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 research that was carried out in Australia indicates that it is an important component in deterring young people from taking up cigarettes. We have also had the point-of-display advertising ban, a ban on vending machines and the very successful ban in restaurants, pubs and clubs, all of which have driven down the number of smokers in Northern Ireland. We are down now to 22%, but — there is a big "but" — unfortunately, in the most vulnerable communities in our society, the prevalence is 31%. We still have to drive that down, and we still have to drive down the number of young smokers taking up the habit. Smoking is unique in that it has to replace half of its customers because those customers die from using its products. Anything that can be done to discourage young people from considering smoking to be glamorous must be considered.”
“I think that a dominant factor is that, if the rest of the United Kingdom and the Irish Republic are going down the same route, I see practical difficulties in Northern Ireland, which represents only 2% of the British Isles market for cigarettes, having its own brightly coloured packaging whilst the rest of the islands have plain paper packaging. However, that is not my decision; it is a decision for OFMDFM. I understand that it will be looked at very quickly.”
“As the honourable Member knows, as far as the rest of the United Kingdom is concerned, last week, the announcement was made that there would be a free vote in Parliament on the issue and that would affect the situation in England. I understand that Scotland, Wales and the Republic of Ireland are at varying stages in implementing plain paper packaging. We as an Assembly unanimously passed a legislative consent motion last year enabling that to happen. It falls on the First Minister and deputy First Minster to take the final decision. That is where the decision will rest.”
“Yes. We are doing a workforce review, particularly of district nurses who go round the community looking after people who also have a domiciliary care package. I hope that the workforce review will be published some time in mid-2015. It was due to be 2016, but I asked that it be brought forward. I am certain that the review will indicate that we require more district nurses to meet the needs of Transforming Your Care. I could go on about the number of extra consultants that we have also taken on, but we have shown already by our enormous commitment that we are utterly determined in this Department to put the resources where they are needed, which is where the patient is being cared for — in the community or in the hospital.”
“That gives an indication of the commitment of the previous Minister and me to making certain that resources are put into front-line care, and you do not get much more in the way of front-line care than nurses. The trusts, the board and the Department are to be congratulated on giving this the priority that it deserves.”
“When the honourable Member for South Belfast was the Minister of Health, I distinctly remember him saying just before he left office that, inevitably, out of the comprehensive spending review Budget agreed by the main parties, there would be 4,000 compulsory redundancies in health. That has not happened. Over the three years when Edwin Poots had control of the Department, we increased the number of nurses in Northern Ireland by 780 or 6%. That is 300 more nurses in acute service; 55 more in mental health; 33 more midwives and student midwives; 30 more district nurses, which is an increase of 4%; 23 more health visitors, which is up 5%; 112 more paediatric nurses, which is up 18%; and 147 more specialist nurses, which is up 21%.”
“As far as consultation is concerned, it was flagged up extensively in Transforming Your Care. There was extensive consultation in it. Also, we are not changing the service as such. We are not losing a service; we are simply changing the way in which the service is delivered to people's homes, in the case of the South Eastern Trust. The food is still coming. OK, it is coming in bulk, as it were, but it is still being given, and there is still help being given for its preparation and serving.”
“Only to the extent that I have mentioned, which is that some trusts are much further on in the process than others. In the Member's area, I think that the process is more or less complete. The Southern Trust has decided, after a rigorous examination of the facts, that only 47 people in the Southern Trust area require this form of service.”
“I want that to be done in a way that minimises the alarm caused to the service users.”
“Transforming Your Care clearly flags up the process of reablement. It is clear that, particularly in the Member's area — the Southern Trust area — there will be an extensive programme. I raise the question with her. She has been a public representative for I do not know how many years — certainly for as long as I can remember. The general assessment of the community seems to be that what the Southern Trust is doing is correct and that older people living on their own now feel much more certain and secure. Therefore, as a result of that, they no longer require community meals. I still say that I want any change in the process to be tested calmly and rationally by those who have specific expertise, particularly in the areas of malnutrition and the care of older people.”
“<BR /> <BR />I suspect that the reason why the other trusts are not just at that level is that they are not through the reablement process to the same extent. Under Transforming Your Care, the intention is that every person in that situation would get that advice and assistance, so I expect that that number will continue to fall.”
“I am not actually 100% certain what the question is. What I can say is that the Southern Trust has maybe been more forward-thinking on reablement. It has sent its staff out to give advice to many elderly people, particularly those living on their own, on how they can manage without requiring the community meals service. I represent the Southern Trust area and have done for about 20 years, off and on. Surprisingly, though the service has been scaled back dramatically in places like Newry and Mourne and Banbridge, I have had very little in the way of complaints from constituents about it. That indicates to me that the Southern Trust is able to provide the support that individuals need in such a way as community meals are no longer required.”
“If the person requires help in cooking that meal, that is given. It was not a question of leaving people on their own. Equally, if the person did not have a fridge or freezer that could accommodate those meals, they were not included in that service. I will watch with great interest to see how that new arrangement works. We will monitor it carefully, but it is a genuine attempt by the South Eastern Trust to make the service more effective. It is interesting to note that, when full reablement is carried out, the need for community meals drops dramatically. As I said, in the Southern Trust's case, it is down to only 47.”
“It may be of interest to the Member to receive the statistics on what are called community meals. The Belfast Trust gives out 982 meals a week; the Northern Trust 437; the South Eastern Trust 408; the Western Trust 1,227; and the Southern Trust gives out 47. The reason why the number for the Southern Trust is so low is that it has carried out a full reablement programme. Elderly people living on their own are given advice and help on how to manage in a much more effective way, without requiring what many people regard as meals on wheels. <BR /> <BR />The decision of the South Eastern Trust, which has 408 clients, was based on making the service more effective and more cost-effective, but it also has to be emphasised that it is not a case of simply going with a dozen or 14 meals, putting them in a freezer and driving away.”
“The Public Health Agency, which leads on the implementation of Promoting Good Nutrition, the vision for good nutritional care strategy for adults in all care settings in Northern Ireland, advises that it aims to have the majority of actions in the strategy that relate to training, assessment and assistance with feeding, food service provision and the patient experience in place during 2014-15, so that is obviously imminent. During 2015-16, they aim to focus on arrangements for governance and related structures, along with any outstanding actions from 2014-15.”
“I understand, of course, that, if someone has lived a large portion at the end of their life in a private residential or nursing home, the trauma and upheaval of having to be moved out and be split from friends is very difficult. You will understand that the Department could not get into the situation of moving in and bailing out, or rescuing, private residential nursing homes, because, when there is alternative provision, we have to make use of it. There have been some isolated incidents of this happening, but, on all occasions, the residents have been relocated to other facilities in a reasonably short period.”
“Orchard is a private facility. The Department has no direct control over private nursing homes. We have had situations where they have announced closure, and, of course, they have to consult before doing so. It then becomes the trust's role, in this case the Belfast Trust, to provide alternative accommodation for the residents of a private home. <BR /> <BR />We had a similar situation in Bangor. You will understand that, as a privately owned facility, it is a matter between the Belfast Trust and the RQIA that, during the period of notice, they meet all the relevant registration and contractual requirements and that the residents are appropriately and successfully relocated. <BR /> <BR />From experience, I have found that it is always possible to relocate residents in this situation.”
“It is only the non-essential packages that are being restricted and, even then, it is two out of three, and that policy does not apply to all trusts. <BR /> <BR />This is a rapidly growing part of our budget, and, indeed, as part of Transforming Your Care, one of the main focuses of that document is to transfer funding from further up the healthcare ladder down to domiciliary care.”
“The overall level of domiciliary care is actually continuing to increase. I think that she is referring to the fact that, under the contingency plans to save money in the last four months of this financial year, some trusts have been adopting a policy of providing only two out of three non-urgent packages to slow down demand and restrict growth in the budget. This does not mean that there is not an overall growth in the programme, and it continues to be a major component of the social care budget. This will be reviewed, of course, in the context of Budget 2015-16. I have not yet had direction from the trusts on what they intend to do, but, if anyone needs a domiciliary care package urgently, they are still getting it. I emphasise that.”
“<BR /> <BR />We also provide domiciliary care to 25,000 people in Northern Ireland, many of whom, of course, are elderly people, and some of whom have palliative care needs. So, there is a commitment throughout Northern Ireland to ensure that we do our best for people who wish to remain in their community in their last days. We know how difficult a period this is in their lives and the lives of their families, and I would like to think that the Department, through the five trusts, is working to ensure that people, in even the most remote areas, are getting the care they require.”
“The Department places huge store on protecting and enhancing palliative care services. Indeed, we have an agreement with Marie Curie, which organises visits to those in rural areas who have end-of-life care needs. Indeed, I was also up at the Northern Ireland Children's Hospice, and I noticed that it has a team of nurses who go to every county in Northern Ireland to provide care to people who look after young children who have end-of-life care needs. I was very impressed with the quality of the care that I saw, and I am committed to ensuring that the review of palliative care continues to reach out to rural communities. I want to continue to work with the charitable NGO sector in this respect.”
“The Department's review of paediatric services — Sorry, I did not quite hear the Member. Was it paediatric or palliative care?”
“I know that the Member is raising it on behalf of her constituents, and I am more than happy to follow up on that with Minister Kennedy.”
“As the honourable Member for East Londonderry will know, rural transport is outwith the control of the Department of Health. However, I realise that it is an important factor in people getting access to essential services. <BR /> <BR />She raised the particular issue of the Blind Centre in Coleraine. I am more than happy to take up that issue with Minister Kennedy to see what is happening. In my area, the Down Armagh Rural Transport Partnership (DART) is having huge difficulties with funding at the moment. Essential services are being withdrawn because the cash is not being made available to enable an extensive service to remain available to the community. I am therefore more than happy to pursue the issue. Coleraine is not the area that I would be in most often, so I am not across the particular issue raised.”
“As I already mentioned to the Member, the Executive have adopted the rural White Paper action plan for Northern Ireland. That followed extensive engagement with stakeholders and Departments. It was agreed by the Executive in May 2012. That demonstrates the Executive's commitment to improving the quality of life of those who live in rural areas. <BR /> <BR />The plan was developed to provide a strategic framework for rural policy for the next 10 years. It provides a framework for a more integrated approach by the Executive to seek to address the challenges facing rural communities and to help ensure the future sustainability of rural areas. It contains commitments on rural issues by all Departments, including mine.”
“<BR /> <BR />The Health and Social Care Board and the Public Health Agency, in conjunction with Marie Curie, are taking forward the Transforming Your Palliative and End-of-life Care programme. The programme aims to improve the design and delivery of coordinated services and ensure equity of access to services for urban and rural communities. It will do that through the development of person-centred care so that people with palliative and end-of-life care needs will have, as far as possible, choice in how and where their care is provided.”
“With your permission, Mr Deputy Speaker, I will respond to questions 3 and 8 together. <BR /> <BR />I am committed to improving the health and well-being of the rural population and to taking forward the commitment for health in the rural White Paper action plan. My Department and the Public Health Agency are committed to working jointly with the Department of Agriculture and Rural Development on initiatives such as the maximising access in rural areas (MARA) project and the farm families health checks programme. I also want to ensure that high-quality care continues to be provided to people with palliative and end-of-life care needs, irrespective of where they live or where their care is delivered.”
“I pay tribute particularly to the Chief Medical Officer and chief executive of the Belfast Trust, who was seen walking the wards on Christmas Day at the Mater Hospital and the Royal Victoria Hospital. That is the sort of dedication that we have in the health service. I know that that can be replicated by many chief executives throughout the trusts, so I say "Well done" and "Keep up the good work".”
“By the way, those 179 routine procedures were out of several thousand procedures; it was a very tiny fraction — maybe less than 4%. Therefore, I say, "Well done" to the consultants, the doctors, the nurses and all the allied health care professionals who worked so hard over that period to ensure that we got through those very difficult few weeks without having to worry about the situation that arose a year earlier. <BR /> <BR />It is worth saying that, in GB, 220 operations a day are being axed as units struggle. That gives you an indication of what is going on in areas where they have a very strong resource base. So, I admire the work that is being done.”
“As I said in the media, I am immensely proud of how our six health trusts handled the enormous pressures in the period just after Christmas. There was a 7·5% increase in demand, and that 7·5% increase was on top of the huge increase in demand in January 2014. Despite that, we did not have the meltdown that was experienced in the Irish Republic, where there were 600 patients on trolley waits at one stage, or the situation in England, where 12 health trusts had to declare emergency incidents when the system completely collapsed. <BR /> <BR />I accept that 179 routine procedures were postponed, but all those will be carried out within the next three to six weeks. In the Southern Trust, only one procedure was postponed. We got through a terribly difficult period with the minimum of disruption.”
“As the Member knows, there is an ongoing consultation on the Cottages facility in Londonderry. I notice that there has been some press speculation in the 'Londonderry Sentinel' and the 'Derry Journal' and on Radio Foyle about my view on this. I have made no determination on the future of the Cottages. It is still being discussed. I am very aware of the excellent resource that it is and the support that it gives to some very profoundly handicapped members of our society. However, at the moment, the board is still discussing the issue. I understand that the chief executive of the trust met local MLAs to discuss the issue last week, and I think that we are quite close to making a determination on it. At the moment, however, there is no final decision on the Cottages.”
“If we decided that the Fire and Rescue Service was not to be part of that, I think that it would be almost impossible to find that £50 million. By finding that £50 million and taking efficiency savings elsewhere in the budget, we want to retain the protection of front-line services such as GPs, out of hours, minor injuries units and A&E.”
“Absolutely. As I mentioned, the Choose Well campaign is an attempt to get our 1·8 million citizens to take sensible decisions on accessing the health service. Often we find that people who should be in out of hours are going to A&E and people who are in out of hours should perhaps be going to their GP's surgery. The wrong choices are being made. Therefore, it is important that that campaign is successful. <BR /> <BR />We have made commitments in the budget to try to protect those services as much as we can, but my problem is that I still have to find £50 million cash savings and reductions in what are termed "non-front line". That means organisations like the Fire and Rescue Service, the Public Health Agency, the BSO and a whole raft of arm's-length bodies. That has been painful.”
“The Northern Ireland Fire and Rescue Service is similar to other front-line services, such as the PSNI, but is not afforded the same protection.”
“The front line in health, social care and public safety is a quite complex concept. It comprises a closely integrated team of staff who have direct contact with patients, clients and families, together with other staff who provide a wide range of critical support activities to individuals and the community. <BR /> <BR />I suspect that the question is aimed at the Northern Ireland Fire and Rescue Service, which would normally fall under the description of a front-line service. However, for the purposes of the draft Budget for 2015-16, which was endorsed by the entire Executive, the protection from reductions for front-line services relates solely to the health and social care elements within my budget — basically the expenditure of the five trusts.”
“The 18 to 20 potential confederations lend themselves to that type of activity. We certainly need to do something to cut down on the inordinate amount of paperwork that our GPs have to carry out. <BR /> <BR />The reality is that we will only really solve the problem when we encourage more young doctors to take on the role of being general practitioners, rather than going down a route of hospital work, where you can become a consultant as young as 34 or 35. That is the ultimate problem that we face, and the signs are quite worrying. Therefore, it is essential that the workforce review take urgent action to address that difficulty.”
“The Member is aware of the campaign that I think has been organised by the Royal College of General Practitioners and supported by the BMA to increase the proportion of the overall budget from 8·5% to 12%. The initial difficulty is, of course, that that would cost about £130 million and, in the present economic situation, it is very difficult to envisage where that money would come from. <BR /> <BR />Under Transforming Your Care, we are asking our GPs to come together in confederations in which they could have the scale to enable them to take action to reduce demand. One suggestion is that a group system or collaboration could employ a pharmacist to take on the role of dealing with the huge number of prescriptions and repeat prescriptions, which is a very time-consuming and bureaucratic activity for doctors.”
“There is an increase of almost 3·5% per year in demand, and that is bound to put pressure on GP surgeries, particularly when we know that we are 20% understaffed. I pay tribute to the GPs who are dealing with that situation. <BR /> <BR />The Choose Well campaign indicates that people should go for treatment only if they require it. It may be that, for instance, going to their pharmacy is an option, rather than going to their GP. People must use the service wisely and not automatically think that, if they are feeling a bit under the weather, they should see their doctor.”
“The one thing that the honourable Member for South Antrim will agree with me on is that our GP doctors are extremely popular with their patients. <BR /> <BR />In 2008-09, 10·2 million consultations were undertaken by GP practices. In 2012-13, that had risen to 12·4 million, which works out as 6·9 consultations for every man, woman and child in Northern Ireland per year — almost seven consultations — which compares to the figure of 3·4 consultations per year in England. In the Republic of Ireland, it is only three, yet there is no indication that the people in the Republic of Ireland are any less healthy as a result of visiting their GPs on less than half the number of occasions that we do. <BR /> <BR />That places a huge burden on GP surgeries.”
“Therefore, in this rapidly evolving situation, we are taking on board the trend to move away to other countries. <BR /> <BR />We do not have an awful lot of evidence of many of those doctors coming back, which is another issue. We thought that maybe they would go off, have a couple of years' experience, and then return to work in Northern Ireland. Maybe it is the sun, the social life or the wonderful scenery, but an awful lot of those young people are not returning. They are settling down in Australia and staying there. That issue does not just affect us but the whole of the United Kingdom, and it is a particular problem in GP surgeries. Whilst we have a general shortage of middle-grade doctors, that is particularly apparent among GPs, as becoming a GP is seen as a less attractive option to recently qualified doctors.”
“The Member for South Belfast is absolutely correct. There are over 250 trained GPs from Queen's University who are currently in Australia, Canada and other Commonwealth countries. The difficulty we face — this is something that we could not have foreseen, say, a decade ago — is that Commonwealth countries are offering better salaries and working conditions and more modern hospitals with excellent career progression. The Member will have to understand that, in order to turn round the situation, because training someone to be a GP is such a long-term process, you cannot immediately change your policies to adapt if things move rapidly. It can take seven or maybe eight years to be fully trained as a general practitioner or hospital doctor.”
“<BR /> <BR />Let me say that, despite the difficulties that the Member quite rightly outlines, in May 2014, the Patient and Client Council launched a report on access to GP practices, and 73·5% of those who responded said that they were satisfied with access to their GP, which indicates to me that, whilst our GPs are under considerable stress, they are doing excellent work in ensuring that there is access for all their patients throughout Northern Ireland.”
“What the honourable Member says is correct. Some 25% of GPs are over 55 and, of course, retirement is at 60. Currently, we have a 20% vacancy rate amongst GPs. I am sure that she understands that, before we can take significant action, we need to have the workforce reviewed to find out exactly what the extent of the problem is and take the necessary action. <BR /> <BR />There is also another difficulty, in that the GP role is not seen as particularly attractive to young medical graduates. The vast majority seem to want to go onto the hospital floor and, perhaps, become consultants. Therefore, we also have to try to make the GP route more attractive to young qualifying doctors. My understanding is that we will be reporting very soon on what is required to be done.”
“<BR /> <BR />No final decisions will be taken until the Department has considered the findings of those reviews. Increasing the number of GP trainees would, of course, require increased funding, and any decisions would need to take account of the overall financial position of my Department.”
“I am fully aware of the issues around recruitment and retention within general practice. As a result, under the remit of the regional workforce planning group, whose role is to take forward the Transforming Your Care (TYC) recommendations relating to workforce issues, a medical workforce planning subgroup was established to develop a suite of medical workforce plans, including for GPs, for the five-year period 2013-14 to 2018-19. The GP medical workforce group included representatives of the board, the Northern Ireland Medical and Dental Training Agency, the Northern Ireland General Practitioners Committee, the Royal College of GPs and my Department. In addition, the Health and Social Care Board has undertaken further work specifically examining potential initiatives aimed at improving the recruitment and retention of trained GPs.”
“Across Northern Ireland, there are currently 351 GP practices with over 1,215 GPs providing primary care medical services to a population of 1·8 million.”
“— teams available, do I ignore that and say that I know better? The answer is that I do not.”
“When all the clinicians and medical experts are telling me that the best way forward for stroke patients in Northern Ireland is centralised specialist units with a wide range of clinical —”
“We have a GP out-of-hours service that will continue to operate a seven-day-a-week service. We have a comprehensive range of assessment, diagnostic and treatment services, outpatient, mental health, children’s assessment, midwifery-led maternity, therapy and older people's services. <BR /> <BR />I hope that that indicates that there is still a commitment to Downe Hospital, that some of the services that have been removed have been taken out of our hands in the sense that we had absolutely no choice, and that the decision on Daisy Hill is based on the best clinical assessment of the situation. Now, am I going to ignore the stats and the science and say, with my GCSE biology, that I know better?”
“That does not mean that there is not a very effective role for hospitals in other fields. Indeed, we have been moving services to Downe Hospital to compensate for the fact that we have been forced, for other reasons, to reduce some services. If patients are transferred to the Ulster for clinical reasons, they are often transferred back to the Downe Hospital at the quickest possible opportunity. <BR /> <BR />We are committed to delivering a comprehensive range of assessment, diagnostic and treatment services for the local population, including inpatient beds providing 24/7 care for patients with long-term conditions and for the frail elderly close to home. We have a very successful day surgery across a range of surgical specialties. Indeed, the trust is keen to maximise day surgery services.”