More heat than light: The health committee debate in full
Yesterday the Stormont committee whose job is to scrutinise the workings of the health department put minister Edwin Poots in the hot seat over the funding shortfall that he says is threatening vital services. The following is an edited transcript of what took place.
Health Minister Edwin Poots was questioned by members of the Assembly's Health committee, accompanied by chief medical officer Dr Michael McBride and Julie Thompson, director of finance and resources in the Department of Health. Mr Poots was first invited to make an opening statement and said he would be brief.
EP: "Despite submitting compelling bids in June, £20m has been set aside subject to my department showing it is living within its budget.
(This was a reference to his party colleague, Finance Minister Simon Hamilton, criticising "poor management" of the health service budget in recent months because of an overspend of £13m).
Mr Poots then referred to his letter sent last week to his fellow Ministers and committee members which pointed up he is already committed to delivery of £170m of savings this year on top of the £490m saved in the last three financial years.
"My letter...identifies areas where money can be saved. It is not scare-mongering, it is a factual analysis of what can be achieved in the current year, he said. We are already saving £170m.
"Given the serious and detrimental effect on patients these would have, I do not support their implementation."
He said they would impact on commitments in the Executive's existing Programme for Government – due to be extended by a year following the delay of the next Assembly election, to 2016.
And he pointed out a number of successes in the health service, including a 65% reduction on waiting for vital drugs and the halving of waiting times and overall improvements to the "range, access and quality of services provided.
"I am absolutely committed to making savings and have achieved £490m of savings since I took up office," he added.
"Either money must be found or the Executive must take collective responsibility."
Sinn Fein's Maeve McLaughlin, chairman of the committee, said: "All of us as citizens do deserve a first class health service, free at the point of contact.
"This current scenario is a mess. Mr Hamilton has pointed up mismanagement of your budget. There are clearly very real questions in relation to the management of your budget.
That has been backed up by your party colleagues and indeed by your admittance that you can't or won't deliver these cuts. I would ask you to reflect on that.
"Also a further comment in January 2014, where a statement was given to the Assembly from Mr Hamilton, 'I have made it clear to the health Minister that I expect his department to contain the costs'."
EP: "If it is a mess it is a mess of the member's own party's making. Over the course of last three years we have been living within our budget better than most departments. Last year we overspent by £13m. We are currently setting aside £8m a month to pay back for welfare reform. If I had that £8m, I wouldn't be sitting here today.
"I make no apologies for the fact that we went £13m over budget because, as I started to look at waiting lists, there were problems coming in from the Trusts and those problems would have been much worse (If I hadn't acted). If your party's priority is welfare, stand up and say that. My party's priority will be health.
MMcL: The issues within your department pre-date the debate and debacle around welfare cuts. There needs to be a separation out of these issues."
EP: "We have lived close to but within our budgets. I very much welcome the help I have had during my period in office from (the former Finance Minister) Sammy Wilson and Mr Hamilton.
The £13m overspend was purely that I would have had to stop a lot of the elective procedures which would have gone into the current financial year. All you would have been doing was pushing the problems down the track. I would hope that this committee would support me in going to the Executive to fight for resources for the health service."
MMcL: "Certainly you have the support of the chair for proper management of the health service. Has the budget to date been properly managed?
EP: "Absolutely. If you are asking me is there waste in the health service, there is. There is waste in every department. Yes, there is more to be done. It is good when those things are identified.
"We are providing a world class health service and why should we move away from that?"
MMcL: "Why then have you failed to convince your colleagues to increase the funding in this round?"
EP: "It was the insistence of your own party which removed half of the money which was being allocated. You would need to go and look at how your party has performed because it has performed despicably and I cannot carry out these proposals put in front of me.
"Your party has (also) attacked the health service in a way and undermined it in a way which has put me in a wholly untenable position."
"We have to change the direction we are going in in going forward. I am not crying wolf, by the way. I have identified we have reached crunch point and I need the Assembly and this committee's backing to continue to provide a world-class service.
MMcL: "Does that require more oversight of your budget?"
EP: "Has this committee failed in its monitoring of me of the last three and a half years? If you look at the underspends over the last four years we have been excellent. We have continually managed our budget well."
Jo-Anne Dobson (Ulster Unionist): "Do you acknowledge the cuts from the June monitoring round really have nothing to do with welfare reform? Outside this building the public are genuinely concerned. Was this a deliberate attempt to mislead the public when the issues had been simmering about for months. When did you realise about the shortfall?"
EP: "You are completely wrong."
JD to Dr McBride: "What concerns did you have on the budget agreed in 2011 and when did you first bring those to the Minister's attention?"
Dr McBride: "I became aware of the pressures in the summer of 2013 and obviously did make those known. The potential implications go not just to public health but the efficiency of services – for example to highlight two particular areas – winter pressures, attendance at accident and emergencies which figures showed increased by almost 2% in the last year.
"It is very easy to forget that behind all these numbers, there are services that people depend on."
The chief medical officer detailed some of the measures to deal with the annual problem of winter pressures.
"Clearly we will not be able to put those in place, and also enhanced home help provision... on which 25,000 people in Northern Ireland depend."
EP: "This is a new problem, it arose from last August."
JD: "39 months have passed since you became minister, why has it taken so long for you to essentially ring the alarm bells?"
EP: "I didn't have cause to ring alarm bells over the course of the last 39 months. I did ring alarm bells in April of this year, it is August when your party and others are picking up on it.
As the Deputy First Minister (Martin McGuinness) left the meeting (in April) he said: 'We will have to see if we can help you'. I need support and assistance to do this."
Kieran McCarthy (Alliance): "In May your figure was £160m and you said waiting times would be longer, safety and quality may be compromised and I described those comments as shocking, horrendous and dreadful. Three moths later we are told £20m is suggested... we now get this letter describing the consequences. It has to come in the context of a proper strategic review of expenditure across the Executive. We cannot put money in if there is money being squandered by the Department."
EP: "I wish we could put in £1m a month to waiting for problems to arise". He then made a comparison to the protest camp at Twaddell Avenue which costs £1m a month to police even though nothing has happened. He also referred to the £20m given out to legal aid (under Alliance Minister David Ford) which he said he would not give.
"I have conflicting responsibilities – to meet the programme for government, to live within my budget, to provide the services. Some of these matters are of such a controversial nature that a Minister would be liable to challenge in court and that is not abdicating your responsible."
Kieran McCarthy suggested the current £21m bid for the Transforming Your Care programme would not be met. "You will not get it, what happens to TYC ?"
EP: "£8.7m is the gap. Some Trusts will be falling behind, because some are more further advanced."
Mickey Brady (Sinn Fein): "It seems to me the world class health service is going to disappear overnight. Compassion unfortunately seems to stop when it comes to welfare cuts. I would first of all refute that my party has behaved despicably and I think you are being disingenuous. You have told me in the past that there should not be politics in health (but) you have made a big issue of making health political in this last while.
EP: "I am a politician and we all are politicians so politics is part of what we do daily. We have got the best deal anywhere in the UK on welfare reform. It absolutely really gets to me that I have people going to work every day who are getting around half of what the cap on welfare is – £26,000. Sinn Fein is actually the party that is allowing the cuts, I haven't created a doomsday scenario. I have stated the facts."
Fearghal McKinney (SDLP): "Can you give me a figure or estimate of how much wastage there is?"
EP: "It will be a small percentage of the overall budget. Cancelled operations, emergency hospital admissions..."
FMcK: "You can't take for granted this committee's support. Why can the department not explain there were 191,000 hospital cancellations last year?"
EP: "That figure is coming down and progress is being made."
Julie Thompson of the Department of Health reiterated savings over the last three years were £491m in total and Mr Poots said £42m has been spent on Transforming Your Care.
JUT: "There was a tsunami of care that we need to provide. (We are) anticipating a 30% increase in asthma (and) increases in cancer. We were looking to a three to five year delivery of TYC, it is going to go more towards the five year."
FMcK: "We may find it difficult to back you given the wastage and lack of implementation..."
MMcB: "The Northern Ireland health care system is no different to health systems across the world, with more elderly people in the future. I have made clear as early as 2009 of the need for change
TYC is our blueprint. It is about more than a document, it is about the commissioning process, pathways... and models
"I have not at any stage said I have concerns about the implementation of TYC. I have concerns about the pace of change to live within the Budget."
FMcK: "When did you become concerned about TYC and why have you not been telling the committee?"
MMcB: "I have already answered that. Our plan is no different than (others across the world) but in terms of the recurrent budget the implications, in term of the cuts, are quite wide-ranging.
"The choices we are being faced with are short-term, short sighted and, in short, I cannot recommend these to the minister."
EP: "I find that very depressing. His (the SDLP) is the other party which has objected to welfare reform happening in Northern Ireland. The areas we are identifying – £1m would buy 72,000 hours of domiciliary care, 27 weeks in nursing homes, 100 coronary by-pass operations, 175 knee procedures, 35 nurses."
Gordon Dunne (DUP): "You (Mr Poots ) have the most difficult job in the Executive and I think many members of the public recognise that and that you have have not shied away from challenges. What convinces you that these are too much?"
EP: "We have delivered £490m over the last three years, and there will be another £170m in the next year – that is £660m of savings.
"We cannot save it in the course of the seven or eight months that remain in this financial year. I will make savings this year but the deeper we go into this £140m the greater the consequences for the public."
Roy Beggs (Ulster Unionist) asked whether the budget for health had been protected in recent years – ringfenced from further cuts – and whether the already-recognised increased inflation rate has been taken into account.
EP: "The budget itself has been protected. In the middle of last year the Trusts were indicating they were coming under pressures they were no longer able to absorb, which they had absorbed before.
RB: "Was there not a very clear signal there was going to be a problem this year?"
EP: "I asked my officials to prepare papers for me, and I also asked for a meeting with the First Minister and Deputy First Minister and that took place on April 6, as I have said. Then I came to speak to the committee in May and in the Assembly."
RB: "Do you accept we need to look at the overall budget (of the Executive?)"
EP: "We are already looking at handing back £100m to Westminster this year."
MMcB: "If you look at the pressures back (last year) we are seeing an element of predicted pressures but also over and above that increased demand. We have a system that is under pressure, a system that is now demonstrating the strain. My professional duty was to voice my concerns to the Minister. I would be in dereliction of my duty if I didn't (say they) will impact negatively in the range of services and improvements we have made."
FMcK: "Why have you not been vocal in the last number of years?"
MMcB: "TYC is a long term strategic plan. There's a fundamental misunderstanding here."
RB: Do you welcome the support from (former Ulster Unionist health Minister Michael) McGimpsey given the hounding of him (by your party when he was minister?)
EP: "Absolutely, and I would welcome the support of this committee."
MMcL: "This committee is concerned and will play our part in the delivery and enhancement of our health service to ensure better outcomes. However, today I have heard conflicting and contradictory messages in relation to the budget. I have heard the blame being put at the door of welfare cuts and increased demand. So I therefore remain unconvinced that there is proper, actual oversight, actual management and proper scrutiny of the current budget. There are questions why the Budget bid went up from £67m in January to £160m in June.
There is a need for more scrutiny because in many ways it would appear money is not going in the right direction. I would want to make the request today, to say we have listened carefully and I would request additional levels of scrutiny and monitoring to your budget."
EP: "You are the scrutiny committee and I regret that you are condemning your own scrutiny. We are not going to have someone standing in every ward because that would cost us more money than the wastage."
TYCs - an initiative shrouded in controversy
It may be three simple words but Transforming Your Care (TYC) is a multi-million pound strategy announced in June, 2011 by Health Minister Edwin Poots that aimed to revolutionise our health and social care service.
Described as "an overarching roadmap for change" by the Department of Health and Social Services, it was designed to gradually move from a hospital-based health system into a more community-managed service.
It was announced – amid much scepticism and concern – after a major review of the health and social care system and it aimed to dramatically make the best possible use of resources.
Based on 12 underlying key principles, safeguarding the vulnerable and adopting a population-based method of planning of services, were two of the most discussed by trade unions and healthcare professionals.
The closure of health trust run care homes was the most controversial TYC initiative. However, Mr Poots announced a U-turn earlier this year.