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 honourable Member for South Belfast would like to be the undertaker for Transforming Your Care: he takes every opportunity to knock that fundamental review of healthcare provision. <BR /> <BR />The reality is that, if we were starting with a blank sheet of paper, we would not make these decisions because we are in a firefighting situation. Seven months of the financial year have gone, and we have five months in which to save £7 million.”
“I will make absolutely certain that this decision stacks up, because new information has been made available to me by the GPs, and I have to interrogate the Northern Trust on that.”
“The honourable Member for North Antrim makes a very valid point about middle management. The problem is that over 90% of the cost of management comes from staff costs. Even if I decide to save that money in staffing immediately, it would mean redundancies and you would not save any money for three years. That is the difficulty we have: 63% of our budget in Health and Social Care comprises wages, pensions and National Insurance, and we have no flexibility whatsoever to save money there. So it sounds like a good argument until you analyse it. <BR /> <BR />Mr Frew has also made some very good points to me about this decision. Mr Storey, Mr Paisley and Mr Frew have been very articulate in putting their views across on this issue.”
“The temporary closure of respite beds and intermediate care beds in the Dalriada Hospital will save £0·6 million in this financial year. The difficulty I have with this decision and many others is that, if by chance I listen to the comments made by the Members for Northern Antrim and reverse the decision, I will have to ask the Northern Trust to come up with another saving of £0·6 million. No one from North Antrim in the Assembly has given me any indication of where they would like that cut to be made.”
“Certainly, very valid concerns have been raised about the whole issue, and I intend to make absolutely certain that the Northern Trust, on this occasion, has made the right decision. <BR /> <BR />I also need to emphasise the fact that I have to balance the books by the end of this financial year. We are £70 million short of doing that, and therefore each of the five trusts, not just the Northern Trust, has had to make very difficult decisions. I have received representations from Bangor, Whiteabbey, Armagh and from throughout Northern Ireland on similar difficult decisions, but this is where we find ourselves as far as budgets are concerned.”
“The answer to the last question is, "Yes". This morning, I met the MP for the area, Ian Paisley Jnr, Mr Mervyn Story, an MLA for North Antrim, Dr Mary McLister and Dr Martin O'Kane, who made very articulate points about the future of the Dalriada Hospital. I have undertaken to interrogate the Northern Trust on the points raised with me this morning. They put those points much more politely than the Member just did, but apart from that they were very similar.”
“<BR /> <BR />Respite services to MS patients will still be provided, and everyone who requires respite will receive it. The trust will be working with everyone involved to ensure that service users' assessed needs are central to the process moving forward. The trust has also assured me that respite care for anyone who has been booked in for November will be honoured and that there will be no change to the booking. My Department will monitor the situation closely over the coming months to ensure that the service provided to MS sufferers in the Northern Trust continues to meet the needs of the local population.”
“As a consequence of the Budget pressures, it would simply not be possible to maintain the current levels of service provision in the absence of the entire required funding of £130 million right across HSC. However, I assure Mr McKay that the trust will endeavour to minimise the impact on front line patient care. Key workers are therefore arranging to meet service users and families over the coming days to ascertain their specific needs and identify the providers that would provide the best alternative to Dalriada Hospital. That will include the consideration of individual and group bed-based provision. Where service users would prefer to have direct payments made so that they can make their own arrangements, that will also be an option.”
“In my statement of 30 October 2014, I said that my priorities are to ensure that services provided by Health and Social Care (HSC) are safe and effective, and to ensure that my Department achieves financial balance, which is required of all Ministers. To achieve those aims, trusts have provided a range of contingency proposals. Each trust has provided assurances that its services will remain safe and effective. <BR /> <BR />As part of its contingency plans, the Northern Trust has proposed the temporary closure of respite beds in the Dalriada Hospital, Ballycastle for sufferers of multiple sclerosis. I regret that the trust has had to take that action.”
“Mr Deputy Speaker, you have been very generous. <BR /> <BR />Therefore, the commitment to the additional million pounds stands, and my door is open to anybody in the Chamber or any group that requires further clarification of the route on which we are travelling.”
“I am happy to reiterate my Department's commitment to investing in the service. One Member raised the issue —”
“<BR /> <BR />Remember that some of the gentlemen and ladies who are experts in this field will simply carry on the same work in a different location. Remember that all those specialists have the same high level of training and work together. There is no form of closed shop between Northern Ireland and the Irish Republic in the field. Specialist paediatric cardiology skills will be retained and strengthened in Northern Ireland. I want to go further and say that that strengthening will make Belfast a centre of excellence for cardiology. I have asked the Health and Social Care Board to make investment proposals to secure that and strengthen the regional cardiac network at the same time. That will secure the specialist skills available in Belfast as we go forward to a single-service model.”
“<BR /> <BR />Several Members raised the issue of the 18 months, and I hope that I have already indicated that the service-level agreement will continue. There is no intention of having any falling off the cliff edge as far as any of the service delivery is concerned. I am fully aware of the risks surrounding the 18-month period and how those skills will be implemented during it. It is essential that, during the transition, the skills be maintained, and my Department will work closely with the commissioners in Northern Ireland and the Republic of Ireland during that period. For example, we envisage that Belfast cardiologists will carry out interventional procedures in Dublin as early as possible in the new year.”
“<BR /> <BR />I have listened to the speeches made by Members this evening and will respond to some of the points that have been raised. Mrs Dobson was her usual articulate self, and she raised a number of points that I want to deal with. First, recommendation 6 of the working group report is clear that there is a need to expand and upgrade the links between the Republic of Ireland and Belfast in paediatric cardiology and to provide ongoing information and technological support. It specifically states that IT be targeted, and it is the view of the IWG that the infrastructure to support the remote acquisition of radiographic images already exists and there is a significant benefit to be had from utilisation of that infrastructure. That will be a key element in the model that is being taken forward.”
“I made the oral statement about the international working group's proposed model and the way forward. However, I wish to restate that I am particularly pleased about the strong voice that it gives to families' representatives on both the governance vehicle and the family advisory group. I have met many of the parents, and not only are they deeply caring and loving — their children are very fortunate to have such wonderful parents — but they are very articulate. I have no doubt that, if we get this wrong, they will be beating on my door to tell us that that has happened. Therefore, they have a strong voice, and we want to utilise that. We believe that the proposals, if implemented, will empower the families in shaping the future service in a way that they could never have envisaged. It is something that is completely new.”
“I can place myself in your shoes, and I suspect that, if I were in your position, I would probably say the same. However, I have to take a decision in the Chamber that is best for all the children of Northern Ireland. Although I am a unionist and want to retain services in the United Kingdom and in Northern Ireland, I have to say that I am left with no option. My predecessor Edwin Poots, whom I have the highest regard for, wanted to publish the report as soon as possible, but we reached the situation where joint statements were made this morning. <BR /> <BR />As I said, I have experience of meeting many of the families, and I am well aware of their views. They also made representations to me in my position as Deputy Chair of the Health Committee. I do not want to repeat the debate that we had this morning.”
“<BR /> <BR />On the first Saturday after my appointment, I attended, with Mrs Dobson, a very moving event in Banbridge. I must say that I found that a difficult event. I met parents who had given their lives to looking after terribly vulnerable, ill young children. I met the parents of Grace McKee at that event, and I met them yesterday. I have nothing but admiration for these people and what they are doing. Therefore, it is absolutely vital that all of their experience at the coalface is taken into account and that we make certain that the move to Dublin, which looks likely to occur, gives rise to as few problems and practical difficulties as possible. <BR /> <BR />I must say that I am fully aware of the deep concerns felt by Members, patients and their families.”
“That was not an attempt to undermine Mrs Dobson's debate, although I appreciate that she may have felt that it was. <BR /> <BR />We have the report, and it is emphatic and clear. No one has attempted to say that the Mayer report does not point us in this direction. The stats, unfortunately, tell us that there is only one route that we can go. I hope that I outlined this morning that we intend to build in safeguards to make absolutely certain that the transition is made without affecting the care of our very vulnerable and needy children. I have also indicated that there will be structures to make certain that the wishes of parents, North and South, are fully considered as we set up the new service. That has to be done. I, personally, intend to pledge myself to ensuring that that happens.”
“We have to work closely with the authorities in the Irish Republic and Minister Leo Varadkar. As it happens, he is new to office, and I am new to office. The dates on which we came into office are not that far apart. It has been difficult, in that situation, to get agreement on when the report would be published. We could not do a solo run. This is a joint approach by the two Governments, my Department and the HSE in the Irish Republic. We could not go on our own. I think that Mr Poots felt duty-bound to give some indication, but he was not in a position to publish the report — he could not. One of my first decisions was to issue a written statement to tell the public about the direction of travel, but we were not in a position until now to publish the report.”
“That leaves us with two choices: to send all our children to England — to Birmingham or London — or to concentrate an all-island service at a location that, I realise, will cause considerable difficulties but is preferable, as Mr Swann said, to having that service in England. <BR /> <BR />There is only a single service in the Irish Republic at the moment. Babies from places such as Kerry, Sligo and Waterford already travel longer distances than children from Northern Ireland would be expected to travel for the same service. I hate mentioning statistics, but the outcomes tell me that this is a safer model than the one that we have. <BR /> <BR />I accept that all sorts of allegations were made this morning that the coincidence of events happening today was a chance to stymie Mrs Dobson's debate. Nothing could be further from the truth.”
“I hate to mention statistics, because we are dealing with human beings — passionate, dedicated parents — but the demographers tell us that Northern Ireland will never have a sufficient number of children to guarantee that the service would be sustainable and would attract clinicians. The problem that we have is that these specialists can move freely across the world. We have difficulty attracting and retaining surgeons in many fields in Northern Ireland because of our size. It would not matter if I committed to the Clark clinic and surgery in Belfast. If I cannot attract and retain the expertise that the trust and I need to continue this surgery, we cannot provide the best service for our children in Northern Ireland.”
“The Member will see from the report, which I am certain that he has had a chance to look at briefly, that Dr Mayer is absolutely emphatic that we just cannot continue with the model that we have at the moment. There are all sorts of reasons for that, not only numbers. We cannot attract and retain the specialist surgeons that we will need —”
“I would love to have come here this morning, this afternoon and this evening — the topic has been raised three times — and said that we have the numbers, the resources and the clinicians to run a full, sustainable service in Belfast. Nothing would have made me happier. However, the obvious fact is that everyone who looked at the issue has said that it just cannot be done. The honourable Member welcomed the international working group led by Dr Mayer and accepted that he is one of the world authorities on the issue. He works in Massachusetts, where he deals with this very issue of smaller congenital cardiac units, and he looked at this.”
“Those are the realities that we face. Indeed, in some years, the entire island of Ireland has just about enough procedures for a safe and sustainable service. <BR /> <BR />My difficulty, which I mentioned to Mr O'Dowd, is that I have had four separate reports by four separate bodies telling me that this is not safe. What do I do with my GCSE biology? Do I say that I know better, or do I listen to world authorities from places like Harvard and to the Chief Medical Officer, who tell me that we cannot continue in the way that we are going and we have to change? Which advice do I take? I am afraid that I am left in an extremely difficult position. <BR /> <BR />Frankly, it is a decision that I did not want to make.”
“Yes indeed, there is much more to my speech than cold, hard statistics. The Member is across the statistics and has rightly taken a deep personal interest in the issue. However, it is only when you see where the statistics are taking us that you realise why we are in the position that we are in. Hopefully, none of this is revealing any personal information about any patient. <BR /> <BR />The reality is that, in the first five months of this year, only 12 procedures were undertaken in Northern Ireland, with four in Dublin and 58 in England. The total so far is 74. The reason why I make that point is that all the expertise tells me that we need at least 400 procedures in order to have a safe, sustainable service for our children, Unfortunately, even in the best year, we had 159 procedures, which is a long, long way short of 400.”
“First, I thank Mrs Dobson, a Member for Upper Bann, for securing the debate. This is not a question of right or wrong; it is a question of two rights. It is not a black-and-white argument. When I first came to the issue, I thought that it would be very attractive to retain services in Belfast, but we need to look at some cold, hard statistics. In 2011-12, there were 140 surgical procedures involving children from Northern Ireland. Of those, 97 were carried out in Northern Ireland, 13 were carried out in Dublin and 40 were carried out in England. In 2012-13, 69 were carried out in Northern Ireland, 36 were carried out in the Republic and 37 were carried out in England, a total of —”
“Mrs Kelly raised the same point. The service level agreement will be continued past the end of the consultation period. There will be no change, no hiatus or two-week gap. It will just continue on well past the consultation period because, remember, we will still need time to look at the consultation responses. So, that will not cause any problems.”
“Will the Member accept that this was the fourth report recommending the same policy change and that I was faced with a situation in which four totally different bodies, coming from totally different angles, had all reached the same conclusion, which is that we have to concentrate on Crumlin hospital and that therefore to do anything else would be totally negligent?”
“A report that we received on 30 September shows that there have been 2,363 new registrants on the register through the Northern Ireland website. So, this is good news. <BR /> <BR />What we really hope will happen is that people like me will voluntarily put their name on the register and that we will have sufficient organs to ensure that everyone is covered and that there is no need for any further legislation. This is the commitment of the previous Minister to try to deliver that, and well done to the 2,363 people who have newly registered. They could save somebody's life some day, and they have to be applauded for that.”
“<BR /> <BR />This campaign has included the development and production of two TV adverts; two radio advertisements; outdoor posters, which I am sure that we have all seen; online advertisements; Northern Ireland-branded organ donation leaflets and posters; and, of course, an information website. The initial phase of the media campaign ran from 12 February until 31 March 2014. The second phase of the campaign began on 1 June and will run to the end of this month. <BR /> <BR />The impact so far has been significant. I know that the honourable Member is taking an interest in this. Since the campaign was launched, there have been 23,148 visits to the website. Before the campaign started, there had been 20,826 new registrants on the organ donor register. That is 598,000 in total.”
“The PHA, as you know, has been organising and running the Speak Up and Save a Life campaign for organ donation, and that has encouraged people to talk to their family and friends about their organ donation wishes. The moment that I was appointed Chair of the Health Committee, I immediately registered my organs for donation. They should be good, because there is not a hint of alcohol in any of them, so they are good quality organs. I also did it because a certain radio show that begins at 9.00 am on a Monday and ends at 10.30 am and which will remain nameless would have asked me that question.”
“So many people were expecting to go to places such as the North West clinic and Kingsbridge for surgical procedure, but that is no longer available because of financial constraints. We are in great difficulty, financially, in health. We still need an extra £70 million. I understand that very little is coming through the pipeline in monitoring rounds, so we have difficult decisions to take, and there will be complaints about those decisions and what affects people. Worrying about that is probably what keeps me awake at 1.00 am. If I had an extra £71 million, I would be sleeping very soundly.”
“The Member will accept that, despite the enormous difficulties of the recession, the previous Minister invested in 500 more full-time nurses and a 15% increase in consultants and that we are about to appoint 61 new health visitors. The doom and gloom that his party and the Members to my right painted have not come true. <BR /> <BR />I go back to my early point. We have had a very large increase in demand and a finite supply of experienced staff and facilities. Often, that can lead to a situation where a bed is not available. In an emergency you tend to have to use a bed rather than use it for an elective procedure. The other problem, of course, is that we no longer use the route of the private sector to relieve waiting lists. That is a huge concern for me.”
“I read that front-page article in the 'Belfast Telegraph' last night. It is a worry. I would like to dig down to see where exactly those figures came from. Presumably, they came from a freedom of information (FOI) request by the appropriate journalist. There are, often, reasons for this. There can be staff illness, a lack of backup or problems with some of our consultants who are flying in from other places to do the work. I do not know what the cause is. However, we will investigate that story and find out what is happening and come back to him on it. I know that my life will not be worth living if I do not answer his question; he is a bit of a terrier on this type of issue. He is right to raise it, but the first indication that I had of that story was when I opened the newspaper at about 1·00 am.”
“In surgeries, I would like to see spring chickens rather than old roosters, as it were, who are about to retire and, indeed, have made the point that, if they were given an appropriate package, they would go in the morning. That attitude worries me. When you go to hospitals, you see far more young doctors who are keen to advance their career.”
“Whilst I accept that GPs are under incredible pressure and the statistics that they have provided me with show an escalating number of patients, remember that Northern Ireland's population is now 1·826 million. That alone puts pressure on doctors. There is no indication of any closures, but, without doubt, there is an indication of very hard-pressed staff. At hospital level, of course, we have had to curtail hours in places such as Downe and Lagan Valley because we could not get the middle-grade doctors. The Member is right to flag this up. We will have problems here, and that is why the review is so timely. We are looking at an intensive study of our workforce to identify where we will get GPs in the future. As I go round surgeries throughout Northern Ireland, unfortunately I see that many GPs look my age. That is worrying.”
“<BR /> <BR />What I can tell you is that the Department is carrying out a review of the medical workforce to look at issues like that. Undoubtedly, the shortage of candidates presenting themselves for GP cover will be an absolute priority and something that we will have to deal with at university level. On top of that, of course, many of the potential GPs are not here but on Bondi Beach. We lose 50 trained doctors a year to Australia, where the salary and the conditions are much more attractive. That has a profound impact on the pool of experienced medical graduates as well. The Member is pushing at an open door, and it will have to be dealt with as soon as possible.”
“The honourable Member for Strangford asks a very apposite, topical question. I had dinner on Friday night with the leader of a GP surgery in the East Londonderry constituency, and he made exactly the same point. The sad thing is that the GP route is not seen as an attractive one for young local doctors. Many of them want to be consultants. Many of them want to have career progression at the A&E or hospital level. Nothing surprises me now, but I have seen consultants who look like my grandson. They are so young that it is absolutely unbelievable. People are becoming consultants at 30, 33 or 35. That is very attractive, but, meanwhile, GP surgeries tell me that they are having great difficulty attracting the same young doctors to work for them.”
“I want to make it clear that Belfast will still be a centre of excellence for cardiology. We are not closing that down. The concern that that might happen was raised during the consultation period. However, I am left with four independent reports that all tell me that the option of Our Lady's in Dublin is the only way forward. I would be negligent to ignore that.”
“A bit like with Transforming Your Care, we will move into a difficult transitional period between the removal of services from Belfast and a greater uptake in Dublin and then, in 18 months' time, the final service provision in Dublin under a memorandum of understanding. That has to be watched extremely carefully. However, remember that, since January 2014, many children from Northern Ireland have already been down to Dublin for congenital heart surgery. As far as we can see, that has generally worked well. Many patients from Dublin have been sent to either Birmingham or London for surgery, so it is an almost international arrangement that we have. <BR /> <BR />I regard it as absolutely essential to watch carefully to ensure that none of the care of these very vulnerable children is remotely affected for these 18 months.”
“I have no party political baggage in this; I will do what is best for those children. If the best place for those children to be treated is Dublin, so be it. There can be no boundaries or difficulties with that. We owe it to the children. They should go to Birmingham or London if needs be. Equally, there will be people in the Irish Republic with other conditions for whom the best care in is here. That is sensible cooperation between two self-governing jurisdictions.”
“I have published on the Department's website this morning the full, unabridged report; it is all there. I have read it, my officials have read it and we believe that what it recommends is the best way forward for very critically ill children. However, there may be some important observation during the consultation; we do not know. Legally, we are duty-bound, but we can, of course, make preparations during the consultation period. Then, if the consultation comes back giving it a full bill of health, we can move on. <BR /> <BR />I remain open-minded. I have to say, Mr Kelly, that my priority is how we deal with some of the terribly ill children whom I have seen over the last three or four weeks. It has broken my heart to sit in rooms and see how ill those children are.”
“I think that he is a world authority on court services, and he is not a barrister. With any consultation, in order to do things legally, you have to have a period when people can reflect.”
“The honourable Member for North Belfast has vast experience of the Court Service, and he will understand that, when any consultation is carried out —”
“Whilst the ways of contamination are very specific, we have seen health-care workers, who have returned from Liberia, Sierra Leone, Nigeria and other affected areas, becoming infected. Therefore, we have to do absolutely everything to ensure that the condition does not spread; but, remember, the vast majority of people coming from west Africa come through airports in London or Dublin. That is where controls have to be effectively exercised to ensure that, when they move on to Northern Ireland, they have already been screened for the dreadful condition.”
“<BR /> <BR />In recognition that some staff may wish to volunteer to work in the affected areas, the UK Chief Medical Officer recently issued advice to health-care workers advising them to register with the UK international emergency medical register. That will enable an appropriate mix of staff to be selected and trained, with arrangements to follow up and monitor them on their return. As I have mentioned, we reckon that there are about 600 front line staff in countries like Sierra Leone, which, being part of the Commonwealth, has strong UK links. <BR /> <BR />The monitoring of this terrible disease is an absolute priority. It has killed over 4,000 people in west Africa.”
“Yesterday, I had a call from the junior Minister for health in London, and he brought me up to date with the UK-wide situation. I am sure that the Member is aware that an exercise was carried out on Friday in readiness for the potential for Ebola to arrive in the United Kingdom. We believe that there is a small number of UK health workers who are caring for Ebola patients in west Africa. Indeed, the Minister quoted a figure to me yesterday of about 600. That would indicate that between 15 and 20 of those people could be from Northern Ireland. Indeed, given the history of Northern Ireland people in helping those in need in the Third World, it might be more, but that gives you an indication of the numbers that could be involved.”
“In Northern Ireland, the Public Health Agency, through its health protection service, has communicated with colleagues covering all sea ports and airports in Northern Ireland, informing them of the current situation and directing them to sources of other information. In order to reduce the risk of international spread of the disease and in line with World Health Organization guidance, the affected countries have introduced exit screening at airports to ensure that individuals who are unwell do not board flights.”
“<BR /> <BR />In addition, the Chief Medical Officer has sent five letters to the chief executives of the health and social care organisations providing information for all front line clinical staff who may be treating or admitting patients, all infection prevention and control staff, and GPs and practice staff. The letter includes flow charts for use by staff in emergency departments and by staff in primary care for dealing with patients who present with Ebola-like symptoms. The Chief Medical Officer has also written to all schools, universities and further education establishments. <BR /> <BR />It is important to note that the UK has robust systems in place for infectious disease control, including at airports and ports. Advice by the UK Border Agency has been circulated to all United Kingdom ports.”
“Again, that is a very timely and topical question, and I thank the honourable lady for that. <BR /> <BR />In order to deal with the potential importation of a case of Ebola disease in Northern Ireland, my officials have been working closely with our counterparts across the rest of the UK and the Republic of Ireland. The Public Health Agency is responsible for protecting the public from communicable diseases in Northern Ireland. The PHA has been coordinating with regional planning, in conjunction with the Department and the five trusts. The planning has included the development of patient care pathways by all trusts; preparation for the management and isolation of suspected cases; the accumulation of appropriate personal protection equipment; and the carrying out of staff training.”