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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“I have had a lot of letters and questions from Members across the board on that particular issue. For those who are not aware, TTIP is a transatlantic trade agreement between the United States and the European Union. My colleague in DETI is very keen on the arrangement because it could open up new markets for Northern Ireland exports and further trade across the Atlantic, but there is a concern that it will open the door for private American companies to come in and take over the running of the health service in Northern Ireland. I have seen a petition calling for the NHS to be taken out of TTIP, but there is no evidence at all to indicate that it is to be included, and there is never any indication in the negotiations that that will happen.”
“I have seen proposals to take some management staff out of Fire and Rescue Service headquarters in Lisburn. We think that that is doable without affecting front-line support services, but this has been one of the most difficult issues that we have faced as a Department.”
“I have also made it clear that I am opposed to any form of compulsory redundancy in the Fire Service. I will require full detailed plans on how Fire Service savings can be delivered, and a final agreement on the savings proposals will take place after public consultation and be based on public safety. <BR /> <BR />This has been a very difficult issue. The very fact that we have been in a position in which we cannot define the Fire and Rescue Service as a front-line service in the same way as, for instance, blood donation or ambulances is causing us huge difficulties, but that is what the Executive agreed. We are working with the Fire and Rescue Service to find ways in which it can achieve its savings with the least possible impact on its front-line services, which, of course, are not only fires but traffic accidents, flooding and so on.”
“Earlier, I said that I have to find £50 million in direct reductions in funding out of what are described as the non-health trust organisations. I also mentioned that I have to find a huge amount of savings in 2015-16, and we have asked the arm's-length bodies initially for their scenarios based on 5%, 10% and 15% reductions for 2015. We have had an initial examination of the proposals for the Fire and Rescue Service, and, frankly, I consider savings at the upper end to be unachievable. They are not achievable while retaining a safe service. Consequently, the Fire and Rescue Service is working now on a 5% savings target for 2015, and I have made it clear that its focus should be on support functions and central management structures rather than on front-line service delivery.”
“<BR /> <BR />I realise that Oisin's family had to make a very difficult decision, but, no matter what happens, even under Mrs Dobson's Bill, families will still be consulted. They will still have to make that difficult decision. I am on the register and have made it very clear that, if I go under a bus, you are welcome to any part of me that saves lives. <BR /> <BR />I remember the courage of a Coalisland family when a young man was killed in a traffic accident. The donation of his organs saved three lives and enhanced another three. That example is tremendously important as we encourage people to have the conversation and make the right decision on organ donation.”
“I will be guided by the honourable Member for Upper Bann on when we can expect the introduction of her Bill, which deals with the very issues that the Member raises. As Minister, I am in a difficult position because I previously expressed my personal views on this. However, it would not, I think, be helpful if I were to hold hard and fast to those views as Minister. All I can say is that the debate will be a very interesting test of the maturity of the Assembly. <BR /> <BR />It is very difficult to predict what will happen because I suspect that it will be a free vote for every Member, and, therefore, 107 different views will become clear. So, we await the Bill with interest. I hope that Mrs Dobson will get a chance to come in on this because I am very keen to learn how it is progressing.”
“We have had an advertising campaign to encourage organ donation and employed nurses whose role is to liaise with distressed families and encourage them to donate organs. This is a very complex and important period in the whole debate. I suspect that, when Mrs Dobson's Bill eventually comes forward, there will be a free vote for many of us. I would like to think that progress will be made within the next few weeks because of the coming together of various events.”
“I thank the honourable Member for giving me an opportunity to pay tribute to Oisin's family, who took the very brave decision in tragic circumstances to save or enhance not only one but several lives by giving up his organs. I think that that example will help enormously in our debate on the issue. I had intended to contact the family to praise them for their courage. <BR /> <BR />We await the introduction of a private Member's Bill from the Member for Upper Bann Jo-Anne Dobson and for the results of the PHA's second survey on public attitudes to organ donation. So we are very much in a situation of watching and waiting. We are also waiting to see the outcome of the Welsh model. The Welsh passed legislation on the issue, and we want to see what happens there. Does legislation lead to a radical increase in organ donation?”
“I hope that that shows that, in areas where there was not much in the way of dissension or where there had already been discussion, we are already setting up procedures to implement it. We also want to hear the public's view on Donaldson, particularly recommendations 2 to 10, on which we need an awful lot of debate, as well as recommendation 1.”
“When you throw a document out into the public domain for consultation, you have to be very careful that you are not seen to pre-empt some of the outcomes. The six trusts, including the Ambulance Service, have already been asked to work with each other, their staff and their stakeholders to develop a combined response to the report and its recommendations by the end of April 2015 and to consider urgently the "never events" list for England and determine its applicability to Northern Ireland, and initial discussions on that have taken place with the board. I am sure that Members will remember my explanation of a never event. The RQIA has been asked to speed up the programme for unannounced inspections of hospitals, and a number of pilot inspections will take place between April and June 2015.”
“That is the difficulty that we are in, and we have to make some terribly difficult decisions in the next few weeks.”
“I accept, however, that there is a perception that we could be doing more to look at admin and management, which is why the permanent secretary has been tasked to do a full analysis of the structures of health care in Northern Ireland to see whether any further level of administration can be taken out to pump money into front-line services. <BR /> <BR />I will give the Member a few figures. We could maybe save £15 million or £20 million, but that is being very optimistic. I have to find £165 million in efficiency savings for 2015-16 and an additional £50 million out of non-health trust expenditure. That is real money from the Fire Service, BSO and the Public Health Agency. So I have to find £215 million. Even if we waved a magic wand and looked at his concerns about management, we are talking about only 12% of that.”
“I have just quoted to the House the huge increase in front-line staff that my predecessor, Edwin Poots, instigated and which I support. The equivalent of 1,400 full-time additional staff have been employed in the health service since 2011. If Minister Foster were to announce a factory employing 1,400 full-time staff, we would all congratulate her on an outstanding achievement; fortunately, she has been making announcements like that in the last three or four years. That indicates that, under my predecessor's role and my own, we are making that commitment. We know that those folk are there because we are paying them, and we know that they are on the ground working hard. It is wrong, therefore, to indicate that we are overstaffed at administrative level and not bringing resources to front-line care.”
“Frankly, at the moment, some aspects of our health service, particularly in rural areas, are under the most enormous stress and strain, and we need to start that debate. <BR /> <BR />Some of you may have seen an interview that I did on the BBC on this very issue with Mark Carruthers. I call it elder abuse because I was given an absolute pasting for 15 or 20 minutes on the issue, when he tried to tease out of me the same answers that the honourable Member for Fermanagh and South Tyrone is trying to get. I am not going to pre-empt that debate by saying what my views are on how we should go forward. I am encouraging the entire community to look at this terribly difficult situation, which for me is one of the most intractable problems that we face in Northern Ireland, and for us to reach a consensus.”
“<BR /> <BR />If we were starting with 1·862 million people today, bringing them to an area the size of Northern Ireland and configuring a hospital service, we would never start from where we are, with 10 A&Es, the Royal Belfast Hospital for Sick Children and six local regional hospitals. That is a model that would never be implemented anywhere in the Western world. We have to accept that, because of history, tradition and local support, we are in a rather different situation. The only way forward is for us to have an intelligent debate to decide how we progress and how we reconfigure our health service to ensure that a modern, high-tech, high-level service is given to all our people.”
“The Chair of the Health Committee announced that the cost of the Donaldson review was £118,000, from memory. As we had engaged one of the leading authorities for a significant period to look at our health service, I felt that that was justified. Yes, I can stand over that. Will we, if we implement the Donaldson review, effectively save £118,000? We certainly will, and a lot more. <BR /> <BR />Recommendation 1 is only one of 10 recommendations in the Donaldson report. Indeed, it has been slightly disappointing that almost all the press attention has homed in on that issue. We have to have a very honest and open debate in this Chamber because this is where the decision will be made.”
“You will also be aware that some of the changes required to address the recommendations will require legislation and some will require Executive approval. However, I am determined to make substantial and steady progress wherever it can be made. With that in mind, I have already asked Sir Liam Donaldson to return to Northern Ireland next year to review progress against the implementation of his recommendations. Following the completion of the consultation on Sir Liam's recommendations, I will inform the Assembly of its conclusions and any further actions that may arise.”
“Mr Speaker, with your permission — Mr Principal Deputy Speaker; I will have to get used to that accolade — I wish to answer questions 3 and 14 together. <BR /> <BR />As you will be aware, the Donaldson report makes 10 recommendations. In my statement on 27 January, I set out a number of actions that are being taken forward to progress some of those recommendations. However, many of the recommendations pose fundamental questions, and I want to ensure that stakeholders have the opportunity to provide their thoughts. That is why I have asked for views and comments on the recommendations to be submitted to my Department within a 12-week period. <BR /> <BR />Transformational change takes time, and it will be important to map out such a change fully at the outset and to address the budgetary issues.”
“In many aspects of health, if we could get all our trusts performing as well as the best trust in any particular field, many of our problems would be solved.”
“I think that he knows what I am referring to. It was very helpful that he highlighted a high standard of service at the Causeway Hospital. <BR /> <BR />There has been a significant reduction in missed appointments. I have some cold, hard statistics. For instance, in 2009-2010, there were 1·5 million appointments, of which 172,000 were missed because people did not show up. That is a did-not-show rate of over 10%. That rate has gone down in 2013-14 to 9·1%. That is a 1·2 percentage point drop, which is significant. It is an improvement of more than 10%. Clearly, the message is getting through to the public that you really need to treat your health service with much more respect. I would like to see a continuation of that and to bring the rate down to the best performance in Northern Ireland. <BR /> <BR />We are not reinventing the wheel.”
“I hope that the honourable Member for East Londonderry will not mind me commenting on the very helpful letter that he recently sent us about the Causeway Hotel — the Causeway Hospital, sorry. That was a Freudian slip.”
“<BR /> <BR />Clearly, Northern Ireland people are very much in love with their GPs and consultants and are very keen to see them, but we need to, first, rationalise the demand on the service and, secondly, make certain that, once people are booked, they turn up and present themselves for treatment. The other aspect, of course, is that this can lead to people's conditions deteriorating significantly, adding further expense to the health service. There have been many cases of people whose onset of cancer and other serious conditions have been missed because they did not turn up for their appointment.”
“<BR /> <BR />The overall consultation rate in Northern Ireland rose from 4·04 consultations per person in 2003-04 to 6·6 in 2013-14. That is an increase of 63% in the Northern Ireland consultation rate per person. That is an incredible increase in such a short period — a 10-year period. That shows the pressure that our consultants and clinicians are under. Equally, as far as GPs are concerned, we have an average of 6·9 appointments per year per person. That is for every one of our 1·82 million population. In the Irish Republic, the average is three, yet the Irish seem to have very similar outcomes in health to ours.”
“The difficulty with many of the patients involved is that there are co-morbidities; there is a mixture of conditions. Whilst the person may be coming in to have a consultation on their back, for instance, they may have had depression or have a bipolar condition etc. Therefore, it can be very difficult to identify the reason for people not attending. We are not going to differentiate between various reasons or conditions where there have been cancellations or missed appointments. We are sticking to the target. If we can get it down by 20% by March 2016, I think that we will have done very well. In addition, the Department is proposing a number of performance indicators to monitor outpatient cancellation and non-attendance for new and review appointments.”
“It is very difficult, but it is certainly a frequent complaint from clinicians at all levels in Northern Ireland that people continue to do this in an irresponsible way. The good news, however, is that the message is getting home and the situation is improving.”
“We have also established a short life working group to establish how information on cancelled appointments can be recorded in order to identify where there has been a direct impact on patients and to quantify actual lost capacity. As a result of that work, information on the number of hospital-cancelled consultant-led outpatient appointments that have had an impact on patients is now available. <BR /> <BR />It is a terribly difficult thing to put a financial figure on, because what happens in most cases is that, if Mrs Smith does not turn up, Mrs Jones or Mr Jones, who have been waiting, go up the queue. Therefore it is difficult to assess the cost of generating the appointment and the cost of reappointing, and the amount of time that was spent by the consultant in, perhaps, reading up before the patient arrived.”
“The honourable Member for Foyle is absolutely right. Indeed, when the Southern Trust was implementing its change of policy, it made it very clear that that was a totally unacceptable reason for the cancellation of an appointment, on the basis that someone who was taking a holiday would presumably have had to book their flights and accommodation. They would have known in advance, so that should have enabled the trust to fill the gaps created. I commend the Southern Trust on that measure, and I urge other trusts to do the same. <BR /> <BR />It is difficult to pinpoint the total cost. There is, certainly, an intangible cost here because it leads to inefficiencies in the system. We are continuing to monitor and report the number of cancelled appointments.”
“I believe that it would be difficult to implement this on a Province-wide basis. It is not like the discussion we had this morning, where people may not be able to turn up for all sorts of reasons, and it places the GP or the doctor in a very difficult position. So, I am not minded to go down that route. I am glad to say that there has been a noticeable drop in the number of cancellations recently, so we are moving in the right direction. Again, however, informing the office of the relevant condition is absolutely essential.”
“Some Members have suggested to me that we charge for missed appointments; in the same way that I recently had to pay £25 to my dentist for a missed appointment. Unfortunately, I turned up on Friday and he extracted two teeth. I wish I had missed it in the first place.”
“Yes, well, the target is that, by 2016, we will have reduced this by 20%.”
“It is worth adding that, by March 2016, I hope to have reduced the number of hospital-cancelled consultant-led outpatient appointments by 20%. Sometimes, the problem is not with the patient; the problem is with the consultant or doctor. Indeed, when the Health Committee looked at the issue, we discovered that the Southern Trust had implemented a new policy to drill down on cancellations caused by clinicians, which led to a dramatic fall in numbers. If we could get the rest of the health trusts to the same standard as the Southern Trust, we would have a much more efficient system. <BR /> <BR />I think that the honourable Member almost mentioned the possibility of charging —”
“I accept that there are times when life becomes very complex and individuals cannot make it to the GP's surgery, clinic or hospital, but the very least that they should do is give adequate warning of that, so that another person who is perhaps waiting for an appointment can be slotted in at short notice. A deep concern of mine is that people are not showing that courtesy to health-care professionals by letting them know in the first place.”
“It is not possible to quantify the financial effect of missed appointments on GPs and health and social care organisations. However, it is clear that the real cost to the health service is the missed opportunity for GPs, consultants and other healthcare professionals to see and treat other patients, which in turn has an adverse impact on waiting times for other patients to receive the treatment they need. We all have a key role to play in ensuring that missed appointments are kept to a minimum and that our valuable health and social care resources are utilised in the most effective manner. I therefore encourage everyone who cancels a GP or hospital appointment in advance because they cannot attend to at least inform the health-care professionals so that the slot can be allocated to another patient.”
“I accept that, whilst we are doing that, we still have to concentrate on delivering TYC, and of course those staff will be doing so. <BR /> <BR />It is interesting that Sir Liam Donaldson, a world authority and internationally renowned expert on health — as I said, the Sir Alex Ferguson of health provision — concluded that TYC was still the best way forward. He understood the difficulty that we are having with funding. Therefore, I see it as a process that is not going as swiftly as we would like, but I believe that we are going in the right direction. We will eventually get there, but it will be at a slower pace. It is my role to try to ensure that my colleagues in DFP recognise that and continue to release resources to deliver a project that is fundamental to future health provision in Northern Ireland.”
“I reassure him that we will not use the voluntary exit scheme to take out staff who are essential to front-line delivery only to replace them at the same cost. That does not make sense. I see the voluntary exit scheme as a way of perhaps looking at administration and management, rather than front-line services. We are still recruiting staff. It is worth mentioning that, since March 2011, we have recruited 218 full-time equivalent consultants, 823 full-time equivalent nurses and midwives, 91 staff grade and speciality doctors and 409 qualified allied health-care professionals. I know that people do not like to hear those facts, but that indicates to me a solid investment in front-line services throughout the health trusts and the Ambulance Service.”
“There is always one question that comes completely out of the blue that all the soothsaying and predictions of those in the Department have not been able to identify. I will get the facts on that for the Member. That is an important issue but one that has not had huge publicity. I will get the answer to the honourable Member for Mid Ulster. I will write to her and give her chapter and verse on it. That was one that I did not see coming at all.”
“No one has been able to tell me that there is a better option for care in the future.”
“The fundamental point that John Compton made — this is the one that we will all be very uncomfortable with — is that, if we do not crack the issue by 2025, the health service simply will not be able to continue in the way that it is going. We have far too many people up the ladder of health-care provision commensurate with their needs. Unless we tackle that issue and grasp it, we will be in a difficult position. <BR /> <BR />There was to be a three- to five-year horizon for the implementation of TYC, and I would like to have seen it happening slightly quicker than that. We are going at a slower pace, but we are still going in the same fundamental direction. I need to emphasise that, on the ground, apart from the funding issue, major progress is being made on the implementation of TYC.”
“Everyone, including even perhaps the Member, is agreed that it is the best way forward for our health-care structures in Northern Ireland, although it has made less progress than we would have liked. I would argue with him about the monitoring rounds: we have made a large number of monitoring round bids for extra resources for TYC. However, I accept that, on many occasions, there have been much more pressing demands on the Department of Finance and Personnel. I would not like to be in the shoes of the Minister during those four monitoring rounds each year, because, frankly, it is a wisdom-of-Solomon choice that he has to make. <BR /> <BR />We will continue to make those bids and will continue to find ways of freeing up resources in the Department to push TYC forward.”
“First, I want to concur with him. The estimates are that between 12,000 and 15,000 people were on the streets of Downpatrick to express their support for the Downe Hospital. I issued a statement that I still see the Downe Hospital playing a crucial role in health-care provision in the South Eastern Trust in the future. Indeed, there are more patients going through the doors of that hospital than ever before, but I accept that the local community has difficulties and feels that it is the wrong sort of patient and that there are not enough ED, accident-and-emergency and surgery patients. Still, that indicates that there is a positive role for the Downe Hospital, and I welcome the huge support that the community has for that new facility. <BR /> <BR />On TYC, we are not going into reverse.”
“Through workforce planning, we will have to ensure that we get the numbers back up to a level that will allow us to create federations. That is a priority, as we are certainly not attracting enough young medical graduates into the field.”
“One of the aims of the federations is to employ a full-time pharmacist who would take on that entire administrative role to free up the time of GPs for diagnosis, referral etc. I see it as a vital component of TYC. It is clearly working and working well, but, in other areas, it is certainly not making the progress that we had assumed it would. <BR /> <BR />One of my priorities will be to follow up with the board and the implementation team to see what we can do to encourage GPs to coalesce and have the quantum of resources and experience that is needed to deliver a 21st-century model of GP care. I do, of course, realise that, underlying that, is the problem that we are 20% short on our GP numbers in Northern Ireland.”
“The formation of about 20 GP federations covering all of Northern Ireland was one of the basic tenets of Transforming Your Care. In some areas, particularly greater Belfast, there has been a great deal of progress. In other areas where I have visited individual GP practices, I have been a bit worried that there has not been the same success in setting up the federations. <BR /> <BR />The federations are absolutely essential because a one-man or a father-and-son practice in some remote part of Northern Ireland operating effectively on its own is simply not a sustainable model. Therefore, it is important that GPs come together. A practical example can be seen through GPs telling me that a huge amount of their time is spent on prescriptions and repeat prescriptions.”
“It is difficult to quantify their value, but they are reaching the goal of TYC. <BR /> <BR />I have the task of trying to find or campaign for the funds to enable us to obtain the additional resources that we need to implement TYC. When I was first appointed to this position, I was asked for my three priorities, and I said that finding the resources to implement TYC properly was my number two target. We are still striving, as effectively as we can, to obtain that funding.”
“The Member is broadly right in her assessment of the situation. We had envisaged a shifting left, to use the parlance. John Compton, the author of 'Transforming Your Care', could not have envisaged the present financial backdrop. We have made bids to achieve the £83 million, most of them in the monitoring round, and they have not been successful. Therefore, that has put the whole Transforming Your Care process under considerable stress. <BR /> <BR />It is worth saying, however, that there are two aspects to TYC. First, there is the sea change in the trusts as they align their working practices within TYC, which does not require additional service development or resources. Secondly, there is the £83 million required to make the major changes. The trusts are implementing service changes on the ground every day.”
“<BR /> <BR />I and my predecessor have always been clear that ideally we are working to a three- to five-year implementation framework. That, of course, is dependent on financial circumstances. That remains the case, as does the broad requirement identified in the original report for transitional funding to support the new model.”
“Mr Principal Deputy Speaker, with your permission, I will answer questions 1 and 8 together. <BR /> <BR />In response to the agreed budget for 2015-16, a financial plan has been developed that is expected to deliver a balanced position for 2015-16. However, that financial plan does not permit funding for any new service developments, including those that might support the delivery of Transforming Your Care (TYC). That said, the delivery of TYC remains a priority for my Department, and the draft commissioning plan direction is clear that the Health and Social Care Board (HSCB) should, in setting out how services will be delivered in 2015-16, strive to shift services into the community or primary care settings in line with the objectives of TYC.”
“The fact that we have four MLAs who are serving their constituents diligently in this House — they are very much with us, I am delighted to say — indicates that real success is being achieved. We want to see that becoming the norm. We want to reach a situation in which cancer is seen not as a death sentence but as a long-term condition. For 50% of the population, that is where we are at. I believe that the extra money can ensure that others reach that position. We would all be quite happy to pick up the tab for that because it would mean that people are living long, fulfilling and active lives with a long-term condition.”
“A gentleman in my church was diagnosed with prostate cancer nine years ago and thought that it was terminal. Since the diagnosis, he has become a grandfather three times, got a degree and is still very much alive and healthy thanks to the magnificent treatment that he received in the Belfast City Hospital cancer centre. Therefore, we have to accept that, as we age as a population, there will be more and more cancer. Indeed, I have to set aside £35 million a year in my budget simply to take account of the fact that we are living longer and that much of the disease that we encounter is a result of age. <BR /> <BR />As we become more successful in treating cancers such as breast cancer and prostate cancer, costs will rise even further, because we will have to continue to find the drugs and treatment to keep those people alive and healthy.”
“Earlier, I mentioned that the figures are rising very significantly, by 8,500 new diagnoses a year. I do not think that any of us who have not been through that experience — of course, four of our Members have — can understand what a body blow it is for someone to be brought into what is known as "the bad news room". Within the last fortnight, I have been in the "bad news room" twice, so I know exactly what that entails. Individuals sit down with their husband, wife or family and are told, "I'm afraid, Mr Smith or Mr Jones, that the diagnosis is cancer". To this day, that phrase instils fear in the hearts of many. However, I have a friend who has had stomach cancer for 23 years and had a work colleague in Saintfield who has had breast cancer for 19 years. We meet such people regularly.”