There has been much talk recently about the delay in implementing the remaining changes to health and social care structures that were proposed under Direct Rule. As a devolved Minister, I make no apology for taking time to ensure that our local structures meet our local needs and are efficient and effective for the good of patients.
I will not blindly follow Direct Rule proposals.
The Review of Public Administration proposed major changes for local government, education and, of course, health. To date, in stark contrast to the lack of progress in other areas, health has been pushing ahead with RPA reforms. In April this year, 19 Trusts were reduced to six - five Health and Social Care Trusts plus the Ambulance Service. My Department is leading the way and this reform alone will deliver more than £53m as part of my total efficiencies of £343m over the next three years.
I am still considering the other proposals for health. I want to be satisfied that any new structures will deliver the best standard of treatment and care for all. To do otherwise would fail the people of Northern Ireland. I am clear that the key principles for any new structure are robust performance management, financial accountability, local commissioning, local democracy and interaction from local councils.
It has been the proposal to establish a huge regional authority with 1,800 staff and a budget of over £100m, that has concerned me most. Direct Rule proposals were for this body to be similar to the Health Service Executive in the Republic which has been the subject of much controversy and criticism over lack of accountability.
There must be clear and democratic accountability. Local democracy is something that Peter Hain went out of his way to ensure didn't happen. I want to fix that problem.
Many have commented that in taking the time to consider this very important issue, I am jeopardising much of the good progress that has been made within health and social care. I must emphasis, it is very much business as usual. Due to concerted efforts by staff, waiting times have dropped dramatically. For example in March 2007, there were 22,000 patients waiting over 13 weeks for a first outpatient appointment, by November 30 provisional data has shown that this has reduced to 3,943.
The service is continuing to push for better service delivery and working towards other challenging targets such as a maximum four-hour waiting time at A&E and the reduction of healthcare acquired infections.
I am determined to ensure that any major alteration to our structure is right. I will continue to push for improvements in service delivery. I will achieve the necessary efficiency savings and plough them back into frontline services. And I will continue to fight for the resources I need to deliver a health and care service that the people of Northern Ireland deserve.
I fully subscribe to the idea of a cradle to the grave Health Service, free for all citizens, funded by the taxpayer. However, with the health spending gap between Northern Ireland and England set to increase to £600m by 2011, if the current draft budget allocation is agreed, we appear to be saying that people here can have that service, but it will not be as good as it is in the rest of the UK. That is wholly unacceptable and without appropriate investment, the question will remain as to whether Northern Ireland, as a society, can sustain the Health Service.