Jim Wells
South Down · Democratic Unionist Party · Northern Ireland
“On a point of order, Mr Deputy Speaker. In November 1982, I made my maiden speech in the Chamber, and, here we are, 40 years later, and I am making my last speech in the Chamber as a DUP MLA. I was the last person in the Public Gallery when the Assembly collapsed in 1976.”
“<BR /> <BR />Mr Deputy Speaker, I thank you for your indulgence and for your patience with me over many years. Unfortunately, Mr McGlone has just left the Chamber; I was about to thank him. I have enjoyed my 27 and a half years in this Building.”
“I wish that I could, but I have only five minutes. <BR /> <BR />That was so that a very small number of Irish language zealots could go in and register their marriage or civil partnership in Irish or in dual language: £261,000. Did anybody stop to think about whether there was a more cost-effective way of doing that?”
“We are all perfectly happy with a genuine expression of people's culture. That is fine. However, when the language is so cynically used by militant republicanism, unionism has difficulties. Why, for instance, is there no translation into Irish of the words, "United Kingdom", "Londonderry", "Northern Ireland" or "Her Majesty The Queen"?”
“The Member has made the point for me. The official who came to the Committee made it absolutely clear that £261,000 had been spent already. It was farcical to bring that before either the Finance Committee or the Assembly, because the money had been spent and the processes had been set up.”
“If they want the unionist community to accept the Irish language as a genuine cultural expression, they should get rid of the political baggage and extremism, and stop using the Irish language as a political weapon to try to subjugate unionism.”
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“Those are exactly the same arguments that were used in 1966 when Lord Steel was putting his private Member's Bill through the House of Commons. His Bill was designed for exactly the difficult cases that the Member has raised: foetal abnormality, rape and incest. He produced the 1967 Act with that intent. What has happened? De facto, what we have in the rest of the UK is abortion on demand and eight million human beings have had their lives terminated since 1967. That is the argument that he is making this evening — in fact, it is almost morning.”
“Will he support any change in legislation that will force Marie Stopes, like every trust facility in Northern Ireland, to reveal every statistic about what is going on behind its closed doors? Will he support that?”
“It is noticeable that Marie Stopes situated its new clinic immediately opposite the Great Victoria Street train station. It was quite obvious why that was done. It wanted to attract trade from the Irish Republic. Therefore, some of those who could be accessing abortions at Marie Stopes do not even come from Northern Ireland. Is he happy with a clinic that is not only unregulated but refuses to reveal one statistic about what is going on behind its closed doors? The fundamental difference between state provision and private provision is that the state has to provide all the statistics of who it is treating and what it is doing; yet he knows that every time that we asked Marie Stopes to give one scintilla of information about what was going on in Great Victoria Street, it consistently refused. Is he happy with that going on?”
“The reality is that the legislation does not require Marie Stopes to give any of that information. I was on the Health Committee when we asked them to tell us what was going on, and they refused point blank to tell us anything that goes on with terminations in that building. Therefore, RQIA cannot do anything to address that problem, and Marie Stopes is not prepared to give us the information about what it is doing.”
“So it is semantics to say that it should or should not be brought under RQIA control. <BR /> <BR />Secondly, does he accept that Marie Stopes has continuously refused to tell anyone — RQIA, the Department or the board — what it is doing: how many people it is seeing, how many terminations it has organised, how many people it has referred to England? It will tell absolutely nothing. It is state secrecy. Therefore, how can he be confident that what is going on in the Marie Stopes clinic is in line with the law?”
“First, may I congratulate the Member on being the first MLA, as far as I am aware, apart from Mr Agnew, to stand up and honestly say that he is pro-abortion, pro-choice and pro-abortion on demand? I think that that is a degree of honesty that is missing from so many other Members of the House. However, if he knew anything about RQIA, he would know that RQIA would be concerned with the cleanliness of the facilities, the parking, the emergency access and whether there is enough staff etc. It would have no interest whatsoever in what was actually going on in the clinic in terms of the ending of the lives of unborn children. Therefore, it does not matter one iota whether the clinic is under the control and authority of RQIA because RQIA does not regard it as its business to make any judgement on whether the law is being adhered to.”
“I wish that they would be honest with the people of Northern Ireland and stand up and say, "We are for abortion on demand", and tell the people that, rather than trying to hide behind spurious arguments.”
“As the Member knows, when I was on the Committee, I proposed the amendment, and I understand that there were 25,000 responses to the amendment. I stand to be corrected, but that is probably the largest response received to any amendment to any Bill in the House since 1998. That gives an indication of the huge level of understanding, both in favour of and against the amendment. The last time that the issue was discussed, in 2013, the pro-abortionists who wanted to defeat this legislation used the argument that we had not properly consulted. Having done that, they now seem to be moving the argument on to a new platform. It strikes me that they simply want to allow Marie Stopes to continue giving advice and perhaps taking things a bit further as far as abortion is concerned.”
“Will his Department continue to work with those who already have planning approval for a hotel in the town to ensure that this facility, which has been missing for so long, is brought back to the area?”
“I join others in welcoming Mr Bell to his position, and I am sure that he will join me in congratulating the previous holder of the position. He is building on a very firm foundation laid by Mrs Foster, who achieved so much in that role. Will he accept that it really is very regrettable that a town the size of Downpatrick does not have a new, large, modern hotel at the moment, and that the issue of displacement does not arise because there is really no provision over a very wide part of east Down?”
“I was almost going to ask the Minister if he had any free tickets for the event, but maybe he has not. <BR /> <BR />I welcome that development and hope that, when he does visit south Down and Newcastle tomorrow, he will get a chance to apprise himself of the enormous opportunities that the event will create for Newcastle and Northern Ireland generally. Hopefully, as a result of his investment, he will be able to show that we can regularly host such major competitions and bring a great deal of credit and good news to Northern Ireland.”
“I am sure the Member will accept that the present facility is certainly not adequate for a town the size of Kilkeel, particularly with its tourist infrastructure. Can he at least promise the Assembly that, whilst finance may be limited, his Department will continue to explore options so that, when funds become available, he will be ready to move quickly?”
“That is as far as I am prepared to go at this stage, but I hope that the huge investment we are making in the Causeway Hospital in staffing at the moment indicates how important a role we see it having in the north coast area.”
“All that I can say in reply is that there is not much sense in me calling a consultation on Donaldson and then issuing an edict as to what I think it should agree. When the consultation is closed, we will have a chance to sit down and analyse what has been said alongside documents such as this and the Hansard report of this debate. We can then have an intelligent debate on the best way in which to configure hospital services in Northern Ireland.”
“He is entirely wrong to suggest that we should bin the Donaldson review or not take it into account.”
“When he makes recommendations, we should sit up and take note. That does not mean that we slavishly follow everything that he says, but we have to give it due and careful consideration. I think that Mr Allister is slightly wrong to say that —”
“We are not wedded to any particular recommendation of Donaldson, but I was enthusiastic, because Donaldson has caused us to stop and think on many issues about where we are going in Northern Ireland and how, in many ways, we can configure our services. It has prompted the debate that we need to have. There are MLAs and MPs who see a very bright future for the Causeway Hospital through documents such as this. It is important that the review team has that information and can take it on board. <BR /> <BR />People who might cast aspersions on Liam Donaldson's track record have to remember that we are talking about the Sir Alex Ferguson of health. This is an individual who was the Chief Medical Officer for England and has vast experience and an impeccable track record in this field.”
“<BR /> <BR />It is important that the work of the turnaround and support team be substantially implemented before further work is carried out on the options appraisal on future management arrangements. When the recommendations from the team have been implemented, the focus can once again turn to the appraisal of the management options recommended by Transforming Your Care. <BR /> <BR />Donaldson is out for consultation. The points that have been made today should be made to Donaldson. Mr Storey has just made a point of handing me 'Causeway's Future: Proposals for the Way Forward for Causeway Hospital', which was prepared by the Causeway Hospital Campaign group. Those are all the sorts of points that the Donaldson review wants to hear.”
“Indeed, while I was there, there was a patient from Coleraine and a patient from Castlerock, both in the Northern Trust area, being treated by that outstanding technology. That shows the advantage of sharing services with Altnagelvin. In both cases, within the hour, the patient had been transported from the scene of their cardiac arrest to the cath labs and treated in a very effective way. That shows that the new links with Altnagelvin are bearing fruit. Now, it would not be possible to have a cath lab at the Causeway in Coleraine or, indeed, at any smaller hospital in Northern Ireland, but it is good that we have hypothecated that service for not only the Western Trust but a very large section of the Northern Trust.”
“My predecessor indicated that an appraisal of the future management options for the Causeway Hospital should be informed by the work of the turnaround and support team that was appointed to the Northern Trust in 2013. A key element of that team's work was a series of service reviews, including the networking of clinical services and the development of a new model for medical leadership and management. <BR /> <BR />I remind Members that I was up in Londonderry last week, where I inspected the new cath labs that have been installed. They are absolutely state of the art — the most modern on the island of Ireland and in the United Kingdom. The people of the Causeway area have access to those.”
“That is entirely normal. Current projects under consideration for the Causeway Hospital include the installation of a wind turbine generator at an estimated cost of £1·2 million. There is already one at the Ulster University and one at Antrim Area Hospital. Again, the fact that we are prepared to spend such a large amount of money on renewable energy indicates a commitment to the site and to hospital. As Members will be aware, Transforming Your Care recommended three options for the future management of the Causeway Hospital.”
“You would not expect a huge degree of capital investment in a hospital of that age because it is still relatively modern. That having been said, we spent £2·3 million and £1 million in the last two years, so there is £3·3 million that has been invested in that hospital.”
“That is a valid point. Urology is a particularly difficult area throughout Northern Ireland. Every trust is finding it difficult to recruit consultants in that field. Indeed, yesterday, in response to a question about cancer waiting lists, I quoted urology as causing 35% of the delays. However, that is a specific issue that is related not so much to the Causeway but to that specialism, where we really cannot appoint people at all when vacancies arise. I would like to think that all the other issues that I have quoted indicate that there is a commitment to the Causeway. <BR /> <BR />In capital investment, remember that the Causeway opened only in 2001. I very clearly remember it being built. A friend of mine designed the roundabout at the hospital; I remember chatting to him about it. It is a very modern hospital.”
“It is expected that these permanent — I emphasise that word — postings will enhance the continuity and quality of care for patients. I do not know where the problem that Oisin — sorry, I will say "Oisin" because I cannot pronounce his second name — identified about the lack of continuity is coming from.”
“Much of the praise for the turnaround in that situation has to go to the new chief executive and his team, who have done a lot of work to transform the future of the Northern Trust from one that was shrouded in doubt to one where there is a very bright future. That augurs very well for the future of the Northern Trust. Equally, public representatives tell me that there is an open-door policy; Members of the Assembly and MPs who have problems and difficulties are getting their voices heard by the new management team. That has to be a good thing. <BR /> <BR />Causeway Hospital, like several other smaller acute hospitals across Northern Ireland, has, in the past, experienced difficulties. However, these appointments are good news for the people who use the Causeway Hospital.”
“Those are very highly qualified and highly paid clinicians. If you add up all those appointments, it is a very significant revenue investment in the future of the Causeway Hospital. <BR /> <BR />I have to be honest — many people have mentioned this — that there were difficulties and uncertainty about the future of the Causeway Hospital, and it was difficult to recruit consultants as a result of that. As a result of the new management team that we have in the Northern Trust, there is a much brighter future and a certainty. There is a commitment from the chief executive to the Causeway that has encouraged senior clinicians to apply for positions in the Causeway.”
“All appointments made in Northern Ireland are made to a trust rather than a specific hospital. These posts were advertised, and it was made very clear to the applicants that they were for the Causeway. They were in response to demands from many MLAs and the MP for the area for new permanent staff. It is a huge commitment by the board and the trust to the Causeway that those have been made. We are also making a joint appointment to a post with Altnagelvin hospital for a consultant cardiologist; that person is in the process of being recruited. That gives us an indication. On top of that, as Mr Campbell said, the trust is recruiting three further posts: a consultant in emergency medicine, a consultant physician in general medicine and care of the elderly and a consultant physician with an interest in respiratory medicine.”
“<BR /> <BR />There are partnership arrangements for the community and voluntary sector within the Causeway area. That supports the integrated model of service. The commitment to maintain acute services at the Causeway Hospital was clearly demonstrated in January this year, when the Northern Trust made new clinical appointments to the hospital. Many people raised that issue. Those are permanent appointments. <BR /> <BR />I want to come back to the concern about the lack of continuity of tenure. I do not know where that is coming from; these are permanent salaried posts in the Causeway Hospital, including consultants in surgery, respiratory, obstetrics and gynaecology and a consultant physician in internal medicine. They have been appointed and funded, and they are there on a permanent basis.”
“Yes. He made a statement. I am going to come back to it, because the Member raised a very crucial point about recommendation 1 of Donaldson. I wish to deal with that, because several Members, including Claire Sugden, raised it, and I want to deal with it. <BR /> <BR />What I can say to you is that that is our position on the Causeway Hospital. Donaldson is out to consultation, which ends on 22 May. I am not going to pre-empt the public response to Donaldson on a whole range of issues. Let me remind you that there was more than one recommendation in the Donaldson report. Everybody has homed in on recommendation 1, to some extent ignoring the other nine recommendations, which are equally important. I will come back to that, and I am sure that the Member will remind me if I do not.”
“It is worth saying that Donaldson did not make any reference whatsoever to the Causeway Hospital.”
“<BR /> <BR />The model for services in the Causeway and the glens area will be based around an acute hospital in Coleraine, with an emergency Department, supporting clinical services, a well-developed intermediate care service and community teams evenly distributed across the area. Of course, it is a very wide area. Perhaps one of the most fortuitous aspects of local government reorganisation is that the new council area more or less fits very neatly the area the Causeway Hospital covers, going right out to Limavady at one extreme and right over to Moyle in the other.”
“<BR /> <BR />The hospital is in one of the most beautiful scenic areas of Northern Ireland. In fact, it is almost as scenic as south Down. That was a joke, by the way, in case 'The Coleraine Chronicle' should happen to raise it in next week's edition. The hospital provides services to the local population and the many visitors who come to enjoy the north coast's beaches, attractions and, of course, its world-class golf courses. Such an area needs a vibrant hospital, and I am, therefore, committed to retaining the Causeway Hospital as a local acute hospital. I hope that that allays Mr Allister's fears.”
“However, I commit to visiting the Causeway as soon as possible and to discuss some of the issues raised. <BR /> <BR />I know Fred Mullan very well. He went to Queen's with me many years ago, and I have kept in touch with him about this issue. I have found his input and that of all the Northern Trust's senior staff very helpful. I thank Mr Dallat for raising the issue, and I take this opportunity to thank all the staff at the Causeway Hospital for their service to the local community and for their commitment to deliver high-quality health services. I think that every Member who rose to speak during the debate made exactly the same point, which is that there is absolutely no problem with the standard of service that the people of the north coast are getting from that team.”
“First of all, I thank Mr Dallat for his patience. This debate was due to have been held last week, but because I was witnessing first-rate care in the Royal for my wife, I simply could not make it. I am glad that the Assembly Business Office and, indeed, the Business Committee were able to facilitate his request to have the debate moved on a week. <BR /> <BR />As the Member for East Londonderry Mr Campbell said, I visited the Causeway Hospital at his request. I have to say that that was in my capacity as Deputy Chairman of the Health Committee. I was impressed by the large number of staff who arrived at the door to meet me and by the very detailed tour of the hospital that I had. I was due to go back to the Causeway quite recently, but, again, because of the problems with my wife's health, I was not able to make it.”
“In Kilkeel, as the Member knows, the options are very limited. You go to Newry, Downpatrick, Craigavon or wherever. It is a long distance to the other cover, and it is therefore important that we plug the gaps in Kilkeel. As he knows, this has been going on since last May. In July, there were long shifts around the Twelfth fortnight for which there was no cover, because staff were not available to do it. That is why I am hoping that the £3·1 million will have some impact on overall performance in Northern Ireland. I do not want patients to be going to A&E at Daisy Hill Hospital or Downe Hospital, because, on many occasions, that is not what is required. We are simply storing up trouble for down the road, as it were. We need to improve out-of-hours provision throughout rural parts of Northern Ireland.”
“The Member for South Down's point is well made. Indeed, that is the reason why, 10 days ago, I announced an extra £15 million in funding for GP services, including £3·1 million in additional moneys for out-of-hours provision. The BMA and the Royal College of General Practitioners have been lobbying the Department and me on that. Indeed, on Thursday night, I was at a meeting with the BMA at which the issue arose again. <BR /> <BR />I have seen the rotas for Kilkeel — it is a particularly difficult area, where there are large gaps throughout this month and beyond — and I can see the problems that we are having. Many MLAs throughout the country, particularly those in rural areas, have mentioned the problem to me. We are hoping that the extra £3·1 million will enable us to employ locums to provide cover in difficult areas.”
“<BR /> <BR />I want to flag up one other issue. Many English trusts are moving to joint health and social care provision, whereas, up to now, they have been split. Where is the only place in the United Kingdom that they can get good, experienced staff with skills in health and social care? It is in Northern Ireland. Therefore, we have to watch out that more staff are not lured to southern England. We need to look at that, but any change would, of course, need to fit in with broader Northern Ireland public sector pay and have the approval of DFP. It is a difficult issue, but I do not think that our top staff are recognised sufficiently.”
“We are looking at that, but I assure you that we will never reach the situation where anyone in Northern Ireland is paid anything like that amount of money. Some of our top staff are in charge of budgets of £600 million or £700 million — indeed, it is over £1 billion in the Belfast Trust — and in their delivery, the better and efficient management of their trusts and a more efficient delivery of health-care provision, good chief executives or directors can save more than their salary. Liam Donaldson's report stated clearly that we needed to recognise that talent. It is not just me who recognises it. Chairmen of trusts throughout England are eyeing up Northern Ireland for potential transfer deals, if I can put it that way. That tells me that we have some very capable and special staff in Northern Ireland.”
“<BR /> <BR />I believe that we now have in place a very strong team of chief executives and directors at all levels in the health trusts. We have seen some quite remarkable turnarounds and improvements in performance throughout the service in Northern Ireland. One of my roles is to try to keep that team together for as long as possible. That will be difficult, given what I see happening in England, where that talent is recognised in both status and pay.”
“However, I flag that up as an issue that will arise in the future that I am particularly worried about. <BR /> <BR />Senior health staff all have contracts under which they are permitted to receive statutory pay increases. I can assure you that those have been very modest, and, taking into account increases in their pension contributions, all of them, as far as I am aware, have taken a pay cut. There are two exceptions to that, because two trust chief executives are also qualified consultants. They are on a different pay scale to the non-consultants, which is why it may seem that their pay is quite high. However, you should remember that, if they were doing consultancy work with some private add-ons, they would be receiving a very high standard of pay.”
“Our senior health staff have actually had pay reductions because of the increase in their pension contributions. I know that it is quite easy to criticise our chief executives and directors, but the problem — the Member will have to face up to this — is that we have recently lost three very capable senior executives of health trusts to England, where they offer packages that are way in excess of anything that we are allowed to offer under the guidelines issued by DFP. I am particularly annoyed about losing one individual who, everybody in the House accepted, was absolutely outstanding. If we are to retain the best talent in Northern Ireland, we have to look at pay and conditions. I know that it will be unpopular if I suggest that they should be paid the going salary for the crucial work that they do.”
“I do not think that we are yet in the position to deliver the Right to Know campaign's demands, which could be said to be legitimate, but we will continue to ensure that people in Northern Ireland with suspected Alzheimer's are diagnosed as quickly as possible and given the best care pathway in what is a very challenging economic environment.”
“Those are the aspirations of the Right to Know campaign; it is not based on any clinical recommendations from those directly involved. One of the reasons for that is that it is extremely challenging to have a guaranteed wait of only 12 weeks. To have a guaranteed nurse practitioner looking after the patient is terribly demanding in the present economic situation. I have to say that, when I reveal the budget for 2015-16, there will be a lot of pain for a lot of parts of Northern Ireland and a lot of concern expressed about reducing services yet maintaining our high standards of clinical care.”
“I hear regularly reports in the media of some breakthrough cure or diagnosis for Alzheimer's, and I really hope for success, because, at the moment, there is no quick fix for this awful condition, which is progressive and causes huge difficulties for sufferers and their families. Nothing would make me happier than to introduce some form of medicine that would curtail the progression of the condition or better. We are doing our best in difficult conditions, and we can stand up proudly with the rest of the United Kingdom in what we have achieved. Is that enough at the moment? No. It is becoming a more difficult issue as the years progress.”
“I am very supportive of the Alzheimer's Society's Right to Know campaign, and I work closely with the charity in that field. We have to understand that, whilst the percentage of people with Alzheimer's is falling, the overall numbers are rising dramatically, because we are an ageing society. That puts tremendous pressure on clinicians. A greater awareness of Alzheimer's is combined with larger numbers. It is, therefore, still a real challenge. Northern Ireland has been commended as the best region in the United Kingdom for making an early diagnosis of dementia, so we are getting it right to some extent. <BR /> <BR />I have to set aside £35 million every year in the health service budget simply to take account of the fact that we are an ageing society. That gives you an indication of the pressure I am under. We are making progress.”
“Getting this wrong will not help the health professionals. If I issue a document that is immediately referred to the High Court and that leads to long and turgid judicial review, we still have a lack of clarity as far as the clinicians are concerned. We all have vast experience in the Chamber of legislation being referred for judicial review and sitting for years before agreement is reached on the way forward. <BR /> <BR />I will be honest with you: I think that this is the most difficult issue that I have on my table at the moment in terms of reaching a consensus that, I feel, will be deliverable in the community. It is one that I have spent a huge amount of time on and one that I would prefer to see resolved, but I have to say that I cannot see that happening in my time as Minister of Health and probably not in my successor's.”
“<BR /> <BR />As far as the timeline is concerned, we are coming close to a situation where we will be able to refer the guidelines to the Executive for discussion, but I can assure him that that will not be the last of it. We know from experience in the House how frequently our constituents and lobby groups go to the courts. I will, therefore, be very surprised if the issue is permanently resolved within the year.”
“This is an incredibly difficult and complex issue, as the Member will understand. It is inevitable that whatever I decide will be judicially reviewed. If the guidelines are perceived by some as being too weak, those who campaign in the pro-life movement will judicially review them; if they are seen as being too strong and seem to others to be too pro-life, inevitably those in the charitable and NGO sector in what is called the pro-choice lobby will judicially review them. It is, therefore, very difficult. We have been trying to deal with the issue for, I think, nine years. Each time, obstacles arise because it is such a difficult moral issue and one that many, many people in Northern Ireland and their public representatives feel exceptionally strongly about.”
“Remember that we do not have direct control of all these issues, but we will certainly look at it.”
“Yes, I will look at this. Rev McCrea gave me information on a very distressing incident that he was involved in with a family from Magherafelt. No one could give a definitive answer to the family. Unfortunately, the deceased passed away at the weekend, and there seemed to be a hiatus before anything could be done to assist them. I suspect that that issue, which was raised in the local media in mid-Ulster, is the one the Member is referring to. You have to balance that with whether you keep staff working over the weekend when there may be very few cases to deal with. But, having heard from Rev McCrea of the huge hurt that that particular issue caused, I think it is something we should investigate, and I will do that. It will not be a formal review but a departmental look at where we are going on this.”