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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“The Chair asks some very valid questions, which I would expect from the House. First, the model that we are thinking of, which will go out to public consultation, is along the lines of a 30p, 50p or £1·00 charge per prescription per person for everyone. However, because there are so many people with long-term conditions who could not possibly afford to pay that regularly, we are thinking about a season ticket — let us call it that for the sake of argument — costing, we think, although we do not know, about £20·00 or £25·00. <BR /> <BR />Those are the sorts of figure that are being suggested. We are still working on the model at the moment. Figures will be released for the consultation to work out how much each of the models would produce. That would cover all prescriptions for an entire year.”
“I assure Members that once the public have had their say on this important issue, I will bring it to the attention of the Executive as a matter of urgency. <BR /> <BR />In view of the tremendous interest in the evaluation, I release today the findings of the report for public consultation. The consultation period will run for 12 weeks from today, and my Department will hold a number of consultation events to make sure that everyone’s voice is heard before we finalise these proposals. I look forward to hearing the public’s views, and I also look forward to hearing the views of Members, especially those who sit on the Health Committee, on this important issue.”
“In view of the current financial position, I do not think that it is unreasonable to ask people to contribute to the cost of their prescriptions and to provide a financial foundation for innovative and specialist medicines for the future. I believe that this is an appropriate time to reconsider the provision of free prescriptions in Northern Ireland. <BR /> <BR />Reintroducing charges for prescriptions is about making funding available for specialist medicines in a secure and sustainable way in the long term. I understand that it will take time to put this into practice, and, in the coming months, I will explore every possible option for making the changes to the IFR process as quickly as possible.”
“However, we need to face the fact that my Department does not currently have the finances required to introduce the changes that I have set out in a sustainable manner. The issue is one that I feel passionately about. I want to make sure that the changes happen and that they are sustainable in the long term, but I cannot do it sustainably without finding a source of additional funding. <BR /> <BR />Prescription charges were abolished in Northern Ireland in April 2010. The cost of providing free prescriptions was found from increased efficiencies in the Department of Health's budget at that time, and no additional funding was sought to support the introduction of that policy.”
“Removing the 95% exceptionality criteria and creating one or more regional scrutiny committees will, of course, attract costs, whether due to the increased number of IFR applications or the administrative costs attached. To ensure that the changes are sustainable, I propose the creation of a specialist medicines fund to fully resource the developments and support wider medicines pressures. <BR /> <BR />To resource the new fund, the recommendation is that the HSC reintroduce charges for prescriptions. I empathise entirely with patients who have undergone trauma and stress related to their treatment, and I want to make certain that they receive the most effective treatment possible for their condition.”
“I suspect that there will be a lot of interest from Members in that recommendation.”
“As well as reviewing the administrative arrangements, as I mentioned, it would be a worthwhile exercise to review the existing guidance to increase transparency for clinicians and patients in the overall process. <BR /> <BR />The fourth recommendation is that the Department should establish a specialist medicines fund to meet the costs of administering and maintaining access to specialist drugs.”
“The Department also heard anecdotal evidence that this local variability can have the effect of discouraging applications and may have a negative impact on patient confidence through a perceived lack of transparency in the process. To resolve this, the Department proposes to work with the Health and Social Care Board and the trusts to establish one or more regional scrutiny bodies to consider all IFR applications at trust level. <BR /> <BR />The third recommendation is that the existing IFR guidance should be revised to include greater transparency. Throughout the evaluation process, the team received feedback criticising the alleged lack of openness of the process for patients. The team also found that there was a perceived lack of accessible information on the numbers and detail of unsuccessful applications.”
“While it is reasonable to expect clinicians to demonstrate some level of exceptionality, there is a compelling case that the current definition applied in Northern Ireland sets the bar too high. Many groups have contacted me in the last four or five years in my position as Chair of the Committee, Deputy Chair of the Committee and currently as Minister to say that they felt that this is an incredibly high threshold and is very difficult to meet. <BR /> <BR />The second main recommendation is that the establishment of regional scrutiny committees should be considered to ensure that all IFR applications are subject to regionally consistent clinical input and peer review. At trust level, the scrutiny of IFR applications varies significantly, which may result in some variation in decisions made regionally.”
“In the course of discussions with stakeholders, the most commonly cited difficulty with the current system has been the 95% exceptionality criteria, whereby clinicians who seek to apply for an IFR must be able to demonstrate that their patient is:”
“Officials in the trusts and the Health and Social Care Board have worked hard and shown great commitment in making decisions about access to new specialist drugs within the constraints of the existing IFR system. I thank them for this work and emphasise that the changes that I am now proposing are no reflection on their performance; rather, they are about improving the system in which they operate. Having considered the available evidence, I still believe that, with the significant changes that I will now outline, the IFR process can remain an effective mechanism for providing access to specialist drugs for patients in Northern Ireland. <BR /> <BR />With this in mind, the findings of the evaluation are as follows. First, the existing exceptionality criteria should be amended to remove the reference to 95%.”
“The PPRS agreement is a UK-wide arrangement, negotiated between the Department of Health in London and the Association of the British Pharmaceutical Industry (ABPI). The 2014 PPRS was implemented in Northern Ireland on 1 January 2014. At this stage, I cannot be definitive about the scale of the payments Northern Ireland is likely to receive through PPRS. The current financial pressures on the health service also mean that it is not possible to commit to using PPRS receipts solely to fund new medicines. However, I very much welcome the scheme and the positive way in which the ABPI has worked with government to bring it about. <BR /> <BR />In Northern Ireland, the IFR process was originally set up to provide access to specialist drugs that are not normally commissioned in circumstances in which there is an agreed clinical need.”
“<BR /> <BR />In its original format, CDF offered no incentive to the pharmaceutical industry to keep prices low and, in fact, introduced a risk that companies could bypass and undermine NICE assessment of new drugs. Indeed, in the aftermath of the well-publicised overspend of £150 million on the CDF, the authorities in England are developing an enhanced link to clinical and cost effectiveness for any drug to be made available through it. The new Scottish system, the new medicines fund, is a more attractive model, offering as it does a new clinical peer-review process and an enhanced role for the patient within that. <BR /> <BR />However, the Scottish national health service is in a very different financial position to our own and is using receipts from the pharmaceutical price regulation scheme to resource this new fund.”
“We should not simply confine our understanding of the situation to cancer alone. As I see it, any solution should therefore address access to specialist drugs for all patients, rather than focusing on one distinct group, to the disadvantage of the rest. Furthermore, there are a large number of new licensed drugs coming onto the market each year. In order to determine which of those new treatments offers the best prospect of improvement over standard therapies, they must be assessed for clinical and cost effectiveness before they are made routinely available. The National Health Service and Health and Social Care (HSC) in Northern Ireland are guided in that process by the National Institute for Health and Care Excellence (NICE), which has an international reputation of excellence in scientific rigour, independence and objectivity.”
“However, its remit was later widened to include additional factors, such as: arrangements for access to specialist drugs in other UK jurisdictions; the early access to medicines scheme (EAMS); the pharmaceutical price regulation scheme (PPRS); and the potential for the reintroduction of prescription charges to finance a specialist drugs fund. <BR /> <BR />The evaluation report covers each of those areas, and I will outline the findings in a moment, but I want to make it very clear, to the avoidance of all doubt, that I am opposed to the introduction of a cancer drugs fund (CDF) similar to that operating in England. I am opposed to that. There are a number of reasons for that, not the least of which is that specialist drugs are used to treat a large number of serious conditions other than cancer.”
“There are approximately 8,500 new cases of cancer diagnosed each year in Northern Ireland and, with an ageing population, that is likely to increase. Indeed, on World Cancer Day, Cancer Research UK announced that, according to its findings, one in two people will be diagnosed with the disease over the course of their lifetime. That is a staggering statistic, but it is also at least partly good news, in that it means that more people are being diagnosed and are surviving longer. Although that is categorically a good thing, it will of course lead to increased pressure on our cancer services. <BR /> <BR />I move on to the IFR evaluation. The evaluation in the report that I am dealing with this morning was originally intended to test purely whether the IFR process was meeting its objectives.”
“Older Members of the Assembly will remember that, at one stage, that very welcome new facility was cancelled because of an apparent lack of funding. I am glad to say that my predecessor, Edwin Poots, made absolutely certain that funding was found for that much-needed facility, and I have committed myself to providing the funding for the running of it, in conjunction with my colleagues in the Irish Republic. <BR /> <BR />The improvements have been impressive, but we cannot afford to be complacent. This has all been achieved against a background of increasing demand. The next few statistics that I am about to give you will be quite shocking. Since 2009-10, the number of patients receiving treatment for cancer after an urgent referral has increased by 42·3%.”
“Patients who are treated by professionals specialising in cancer and working together as a multidisciplinary team have a better outcome than those not managed by such teams. <BR /> <BR />Investment in cancer services over the past 10 years has been considerable. It has included: the opening of the Belfast cancer centre in 2006 at a cost of £70 million; additional radiotherapy capacity at the Belfast cancer centre, where two new linear accelerators have been installed at a cost of around £3 million; and a £66 million investment has provided a new radiotherapy unit at the Altnagelvin Hospital, which is planned to open in 2016, by which time the Belfast cancer centre will have reached full capacity.”
“The improvements that have been made have been brought about through investment in cancer services and by a major refocusing on how the service is delivered. We have established cancer targets, instigated extensive reforms and invested in the staff and infrastructure necessary to bring our cancer services up to the standard expected of a modern high quality health service. We have also been able to provide better access to a wide range of evidence-based treatments, including drugs and radiotherapy. Cancer services have been reorganised in recent years so that professionals with an expertise in treating the most common cancers can be brought together.”
“Before going into the results of the evaluation, I should be clear that, while I absolutely recognise the importance of new drugs to patients, we do need to acknowledge that drug therapies are only one aspect of cancer treatment. Early diagnosis, timely surgery and radiotherapy are of paramount importance in improving patient outcomes, and those are also the treatments that have the potential to lead to actual cures. <BR /> <BR />In recent years, we have seen significant investment in cancer services in Northern Ireland, and that has led to real improvements in outcomes for patients across a range of cancers. A recent European-wide study has shown that survival rates for lung, breast and prostate cancers in Northern Ireland are the best in the United Kingdom.”
“Mr Speaker, at the outset, I thank you for your letter regarding my wife's health. It was much appreciated, along with all the messages of support that I have received from Members throughout the House. <BR /> <BR />My predecessor launched an evaluation of the individual funding request (IFR) process for specialist drugs on 24 September 2014. The evaluation is now complete, and I want to take this opportunity to brief the Assembly on its findings and on how I propose to take the issue forward. <BR /> <BR />Like the previous Minister, I have heard the concerns raised by cancer patients and survivors, charities, the pharmaceutical industry and, indeed, many colleagues in the Assembly that the current process of providing access to new specialist medicines in Northern Ireland could be strengthened.”
“You are not comparing like with like, but we have achieved significant progress on the 12-hour waits.”
“I should let the honourable Member know that the four-hour waiting list in December 2012 was 75·4%. At the minute, a very similar figure of 76·7% of patients are seen within four hours. So, there has not been a cataclysmic drop in performance. On the 12-hour waiting times, the overall trend for 2014-15 to the end of December continues to improve, with a 32·4% reduction in the number of patients waiting more than 12 hours over the last period. <BR /> <BR />We have grasped the nettle — in fact, some hospitals go many months without a 12-hour wait. Therefore, real work is being done on the ground to reduce waiting times. We all want to meet the UK target, but, remember, there is a difference in the measurement of some of the waiting times between ourselves and the rest of the UK.”
“The difficulty comes next year, because we allocated £63 million to elective surgery in the private sector last year, and I do not see where we will get another £63 million to fund that in 2015-16.”
“As I said to the House earlier, we are now down to seven people in Musgrave Park in that situation. We are working our way rapidly through the 179 who had their procedures postponed, and we have given the commitment of three to six weeks. If the lady would like to write to me about that gentleman, I would welcome that because I am always keen to hear about individual cases, and we will see where he stands on the present list. Be careful because, of course, some of those patients have been assigned to two clinics in the private sector, and we have reinstated those who had a date and an expectation. We are working our way through those. Indeed, we expect that all of them will be out of the system by the first quarter of 2015-16.”
“Indeed, as I mentioned in Question Time the other day, the CMO/chief executive of the Belfast Trust — because he is still carrying on both roles — was seen walking the wards of the Mater and the Royal on Christmas morning. He was never asked to do that by me. It was not part of his job description, but, such was his commitment to making certain that we came through this very difficult period, he was on the ground. <BR /> <BR />We risk belittling the huge effort that was made by staff. Therefore, we should not take the opportunity to give the staff a good kicking; we should be saying, "Yes, life was tough, but we admire the way that you overcame a terribly difficult situation".”
“Absolutely, and I pay tribute to the work that the Member did as Minister. After the situation that developed in the Royal last year, he asked the Regulation and Quality Improvement Authority (RQIA) to step in and do a very important piece of work in order to make life easier this year. We also had the College of Emergency Medicine coming in and providing expert guidance on the matter. As a result of those steps, we were able to deal with a terribly difficult situation. <BR /> <BR />It was mentioned earlier that I was in regular contact with the various chief executives. When I say "in contact", I mean it was not unusual for me to get a text message at 2.00 am from a chief executive who clearly was still on duty and was walking the wards and telling me what was going on in Daisy Hill, the City Hospital, Craigavon or wherever.”
“The Appleby report recently indicated that we are 25% over-provided for in comparison with the rest of the nation. So, you can hardly accuse us of under-provision. The honourable Member should at least recognise that, since Mr Poots was appointed Minister, we have taken on 780 extra full-time equivalent nurses, who are on the ground, providing care in our hospitals for ED and elective surgery. Will he at least recognise that that indicates that we are genuinely committed to the service and are doing all that we can in difficult circumstances?”
“I have a lot of time for the honourable Member, but every time he sees light at the end of the tunnel, he goes out and orders more tunnel. There is always darkness, gloom and doom. The problem recently was not the lack of beds; it was the difficulty in getting people out of hospitals through care packages, intermediate care beds etc. Therefore, at any given time, there were people who were perfectly able to leave hospital, but the difficulty was in finding somewhere they could be cared for. We had enough beds to deal with them. <BR /> <BR />It is worth saying that, in the Southern Trust, there was only one cancellation of an elective procedure in the entire trust area. I think that is quite remarkable. The number of beds in Northern Ireland is still in excess of the UK average.”
“I was getting messages at all times of the morning from the chief executives telling me how it was going, and, in my opinion, they were doing a good job and did not need political interference.”
“At the end of the day, we are down to a small number of people who, quite rightly, are annoyed that their non-essential, non-urgent procedure — sorry, non-urgent, not non-essential, procedure — was postponed for a short period to enable many thousands of people to be brought through the system and treated at EDs. I think that was the right decision, and the scale at which it was being implemented was right. It, therefore, indicates that the Chief Medical Officer (CMO), who is now the chief executive of the Belfast Trust, felt that he had the flexibility to do that. He will not receive a single word of criticism from me for doing what he had to do. That is why I kept out of that debate. My role is only to get involved when things are not going right.”
“I thank the honourable Member for that question. I find it frustrating, as I go round all the hospitals and trusts, that so much excellent work goes on and I find it very difficult to attract press interest to cover that. Part of the problem that the press faced in January was that we did not have the situation that emerged in early January last year, so, effectively, there was not much of a story. I well remember a headline that pleased me; one that appeared on the front page of 'The Irish News'. On day one, it criticised me because we did not have enough staff to deal with the huge waiting list. On the following day, reporters went to the waiting room in the Royal and there were only two people there. Then I was criticised for having so many staff on to treat too few patients. You simply cannot win in this business.”
“So, I still maintain that what our staff achieved over the last month has been remarkable. Indeed, I have written to every chief executive and every chair of the five boards, plus the Ambulance Service trust, to say, "Well done. You faced enormous pressures, and you managed to overcome them without the meltdown that many of my detractors predicted."”
“Some day, Mr Dickson, you may have the privilege of standing at this podium, and you will just see what is going on with pressures in the Belfast Trust. Let me mention to you that, currently, only seven fracture patients are receiving care in Musgrave Park Hospital: that was the position at 30 January 2015. At one stage during the holiday period, there were 35 such patients. These fracture patients have been treated in the fracture service in the Royal Victoria Hospital. It is worth saying that a recent report has indicated that 220 operations are postponed every day in England. We are talking about seven operations in Belfast, but that happens every day in England, where there is much more resourcing, much more concentration of services and bigger acute units.”
“However, the point is that, by adopting the flexibility of postponing the non-urgent orthopaedics and other operations and having the flexibility to move patients around the various hospitals in the Belfast Trust, we managed to avoid a very critical and damaging situation. Therefore, rather than criticising the chief executive and directors of the Belfast Trust for what they have done, we should be congratulating them because, as a result of their action, we avoided a major emergency situation. At the end of the day, whilst it is very distressing for the individuals, the numbers are a very small proportion of the 56,000 people who were treated.”
“I think it unfortunate that the honourable Member for Upper Bann has repeated the accusation that the patients in Musgrave believe that they are being treated in a holding bay. That is demonstrating an attitude to patients that I do not want to see in any part of the health service that I am responsible for. It is entirely unacceptable, and, indeed, it is untrue. <BR /> <BR />I agree that we are facing high pressures, but the stats tell us that. They tell us that we have a 7·5% growth in demand. No one can contest that; it is a fact of life. Therefore, it is bound to put pressure on our clinicians and lead to an increase in waiting times.”
“That is the difficulty that we face. We will inevitably encounter those difficulties at the start of each year. All I can say is that we overcame them much better than the Republic of Ireland did, much better than parts of southern England did and much better than last year.”
“The honourable Member has considerable contacts in the Republic of Ireland. During the same period, when our staff were managing very effectively in terribly difficult situations, there were 600 patients on trolleys in hospitals in the Irish Republic. Twelve health trusts in England had to declare emergency situations, yet they were not experiencing the growth in demand that we had — 7·5% or over 200,000 extra patients — on top of a huge rise in January 2014. It is not a question of a failed plan. It is that we cannot build capacity in Northern Ireland to cover every eventuality. When you think about it, for maybe 20 days a year, we have that huge demand on our services. If we were to build that capacity into our hospitals, you would be financing capacity that was not being used for the rest of the year.”
“We are making the same commitment to the people in Musgrave that, as soon as we can, they will be back on the list for their procedure.”
“I certainly can. We have given an undertaking that the 179 cancellations for all of Northern Ireland will be rescheduled for between three and six weeks after the original date. That gives a clear certainty to those people. I know that it is difficult and that many of them had to arrange care facilities and had to organise so many aspects of their lives to be booked in for those elective procedures and then found that they had been cancelled. However, one has to remember that, every month in Northern Ireland, 4,600 procedures of that type are carried out in our hospitals. That gives an indication of how small a percentage 179 represents: it is about 3% or 4%. That, plus the guarantee that their procedure will be carried out very quickly, is, in my opinion, the best that we can do for those people in very difficult circumstances.”
“What I can say — the figures verify it — is that our hospitals in Belfast treated a significantly larger number of people and did so without the emergency situation that arose on 8 January last year, and I pay tribute to them.”
“In 2013, the equivalent figure was 55,057 patients, and, in 2014, it was 56,656 patients. I make it absolutely clear that Musgrave Park was not used as a holding bay for the elderly. Patients in Musgrave Park received the same extremely high quality of care as they would have received in any other Belfast Trust hospital. <BR /> <BR />I resent the comments made by that newspaper. It is very sad that a member of staff from Musgrave Park took it on himself or herself to give an anonymous interview to the paper. It is simply not true. It is a totally unwarranted criticism of the staff of Musgrave Park Hospital. The hospital was quite rightly acting in a very difficult situation to relieve the pressure on the Mater, the City and the Royal to get over a tremendously difficult period, as is traditionally the case.”
“First, I think that the honourable Member for West Belfast needs to look at the statistics. In October, November and December 2012, our EDs treated 54,606 people.”
“In addition, £750,000 has been made available from the Health and Social Care Board's baseline funds and allocated equally to each trust to support the delivery of unscheduled care services this winter. The Health and Social Care Board continues to work with the trusts to address the increasing trauma and orthopaedic pressures and recently agreed an additional £4 million for this service, which will increase capacity in the Southern Trust and help to alleviate pressure in the Belfast Trust.”
“The trusts will continue to make every effort to deliver effective, high-quality care to the people of Northern Ireland and to reschedule these patients as soon as possible. <BR /> <BR />My Department, through the work of the unscheduled care task group, has been working closely with Health and Social Care (HSC) to ensure that our emergency care services are better prepared for this winter. Considerable progress has been made in better planning for periods of increased demand; better access to specialty services, thus avoiding emergency departments; and developing indicators and standards for services, including those for our frail and elderly. <BR /> <BR />My Department has allocated £5 million of additional funding to the HSC this winter.”
“Like health services across the United Kingdom and in the Republic of Ireland, we continue to face considerable pressures on our emergency departments (EDs), and this has been particularly true over the last number of weeks. This has resulted in the health trusts having to postpone some elective procedures in order to provide the additional bed, staff and theatre capacity needed to manage and maintain the safety of patients. <BR /> <BR />I regret that a number of non-urgent elective orthopaedic procedures have had to be postponed in the Belfast Trust, and I apologise to the patients affected. The Belfast Trust has had a 12% increase in fracture patients, all of whom required an immediate operation and post-operative care in hospital.”
“I thank all Members who contributed. This has been a useful debate, and I thank the Chair of the Committee for tabling the motion. It will help us as we make up our mind about what we can do best to protect some of the most vulnerable members of society.”
“In addition to requiring robust arrangements for whistle-blowing and complaints, standards relating to staff recruitment and safeguarding have been updated, and the new standards on personal care and on individual rights to privacy and dignity have been added. <BR /> <BR />I hope that the announcement that I made this morning on the duty of candour will be helpful in this respect. From now on, it is simply not enough to have regard for openness and transparency. Part of one's responsibility in this sector will be an imperative that, if something that you see is going wrong and you have concerns, you must report it. You must bring it to the attention of the regulators, the Department or the appropriate body. That is a positive step forward in looking after our elderly. <BR /> <BR />I am running short of time.”
“RQIA can apply a range of sanctions and enforcement measures to protect the safety of service users and the drive to improve services. However, I accept all Members' criticisms that, in the case of Cherry Tree House, that did not go far enough. We and RQIA have learnt some very hard lessons from that whole incident. I suspect that inspections have improved dramatically because of those lessons learnt. <BR /> <BR />My Department, in conjunction with RQIA, has recently reviewed care standards for nursing homes. Those are being finalised and will be published in March this year.”
“That might require legislation, it might require awareness raising, or it might simply require a change of policy through the present legislation. I do not know. I am not going to give a black-and-white view on the matter. I am very keen to engage with Claire Keatinge and her team to further consult on the issue. <BR /> <BR />Members will be aware that the Regulation and Quality Improvement Authority registers and inspects establishments and agencies delivering a wide range of health and social care services. That, of course, includes residential homes and nursing homes, which operate within a regulatory framework and which are inspected against minimum care standards. My Department publishes that information.”