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Mr. Roy Beggs (East Antrim): The Minister might be able to clarify the point that education and library boards have some discretion in such matters, but they may not have been exercising it.
Rev. Martin Smyth: It occurs to me that the boards might have used their discretion in their own way, to the disadvantage of the student I have mentioned. That has put additional pressure on an ill person.
There are many important issues on which I could spend time, but I wish to consider the projected expenditure for 1996-97.
I was a little concerned that, in the Minister's answer to my question on 11 January, there might have been not a deliberate misleading, but certainly a misleading, of the House. When I pressed the question of the 3 per cent. up-front cut, the answer was that the same had happened in the past three years. The chairmen of the boards, and those in the trusts, were certainly not aware that the recommendation from the Department and the management executive was a repetition of what had happened for the past three years.
In my question, I suggested that there would be reductions in elective surgery. I welcome the fact that the Minister has listened and made some adjustments, but is there something wrong with the Department and the management executive? Are they out of touch with reality? What is the motivation for some of their decisions? They have been completely out of kilter in regard to the capitation charges that have been going on for some years; now, in trying to correct them, they have come up with another howler. There has been a postponement for another year to allow more consultation between the boards, the providers and the Department. Who is making the decisions, away from the reality of work?
Can the Minister tell us--especially those of us who are involved with the eastern health board--why, although it seems to have been possible for contracts to be finalised quite early in the year in the southern, western and northern boards, at least two of the eastern board's main providers, Belfast City hospital and the Royal Victoria hospital, are finding it difficult to get contracts finalised until after September? Is there something wrong with the bargaining process? Did it not start in time?
Reference has been made to the knock-on effect and the two-tier system. GP fundholders have regularly been blamed for that system. To what extent are the health commissioners here and the health boards in Northern Ireland playing the sysytem with the trusts providing the services?
I gave some statistics in Health questions recently, from which it seems that there is an undoubted pattern throughout the nation and certainly in Northern Ireland:
people come from GP fundholders to be treated three to six months earlier than those who come from the health boards and health commissioners.
I have seen figures for both Great Britain and Northern Ireland, and I have discovered--perhaps the Minister will correct me if I am wrong--that the providers purchase the service that the GP fundholders are purchasing, knowing that, at the end of the year, extra money will be available through the boards to fulfil their contracts. In the meantime, the boards have had to deal mainly with emergency work.
Are the boards playing the system, while not providing patients with the care that they require and that their doctors are recommending? I do not believe that it is a fair system if that is what is going on. Is the system allowing that to happen, or is it human manipulation of the system?
I have looked at the impact that the cuts will have, and not only on elective surgery, because in Northern Ireland, as well as the boards and trusts, there are health and social services, provided, for example, by the South and East Belfast Community Trust. It is concerned about the impact that the cuts will have on the provision of social services. In that context, I pay tribute to the experimental and positive work that the South and East Belfast Community Trust has done.
Is there not something wrong with a system in which a perverse incentive allows people to go into residential and nursing homes when they could be better provided for in the community, in their own homes where they want to be? The figures show that, even at grade 3, which is the highest grade for a nursing home, the community trust can do it much more effectively and economically. The patients we visited in their homes were singing its praises. They had benefited when in hospitals and institutions, but now they are back in their community and are getting excellent service.
The state could do more and adjust the funds, which, in my judgment, are wrongly going into nursing homes and residential homes rather than into community trusts. It might mean that we would need some changes in legislation, for it was obvious that some of the people in their homes who were getting the service free were also in receipt of other benefits, such as attendance and mobility allowance. One wonders whether that could be used to extend the scope to others.
I should like to deal with the penalty clause. I was in one of our larger hospitals on Saturday, and discovered that, as it was getting near the end of the year, it was holding Saturday theatres, Sunday theatres and night theatres. Although there would be a penalty if it was over-productive, it would not be as great as if it was under-productive. The management is pressing it and saying, "We must fulfil these contracts; we must get these patients in," and so on. Is that part of the folly of the traditional Treasury attitude: "There is only so much money and if it is not spent by the end of the year, you will not get the same amount next year"? Can we look again at some way to improve our budgetary arrangements, so that they do not cause that last-minute splurge?
I look forward to the developments in hospital provision. Does the Minister agree that there was something wrong with the approach that allowed obstetricians in Belfast to say that what they needed was
a modern maternity provision on a green-field site--they were not terribly worried whether it was the City site or the Royal site?
Mr. Robert McCartney (North Down):
As the only independent Northern Ireland Member, I collect the crumbs, or perhaps it is an advantage to have all the salient features of the Northern Ireland apportionment of funds dealt with so comprehensively and so unanimously by Members representing the major parties.
I have discovered this evening that a Minister's lot is, indeed, not a happy one. The hon. Member for Belfast, East (Mr. Robinson) has properly, on behalf of Belmont primary school, given us a catalogue of disrepair and other afflictions from which that school suffers and has asked the Minister to make it one of his priorities. However, we all appreciate, despite the extent of our respective begging bowls, that what the Minister has to allot is finite. The hon. Member for Belfast, East was more than generous when he acknowledged that the Minister, in the allotment of funds, had given priority to a major grammar school, Grosvenor grammar, in his constituency. Many of my constituents send their children to that school and I join the hon. Gentleman in thanking the Minister for the priority given to Grosvenor. It has rendered me conscious of the fact that there are many other hon. Members and many other people who are assiduously seeking a slice of the goodies that the Minister from time to time has it in his power to allot.
I am equally conscious that the funds that any Minister in any Government has available to him are limited. It is a matter of fine judgment as to which of a number of competing priorities he allots some of the money at his disposal. However, one constant theme from every Northern Ireland Member who has spoken this evening has been a reference to the draconian cuts that have been administered in relation to the money allotted to the action for community employment schemes. There has been a 25 per cent. cut, capitalised at £12.5 million, in funds for a group of people who can least afford the cut, belonging as they do to one of the most economically and often socially disadvantaged strata of the community.
The schemes are designed to enable the long-term unemployed to re-enter employment society. They have given sterling service to Northern Ireland in an area where it was much needed. Northern Ireland generally,
compared with the rest of the United Kingdom, has always suffered a high level of unemployment, both male and female. In certain areas of Northern Ireland, male unemployment has been absurdly high. It was to address that particular area of chronic long-term unemployment that the action for community employment schemes were introduced. Not only did the schemes benefit those who had been out of work for a long period, but they gave hope and succour to young people emerging from school into the employment sphere in an area where the prospects of immediate employment--particularly for those without academic skills or those lacking any form of training--were particularly prejudiced.
The schemes have been enormously successful. Many of them have high success rates, with between 50 per cent. and 60 per cent. of those passing through the schemes ultimately finding long-term or permanent employment. The schemes not only provide and train people for permanent employment, but in many cases they have achieved rates of between 40 per cent. and 50 per cent. of nationally recognised training qualifications. It is a matter not simply of training people, but of giving hope to those who have perhaps lost their self-respect through chronic unemployment or the absence of any prospect of employment.
As a peripheral benefit, the schemes have provided a great service to the community. That can be demonstrated by the wide nature of the groups that have written to me. These include Donaghadee Community Work Force Ltd., North Down local trust, Youthnet, YMCA Ireland, the Shankill road mission, the Northern Ireland Association of Citizens Advice Bureaux and the Newtownards community work force. A wide range of charities and other community organisations have been mentioned by other hon. Members tonight in this regard.
While recognising that the resources at the disposal of the Minister have a finite quality, I also recognise that he is called upon to make judgments as to the allotment of resources to those who would lay claim to at least a small portion of the largesse that may be on offer. Every hon. Member in the Chamber this evening would make common cause in advancing the case for the restoration to the action for community employment schemes of something more than the £2 million that is currently on offer.
What has been demonstrated here this evening is the unanimous, cross-party, cross-community support from every hon. Member from Northern Ireland for the schemes, which enjoy that unanimous support because something about them touches a common chord in everyone. Every hon. Member from Northern Ireland is aware not only of the validity of the objective of the schemes, but of the success that they have enjoyed in delivering to deprived people--in every sense of the word--some prospect of hope. They have also managed to engender a sense of community. Not only do they offer training and the prospect of permanent employment or a qualification, but, in a peripheral sense, they provide services to other disadvantaged members of the community--the sick, the aged and those suffering chronic invalidity. A number of organisations benefit from the action for community employment schemes--from meals on wheels, to the St. Vincent de Paul Society, to Donaghadee Community Work Force Ltd., an organisation in my constituency.
In a letter addressed to me, Donaghadee Community Work Force Ltd. refers to the organisation of the local summer festival--which attracts huge crowds--and the entertainment of Prince Andrew, among others, who visited as part of the VE day celebrations. The planning, creation and maintenance of the town's floral displays resulted in its winning first place in the Ulster in Bloom competition and being selected to represent Northern Ireland and the United Kingdom in the finals.
The organisation offers a range of adult education courses designed to promote education as a constructive use of leisure time. I give these examples as an illustration of the filtering down of the work of these community organisations, not simply in the people whom they train but in the sense of community purpose that they afford to a much wider range of people. I am not in a position to calculate all the benefits in financial terms, including the knock-on benefits of schemes of this kind.
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