Northern Ireland Budget (Anticipation and Adjustments) (No. 2) Bill

Karin Smyth Excerpts

2nd reading: House of Commons
Tuesday 5th March 2019 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

We have heard a wide range of speeches on the Bill, but they have a similar theme. Before entering this House, I was a manager in the NHS in England. I have been a school governor and a non-executive director. I have served on finance committees, audit committees, and, since joining this place, I have been a member of the Public Accounts Committee. Like many people in this place, I take seriously the issue of spending taxpayers’ money. I believe it warrants scrutiny, analysis, challenge and, critically, accountability. As has been noted in all the speeches we have heard this afternoon, we should not be discussing the Bill, but, as we are, we should be doing it properly, and we cannot.

[Paul Masterton]

The hon. Lady mentions her role on the Public Accounts Committee. Does she think that, for as long as Stormont continues to not sit, there would be any merit in having the reports of the Northern Ireland Audit Office reviewed by the Public Accounts Committee?

[Karin Smyth]

I understand that the reports of the Comptroller and Auditor General for Northern Ireland are currently not being scrutinised in the way that we would expect here. If the Public Accounts Committee was to undertake that role, it would be a very serious change to constitutional arrangements. The actuality discussed by the Chair of Northern Ireland Affairs Committee and others is that there needs to be some sort of process. I am not sure whether this is the right process, but I agree that there needs to be some sort of process for the reports already coming out of Northern Ireland that are highlighting some serious problems.

I make no judgment about the work of the Northern Ireland Office, the civil servants in Northern Ireland and the many public servants trying to continue to deliver services, but the lack of scrutiny and analysis of that money, and our incapacity to challenge, means that that huge area of spend, involving UK taxpayers’ money, is receiving less attention than school budgets get when we audit them. We know—this has been reinforced—that there are huge problems under the headings of this debate. As my hon. Friend the Member for Rochdale (Tony Lloyd) said, the Opposition want the Department to make progress on the Hart inquiry, victims’ and survivors’ pensions, and the medical school at Ulster University. I recently visited the team behind the project to progress the medical school in Derry/Londonderry. The scale of the work to date, and their ambition for their city and region, is to be commended, and the Secretary of State must find a way to support them. We have the ridiculous situation in which civil servants can support the business case but not agree the funding, because that is beyond their powers and would be considered a reallocation.

Why is a medical school important? The Government are proud of their announcement of new medical schools in England. The areas chosen need those schools because we need the recruits. As the chief executive of Health Education England said when the announcement was made—MPs in those areas know this—

“studies show that doctors tend to stay in the areas where they train so it means more doctors for the region to deliver high-quality care.”

In Northern Ireland, the locum bill is more than £80 million per annum and rising—an increase, according to the Bengoa report, of more than 78% in five years. It is clear that Northern Ireland needs to be training more of its own doctors and other clinical staff. It also needs to pay them properly, but the rates of pay of those staff are falling behind those in the rest of the UK.

[Mr Gregory Campbell]

I commend the hon. Lady for raising the issue of the medical school. Does she agree that there is an urgent need to develop not only the medical school in Londonderry but the veterinary school in Coleraine for precisely the same reasons, albeit in a different sector?

[Karin Smyth]

I am grateful to the hon. Gentleman for making that point. I have not been able to visit that project, but I would very much like to. I agree that investing, training and keeping people local is an important and valuable symbol.

I recently visited the stunning new Omagh Hospital and Primary Care Complex, which is part of the Western Health and Social Care Trust. It is doing great work across the area to manage the challenges of rising demand and costs, which all health systems face. Its top issues of concern are the availability of medical staff and the huge amount of money being spent on locums. To ensure cover across Northern Ireland, precious resource is being spread far too thinly. I ask the Minister to tell us whether the Government will direct the Ministry of Justice to support the Lord Chief Justice’s call for funding, and whether he will progress the medical school, which is time-critical.

Some 46% of the Northern Ireland budget is for healthcare, and the history of reports and recommendations is decades-long. Most recently, Professor Bengoa’s report referenced the renowned academic Professor John Appleby, who found that Northern Ireland’s spending is roughly 11.5% higher than in England, but there is roughly an 11.6% higher level of need. The service is broadly funded as well as the rest of the UK, but there are significant disparities. In particular, mental health need is recognised to be about 44% higher than in England, but per capita spending is sometimes 10% to 30% lower. That led to the conclusion that the problem is not the level of funding but how it is being used to deliver services. Today, we are no further forward in addressing that problem. Spending on the acute sector continues to grow. Having a large number of small buildings is expensive and, most importantly, is not fit for the high quality, 21st century care that we should all be expecting across the United Kingdom.

The Bengoa report opens with a quote from the former chief medical officer, Sir Liam Donaldson:

“A proportion of poor quality, unsafe care occurs because local hospital facilities in some parts of Northern Ireland cannot provide the level and standards of care required to meet patients’ needs 24 hours a day”.

What action are the Government taking to address that problem?

The Minister of State and I share a health geography in the south-west. His local hospital is undergoing difficult and controversial changes. He understands the safety issues and the need to make difficult choices about changes to small hospitals and the transformation to different models of care and to greater specialisation at large acute trusts. In his remarks, he needs to reassure people in Northern Ireland, just as we seek to reassure our constituents here in England, about quality of care. He needs to assure us today that the extra money for health is not just covering continuing inefficiencies and deficits, but is doing something to improve services and, above all, that patient safety is paramount.

Previous allocations as part of the confidence and supply money are of course welcomed by people in Northern Ireland, but one-off payments are no way to transform a health system. I recently heard about a preventive cardiology pilot working upstream with GPs. Money for successive years is not known and the trust is expected to continue funding it as part of its mainstream budget. It is not possible to transform healthcare to meet demands in the 21st century on one-off moneys, and it is a very poor use of taxpayers’ money as well as of the staff time spent proposing and developing new bids.

The next greatest area of spending is education, which has dominated today’s debate. As mentioned, the Northern Ireland Affairs Committee has had an informative session on education spending in the last few weeks, and last week again discussed the much reported recommendations to improve education outcomes in Northern Ireland. Sir Robert Salisbury, who gave evidence last week and reported in 2013, told us six years ago that the system was living beyond its means, and he gave the example of the six post-primary schools in Omagh, which has a similar population to his native Nottinghamshire, which has two.

The Education Authority, which has been referenced this afternoon, has a £90 million deficit largely because of special educational needs spending, which has also been addressed this afternoon. Schools are managing very high levels of mental ill health and, sadly, of suicide and self-harm among children, as the hon. Member for Strangford (Jim Shannon) highlighted. As I mentioned earlier, the poor funding of mental health services as part of the overall health budget is exacerbating the problem.

There is a large deficit in schools, as the hon. Member for East Londonderry (Mr Campbell) just said, and the budget is an escalating catastrophe. There are also high levels of achievement, as referenced in the Select Committee last week, and what is described as a long tail of underachievement. There are an estimated 60,000 to 70,000 empty desks in Northern Ireland, two teacher training colleges and two separate statutory planning authorities. The Integrated Education Fund, which I have visited recently, has called the system divided and costly.

I hope that the Northern Ireland Affairs Committee report will shine more light on education spending, but many of the calls have been for a Bengoa-type review. As noted, however, we already have a Bengoa review of health, and without the political oversight and will, it will not make the change. The end of the Committee’s session finished on a depressing note, as the Northern Ireland Commissioner for Children and Young People reported that there needed to be an honest conversation about the allocation of funding within the Department of Education but that there was no appetite for that.

We in the Labour party continue to support the need for integrated education as part of the long-term route to reconciliation in Northern Ireland, and I know that the Integrated Education Fund hopes to visit here in the summer to share with Members the work it does and the challenges faced. It would be good to see some of its thoughts put to the Northern Ireland Affairs Committee in its final report.

Beneath the figures that we are rushing through tonight—without proper process and security—lies the future of Northern Ireland’s children’s hopes, dreams and aspirations and of the people needing treatment and care from the NHS who now find themselves on record length and totally unacceptable waiting lists. We will of course support the budget tonight, so that public services can continue, but the people of Northern Ireland deserve much better than this.

--- Later in debate ---

[John Penrose]

The right hon. Gentleman is absolutely right. There is a significant transformation going on, and a significant amount of funds is going in to let that transformation happen, but it is also true to say that more transformation would be possible if there were political leadership as well. The civil service is limited not so much by the money at the moment; it is about the ability to take fresh policy decisions that would allow further progress to be made. That is the frustration under which we are all labouring during this Second Reading debate. On that basis, I plan to let us move on to consider the remaining stages of the Bill. I am delighted that there is cross-party consensus that it should proceed.

[Karin Smyth]

I am grateful to the Minister for giving way. In my remarks, I specifically asked, given the progress that the Government made on the Lord Chief Justice’s proposals, whether the Minister would give us an answer on progress towards having a medical school as part of Ulster University. The project is not only time critical but critical to the future provision of training places for doctors, particularly, in Northern Ireland, which would help to reduce the locum bill. We would be grateful for the Minister’s comments on that.

[John Penrose]

I shall respond swiftly, as I do not want to hold up the rest of the process. The hon. Lady is right to say that she asked that specific question. Let me make two comments in response. First, the judicial changes are not a Westminster Government decision. They are taken, rightly, by independent judiciary in Northern Ireland. Secondly, her question on the medical school needs to be addressed as part of the city deal discussions that are currently getting under way, and I would be happy to discuss that with local people and, if necessary, with her as well. With that, I propose to do something unusual for a politician: stop talking and sit down.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).