that it was terminal. Since the diagnosis, he has become a grandfather three times, got a degree and is still very much alive and healthy thanks to the magnificent treatment that he received in the Belfast City Hospital cancer centre. Therefore, we have to accept that, as we age as a population, there will be more and more cancer. Indeed, I have to set aside £35 million a year in my budget simply to take account of the fact that we are living longer and that much of the disease that we encounter is a result of age.

As we become more successful in treating cancers such as breast cancer and prostate cancer, costs will rise even further, because we will have to continue to find the drugs and treatment to keep those people alive and healthy. The fact that we have four MLAs who are serving their constituents diligently in this House — they are very much with us, I am delighted to say — indicates that real success is being achieved. We want to see that becoming the norm. We want to reach a situation in which cancer is seen not as a death sentence but as a long-term condition. For 50% of the population, that is where we are at. I believe that the extra money can ensure that others reach that position. We would all be quite happy to pick up the tab for that because it would mean that people are living long, fulfilling and active lives with a long-term condition.

Mitchel McLaughlin (Speaker, South Antrim)

Thank you, Minister. That concludes questions on the statement.

Executive Committee Business

Mitchel McLaughlin (Speaker, South Antrim)

I call the Minister of Finance and Personnel, Mr Simon Hamilton, to move the Consideration Stage of the Budget Bill.

Moved. — [Mr Hamilton (The Minister of Finance and Personnel).]

Mitchel McLaughlin (Speaker, South Antrim)

No amendments have been tabled to the Bill. I propose therefore by leave of the Assembly, to group the Bill's nine clauses for the Questions on stand part, followed by the five schedules and the long title.

Clauses 1 to 9 ordered to stand part of the Bill.

Schedules 1 to 5 agreed to.

Long title agreed to.

Mitchel McLaughlin (Speaker, South Antrim)

Well done, Minister. That concludes the Consideration Stage of the Budget Bill. The Bill stands referred to the Speaker.

Michelle O'Neill (Sinn Féin, Mid Ulster)

I beg to move

That this Assembly consents to The Public Bodies (Abolition of the Advisory Committees on Pesticides) Order 2015 in the form of the draft laid before the UK Parliament on 15 December 2014.

Go raibh maith agat, a Cheann Comhairle. I am seeking the consent of the Assembly to the abolition of the advisory committees on pesticides (ACPs).

The Public Bodies (Abolition of the Advisory Committees on Pesticides) Order 2015 will abolish the advisory committees on pesticides. In practice, the order dissolves the ACPs in law. By way of brief background, the ACPs are based in Britain and the North of Ireland. They are non-departmental public bodies (NDPBs) that were established under the Food and Environment Protection Act 1985 to give independent advice to government on all matters relating to pesticides.

The ACPs advise Ministers in DEFRA, the Department for Work and Pensions (DWP), the Department of Health, the Scottish and Welsh Governments, and our own Executive.

The Advisory Committee on Pesticides covers England, Scotland and Wales, while the Advisory Committee on Pesticides NI covers the North of Ireland. In practice, the same body of experts has been appointed under both regulations, meaning that a single committee serves as both legal entities.

Although there is currently no one from the North of Ireland appointed to the ACP here, there is local representation on various pesticide bodies. The Agri-Food and Biosciences Institute (AFBI) is an observer member on the ACP and the working group on pesticide residues in food. The ongoing local representation on relevant bodies is appropriate and sufficient.

The Government's intention to replace the statutory ACPs with an expert committee was announced on 14 October 2010 as an outcome of their 2010 review of public bodies. The First Minister and the deputy First Minister obtained the agreement of the Executive and, subsequently, the Assembly in March 2011 to a legislative consent motion on the then Public Bodies Bill. The ACPs are listed in schedule 1 to the Public Bodies Act 2011 as public bodies that could be abolished.

Following the passing of the Public Bodies Act, DEFRA carried out a wide consultation exercise in March 2012 on the future of the ACPs, with the intention that it would be reconstituted as an expert committee. No responses to the consultation were received from stakeholders across the North of Ireland. Analysis of the 45 responses showed majority support for the British Government's preferred option, and DEFRA made the recommendation that the ACPs be reconstituted. The procedure to move that forward requires the ACPs to be abolished by the making of an abolition order, and for the new expert committee on pesticides to be formed and operate to terms of reference agreed by DEFRA and the devolved Administrations. Existing members will be invited to transfer to the new expert committee.

The running costs for the activities of the ACPs are modest and met by DEFRA, which will continue to fund the new successor expert committee. The abolition of the ACPs is the joint responsibility of the four Agriculture Ministers in Britain and here. The making of the abolition order therefore requires, in line with section 9 of the Public Bodies Act 2011, the consent of our Assembly, the Scottish Parliament and the National Assembly for Wales. The British Government have requested such consent from us, and that is the purpose of the debate today. DEFRA laid a draft order before Westminster on 15 December 2014 under the Public Bodies Act 2011 to abolish the ACPs.

The change to the status of the ACPs is essentially an administrative issue. The members and functions of the committee will remain the same in the new single expert committee. The impact for the North is therefore regarded as minimal. However, legal procedures are required to implement the change, and this includes the bringing of an Assembly consent motion. I therefore commend the motion to the Assembly.

William Irwin (DUP, Newry and Armagh)

In March 2011, the Assembly agreed to a legislative consent motion on the Public Bodies Act 2011, which allowed certain public bodies to be dissolved or abolished. One such body is the Advisory Committee on Pesticides, the ACP. The ACP is a non-departmental body established under the Food and Environment Protection Act 1985 to give independent advice to government on all matters relating to pesticides. The function of the Advisory Committee on Pesticides is to provide independent advice to government through the four devolved Administrations. Its key output is about whether a pesticide or an active substance is approved for use. It examines whether it is safe, whether controls can be put in place to make it safe and so on. Essentially, it is the key advisory body on pesticides policy and safety.

The Advisory Committee on Pesticides covers England, Scotland and Wales, and the Advisory Committee on Pesticides NI covers Northern Ireland. In practice, the same body of experts has been appointed for both, meaning that there is a single committee serving both legal entities. The Government have proposed to abolish both those ACPs and replace them with an expert committee of DEFRA. That committee would work for the UK Departments, including the Food Standards Agency and the devolved Administrations, including DARD. The new expert committee on pesticides will be formed and operate to terms of reference agreed by DEFRA and the devolved Administrations.

The process will see the abolition of the committee and will result in its re-establishment as an expert committee, meaning that the committee will be under a different name and status, but its functions and members will remain the same. The procedure is essentially an administrative change that has no real practical impact on the functions that the committee carries out. The main outcome expected from the abolishment of the ACPs and replacement with an expert committee is greater transparency and more effective working. It is considered a non-controversial issue, as it is an administrative change only.

As part of the process, a UK-wide consultation took place, with DARD advising local stakeholders. A total of 45 responses were received, with none from Northern Ireland. As a Committee, we considered the proposal from the Department at the meeting on 9 December 2014 and at the meeting on 13 January 2015. The information received by the Committee clearly showed that the abolition will have minimal effect in Northern Ireland. Therefore, the Committee is content for the Department to proceed in seeking the Assembly's consent to the Public Bodies (Abolition of the Advisory Committee on Pesticides) Order 2015.

Michelle O'Neill (Sinn Féin, Mid Ulster)

I thank the Chair of the Committee for his comments on the motion and welcome the opportunity to remove from the statute book the Advisory Committee on Pesticides and Advisory Committee on Pesticides for the North of Ireland as listed in schedule 1 to the Public Bodies Act 2011. I commend the motion to the Assembly.

Question put and agreed to. Resolved:

That this Assembly consents to The Public Bodies (Abolition of the Advisory Committees on Pesticides) Order 2015 in the form of the draft laid before the UK Parliament on 15 December 2014.

David Ford (Alliance, South Antrim)

I beg to move

That the draft Judicial Pensions Regulations (Northern Ireland) 2015 be approved.

Under the provisions of the Public Service Pensions Act (Northern Ireland) 2014, my Department is the responsible authority for establishing a pension scheme for devolved judicial office holders, principally the tribunal judiciary. The judicial scheme must be established by scheme regulations, a draft of which must be approved by the Assembly.

Following the recommendations of the Independent Public Service Pensions Commission, chaired by Lord Hutton of Furness, all public-service pensions are being reformed. The purpose of the reforms is to make public-service pensions more sustainable and affordable in the long term and fairer to scheme members and other taxpayers.

On 8 March 2012, the Northern Ireland Executive agreed to commit to a policy for a new career average revalued earnings scheme model, with pension age linked to state pension age, to be adopted for general use in the public-service schemes and to adopt that approach consistently for each of the different public-sector pension schemes, in line with their equivalent schemes in Great Britain, and not to adopt different arrangements for Northern Ireland. The 2014 Act provides the statutory framework for the reform of public-service pension schemes. The main changes are the replacement of final salary pension schemes with career average revalued earnings pension schemes and the linking of normal pension age to state pension age for those schemes.

I believe that the reforms to judicial pensions constitute a fair balance between judicial pension scheme members and other taxpayers. The scheme regulations make detailed provision for the operation of the reformed scheme, including the payment of pensions and other benefits and new governance arrangements. The scheme regulations also contain certain technical modifications of primary legislation that must also be made for the other public-service schemes. The other schemes must do this in a separate instrument, subject to the draft affirmative procedure. In accordance with the Executive's agreement, the scheme regulations are closely modelled on the Ministry of Justice's pensions scheme regulations, establishing a new career average revalued earnings scheme for eligible members of the judiciary in England and Wales, Scotland and the non-devolved judiciary in Northern Ireland.

The Department of Finance and Personnel consents to the regulations. At this stage, I thank the Justice Committee for its careful consideration of the draft regulations. It is with the Committee's support that I bring the draft regulations before the House and commend them to it.

Alastair Ross (DUP, East Antrim)

I am pleased to speak very briefly on the motion on behalf of the Committee for Justice.

The Committee considered the proposals for the statutory rule in May and December of last year. The Committee then considered the draft statutory rule more recently at the meeting on 4 February 2015. As already outlined by the Minister, the rule provides for the establishment of a career average revalued earnings (CARE) pension scheme for the devolved judiciary and sets out the governance arrangements for it. As Members are aware, the establishment of the scheme is a small part of the wider reform of public-service pension schemes across the United Kingdom. As the Minister stated, there is a strong imperative for the scheme to be in place for 1 April 2015, as benefits to the devolved judiciary under existing schemes end on 31 March.

The Committee noted during its consideration of the rule that, whilst the Department of Justice was statutorily responsible for reforming pensions for judicial office holders, responsibility for the devolved judiciary was a matter for a number of Departments, including the Department for Employment and Learning and the Department for Social Development. The Committee also noted that the scheme regulations had been closely modelled on those made by the Department of Finance and Personnel for civil servants and by the Ministry of Justice for the non-devolved judiciary, which is in keeping with the Executive’s decision to adopt an approach in line with equivalent schemes in Great Britain. On that basis, the Committee agreed that it is content with the statutory rule and, therefore, supports the motion.

Sean Lynch (Sinn Féin, Fermanagh and South Tyrone)

Go raibh maith agat, a Cheann Comhairle. I want to say that I am sorry; I have just arrived in. Things are moving on. This is in relation to the Road Traffic Bill. On behalf of Sinn Féin, I rise —

Mitchel McLaughlin (Speaker, South Antrim)

Sorry, I have to correct you: this is the draft Judicial Pensions Regulations (Northern Ireland) 2015.

Sean Lynch (Sinn Féin, Fermanagh and South Tyrone)

Sorry, I did not know that I was down for this, a Cheann Comhairle. Absolutely nobody warned me.

Mitchel McLaughlin (Speaker, South Antrim)

OK, we will proceed.

Sean Lynch (Sinn Féin, Fermanagh and South Tyrone)

Thanking you.

Mitchel McLaughlin (Speaker, South Antrim)

As no other Members wish to speak, I call the Minister to respond.

David Ford (Alliance, South Antrim)

At this point in these technical debates, I tend to thank all those who spoke but perhaps not today. I thank Mr Ross for his contribution on behalf of the Committee, and, again, I genuinely recognise the close collaborative working between the Department and the Committee on many of these technical matters and, having said that and noted the Committee's full approval, I formally commend the regulations to the House for approval.

Question put and agreed to. Resolved:

That the draft Judicial Pensions Regulations (Northern Ireland) 2015 be approved.

David Ford (Alliance, South Antrim)

I beg to move

That the draft Police Pensions (Consequential Provisions) Regulations (Northern Ireland) 2015 be approved.

I am tempted to say, "Welcome to Groundhog Minute". In respect of the motion that we have just passed, I mentioned consequential provisions regulations as they will apply to the judicial scheme. I will endeavour to be brief in my summary now, given that the same instruction applies and that these regulations will also provide similar benefits to the police pension scheme.

DFP, on advice from HM Treasury, has identified three areas regarding scheme design that require modifications to the Public Service Pensions Act 2014. All three areas of change to the police pension scheme will be beneficial for members and are summarised as follows. First, the 2014 Act requires the police pension schemes to assign a different pension age to active and deferred members. That will mean that actuarial reductions for long- and short-term benefits will use different factors depending on the member's age and employment status. This modification will prevent the police pension scheme discriminating against deferred members by treating them differently to active members. Secondly, the amendment will ensure that police scheme members will have their benefits uprated as if they were active members. Their right to a cash equivalent transfer value and cash transfer sum will apply only when they leave the new 2015 scheme. The amendment will also ensure that the member, if leaving early, will have the right to a refund of contributions only when they leave the new scheme. Thirdly, DFP has agreed that ill-health benefits in the 2015 scheme should use the single-source model, as that prevents the threat of legal challenge from those who might otherwise claim residual rights under the old scheme.

The draft consequential provisions regulations before the House today have been subject to targeted consultation. The consultation ran from 21 October to 14 November last, and no specific comments were received. The regulations have been subject to an equality screening exercise, and no equality issues were identified. On 14 January, the Justice Committee agreed that it was content with the draft regulations, and it is, therefore, again, with its support that I bring the draft regulations before the House today and commend them.

Alastair Ross (DUP, East Antrim)

Brevity is the order of the day, so I shall try to keep to that in my contribution on this statutory rule.

In October of last year, the Department of Justice advised the Committee of the changes required to be made to the Public Service Pensions Act 2014 and that the police pension scheme was one of the schemes affected by the changes. In December, the Committee noted the detail of the proposed changes and, more recently at the meeting on 14 January 2015, the statutory rule itself. As the Minister has outlined, the rule makes transitional and consequential provision in relation to public-service pensions for members of the Police Service of Northern Ireland.

I do not intend to rehearse the detail that the Minister has already set out, other than to say that the Committee noted that the rule would make provision for short-service benefits to facilitate split pension age; transitional provisions to stop transitional members being treated as deferred members of their pre-2015 scheme; and consequential modifications to the tax regime in respect of ill-health benefits. At its meeting on 14 January 2015, the Committee agreed to recommend that the Assembly affirm the statutory rule, and it therefore supports the motion.

Mitchel McLaughlin (Speaker, South Antrim)

I call the Minister of Justice. On this occasion, justice does not grind slowly.

David Ford (Alliance, South Antrim)

Thank you, Mr Speaker. We will grind it as quickly as possible. I thank again the Chair and the Committee members in total for the work that was done with my officials, and I commend the regulations to the House.

Question put and agreed to. Resolved:

That the draft Police Pensions (Consequential Provisions) Regulations (Northern Ireland) 2015 be approved.

Private Members' Business

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I beg to move

That the Second Stage of the Road Traffic (Speed Limits) Bill [NIA Bill 30/11-15] be agreed.

First, I place on record my appreciation and thanks to the Bill Office for its continued support and advice leading up to the introduction of the Bill. I also thank the staff of the Regional Development Committee and the Environment Committee, as well as the Chairs of both. I know that the Chair of the Regional Committee has changed. I appreciate their help in facilitating the briefing sessions that I had with them.

The Bill is not simply about reducing speeds on local roads; it offers an opportunity for neighbourhoods to reclaim their streets and for children to play safely. It is a fresh opportunity for us all to build better communities at minimum cost for a maximum return. There is no higher value in society than that of life. I am in no doubt that the new lower limits will save lives, perhaps not this year or next, but, if we save one life or reduce the seriousness of a victim's injuries with the passing of the Bill, surely it is good legislation.

Key to the success of the legislation is the mechanism for how we launch it. It will not be successful if new limits are imposed. Rather, we seek not a blanket ban but a phased-in, community-requested, community- and stakeholder-led approach with the Police Service, the public transport service and residents and young people alike. Community consensus is key to the success of the initiative. Having undertaken a considerable amount of consultation, I can report to the House in good faith that the reaction to and support for the Bill has been incredibly encouraging.

Alastair Ross (DUP, East Antrim)

I thank the Member for giving way so early in his contribution. He talked about the number of stakeholders. Does he share my concern that the Institute of Advanced Motorists (IAM) has pointed to evidence that suggests that the numbers of serious accidents and slight accidents in 20 mph zones have gone up in the last 12 months? Indeed, Simon Best, chief executive of the IAM, has said that recent advice and guidance and the relaxation of regulations has been making it easier for councils to put in place 20 mph zones, but they do not seem to be delivering fewer casualties. Indeed, that evidence is backed up by the Department for Transport. Second Stage is something that we can agree on, but it is important that we look at that in Committee. Does he share the concerns that have been highlighted by the Institute of Advanced Motorists that this does not deliver the results that some claim it does?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I thank the Member for his intervention. The whole purpose of any private Member's Bill is to have a fully fledged consultation, reflecting everyone's consideration, but I will share clear, definitive evidence with the Member from other places, particularly Britain, that there has been a reduction in injuries and deaths on the roads.

Today, we are working hard to protect and improve life, reduce injury and make our streets more user-friendly and community- rather than road- and car-orientated. I also believe that the Bill will tackle obesity rates and improve community health to increase rates of walking and cycling. If that does not carry the Bill past the threshold of worthwhile legislation, I wonder how high we set the bar.

Let us examine the reality of life on our roads today. In 2013, seven pedestrians and four pedal cyclists were killed on Northern Ireland's roads. In 2013, 162 pedestrians and 42 cyclists were seriously injured. In 2014 —

Sammy Wilson (DUP, East Antrim)

Will the Member give way?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

Yes.

Sammy Wilson (DUP, East Antrim)

Since he is into the statistics of this, perhaps he will tell us if those casualties were on the residential roads that are referred to in his Bill, or were they on roads that would not be covered by his Bill?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I thank the Member for his intervention. As I progress through my speaking notes, it will be obvious that a number of clearly identified deaths on our roads have occurred in 30 mph zones. There are clearly other deaths on our roads that occur elsewhere and are not covered by the Bill.

In 2014, a total of 79 prematurely bereaved families were forced to deal with the consequences of a fatal road collision. Some 523 serious road traffic collisions were recorded by the Police Service of Northern Ireland between January and November 2014. Of those deaths, provisional figures for 2014 show that five pedestrian deaths occurred on urban roads where the limit was 30 mph. In response to the Member who intervened I say that there is evidence where five people have lost their life on roads where the present zoning is 30 mph. That number rises to 21 deaths on 30 mph urban roads where statistics for the last four years were collated. Last week, we lost a further two lives on the roads in Northern Ireland. I am not saying that this legislation would have any impact if implemented on those particular highways, but it is a starting point of legislating to reduce deaths on the roads.

Of course, as at all times, I extend my sympathy to those families on their tragedies last week. In the same manner, I extend my sympathy to those of the more than 600 people seriously injured as a consequence of road traffic collisions in 2014. I have some personal experience of the matter. I am aware that my own words of condolence will have minimal effect on families who are traumatised and struggling to come to terms with the death of a loved one, but they will have some. What is of more benefit is redoubling our efforts as legislators to improve and continuously improve road safety across the roads of Northern Ireland.

In the five years prior to 2014, the number of people killed on the roads in Northern Ireland halved from 115 in 2009 to 57 in 2013. That was certainly a good sign, but it is still too many. It is still too many to have one death in Northern Ireland and a family having to come to terms with the knock on the door by a police officer come to tell them. In 2013, a total of 720 was the lowest rate of serious injuries since records began in 1971. That is not a reason to reduce our efforts; rather it is timely to reinforce them. Certainly, I believe that the public are and will be listening to the debate. Only yesterday, campaigners for "Jake's law", proposing a 20 kph limit in housing estates in the South of Ireland, commenced a vigil outside Leinster House. My condolences go to the mother, Roseann Brennan, who lost her six-year-old child, Jake, in a road traffic accident outside her home in Kilkenny. It is specifically that type of loss that we seek to circumvent, prevent and stop by the progression of the Bill.

Most of us will be aware from the early stages of the Bill and television awareness campaigns that those hit by a vehicle travelling at 30 mph have a one-in-five chance of being killed. That is a 20% chance of death at 30 mph. Those struck at 20 mph have a 97·5% chance of surviving or a one-in-40 chance of dying. There is a huge difference there. I ask Members genuinely to reflect on the statistics that I have presented.

I will return to models of best practice internationally. It is worth noting that Transport for London found a reduction of 57% in serious and fatal accidents, while incidents causing lower-scale injuries fell by 42% in 20 mph zones. The Transport Research Laboratory (TRL) evaluation of 250 20 mph zones found that the average speed fell by nine miles per hour. Accidents reduced by 60%. Importantly, accidents involving children fell by 67%. These are not my figures: these are from the Transport Research Laboratory. The number of incidents involving cyclists fell by almost 30%. Incidents involving cyclists fell by almost one third despite a substantial growth in the number of those cycling in the new 20 mph zones. Hull City Council recorded a growth of six times the incidence of cycling after introducing 20 mph zones. Imagine the tourism ad for Northern Ireland: "Safe for you; safe for cycling; safe for your family". Maybe I am getting ahead of myself. In earlier consultations, many of the key stakeholders —

Sammy Wilson (DUP, East Antrim)

Will the Member give way on that point?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

Yes.

Sammy Wilson (DUP, East Antrim)

Maybe the Member will tell us how many tourists cycle around the Castlemara estate in Carrickfergus or the Antiville estate in Larne. If he is making an argument on the basis that this will increase cycling and tourism, at least let us be realistic about it. The streets that he is referring to are, by and large, not tourist streets. Let him be upfront about that.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

The streets that tourists visit when they come to Northern Ireland are in the city centres. That is where they will find a safer environment. They will not come into the streets but they will come into our city centres. I ask the Member to reflect on what appeared to be his very sarcastic questions identifying areas, knowing that I would not have a response to him.

In earlier consultations, many of the key stakeholders balked at the thought of a blanket reduction. I have reflected on that and will probably take it on board through possible amendments as we progress — hopefully we will do — to the next stage. We are not seeking blanket coverage, but the Bill offers a bottom-up perspective in lawmaking and social engineering. It will allow communities to come together and shape their own neighborhood. It will allow us to reshape our public realm across many of our villages and cities as we see fit.

Jimmy Spratt (DUP, Belfast South)

I thank the honourable Member for giving way. My point is on enforcement and lawmaking. If it is legislation, it should have to be enforced. I am sure that the Member remembers the contribution that the PSNI made to the Committee at a very early stage. It has very serious reservations in relation to 20 mph speed limits and the enforcement of such limits given that it struggles, it is fair to say, to police 30 mph and 40 mph speed limits in most cases and in most areas. That is one of the complaints that most of us, as MLAs, get on a pretty regular basis. Given the police's reservations and that the policing budget has further reduced since that evidence was given to the Committee for Regional Development, I wonder what discussions the Member has had with the Police Service on enforcement. Frankly, any legislation without enforcement is useless.

I also wonder what conversations the Member has had with the Department for Regional Development on signage, because legislation requires proper signage. It is fair to say, during my tenure on the Committee for Regional Development, that the Department was very successful with a number of traffic calming measures in areas where they were necessary. Maybe the Member will shed some light on the conversations he has had on those issues.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I thank the Member, the former Chair of the Regional Development Committee. He makes some good points. Legislation by itself will not change mindsets. There needs to be a cultural change in driving patterns. There needs to be a change in mindset. The Member previously referenced driving instructors possibly; maybe I picked him up wrong. It will evolve. It will take major changes. I will directly respond to your questions. I met two assistant chief constables and have correspondence from the police that is most encouraging. I will quote them verbatim. They said that I am pushing an open door. They want to see a bottom-up approach to the introduction of 20 mph speed limits in residential areas in Northern Ireland. That is your answer. I have met them. I can copy you into the correspondence that I had with them. In fact, I met them only four weeks ago in Knock PSNI headquarters.

I hope the Member is reassured by what I have said today.

No one is seeking to impose these new speed measures. This is about engagement, education and actioning residents' views. It is important to allow young people to make a contribution and participate in the consultation on the streets that they see as their play area. Neighbourhoods will be empowered to make their streets safer for children to play in. In a small way, article 31 of the UN Convention on the Rights of the Child — the right to leisure, play and recreational activities — will be realised. This Bill would assist in creating what the UN Convention describes as the optimum environment for the child: a street setting that is free from stress. Many of us as parents, as we get older, can reflect on the days when we did not have high volumes of vehicles on our streets, where we all played actively. Can many of us say that today? Would you allow your child or grandchild out on the streets to play? I think, at the very least, most mothers would have their heart in their hand at the mere thought of it.

The whole purpose of this Bill is to create an environment that encourages and motivates parents and grandparents. Reducing the speed on these roads will also secure greater participation and recreation in line with elements of the Programme for Government. I refer back to my conversation with Mr Spratt on the police and make the point that more people walking on our streets will deter crime in the community. People trying to break into houses will be deterred by grandparents out walking with their grandchildren, cyclists etc. It will have a hugely positive impact.

Alban Maginness (Social Democratic and Labour Party, Belfast North)

I thank the Member for giving way. The Member referred to attempts to change attitudes and mindsets and said, quite rightly, that legislation alone does not change mindsets immediately. Effective legislation, however, imports values into society that change behaviours. Take, for example, no-smoking legislation. Some 10 years ago, smokeless zones in buildings, public service vehicles etc were unimaginable. Attitudes to smoking have been changed fundamentally. In the same way, this legislation could change attitudes. I see the Member disagreeing, but bear with me. That is the real effect, not immediately but down the line, of this type of legislation.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I thank the Member for his intervention and example. Another very obvious example is seat belts in Northern Ireland. A few years ago a private Member introducing legislation requiring the use of seat belts would have been laughed at in here. Now there are policing campaigns across Northern Ireland on a monthly basis to make sure that people are wearing their seat belts.

Trevor Clarke (DUP, South Antrim)

Will the Member give way?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

Yes.

Trevor Clarke (DUP, South Antrim)

I want to address the previous contribution, when I was seen shaking my head. I do not make any apologies for shaking my head, because Mr Maginness's comparison with 20 mph zones is ridiculous. The ban on smoking in public places is easy to enforce. However, we have got 30- and 40-mph limits, and there is no evidence to suggest that reducing them will actually help. Indeed, the 30, 40, 50, 60 and 70 mph zones are there, but the enforcement is not. The ban on smoking in a public place is, however, easy to enforce. The enforcement has to be right. Indeed, if the 30 mph limit was enforced, there would be no need to reduce it to 20 mph or lower.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I thank the Member for his intervention. I had genuinely hoped to meet with him as Chair of the Regional Development Committee, but time was not on our side. I know that he has reservations about enforcement, but I hope to convince him. The police have the unenviable task of managing the enforcement of the present limit of 30 mph. What difference would it make to enforce 20 mph? We are creating an environment of change across Northern Ireland. We are getting into schools, primary schools, post-primary schools and youth clubs. We are getting involved with policing and community safety partnerships across the new council areas. We are involving the new council areas. That mind change is necessary. Producing a Bill will not change things; it will take a generational change. If it takes a generation to do that, I am content, because it will make a difference.

I am sorry, Trevor, but I thought that I gave good, clear evidence from other places, and I will give it again. There is evidence of a reduction in road fatalities. There has been a serious increase in the number of pedestrians and cyclists killed. I will quote from some groups that clearly want to champion and advocate this cause. The Bill would assist in creating what the UN convention describes as the "optimum environment" for the child: a street free from stress, and:

"An environment sufficiently free from waste, pollution, traffic and other physical hazards to allow them to circulate freely and safely within their local neighbourhood".

Such an environment would increase opportunities for leisure time and an accessible space and time for play. The Bill would create a space and opportunities to play outdoors in a diverse and challenging physical environment with easy access to adult support when necessary.

After medical illness, traffic is the biggest cause of death in children. I want to repeat that: after medical illness, traffic is the biggest cause of death in children. Chief among the supporters of the Bill is the Northern Ireland charity PlayBoard. It is the lead organisation for children and young people's play in Northern Ireland. It makes no bones about it and told me that it would prefer a much lower speed limit than the one that I am proposing. Traffic volume and speed are a major anxiety for parents and people living in communities. PlayBoard research consistently shows that traffic is a recurring concern for children, young people, parents and grandparents. Traffic and the speed at which it travels are a serious barrier to children playing outdoors. In 2013, PlayBoard research found that 33% of children surveyed reported that their favourite place to play was the traditional playground and their favourite games were street games. One comment was that it was not safe because cars drive up and down the street and people park their cars on footpaths. PlayBoard reported that one in five children interviewed said that they did not have a safe place to play outside their own front door. Cars and traffic are the major inhibitors. Among the recommendations made by those children and young people to policymakers was that there should be traffic-less streets and roads for children to play on temporarily, more zebra crossings and restrictions on cars in areas where children play.

Road safety is an issue, as is the consequential failure of children to acquire the independent mobility required to develop and nourish their well-being. PlayBoard is in little doubt that a 20 mph limit in residential areas would considerably help children, young people and their parents to feel safer and less anxious, and it would also improve their children's development, well-being, physical activity, common sense and competency. The Bill is a step in that direction. It will show that the House recognises, respects and resources play opportunities, which in turn allow our children to flourish.

That said, the Bill is not slowing down drivers solely to benefit our children. It will, when desired, bring out many other members of our community. The more people who occupy public areas, the better public ownership we have, the greater sense of pride we have, and a greater sense of spirit will flourish in those communities. Air quality improves in such zones. I think that some members of the Regional Development Committee visited Edinburgh, which reports that its 20 mph zones have the best air quality in Scotland, bucking national and European trends. The evidence suggests that reduced acceleration and braking reduces fuel consumption and associated emissions. The Minister of the Environment assures me that he will continue to make safer driving and road safety a high priority despite a major reduction in his budget.

However, I repeat my earlier point: this is minimal cost for maximum return.

Jimmy Spratt (DUP, Belfast South)

Will the Member give way?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

Yes.

Jimmy Spratt (DUP, Belfast South)

I referred earlier to the cost of signage. The Member has just referred to the visit to Edinburgh, and I think that Mr Dallat was there with the Committee. One issue was the high cost of establishing what is a very small area in the city of Edinburgh. I think that the cost of signage for that was in the region of £25 million or £30 million. Perhaps the Member will now tell us what discussions he has had with the Department about signage, because with legislation and enforcement comes the need for signage. I note that he referred to his Minister, but the signage would come from the DRD budget. What discussions have taken place, given the difficult position of a Minister who had to turn out the lights recently?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I thank the Member for his intervention. There are clearly circumstances in which capital investment will be required. It will not happen within any one year; it will be phased in to ensure the greatest impact. I tried to secure a meeting directly with the Minister. I met his special adviser this week, and we had a detailed and lengthy discussion about the elements of the Bill. I will let the Minister speak for himself, but I think that he will be very encouraging. I certainly want to work with the Minister for Regional Development, who has overall responsibility for roads in Northern Ireland, to ensure that we have the greatest impact and effect —

Cathal Ó hOisín (Sinn Féin, East Londonderry)

I thank the Member for giving way. He said that the provisions could not be enacted within a single year, but clause 7 specifies a period of two years. Is that an adequate period to bring in such measures?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I appreciate the intervention, Cathal, which is a reasonable one. I said at the beginning of the debate that I would reflect on the submissions and on Members' contributions today even if it meant a longer lead-in period. I made the point previously that this will require educational change, cultural change and a change in the mindset of all those who drive in Northern Ireland. A number of elements of the Bill would have to be amended to help it to have more effect. We do not know the full costings, for example, and we will have to get them. There is absolutely no doubt about something that I will come to later in my speech, but I am not sure whether the Speaker might call me to task soon.

Mitchel McLaughlin (Speaker, South Antrim)

I will not call you to task, because it is important that you set out your argument, but perhaps you will advise me how much longer you require.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I suspect that I will possibly need another 15 minutes.

John Dallat (Social Democratic and Labour Party, East Londonderry)

Will the Member give way?

Pat Ramsey (Social Democratic and Labour Party, Foyle)

Yes.

[Interruption.]

Mitchel McLaughlin (Speaker, South Antrim)

Please continue.

John Dallat (Social Democratic and Labour Party, East Londonderry)

Is the Member aware that more people were killed on the roads during the darkest days of the Troubles than through violence? Does it not seem a bit disappointing to him that we are hearing arguments about the cost of road signage that could be introduced over one year, two years or 10 years? Is he aware that the 20's Plenty for Us scheme is not just in Edinburgh but in Glasgow, where I spent some leisure time walking around and witnessing for myself how neighbourhoods had been returned to the people who live in them and how children, for the first time, had the right to go out and play in the street? Does the negativity that we are experiencing here not disappoint him a little?

Mitchel McLaughlin (Speaker, South Antrim)

Perhaps you would respond to that, and then it would be an ideal time to call the lunchtime suspension.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

I welcome the Member's intervention. I will not use the word "negative", but I will take on board any constructive comments from any Member, whether negative or positive.

[Laughter.]

I was about to get on to it, but it would not be fair to do so, given the Speaker's ruling. We are talking about the cost of a life lost on the roads of Northern Ireland. I remember putting a question to Sammy Wilson when he was the Minister of the Environment a number of years ago, and, at that time, it was £1·6 million. That is the cost to Northern Ireland of a death on our roads. Is somebody telling me that the investment of £20 million — if it is £20 million — is not a good investment for the families across Northern Ireland who are still coming to terms with the loss of a loved one? Is that not an investment to save, if we can in any way create an environment in which we save someone's life?

Trevor Clarke (DUP, South Antrim)

Will the Member give way?

Mitchel McLaughlin (Speaker, South Antrim)

May I intervene, given the time? The Business Committee has arranged to meet immediately after the lunchtime suspension. I propose therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The first business when we return will be Question Time.

The debate stood suspended. The sitting was suspended at 12.31 pm.

On resuming (Mr Principal Deputy Speaker [Mr Newton] in the Chair) —

Oral Answers to Questions — Health, Social Services and Public Safety

Robin Newton (DUP, Belfast East)

Questions 9 and 11 have been withdrawn.

Rosaleen McCorley (Sinn Féin, Belfast West)

1. Ms McCorley asked the Minister of Health, Social Services and Public Safety if the commissioning plan direction 2015 is compatible with the financial costs of implementing Transforming Your Care. (AQO 7590/11-15)

Michael McGimpsey (UUP, Belfast South)

8. Mr McGimpsey asked the Minister of Health, Social Services and Public Safety to outline the latest time frame and costs associated with implementing Transforming Your Care. (AQO 7597/11-15)

Jim Wells (DUP, South Down)

Mr Principal Deputy Speaker, with your permission, I will answer questions 1 and 8 together.

In response to the agreed budget for 2015-16, a financial plan has been developed that is expected to deliver a balanced position for 2015-16. However, that financial plan does not permit funding for any new service developments, including those that might support the delivery of Transforming Your Care (TYC). That said, the delivery of TYC remains a priority for my Department, and the draft commissioning plan direction is clear that the Health and Social Care Board (HSCB) should, in setting out how services will be delivered in 2015-16, strive to shift services into the community or primary care settings in line with the objectives of TYC.

I and my predecessor have always been clear that ideally we are working to a three- to five-year implementation framework. That, of course, is dependent on financial circumstances. That remains the case, as does the broad requirement identified in the original report for transitional funding to support the new model.

Rosaleen McCorley (Sinn Féin, Belfast West)

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. Gabhaim buíochas leis an Aire as a fhreagra. I thank the Minister for his answer. Will he confirm that only £27·5 million has been shifted to care in the community, even though there was a target to shift £83 million?

Jim Wells (DUP, South Down)

The Member is broadly right in her assessment of the situation. We had envisaged a shifting left, to use the parlance. John Compton, the author of 'Transforming Your Care', could not have envisaged the present financial backdrop. We have made bids to achieve the £83 million, most of them in the monitoring round, and they have not been successful. Therefore, that has put the whole Transforming Your Care process under considerable stress.

It is worth saying, however, that there are two aspects to TYC. First, there is the sea change in the trusts as they align their working practices within TYC, which does not require additional service development or resources. Secondly, there is the £83 million required to make the major changes. The trusts are implementing service changes on the ground every day. It is difficult to quantify their value, but they are reaching the goal of TYC.

I have the task of trying to find or campaign for the funds to enable us to obtain the additional resources that we need to implement TYC. When I was first appointed to this position, I was asked for my three priorities, and I said that finding the resources to implement TYC properly was my number two target. We are still striving, as effectively as we can, to obtain that funding.

Jim Wells (DUP, South Down)

The formation of about 20 GP federations covering all of Northern Ireland was one of the basic tenets of Transforming Your Care. In some areas, particularly greater Belfast, there has been a great deal of progress. In other areas where I have visited individual GP practices, I have been a bit worried that there has not been the same success in setting up the federations.

The federations are absolutely essential because a one-man or a father-and-son practice in some remote part of Northern Ireland operating effectively on its own is simply not a sustainable model. Therefore, it is important that GPs come together. A practical example can be seen through GPs telling me that a huge amount of their time is spent on prescriptions and repeat prescriptions. One of the aims of the federations is to employ a full-time pharmacist who would take on that entire administrative role to free up the time of GPs for diagnosis, referral etc. I see it as a vital component of TYC. It is clearly working and working well, but, in other areas, it is certainly not making the progress that we had assumed it would.

One of my priorities will be to follow up with the board and the implementation team to see what we can do to encourage GPs to coalesce and have the quantum of resources and experience that is needed to deliver a 21st-century model of GP care. I do, of course, realise that, underlying that, is the problem that we are 20% short on our GP numbers in Northern Ireland. Through workforce planning, we will have to ensure that we get the numbers back up to a level that will allow us to create federations. That is a priority, as we are certainly not attracting enough young medical graduates into the field.

Fearghal McKinney (Social Democratic and Labour Party, Belfast South)

I thank the Minister. Minister, there are some who are trying to divert attention from the Donaldson review to the issue of hospitals and the number of hospitals. You will be aware that the people of Downpatrick, south Down and the wider area gave their answer to that in Downpatrick on Saturday.

The Donaldson report contained other very important issues, including an underpowered commissioning system and a TYC system that is not working. Given that the funding for TYC was to come from monitoring rounds and that the Minister maybe did not apply for it in the January monitoring round — certainly, he did not get it — is the system now not only not making progress but in reverse?

Jim Wells (DUP, South Down)

First, I want to concur with him. The estimates are that between 12,000 and 15,000 people were on the streets of Downpatrick to express their support for the Downe Hospital. I issued a statement that I still see the Downe Hospital playing a crucial role in health-care provision in the South Eastern Trust in the future. Indeed, there are more patients going through the doors of that hospital than ever before, but I accept that the local community has difficulties and feels that it is the wrong sort of patient and that there are not enough ED, accident-and-emergency and surgery patients. Still, that indicates that there is a positive role for the Downe Hospital, and I welcome the huge support that the community has for that new facility.

On TYC, we are not going into reverse. Everyone, including even perhaps the Member, is agreed that it is the best way forward for our health-care structures in Northern Ireland, although it has made less progress than we would have liked. I would argue with him about the monitoring rounds: we have made a large number of monitoring round bids for extra resources for TYC. However, I accept that, on many occasions, there have been much more pressing demands on the Department of Finance and Personnel. I would not like to be in the shoes of the Minister during those four monitoring rounds each year, because, frankly, it is a wisdom-of-Solomon choice that he has to make.

We will continue to make those bids and will continue to find ways of freeing up resources in the Department to push TYC forward. The fundamental point that John Compton made — this is the one that we will all be very uncomfortable with — is that, if we do not crack the issue by 2025, the health service simply will not be able to continue in the way that it is going. We have far too many people up the ladder of health-care provision commensurate with their needs. Unless we tackle that issue and grasp it, we will be in a difficult position.

There was to be a three- to five-year horizon for the implementation of TYC, and I would like to have seen it happening slightly quicker than that. We are going at a slower pace, but we are still going in the same fundamental direction. I need to emphasise that, on the ground, apart from the funding issue, major progress is being made on the implementation of TYC. No one has been able to tell me that there is a better option for care in the future.

Sandra Overend (UUP, Mid Ulster)

Will the Minister outline the costs, financial and otherwise, of removing the substance misuse target from the plan? I understand that the inability to develop the service in 2015-16 was due to a lack of funding.

Jim Wells (DUP, South Down)

There is always one question that comes completely out of the blue that all the soothsaying and predictions of those in the Department have not been able to identify. I will get the facts on that for the Member. That is an important issue but one that has not had huge publicity. I will get the answer to the honourable Member for Mid Ulster. I will write to her and give her chapter and verse on it. That was one that I did not see coming at all.

John McCallister (UUP, South Down)

I have listened to the Minister's earlier answers. In his report, Sir Liam Donaldson said:

"The policy document Transforming Your Care contains many of the right ideas for developing high quality alternatives to hospital care but few believe it will ever be implemented or that the necessary funding will flow to it. Damaging cynicism is becoming widespread."

Does the Minister agree that that damaging cynicism among the public, hospital managers and doctors is doing enormous harm to the credibility of the health service, with people maybe wanting to leave through the voluntary exit scheme?

Jim Wells (DUP, South Down)

I reassure him that we will not use the voluntary exit scheme to take out staff who are essential to front-line delivery only to replace them at the same cost. That does not make sense. I see the voluntary exit scheme as a way of perhaps looking at administration and management, rather than front-line services. We are still recruiting staff. It is worth mentioning that, since March 2011, we have recruited 218 full-time equivalent consultants, 823 full-time equivalent nurses and midwives, 91 staff grade and speciality doctors and 409 qualified allied health-care professionals. I know that people do not like to hear those facts, but that indicates to me a solid investment in front-line services throughout the health trusts and the Ambulance Service. I accept that, whilst we are doing that, we still have to concentrate on delivering TYC, and of course those staff will be doing so.

It is interesting that Sir Liam Donaldson, a world authority and internationally renowned expert on health — as I said, the Sir Alex Ferguson of health provision — concluded that TYC was still the best way forward. He understood the difficulty that we are having with funding. Therefore, I see it as a process that is not going as swiftly as we would like, but I believe that we are going in the right direction. We will eventually get there, but it will be at a slower pace. It is my role to try to ensure that my colleagues in DFP recognise that and continue to release resources to deliver a project that is fundamental to future health provision in Northern Ireland.

Paula Bradley (DUP, Belfast North)

2. Ms P Bradley asked the Minister of Health, Social Services and Public Safety for his assessment of the cost to the health service of patient non-attendances at medical appointments. (AQO 7591/11-15)

Jim Wells (DUP, South Down)

It is not possible to quantify the financial effect of missed appointments on GPs and health and social care organisations. However, it is clear that the real cost to the health service is the missed opportunity for GPs, consultants and other healthcare professionals to see and treat other patients, which in turn has an adverse impact on waiting times for other patients to receive the treatment they need. We all have a key role to play in ensuring that missed appointments are kept to a minimum and that our valuable health and social care resources are utilised in the most effective manner. I therefore encourage everyone who cancels a GP or hospital appointment in advance because they cannot attend to at least inform the health-care professionals so that the slot can be allocated to another patient. I accept that there are times when life becomes very complex and individuals cannot make it to the GP's surgery, clinic or hospital, but the very least that they should do is give adequate warning of that, so that another person who is perhaps waiting for an appointment can be slotted in at short notice. A deep concern of mine is that people are not showing that courtesy to health-care professionals by letting them know in the first place.

Paula Bradley (DUP, Belfast North)

I thank the Minister for his answer thus far. I am certainly in agreement with him that this is one reason why other patients have to wait longer for appointments. Has the Minister considered setting a target for the number of cancelled appointments? Could that improve the situation?

Jim Wells (DUP, South Down)

It is worth adding that, by March 2016, I hope to have reduced the number of hospital-cancelled consultant-led outpatient appointments by 20%. Sometimes, the problem is not with the patient; the problem is with the consultant or doctor. Indeed, when the Health Committee looked at the issue, we discovered that the Southern Trust had implemented a new policy to drill down on cancellations caused by clinicians, which led to a dramatic fall in numbers. If we could get the rest of the health trusts to the same standard as the Southern Trust, we would have a much more efficient system.

I think that the honourable Member almost mentioned the possibility of charging —

Paula Bradley (DUP, Belfast North)

Targets.

Jim Wells (DUP, South Down)

Yes, well, the target is that, by 2016, we will have reduced this by 20%.

Some Members have suggested to me that we charge for missed appointments; in the same way that I recently had to pay £25 to my dentist for a missed appointment. Unfortunately, I turned up on Friday and he extracted two teeth. I wish I had missed it in the first place.

[Laughter.]

I believe that it would be difficult to implement this on a Province-wide basis. It is not like the discussion we had this morning, where people may not be able to turn up for all sorts of reasons, and it places the GP or the doctor in a very difficult position. So, I am not minded to go down that route. I am glad to say that there has been a noticeable drop in the number of cancellations recently, so we are moving in the right direction. Again, however, informing the office of the relevant condition is absolutely essential.

Maeve McLaughlin (Sinn Féin, Foyle)

Go raibh maith agat. I thank the Minister for that response. The Minister will be aware that one of the reasons given for the cancellation of consultant appointments was, "Consultant on annual leave". Will the Minister comment on that? Will he also clarify the cost to the system of cancelled appointments by consultants?

Jim Wells (DUP, South Down)

The honourable Member for Foyle is absolutely right. Indeed, when the Southern Trust was implementing its change of policy, it made it very clear that that was a totally unacceptable reason for the cancellation of an appointment, on the basis that someone who was taking a holiday would presumably have had to book their flights and accommodation. They would have known in advance, so that should have enabled the trust to fill the gaps created. I commend the Southern Trust on that measure, and I urge other trusts to do the same.

It is difficult to pinpoint the total cost. There is, certainly, an intangible cost here because it leads to inefficiencies in the system. We are continuing to monitor and report the number of cancelled appointments. We have also established a short life working group to establish how information on cancelled appointments can be recorded in order to identify where there has been a direct impact on patients and to quantify actual lost capacity. As a result of that work, information on the number of hospital-cancelled consultant-led outpatient appointments that have had an impact on patients is now available.

It is a terribly difficult thing to put a financial figure on, because what happens in most cases is that, if Mrs Smith does not turn up, Mrs Jones or Mr Jones, who have been waiting, go up the queue. Therefore it is difficult to assess the cost of generating the appointment and the cost of reappointing, and the amount of time that was spent by the consultant in, perhaps, reading up before the patient arrived. It is very difficult, but it is certainly a frequent complaint from clinicians at all levels in Northern Ireland that people continue to do this in an irresponsible way. The good news, however, is that the message is getting home and the situation is improving.

Roy Beggs (UUP, East Antrim)

Missed hospital appointments have been particularly high in some units and in some specialised areas. Can the Minister advise what action he proposes to take in the forthcoming year to try to address that specific issue, particularly in relation to those who may have mental health conditions, an area in which absentee rates have been particularly high?

Jim Wells (DUP, South Down)

The difficulty with many of the patients involved is that there are co-morbidities; there is a mixture of conditions. Whilst the person may be coming in to have a consultation on their back, for instance, they may have had depression or have a bipolar condition etc. Therefore, it can be very difficult to identify the reason for people not attending. We are not going to differentiate between various reasons or conditions where there have been cancellations or missed appointments. We are sticking to the target. If we can get it down by 20% by March 2016, I think that we will have done very well. In addition, the Department is proposing a number of performance indicators to monitor outpatient cancellation and non-attendance for new and review appointments.

The overall consultation rate in Northern Ireland rose from 4·04 consultations per person in 2003-04 to 6·6 in 2013-14. That is an increase of 63% in the Northern Ireland consultation rate per person. That is an incredible increase in such a short period — a 10-year period. That shows the pressure that our consultants and clinicians are under. Equally, as far as GPs are concerned, we have an average of 6·9 appointments per year per person. That is for every one of our 1·82 million population. In the Irish Republic, the average is three, yet the Irish seem to have very similar outcomes in health to ours.

Clearly, Northern Ireland people are very much in love with their GPs and consultants and are very keen to see them, but we need to, first, rationalise the demand on the service and, secondly, make certain that, once people are booked, they turn up and present themselves for treatment. The other aspect, of course, is that this can lead to people's conditions deteriorating significantly, adding further expense to the health service. There have been many cases of people whose onset of cancer and other serious conditions have been missed because they did not turn up for their appointment.

John Dallat (Social Democratic and Labour Party, East Londonderry)

I am really sorry to hear that the Minister has been in trouble with his dentist, and I hope that his mouth is getting better.

The Minister will be aware that 180,000 people a year fail to meet their appointments. That is matched only by the hospitals themselves, which cancel 180,000 appointments. Does the Minister agree that the practice at the Causeway Hospital in Coleraine, where text messages are sent the day before an appointment, is good exemplary material? Will he look at that and see how that can be rolled out to other institutions, which, clearly, are not on top of it?

Jim Wells (DUP, South Down)

I hope that the honourable Member for East Londonderry will not mind me commenting on the very helpful letter that he recently sent us about the Causeway Hotel — the Causeway Hospital, sorry. That was a Freudian slip.

[Laughter.]

I think that he knows what I am referring to. It was very helpful that he highlighted a high standard of service at the Causeway Hospital.

There has been a significant reduction in missed appointments. I have some cold, hard statistics. For instance, in 2009-2010, there were 1·5 million appointments, of which 172,000 were missed because people did not show up. That is a did-not-show rate of over 10%. That rate has gone down in 2013-14 to 9·1%. That is a 1·2 percentage point drop, which is significant. It is an improvement of more than 10%. Clearly, the message is getting through to the public that you really need to treat your health service with much more respect. I would like to see a continuation of that and to bring the rate down to the best performance in Northern Ireland.

We are not reinventing the wheel. In many aspects of health, if we could get all our trusts performing as well as the best trust in any particular field, many of our problems would be solved.

Sean Lynch (Sinn Féin, Fermanagh and South Tyrone)

3. Mr Lynch asked the Minister of Health, Social Services and Public Safety whether he will implement the recommendations from the Donaldson report. (AQO 7592/11-15)

David McNarry (UKIP, Strangford)

14. Mr McNarry asked the Minister of Health, Social Services and Public Safety how he will increase the pace of change in health service delivery to take into account the recommendations of the Donaldson report. (AQO 7603/11-15)

Jim Wells (DUP, South Down)

Mr Speaker, with your permission — Mr Principal Deputy Speaker; I will have to get used to that accolade — I wish to answer questions 3 and 14 together.

As you will be aware, the Donaldson report makes 10 recommendations. In my statement on 27 January, I set out a number of actions that are being taken forward to progress some of those recommendations. However, many of the recommendations pose fundamental questions, and I want to ensure that stakeholders have the opportunity to provide their thoughts. That is why I have asked for views and comments on the recommendations to be submitted to my Department within a 12-week period.

Transformational change takes time, and it will be important to map out such a change fully at the outset and to address the budgetary issues. You will also be aware that some of the changes required to address the recommendations will require legislation and some will require Executive approval. However, I am determined to make substantial and steady progress wherever it can be made. With that in mind, I have already asked Sir Liam Donaldson to return to Northern Ireland next year to review progress against the implementation of his recommendations. Following the completion of the consultation on Sir Liam's recommendations, I will inform the Assembly of its conclusions and any further actions that may arise.

Sean Lynch (Sinn Féin, Fermanagh and South Tyrone)

Go raibh maith agat. Gabhaim buíochas leis an Aire as an fhreagra sin. I thank the Minister for his answer. Can he clarify the position around recommendation 1, and can he confirm the cost of the review and whether it represents value for money?

Jim Wells (DUP, South Down)

The Chair of the Health Committee announced that the cost of the Donaldson review was £118,000, from memory. As we had engaged one of the leading authorities for a significant period to look at our health service, I felt that that was justified. Yes, I can stand over that. Will we, if we implement the Donaldson review, effectively save £118,000? We certainly will, and a lot more.

Recommendation 1 is only one of 10 recommendations in the Donaldson report. Indeed, it has been slightly disappointing that almost all the press attention has homed in on that issue. We have to have a very honest and open debate in this Chamber because this is where the decision will be made.

If we were starting with 1·862 million people today, bringing them to an area the size of Northern Ireland and configuring a hospital service, we would never start from where we are, with 10 A&Es, the Royal Belfast Hospital for Sick Children and six local regional hospitals. That is a model that would never be implemented anywhere in the Western world. We have to accept that, because of history, tradition and local support, we are in a rather different situation. The only way forward is for us to have an intelligent debate to decide how we progress and how we reconfigure our health service to ensure that a modern, high-tech, high-level service is given to all our people. Frankly, at the moment, some aspects of our health service, particularly in rural areas, are under the most enormous stress and strain, and we need to start that debate.

Some of you may have seen an interview that I did on the BBC on this very issue with Mark Carruthers. I call it elder abuse because I was given an absolute pasting for 15 or 20 minutes on the issue, when he tried to tease out of me the same answers that the honourable Member for Fermanagh and South Tyrone is trying to get. I am not going to pre-empt that debate by saying what my views are on how we should go forward. I am encouraging the entire community to look at this terribly difficult situation, which for me is one of the most intractable problems that we face in Northern Ireland, and for us to reach a consensus.

David McNarry (UKIP, Strangford)

Minister, as with many things these days, it appears that the Victor Meldrews and the Sir Humphreys are performing to their best. What is your assessment of the change in the balance of the health service between front-line staff and back-room bureaucrats? What obstructions, if any, are you encountering with interest groups acting to block the pace of reform?

Jim Wells (DUP, South Down)

I have just quoted to the House the huge increase in front-line staff that my predecessor, Edwin Poots, instigated and which I support. The equivalent of 1,400 full-time additional staff have been employed in the health service since 2011. If Minister Foster were to announce a factory employing 1,400 full-time staff, we would all congratulate her on an outstanding achievement; fortunately, she has been making announcements like that in the last three or four years. That indicates that, under my predecessor's role and my own, we are making that commitment. We know that those folk are there because we are paying them, and we know that they are on the ground working hard. It is wrong, therefore, to indicate that we are overstaffed at administrative level and not bringing resources to front-line care. I accept, however, that there is a perception that we could be doing more to look at admin and management, which is why the permanent secretary has been tasked to do a full analysis of the structures of health care in Northern Ireland to see whether any further level of administration can be taken out to pump money into front-line services.

I will give the Member a few figures. We could maybe save £15 million or £20 million, but that is being very optimistic. I have to find £165 million in efficiency savings for 2015-16 and an additional £50 million out of non-health trust expenditure. That is real money from the Fire Service, BSO and the Public Health Agency. So I have to find £215 million. Even if we waved a magic wand and looked at his concerns about management, we are talking about only 12% of that. That is the difficulty that we are in, and we have to make some terribly difficult decisions in the next few weeks.

George Robinson (DUP, East Londonderry)

Will the Minister outline what work is under way to implement some of the Donaldson recommendations?

Jim Wells (DUP, South Down)

When you throw a document out into the public domain for consultation, you have to be very careful that you are not seen to pre-empt some of the outcomes. The six trusts, including the Ambulance Service, have already been asked to work with each other, their staff and their stakeholders to develop a combined response to the report and its recommendations by the end of April 2015 and to consider urgently the "never events" list for England and determine its applicability to Northern Ireland, and initial discussions on that have taken place with the board. I am sure that Members will remember my explanation of a never event. The RQIA has been asked to speed up the programme for unannounced inspections of hospitals, and a number of pilot inspections will take place between April and June 2015.

I hope that that shows that, in areas where there was not much in the way of dissension or where there had already been discussion, we are already setting up procedures to implement it. We also want to hear the public's view on Donaldson, particularly recommendations 2 to 10, on which we need an awful lot of debate, as well as recommendation 1.

Robin Newton (DUP, Belfast East)

That concludes the listed questions to the Minister. We move to topical questions. Question 1 has been withdrawn.

Phil Flanagan (Sinn Féin, Fermanagh and South Tyrone)

T2. Mr Flanagan asked the Minister of Health, Social Services and Public Safety for an update on the introduction of the legislation proposed in the public consultation, which the previous Health Minister launched in February 2013, and which had the support of the First Minister and the deputy First Minister, on the move to an opt-out system for organ donation, especially in the light of the tragic death last week of 13-year-old Oisin McGrath from Belcoo, a boy who had achieved much in a very short life and whose passing is a terrible loss to his family, the wider McGrath and Dolan families and his many friends, and particularly because, as a result of Oisin’s death and the bravery of his parents, five people have benefitted from his organs and have been given a chance to experience a more fulfilling life. (AQT 2122/11-15)

Jim Wells (DUP, South Down)

I thank the honourable Member for giving me an opportunity to pay tribute to Oisin's family, who took the very brave decision in tragic circumstances to save or enhance not only one but several lives by giving up his organs. I think that that example will help enormously in our debate on the issue. I had intended to contact the family to praise them for their courage.

We await the introduction of a private Member's Bill from the Member for Upper Bann Jo-Anne Dobson and for the results of the PHA's second survey on public attitudes to organ donation. So we are very much in a situation of watching and waiting. We are also waiting to see the outcome of the Welsh model. The Welsh passed legislation on the issue, and we want to see what happens there. Does legislation lead to a radical increase in organ donation? We have had an advertising campaign to encourage organ donation and employed nurses whose role is to liaise with distressed families and encourage them to donate organs. This is a very complex and important period in the whole debate. I suspect that, when Mrs Dobson's Bill eventually comes forward, there will be a free vote for many of us. I would like to think that progress will be made within the next few weeks because of the coming together of various events.

Phil Flanagan (Sinn Féin, Fermanagh and South Tyrone)

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I thank the Minister for his answer and comments. Oisin's parents, Nigel and Sharon, were forced to make a very difficult decision on whether to donate their son's organs. They decided to do so, in the belief that it was what he would have wanted. In doing so, they demonstrated huge strength in dealing with their tragic loss, but parents and families should not be forced into making that decision. I say this to the Minister and his Executive colleagues: let one of Oisin's many legacies be the introduction of opt-out organ donation legislation. I support the introduction of such legislation. When that happens, will the Minister row in behind it and support it, as his predecessor and the First Minister appeared to do previously?

Jim Wells (DUP, South Down)

I will be guided by the honourable Member for Upper Bann on when we can expect the introduction of her Bill, which deals with the very issues that the Member raises. As Minister, I am in a difficult position because I previously expressed my personal views on this. However, it would not, I think, be helpful if I were to hold hard and fast to those views as Minister. All I can say is that the debate will be a very interesting test of the maturity of the Assembly.

It is very difficult to predict what will happen because I suspect that it will be a free vote for every Member, and, therefore, 107 different views will become clear. So, we await the Bill with interest. I hope that Mrs Dobson will get a chance to come in on this because I am very keen to learn how it is progressing.

I realise that Oisin's family had to make a very difficult decision, but, no matter what happens, even under Mrs Dobson's Bill, families will still be consulted. They will still have to make that difficult decision. I am on the register and have made it very clear that, if I go under a bus, you are welcome to any part of me that saves lives.

I remember the courage of a Coalisland family when a young man was killed in a traffic accident. The donation of his organs saved three lives and enhanced another three. That example is tremendously important as we encourage people to have the conversation and make the right decision on organ donation.

Michelle McIlveen (DUP, Strangford)

T3. Miss M McIlveen asked the Minister of Health, Social Services and Public Safety whether he believes that savings of 10% can realistically be delivered by the Northern Ireland Fire and Rescue Service in 2015-16. (AQT 2123/11-15)

Jim Wells (DUP, South Down)

Earlier, I said that I have to find £50 million in direct reductions in funding out of what are described as the non-health trust organisations. I also mentioned that I have to find a huge amount of savings in 2015-16, and we have asked the arm's-length bodies initially for their scenarios based on 5%, 10% and 15% reductions for 2015. We have had an initial examination of the proposals for the Fire and Rescue Service, and, frankly, I consider savings at the upper end to be unachievable. They are not achievable while retaining a safe service. Consequently, the Fire and Rescue Service is working now on a 5% savings target for 2015, and I have made it clear that its focus should be on support functions and central management structures rather than on front-line service delivery. I have also made it clear that I am opposed to any form of compulsory redundancy in the Fire Service. I will require full detailed plans on how Fire Service savings can be delivered, and a final agreement on the savings proposals will take place after public consultation and be based on public safety.

This has been a very difficult issue. The very fact that we have been in a position in which we cannot define the Fire and Rescue Service as a front-line service in the same way as, for instance, blood donation or ambulances is causing us huge difficulties, but that is what the Executive agreed. We are working with the Fire and Rescue Service to find ways in which it can achieve its savings with the least possible impact on its front-line services, which, of course, are not only fires but traffic accidents, flooding and so on. I have seen proposals to take some management staff out of Fire and Rescue Service headquarters in Lisburn. We think that that is doable without affecting front-line support services, but this has been one of the most difficult issues that we have faced as a Department.

Michelle McIlveen (DUP, Strangford)

I thank the Minister for his answer. In acknowledging the challenges that he has outlined, does the Minister believe that the Transatlantic Trade and Investment Partnership (TTIP) would make health service challenges even more difficult.

Jim Wells (DUP, South Down)

I have had a lot of letters and questions from Members across the board on that particular issue. For those who are not aware, TTIP is a transatlantic trade agreement between the United States and the European Union. My colleague in DETI is very keen on the arrangement because it could open up new markets for Northern Ireland exports and further trade across the Atlantic, but there is a concern that it will open the door for private American companies to come in and take over the running of the health service in Northern Ireland. I have seen a petition calling for the NHS to be taken out of TTIP, but there is no evidence at all to indicate that it is to be included, and there is never any indication in the negotiations that that will happen.

Contrary to that, as Members will have seen in some of my written replies, I have received assurances that EU member states will remain in full control of their public services, including their public-health provision. The EU has followed a consistent line of excluding public-health systems from free-trade agreements, and I want Northern Ireland to continue to determine how it runs its public services. I want the fundamental basis of the health service in Northern Ireland to remain the same, which is that it is free at the point of demand, paid for by the taxpayer and available to all. I cannot see how that model sits comfortably with any buy-in from the United States. Frankly, even if I in a wild, mad rush decided to do that, the Assembly would block it immediately, and that would be absolutely right.

For the foreseeable future, I see no change in the provision of the health service in Northern Ireland, and I do not see the remotest interest from elected representatives to change the present model in any way.

Ian Milne (Sinn Féin, Mid Ulster)

T4. Mr Milne asked the Minister of Health, Social Services and Public Safety when he intends to introduce the mental capacity Bill. (AQT 2124/11-15)

Jim Wells (DUP, South Down)

I have sat on the Health Committee and on the Justice Committee. On six separate occasions, I think, I asked when we will see that legislation. I am told that it is definitely coming before Easter of this year. That is absolutely crucial because, if we are to get it through the Assembly in this mandate, we need to see the legislation very quickly. The complication has been because we decided, about a third of the way through the process, to combine the Bill to cover health and adults in the Prison Service. That caused complications. I am working alongside DOJ on the development of the Bill, and it is my aim to submit a draft Bill to the Executive next month. We hope that the Executive will pass that very quickly, with a view to the legislation having its First Reading in the Assembly in March 2016. Therefore, that is absolutely imminent. If that does not happen, I will ask some very pertinent questions.

This is perhaps the most important legislation that my Department will be pursuing in this mandate. I was here when the previous Bill went through in 1984, and little did I think that I would still be here for the next updating of that legislation. I am absolutely certain that I will not be here in 25 years when the third Bill arises. The Member raises an important point, and I will check again with my officials to see that that deadline of March 2016 will occur.

Ian Milne (Sinn Féin, Mid Ulster)

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. Gabhaim buíochas leis an Aire as a fhreagraí go dtí seo. I thank the Minister for his answer and for his determination in producing the Bill and bringing it to a conclusion. How will the Minister address the concerns that the legislation leaves out the under-16s?

Jim Wells (DUP, South Down)

The Children's Law Centre has been lobbying us consistently to include under-16s in the Bill. First, I have to say that that lobbying started at a time of the Bill's formulation that meant that, if we had gone down that route, we would have had to re-consult on the entire Bill. That would have knocked it back for a very long time and, really, it was impractical. I understand that there have been negotiations with the Children's Law Centre. It is reasonably reassured as to why we have taken this decision.

The Bill is a decision-making framework for adults. There is already a decision-making framework in place that, at its core, safeguards children and that recognises the importance that society places on the role of parents when it comes to making decisions in respect of children. The Bill, as proposed, will not affect that. It will not require any changes to the present situation. It will enhance the existing safeguards in the Mental Health (Northern Ireland) Order 1986, which will be retained as a temporary measure.

I think that it is unfortunate that that request was not made at an earlier stage, but even if it was lobbied for very early on, I do not think that we would possibly have reached the stage of at least giving a tentative commitment that we will have the Bill by March 2016. I can see both arguments, but I saw the greater good of getting a fit-for-purpose, modern mental capacity Bill to cover all over-16s quickly because we simply cannot afford to delay this any further.

Bronwyn McGahan (Sinn Féin, Fermanagh and South Tyrone)

T5. Ms McGahan asked the Minister of Health, Social Services and Public Safety what assurances he can give to the 8,100 people who signed a petition to oppose the closure of Loane House in Dungannon that rural dwellers will be facilitated through the Ambulance Service and other vital transport provision to access the relocated services at Craigavon, given the fact that the Southern Trust approved the closure of Loane House without having conducted a full rural impact assessment. (AQT 2125/11-15)

Jim Wells (DUP, South Down)

The Member has lobbied extensively on this issue, and I met her, along with the MP for the area, this morning to discuss it. As she knows, I have become a bit of an authority on Craigavon Hospital over the last two weeks. The difficulty is that all the medical evidence is telling me that care for an elderly, frail person is best done in the community, or, if the person has severe needs, it is best done very close to full-blown A&E and ED services and all the diagnostics, equipment and expertise that is there.

The commitment is for a new 64-bed unit in Craigavon. Loane House will not be touched until that is up and running. As I said to her this morning, we have committed to that. There may be budgeting issues, but we will watch the progress very carefully. Until I or my successor is absolutely certain that we have a fit-for-purpose unit available in Craigavon to look after the needy people of Dungannon and south Tyrone, there will be no change in the configuration of Loane House.

I had negotiations on Wednesday with folk in Newry who were making the same point about the transfer of stroke services from Daisy Hill to Craigavon. I hope that I was able to indicate to them that the statistics show that the best chance of surviving a stroke and recovering quickly is when you are taken to a bespoke, specialist centre of excellence.

It is the same model for moving stroke patients and intermediate care bed patients from Loane House to Craigavon.

As a rural representative, I know how difficult this is for the community to accept. All that I can guarantee to the Member is that there will be no question of anything happening to Loane House until we are absolutely convinced that the alternative service in Craigavon meets the needs of her community.

Robin Newton (DUP, Belfast East)

There is no time for a supplementary.

Oral Answers to Questions — Justice

Peter Weir (DUP, North Down)

1. Mr Weir asked the Minister of Justice for an update on the proposals to close eight courthouses throughout Northern Ireland. (AQO 7605/11-15)

Gordon Dunne (DUP, North Down)

9. Mr Dunne asked the Minister of Justice to outline the rationale to close Newtownards courthouse. (AQO 7613/11-15)

David McIlveen (DUP, North Antrim)

11. Mr D McIlveen asked the Minister of Justice to outline the rationale to remove the only remaining courthouse in the new Mid and East Antrim Council area. (AQO 7615/11-15)

Robin Swann (UUP, North Antrim)

13. Mr Swann asked the Minister of Justice how the closure of Ballymena courthouse will help to alleviate the delays within the justice system. (AQO 7617/11-15)

David Ford (Alliance, South Antrim)

With your permission, Mr Principal Deputy Speaker, I will take questions 1, 9, 11 and 13 together. I may require a little additional time to do so.

On 29 January, I launched a consultation exercise aimed at seeking the views of the public on the closure of up to eight courthouses across Northern Ireland. The consultation has been launched against the backdrop of the Executive's programme for public-sector reform and restructuring.

In the context of a significant reduction in the funding available to my Department, it has been necessary to reduce budget allocations to all spending areas, including the Northern Ireland Courts and Tribunals Service (NICTS). It is simply no longer sustainable to operate 20 courthouses in a place the size of Northern Ireland. In response, the service has established a modernisation programme aimed at ensuring that the organisation is structured and resourced to provide an efficient and effective service that is affordable. The programme will involve a comprehensive review of current processes and practices, with a view to designing an enhanced, integrated and affordable service delivery model. NICTS is also seeking to rationalise the court estate in order to deliver efficiencies and to ensure that a reduced estate is used to its maximum potential.

The recently published consultation document explains in detail how rationalisation could be achieved. NICTS has strategically reviewed the current court estate in order to identify venues that could be closed and business transferred to an alternative court venue with minimal impact, thus ensuring continuing efficient and effective service delivery. The proposals seek to make greater use of the more modern or larger court buildings in the court estate. The transfer of business from Newtownards to Laganside Courts, for example, will afford court users, including victims and witnesses, a better standard of facilities and accommodation. There is also a proposal for a dedicated family court centre in Belfast.

In relation to impact and delays, there are no proposals to reduce the number of scheduled sittings; capacity will therefore be unchanged. In addition, the colocation of judges dealing with a particular type of business offers greater scope for them to work collaboratively and to deal more effectively with the cases before them.

Under the proposals, a number of local government districts, including Mid and East Antrim, would not have a court building. There is no requirement for each council area to have a courthouse, nor is it the case that there is a courthouse in each of the existing local government districts.

I look forward to receiving the views of the public and will consider them carefully following the closure of the consultation exercise.

Peter Weir (DUP, North Down)

Given the fact that the Lord Chief Justice is against the proposals, how will access to justice be guaranteed, particularly for the people of Bangor, Newtownards and Holywood, where approximately 150,000 people will be left without even a courthouse in the area? How can access to justice be maintained for the people in those circumstances?

David Ford (Alliance, South Antrim)

Access to justice does not mean having a courthouse at the bottom of the street; it means having access to a working courthouse that has suitable facilities for the arrangements that we now need, including facilities for witnesses and vulnerable victims and segregation from defendants. All those are more easily provided in the more modern facilities. There will be no change to the number of court sittings. There will be significantly enhanced use of court buildings, so that, instead of having a number of buildings with empty courtrooms, there will be greater and more efficient use of the buildings that are in use.

Gordon Dunne (DUP, North Down)

When Bangor courthouse closed in 2013, business was transferred to Newtownards. The legal representatives in the area warned that it was not fit for purpose. Now, Newtownards is closing. What additional resources is the Minister putting in place to serve the people of North Down and Ards? For 150,000 people, is it just a matter of rough justice?

David Ford (Alliance, South Antrim)

The population of North Down and Ards or Ards and North Down — whatever the district is to be called — is of no relevance to the issue of the services provided. The issue is whether there are adequate courtrooms available to provide for the services that are required. If Members had actually read the consultation document, they would have seen that there are plans to have the number of sittings in Laganside and to develop the dedicated family centre to ensure that the same number of sittings can be held as would have been the case spread across a wider number of buildings, with the result that there will be significant savings in costs at a time when the Department of Justice is under very significant pressure.

David McIlveen (DUP, North Antrim)

I thank the Minister for his answers so far. Does he agree with me that spending £1·7 million on Ballymena courthouse in one year and then subject it to closure the next shows a Minister and a Department that are fiscally irresponsible?

David Ford (Alliance, South Antrim)

That simply is not the case. A significant amount of money was spent a few years ago to comply with the Disability Discrimination Act 1995 and to ensure that there was a roof that did not leak. Given that Ballymena courthouse is a listed building, the DOJ has obligations to maintain it, and that was carried through. That does not mean that we can continue to use old, inefficient courthouses that are half empty when there are alternative facilities available in more modern buildings in, in the case of Ballymena, Antrim and Coleraine that will provide a better service for those who use courthouses even if they have to travel 12 miles from Ballymena to Antrim to make use of them.

Robin Swann (UUP, North Antrim)

Minister, not only must justice be done but it must be seen to be done. Local courthouses can be covered by local newspapers so that the local population has the confidence that your justice system actually works in some cases. Can the Minister give any reassurance as to how that will be facilitated?

David Ford (Alliance, South Antrim)

I can see no reason why, in the case of Mr Swann's constituency, a reporter from the 'Ballymena Guardian' or the 'Ballymena Times' cannot travel to Antrim courthouse and report what happens there, rather than sitting in Ballymena and reporting what happens there. These are fundamental issues of vital reform to ensure that the DOJ can live within budget. There is a very significant sum of money to be saved by making the reforms, and the DOJ budget is unsustainable if we do not carry through the reforms. Instead of focusing on having a courthouse in every town, people need to focus on the facilities that are provided and the way in which victims and witnesses are treated in courthouses, particularly some of our older ones. While they may be beautiful listed buildings, they are, in many cases, not providing the services that I believe our citizens need in the 21st century.

Sean Lynch (Sinn Féin, Fermanagh and South Tyrone)

Go raibh maith agat, a LeasCheann Comhairle. I think that we have done the rounds, but another one of the courthouses is in Enniskillen. It may be old, but it is not inefficient. They are proposing that they go to Dungannon, which is almost an hour's drive away. That will hit the most vulnerable people, and it is the only courthouse in the county. Do you agree with me that it will impact on the most vulnerable people?

David Ford (Alliance, South Antrim)

I think that, if Mr Lynch reads the document, he will find that the bulk of business is intended to transfer from Enniskillen to Omagh. Of course there will be elements of impact in terms of people having to travel. We are not denying that, but one issue that was followed through was to ensure that there was a reasonable travelling time, even by public transport, to an alternative court venue, with the opportunity for people using public transport to arrive before court sits and to get home later in the day. The key issue has to be how we save the money that has to be saved whilst making use of the better facilities that exist in some of the more modern courthouses. I accept that there are particular issues with the age of the court estate in the west of the region and how we deal with that to ensure that we make the maximum use of the facilities that we have but do not spread resources so thinly that we cannot provide a decent service to those who make use of it.

Dominic Bradley (Social Democratic and Labour Party, Newry and Armagh)

Go raibh míle maith agat, a LeasCheann Comhairle. Taking into account what has been said by the Lord Chief Justice and the fact that millions of pounds have been spent on Armagh courthouse, will the Minister agree with me that it would demean Armagh's status as a city to have its courthouse closed?

David Ford (Alliance, South Antrim)

No, I cannot agree with such a suggestion. The reality is that Armagh is no bigger than many other rural towns that do not have a courthouse.

I do wonder what some Members of this Assembly think of their constituents, when they suggest that a courthouse is so necessary for them, as if there were a major crime wave in their area. The reality is that the facilities at Craigavon and Newry courthouses are significantly better than those in Armagh, and we must make use of the better facilities that we have.

Stewart Dickson (Alliance, East Antrim)

Would the Minister agree with me that the type of measures he is taking, which are similar to those proposed by his colleague the Minister for Employment and Learning for public finances, need to be taken by all Executive Ministers to meet the public service requirements under this current Budget?

David Ford (Alliance, South Antrim)

Yes, Mr Principal Deputy Speaker. I understood that we had an agreement in the Executive to reform, restructure and cut out waste. It is easy for Members to engage in special pleading for a building in their constituency, but I am responsible for managing the budget for the Department of Justice, which is currently unsustainable over the next financial year unless we implement very significant cost-saving measures across a range of services.

If Members read the full consultation plan, rather than merely looking at the concerns that they have about a building in their constituency, they would see that the potential savings across the Courts and Tribunals Service and the prisoner escort and court custody service are in excess of £1·5 million. That simply cannot be ignored in the face of the difficult budget that is set for the DOJ. Unless Members can come up with something better than saying, "My constituency is special", they have not put forward rational grounds for doing anything other than what I am trying to do, which is totally in line with the Executive's overall policy.

Jim Allister (Traditional Unionist Voice, North Antrim)

Why does the Minister think he knows better than the Lord Chief Justice? Does the David Ford who wants to close eight courthouses know better than the David Ford who spent £4·5 million upgrading those same eight courthouses? How many of the eight courthouses has he even visited?

David Ford (Alliance, South Antrim)

Mr Principal Deputy Speaker, I lost track of the number of questions. There is, as I have explained, an obligation to maintain courthouses while they are in operation, which means keeping the buildings functional. It is easy for Mr Allister to sneer. I could not tell you off the top of my head how many I have visited but I have visited a significant number of courthouses.

The Lord Chief Justice has certain responsibilities, and we will certainly listen to what he has said. It is the responsibility of the Courts and Tribunals Service, however, to manage the estate efficiently and to ensure that there are adequate sittings available for judges to hear cases. We are looking at the detail of that at present. I hope that, instead of the sneering, derisory comments we have had from Mr Allister, he and others will put forward serious suggestions as to how we address the budgetary difficulties, provide better facilities in more modern buildings for victims and witnesses and make the justice system work more speedily and efficiently in the interests of something other than maintaining nice old buildings.

Bronwyn McGahan (Sinn Féin, Fermanagh and South Tyrone)

2. Ms McGahan asked the Minister of Justice, given his proposals to cut legal aid and close courthouses, how he intends to deliver faster, fairer justice. (AQO 7606/11-15)

David Ford (Alliance, South Antrim)

The proposals to reform legal aid and to close courthouses should not impact on the delivery of faster, fairer justice. I have just explained the proposals to close courthouses. I have also set out my plans to reduce legal aid expenditure on a number of occasions. Further significant reforms will be implemented shortly.

The need to reform legal aid is evident and urgent as the demand continues to outstrip the available budget. Let me reiterate what I have told the House previously. The forecast expenditure on legal aid for 2015-16 is £103·6 million. Following the cuts imposed by the Executive, the legal aid budget was reduced by 15% from £75 million to £64 million. This leaves a pressure of £40 million — more than the entire budget for the core Department. I have, by cutting elsewhere in my Department, allocated a further £18·5 million to the legal aid budget, which still leaves a pressure of over £20 million. I am resolved to bring forward further measures to reduce the legal aid spend. I am introducing further cuts to Crown Court fees, saving some £7 million a year. I am bringing forward measures to reduce the spend on civil legal aid, which will realise savings in the region of £13 million per year. I am also considering measures to reduce the scope of legal aid that will entail removing specific areas where representation has, until now, been paid for out of the public purse.

Due to the life cycles of these cases, these savings will take some time to be fully realised. Therefore, in the absence of additional funding, I have proposed to the Executive the introduction of emergency legislation to impose a temporary levy of up to a maximum of 15% on all legal aid payments where the forecast exceeds the available budget. That is designed to be a temporary measure. It will be strictly controlled; it will require Executive and Assembly approval. None of that affects the programme to deliver faster, fairer justice.

Bronwyn McGahan (Sinn Féin, Fermanagh and South Tyrone)

Go raibh maith agat. I thank the Minister for his response. Does he not accept that the closure of so many courthouses will result in a backlog and a loss of confidence in the criminal justice system?

David Ford (Alliance, South Antrim)

No. As I have explained, there is adequate accommodation in the 12 courthouses that are proposed to continue in operation to provide courtrooms for the sittings required that are currently carried out over 20 courthouses. Therefore, there is no reason whatsoever to believe that that would slow up the programme. Indeed, as I said earlier, by co-locating judges, we have the opportunity to get better and more efficient management of lists and, therefore, potentially speed up justice.

Pat Ramsey (Social Democratic and Labour Party, Foyle)

Following Bronwyn's question on legal aid, does the Minister not accept that there will be a hugely detrimental effect on progressing family law cases and developing them in court?

David Ford (Alliance, South Antrim)

Mr Ramsey certainly has a point about family cases, but I do not accept that there will be a huge effect. The reality is that we are looking in detail at the way in which cases are funded. The key issue around matters of some family cases is that, whilst the intention is to continue funding initial hearings, such as in the case of a divorce or separation, there is no doubt that, in some cases, people on modest earnings who, therefore, are ineligible for legal aid, will find themselves being subjected to repeated court cases by an ex-partner over things like the exact timing or duration of access to children, because a partner who can get legal aid will continue to go back to court. That is not the kind of thing that anybody funding themselves would do. It is not the kind of thing that we can afford to pay for continuously from the legal aid fund. It must be about getting the decision right and then finding better ways of arbitration or mediation rather than funding continual challenges where one party uses legal aid to damage the other party.

Tom Elliott (UUP, Fermanagh and South Tyrone)

Will the Minister at least accept that, currently, there are unacceptable delays in bringing cases to a conclusion? If he accepts that, will he explain to the House how his actions are going to speed up delayed cases?

David Ford (Alliance, South Antrim)

Mr Elliott does not explain what kind of cases have unacceptable delays. What I have seen across a variety of criminal cases in Crown Courts, Magistrates' Courts and youth courts is a speeding up in recent years. There is not as much progress as we would have hoped at times, but the delays are certainly not getting worse. I do not know many times I need to repeat this: the issue is not the number of buildings; it is the number of court sittings that take place to allow judges to hear cases. There will be no reduction in the number of court sittings, even with the proposals to close a number of courthouses. Therefore, there is no issue of that adding to delay.

Steven Agnew (Green, North Down)

3. Mr Agnew asked the Minister of Justice whether, as part of his consultation on abortion, he has received any evidence that lethal foetal abnormality cannot be diagnosed accurately. (AQO 7607/11-15)

David Ford (Alliance, South Antrim)

With permission, Principal Deputy Speaker, I will answer questions 3 and 7 together. Sorry; I was going to, but the Member who planned to ask question 7 has disappeared.

A large number of responses to the consultation have been received, including detailed submissions from the relevant medical professional bodies. Although the process of analysing the responses is not yet complete, and I do not want to pre-empt the outcome, it is my understanding at this stage that the main professional medical bodies have not raised any issue about the ability of clinicians to diagnose accurately foetal conditions that are lethal. A full assessment of the responses to the consultation will be reflected in the summary document, which I hope to publish as soon as possible.

Steven Agnew (Green, North Down)

I thank the Minister for his answer and clarification of the issue. He will be aware of the statement made by Dr Alasdair McDonnell on the 'Inside Politics' programme that fatal foetal abnormality was difficult to predict. He may have given couples and women who have received that diagnosis false hope that the diagnosis may be inaccurate. Will he make it clear that Dr Alasdair McDonnell was wrong in what he stated and that politicians should not be so irresponsible when trying to protect their party position?

David Ford (Alliance, South Antrim)

I will leave it to Dr McDonnell to justify his stated political position. I can go only on the evidence that I have — for example, from the Royal College of Midwives, the Royal College of General Practitioners, the department of foetal medicine at the Royal Victoria Hospital, the Royal College of Obstetricians and Gynaecologists and the BMA. As I understand it, all those bodies make clear their belief that it is possible to diagnose accurately fatal abnormalities of a foetus of the sort that is proposed in the consultation, which is that two doctors will certify that there is a fatal abnormality that is incompatible with life and that no treatment can be offered after delivery that will make the situation any better. Those are the conditions that were being looked at. It appears to me, from a preliminary look — I am not trying to prejudge the issue — that those with the most knowledge suggest that it is possible that that can be an accurate diagnosis.

Paul Givan (DUP, Lagan Valley)

Does the Minister accept that his consultation document departs from long-established principles whereby a mother's life — physical and mental — is the determining factor in providing choice in these circumstances and that his legislative approach would create an automatic entitlement to an abortion on the grounds of conditions that are incompatible with life, as subjective as that notion could be?

David Ford (Alliance, South Antrim)

Yes, just as an assessment of a mother's long-term physical or mental health may be subjective and may also be objective, those are exactly the same grounds that would be applied to determine, in the context of fatal foetal abnormality, the clinical judgement.

Alban Maginness (Social Democratic and Labour Party, Belfast North)

I thank the Minister for his answers. Obstetricians and gynaecologists, to my knowledge, have said that option 4, which the Minister favours in his consultation paper, is not clear or precise and does:

"rely on an artificial or arbitrary line separating some difficult and sensitive cases."

That gives rise to a situation in which a proper diagnosis cannot be made in all circumstances and which, I believe, is indicative of medical opinion on this very difficult area. I ask the Minister to comment on that.

David Ford (Alliance, South Antrim)

I would be in danger of prejudging the entire outcome of the consultation if I went too far on that. There may, indeed, be difficult cases. Mr Agnew's question was brought about by a comment from Dr McDonnell that "doctors always get it wrong". I do not believe that that is the case.

Leslie Cree (UUP, North Down)

Will the Minister clarify, in the case of foetal abnormality, whether there is a set number of weeks when a termination can be performed?

David Ford (Alliance, South Antrim)

At the moment, the answer to whether there is a set number of weeks in which a termination can be performed is no. Termination on the grounds of fatal foetal abnormality is not lawful in Northern Ireland at present. That issue would have to be considered if there were a proposal to change the law as to exactly how it would apply. However, Members need to be aware that, in many cases, the diagnosis, for example, in anencephaly, the condition that is most commonly cited, does not tend to arise until the 20-week scan, so there are issues that would not relate easily to the normal termination time as the law applies in GB.

Raymond McCartney (Sinn Féin, Foyle)

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I thank the Minister for his answers so far. We welcome the consultation. As people bring their arguments to the table, they should do so on the basis of evidence and fact, but I ask the Minister that they should also consider a degree of compassion.

David Ford (Alliance, South Antrim)

I certainly agree with Mr McCartney's point. It is easy to bandy statistics or opinions or whatever, but the reality is that the small area in which the consultation recommended changing the law is about dealing with the traumatic and absolutely horrific situations in which a small number of women find themselves every year. If we cannot deal with them with compassion, whatever our preferred outcome, we are not in a very good place as a legislature.

Jimmy Spratt (DUP, Belfast South)

4. Mr Spratt asked the Minister of Justice, given that he is responsible for the Policing Board budget, to outline the payments to the chairman, vice-chairman and independent members of the board. (AQO 7608/11-15)

David Ford (Alliance, South Antrim)

The Northern Ireland Policing Board is an independent public body. The level of detail sought in outlining all payments to the chair, vice-chair and independent members is not retained by my Department. The Policing Board's website contains a summary of all payments paid to political and independent members over the previous five years, including expenses. The current annual remuneration rates are as follows: chair, £58,606; vice-chair, £43,954; and independent members, £19,437. I propose to reduce those to £48,000, £24,000 and £12,000 in line with payments to members of other public bodies.

Jimmy Spratt (DUP, Belfast South)

I thank the Minister for his answer. Given the stringent cuts to the policing budget, will he ensure that further cuts are made to the budget for the Policing Board, which has already had a dramatic cut in staff, as well as those that he suggests making to the remuneration rates for the independent members, chair, vice-chair etc?

David Ford (Alliance, South Antrim)

We need to consider the role that the Policing Board has to perform in overseeing the PSNI and the potential increase flowing from the Stormont House Agreement, meaning that it may well have a wider role in historical work. In addition, the Assembly has now agreed that the National Crime Agency should have a role in the devolved sphere in Northern Ireland, and the board would have a role there. However, I entirely take Mr Spratt's point that no part of the justice system can be exempt from the cuts needed as a result of the Executive's Budget decisions.

Pat Sheehan (Sinn Féin, Belfast West)

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. Does the Minister agree that no steps should be taken by him that would undermine the effectiveness of the Policing Board in carrying out its work without fear or favour?

David Ford (Alliance, South Antrim)

I certainly agree with Mr Sheehan on that point, and I do not believe that I have taken or am contemplating taking any such steps. If he is hinting at the potential change in the way in which members of the Policing Board are appointed, I do not believe that, if we were to move to a rolling appointment system — that decision has not yet been taken — it would impinge on the independence and responsibilities of the board, but that is still under discussion in the Department.

Roy Beggs (UUP, East Antrim)

Does the Minister agree that the cuts to the Police Service that have been highlighted and the effect that they will have on the ground mean that the public will want to ensure that appropriate funding is committed to administration and will want to see reductions in that area? Whose call is it, ultimately, to set the figures? Is it his call, and how will he deal with existing appointments?

David Ford (Alliance, South Antrim)

I accept my responsibility as Minister to look at the rationalisation of remuneration for the Policing Board and potentially for other bodies in line with the prevailing rates for similar bodies in Northern Ireland. If you compared, for example, the responsibilities of the chair of a health and social care trust with those of the chair or members of the Policing Board, you might well find that they are not much less onerous, yet the salary is significantly lower. We need to ensure that we have a rational way of determining appropriate remuneration.

I agree with Mr Beggs's general point. With significant cuts being imposed on the DOJ, it is not possible to continue to afford significant payments to those who serve on such boards. Given that the term of office of current members is up in the early summer of this year, this will not impact at all on current members. Those who wish to be appointed to the board when it is reconstituted will be fully aware of the salaries.

John Dallat (Social Democratic and Labour Party, East Londonderry)

5. Mr Dallat asked the Minister of Justice what action is being taken to address the increased levels of drugs found in Maghaberry, Magilligan and Hydebank prisons. (AQO 7609/11-15)

David Ford (Alliance, South Antrim)

Substance misuse is a societal issue and is a significant factor in offending behaviour. For that reason, it is a problem inherited by and concentrated in the whole criminal system, not just prisons. By the time someone enters the criminal justice system, it is very likely that a number of interventions, including those in respect of education and health, will have been unsuccessful.

There is a real and concerted effort by the Northern Ireland Prison Service to address substance misuse based around a three-strand approach: restrict supply, reduce demand and assist recovery. In 2013, the Prison Service increased its focus on intelligence-led searching. The increase in drug finds in all three prisons is clear evidence that the approach is targeting the right people and drugs in particular are being detected. NIPS has also established a team to address the recommendations of the recent CJINI inspection report, 'The Safety of Prisoners Held by the Northern Ireland Prison Service', working in partnership with the South Eastern Health and Social Care Trust, which has responsibility for providing health care in prisons. That includes an examination of the strategy to manage substance misuse in prisons.

Robin Newton (DUP, Belfast East)

That ends the period for listed questions. We now move to topical questions.

Dominic Bradley (Social Democratic and Labour Party, Newry and Armagh)

T1. Mr D Bradley asked the Minister of Justice whether the independent assessment team, led by Peter Bunting of the Irish Congress of Trade Unions, has investigated the disturbances in Roe House last week and, if so, whether he has received a report from the team. (AQT 2131/11-15)

David Ford (Alliance, South Antrim)

I thank Mr Bradley for the question. I have two slight quibbles. First, I am not sure that the other three assessors would necessarily agree that Peter Bunting is the leader; I think that they regard themselves as four equals. Secondly, it is not their job to inspect specific incidents. There are other arrangements for that, including the role of the Prisoner Ombudsman. However, it is certainly the role of the assessors to make a collective assessment of the situation as it stands in Roe House at different times. I will meet them shortly to discuss their current view of the situation there.

Dominic Bradley (Social Democratic and Labour Party, Newry and Armagh)

I thank the Minister for his answer. Will he share with the House the report that he receives from the assessment team?

David Ford (Alliance, South Antrim)

To talk about sharing reports suggests that sometimes they are more formal than some of the verbal reports that I or the director general of the Prison Service receives. The report published last year on the stocktake of the 2010 agreement was a clear example of openness in that respect. Much of the other work that the assessors do is at a rather more informal level than publishing a report.

Adrian McQuillan (DUP, East Londonderry)

T2. Mr McQuillan asked the Minister of Justice for an update on the recruitment process for the policing and community safety partnerships (PSCPs). (AQT 2132/11-15)

David Ford (Alliance, South Antrim)

At the moment, my understanding is that the Policing Board is managing the appointment process for independent members of PCSPs. I believe that councils will largely nominate members to the new PCSPs at the initial AGM, which in most cases is held in March, I believe. The expectation is that independent members, when appointed by the Policing Board, will be in place by June this year.

Adrian McQuillan (DUP, East Londonderry)

I thank the Minister for his answer. Given the pressure on budgets that we heard about earlier, are PCSPs talking shops? Are they a luxury that we can afford at the present time?

David Ford (Alliance, South Antrim)

Ironically, I was at a meeting in Coleraine Town Hall last night with Mr McQuillan's local PCSP. What I see when I visit PCSPs — maybe I visit only the best ones — is that good work is being done in a number of areas and on a variety of topics, such as addressing crime and the fear of crime; antisocial behaviour; diversionary work for young people; providing reassurance to older and vulnerable people; and rural crime, with trailer-marking and trackers. All of that is work that is being done because local partnerships have identified the needs in their immediate area. Although there may be cases of not all PCSPs being as efficient as they might be, there is no doubt that some extremely good work is being done. We are trying to spread the message of that good work to all of them.

Jim Allister (Traditional Unionist Voice, North Antrim)

T3. Mr Allister asked the Minister of Justice why there is such a disparity in anticipated funding in the Stormont Castle agreement in respect of the legacy inquest cases, where some £19 million a year is being sought, in contrast to the Historical Enquiries Team (HET) cases within the historical investigations unit (HIU), where only a third of that figure is thought necessary to investigate hundreds of cases. (AQT 2133/11-15)

David Ford (Alliance, South Antrim)

I am not quite sure what point Mr Allister is trying to make. If he is saying that the funding that is proposed for the HIU is significantly greater than that that goes into the HET, that is entirely correct. Indeed, the Stormont House Agreement did not see the Government provide all the additional funding that was thought necessary, and detailed work is continuing on exactly how that will be managed as we look at the HIU establishment.