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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“However, any final decision would have to take account of the significant workforce and financial implications it would give rise to and the consequential additional pressures it would place on the health service budget.”
“I thank the honourable Member for the question. It is very appropriate and timely. <BR /> <BR />Currently, all patients across Northern Ireland have access to GPs during working hours, which are defined as 8.00 am to 6.30 pm, five days a week. That is supplemented by access seven days a week to the GP out-of-hours service. I am keen to explore how greater flexibility can be provided for patients to access GP surgeries. I already have written to Dr Tom Black and arranged a meeting with him on 23 October to explore this and other issues. Mr Tom Black, of course, is chair of the BMA's Northern Ireland General Practitioners Committee.”
“<BR /> <BR />The good news is that I ate, slept and drank Transforming Your Care, because it came in during my time as Chair of the Committee. I have had many meetings with John Compton, Fionnuala McAndrew and other senior staff about it and expect that there will be many more to come. We will continue to give it absolute priority.”
“It is going to take three to five years to complete, and that remains our ambition. However, the financial pressures that we face today were not evident when TYC was published. We have to be mindful of the potential impact that that could have on the scope and scale of change that may be possible. <BR /> <BR />We are going through the very difficult transition period between the publication of 'Transforming Your Care' and its final fruition. The difficulty is that, while that is going on, demand continues to rise, and budgets continue to be flatlined or go down in real terms. That is a challenge. I talked this morning about paediatric congenital heart disease being in my top five. This is also in my top five of issues that we are going to have to deal with.”
“I think that the honourable Member for Mid Ulster has got it totally wrong. I am committed to Transforming Your Care (TYC), as indeed were the majority of the Assembly, including himself, when it was discussed on numerous occasions. <BR /> <BR />John Compton's analysis is accurate. It is proving difficult in the present financial situation to deliver all that we want to as quickly as possible. However, Compton said that, if we do not change the way that we do things, by 2020, we will not be able to afford an adequate health service. Far too many people are too far up the ladder of health-care provision in Northern Ireland. We need to give them support so that people are treated at the right level, commensurate with their needs. The partnerships are continuing.”
“We need to make certain that, in an emergency, they have the full information. I would welcome the opportunity to discuss that with the Member.”
“It is a very interesting point that the honourable Member for Lagan Valley has raised and one that, in my five years, two months and six days on the Health Committee, I have not heard mentioned before. I suggest that the best way forward on this is that, if he has specific concerns, he contacts my diary secretary and we meet to discuss the issue. <BR /> <BR />It is absolutely vital that Ambulance Service staff have the full information available. As I mentioned earlier, those staff are under incredible pressure, with an increase of 5% per annum. However, it is important that, when collecting a patient, they have the full information required to deal with that patient. Remember, those men and women deal with some of the most horrific and difficult circumstances that any of us could ever face.”
“Examples include provision of specialist information to GP practices on care for patients with long-term conditions; increasing provision of structured education programmes for patients with type-2 diabetes; development of an integrated role for third sector organisations in supporting older people in the community; and collaboration with the Northern Ireland Ambulance Service on its approach to handling emergency calls concerning diabetic cases. <BR /> <BR />I welcome the contribution of all the health and social care providers who are participating in this work to improve the integration of care for patients and service users.”
“Integrated care partnerships (ICPs) work as multi-sector collaborative networks of health and social care providers that come together to respond innovatively to the assessed care needs of local communities. The initial focus of the 17 integrated care partnerships, which were established in September 2013, is on the frail elderly and aspects of long-term conditions, namely, diabetes, stroke care and respiratory conditions. <BR /> <BR />ICPs have been engaged in reviewing care pathways in their respective local areas and have identified opportunities to enhance service provision for citizens of Northern Ireland.”
“I know that I got myself into very serious trouble by saying this to a packed public meeting in St Patrick's Grammar School about a year ago, but I am still convinced that, in the absence of middle-grade doctors, we cannot continue to treat patients. Technically, it is illegal. We cannot do it. Therefore, until we solve that problem, we will have to divert patients to the Ulster Hospital, with all the difficulties that causes. It is not a lack of will by the board or the Department to ensure that those staff are attracted.”
“The honourable Member for South Down has sat with me, when I have been wearing my other hat, in many meetings on that issue. He is aware that the problem at Downe Hospital is not one of resources; the problem is attracting middle-grade doctors to staff the hospital at particular times. All attempts by the South Eastern Trust's personnel department to get experienced doctors to apply and work at Downe Hospital have been largely unsuccessful. <BR /> <BR />Personally, I am convinced that the information that I am getting on this from the chief executive of the South Eastern Trust is correct. I have been shown just how few people are applying.”
“<BR /> <BR />The second phase of the redevelopment programme will see the construction of a new £108 million acute services block. Enabling works started in August 2014, with construction due to start on site in autumn 2015 and scheduled to be open to patients in early 2018. The new acute services block will provide 150 beds, including acute observation assessment beds, an acute assessment unit, acute wards, an emergency department, imaging, new emergency parking, and kitchen, dining and support services. <BR /> <BR />I hope, Mr Dunne, that indicates a huge commitment by the Department to the people of North Down and Strangford. Despite very difficult financial circumstances, the capital budget has ensured that the people of North Down and Strangford are very well catered for at the Ulster Hospital.”
“I know that the honourable Member for North Down lobbied my predecessor very heavily on that particular issue. He is very much a defender of the Ulster Hospital. I have no doubt that will continue. <BR /> <BR />Work on the first phase of the latest redevelopment programme is ongoing and will provide a new £115 million generic ward block at the Ulster Hospital. That new ward block is due to be completed in late 2016 and open to patients in early 2017. We will make certain he gets an invite to that opening. It will provide 288 beds, comprising 12 inpatient generic wards, surgical and medical, each with 24 en-suite bedrooms. There will also be day surgery, endoscopy, and four day surgery and three day endoscopy theatres, pharmacy and support services.”
“I am going to go back to the officials, because doing it for the South Eastern Trust would indicate that it could be in Downe Hospital, Lagan Valley Hospital or the Ulster Hospital, and that is not the level of information that he expects. That seems to be why he is not getting the specific information that he requires. I am going to have a look at that, because I think that he has made a valid point.”
“I am aware of concerns expressed by the Member and others representing Strangford and North Down that SAIs are collected at trust level and not by individual hospitals. There is a question for written answer before me at the moment, and I have turned that around immediately. It has ruined several Saturday nights for me having to answer those questions from the Member and many others. I understand where the problem arises, but the difficulty is that, if there are fewer than five serious adverse incidents, you run the risk of revealing the identity and personal circumstances of the individuals concerned. <BR /> <BR />I must say that I thought the Member raises a valid point.”
“The number of 12-hour waits has reduced significantly, with only 46 people waiting longer than 12 hours in the first four months of the current year, 2014-15. The percentage seen within four hours has also improved, with an average of 76% in the first four months of 2014-15. I am looking to the Health and Social Care Board, working with the trust, to ensure that progress in delivery against those agreed standards continues. I congratulate and thank the staff of the Ulster Hospital for tackling the issue and making solid progress.”
“Since 2011, the Ulster Hospital has seen an increase in emergency department attendances and emergency admissions, again confirming my earlier point. The South Eastern Trust has advised that admission rates in the current year to date represent a 2·7% increase on the same period in 2013-14. There has been an improvement in the trust’s performance against the 12-hour emergency department target for 2013-14, with 1,092 patients waiting longer than 12 hours, which is almost half the equivalent number for 2012-13. Performance against the four-hour target fell slightly to 70·5%, compared with 73·1% in 2012-13. <BR /> <BR />It is unacceptable to me that anyone should have to wait unduly at A&E. Whilst 12-hour waits have not yet been eliminated, there is evidence that progress is being made.”
“We need to concentrate on that rather than on studies that, frankly, do not show a positive or negative correlation either way.”
“<BR /> <BR />Of course, there is the underlying geology of places such as south Down, where radon gas is a problem, but that is well known. We do not yet know about man-made influences, but the truth is that the quick hit — the low-hanging fruit — in Northern Ireland to stop cancer in many cases is to stop smoking. We lose about 800 people a year to lung cancer in Northern Ireland. Some 85% to 90% of those are people who were smokers, and many of the rest were exposed to passive smoking. That is how we save lives, and that could be done at minimal expense. <BR /> <BR />I had a friend in Downpatrick who recently died from lung cancer. I saw what that lady went through in the last six months of her life. She admitted that her heavy smoking had caused that terrible illness.”
“I know that MLA McCarthy and several others who represent east Down have indicated their concern about the presence of Sellafield and clusters of cancer that, they believe, have arisen from that installation. I have to say that the statistics do not really bear that out. The MP for South Down, Ms Ritchie, and her predecessor, the late Eddie McGrady, have also asked parliamentary questions about that. The statistics seem to show that the incidence is no different from that in other parts of the United Kingdom or the rest of Northern Ireland, and that it relates to other factors, such as lifestyle choices, with smoking, and so on, being the main determinant of cancer. We watch those statistics with extreme interest, but, as things stand at the moment, we cannot be definitive in that respect.”
“Unfortunately, some people have to face the ultimate reality. <BR /> <BR />I pay tribute to the four Members who contracted cancer and had the courage to go public and tell of their journey: Jimmy Spratt, Paula Bradley, Oliver McMullan from East Antrim and Seán Rogers. They have come forward, explained their journey and shown that there is hope. I hope that we can give them all a 30-year contract, review their situation at the end of that and that they will be with us for many years.”
“As I said earlier, the outstanding work at our centre in Belfast City Hospital has led to huge changes in survival rates. I am glad that he did not ask me to answer in Irish; the only Irish I have is Bord na Móna. Therefore, I will answer entirely in English. <BR /> <BR />We have achieved so much already using the resources that we have: we have managed to attract from throughout the world some of the top consultants and experts in the field; Queen's University is a world leader in research and development in the field; and we have some top PhD students doing tremendous work. Where we are is not perfect, but it is a long way from where we were before we opened the centre. We are making progress, but we have to be cognisant of the fact that people get terribly bad news, so it is not all plain sailing.”
“It shows that it is not a one-way process. The Irish Republic is sending patients to us, and we are sending patients to places such as Our Lady's in Crumlin. I welcome this. It is full steam ahead. To be honest, I could not go back to Londonderry having not made that announcement — I think that I would have been hounded out of the city. When I go back this week, I think that it will be a very welcome process. I really look forward to the cutting of the ribbon for this wonderful facility and hope that I am still in office for that.”
“Even the Chair of the Health Committee had a small smile on her face when I announced this morning that the radiotherapy unit at Altnagelvin in Londonderry will open on time in 2016. I know that that is of great benefit to Mr Robinson's constituents in Limavady and other areas. Not only is that good news for the north-west, it is good news for Northern Ireland. By 2015, the City Hospital cancer unit will be at full capacity, so Northern Ireland plc will not have sufficient spaces. <BR /> <BR />It is also good news for the people of the Irish Republic. Cancer sufferers in places such as Donegal, Sligo and Leitrim will no longer be forced to go the whole way to Dublin; they can go to Altnagelvin for their treatment. This is a good example of the Irish Republic and Northern Ireland working together on an issue of common concern.”
“It is moving from being a very life-threatening condition to a long-term one. Of course, there are still many who have had the trauma of receiving very bad news indeed, but the movements are in the right direction. I congratulate the staff at the Belfast City Hospital cancer centre and all the clinicians who have done so much to take us to the forefront on these issues. We can do better, but this is a good news story. When I was young, which was a very long time ago, as you know, Mr Brady, 82% of those who had leukaemia in childhood passed away. Now, 82% are alive after five years. We have made real, major changes. Investment in cancer services over the last 10 years has been considerable, including, of course, the opening of the new cancer centre, in which we invested £70 million.”
“<BR /> <BR />I do not know what that report will say, but it may deal with many of the issues that the Member has raised. Remember that we, as a society, have increased our spending on drugs by £30 million, and a large percentage of that has been on cancer drugs. The outcomes indicate that we are doing very well, and, most importantly, for the first time in Northern Ireland's history, more people are now living with cancer for five years after diagnosis than have passed away.”
“I watched that programme twice on the iPlayer just to make certain that I had picked it up correctly. I also met Mr Allister Murphy, who was one of the main, very articulate spokesmen on behalf of cancer sufferers. I met him in my office here at Stormont. Some very strong points were made, but, as he knows, before that programme was made, we had instigated the individual funding request (IFR) review process. We are looking at the whole individual funding request mechanism to see whether the exceptionality test is fit for purpose in the present situation. That is due to report to me at the end of November, so that is how urgently we take the issue. At the moment, that is the best vehicle to deal with the issue rather that instigating other measures.”
“<BR /> <BR />The improvements have been impressive, but we must not be complacent. They have all been achieved against a background of increasing demand. Since 2009-2010, the number of patients receiving treatment for cancer after an urgent referral has increased by 42·3%, which again emphasises the point that I made earlier. With an ageing population, that figure is likely to increase. It is predicted that, by the age of 75, one in three in Northern Ireland will have cancer.”
“Over the past decade, we have witnessed significant progress in cancer provision in Northern Ireland, which has led to real improvements in outcomes for patients across a wide range of cancers. A recent Europe-wide study shows that Northern Ireland cancer survival rates for lung, breast and prostate are the best in the UK. These improvements 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.”
“I am absolutely convinced that it is the sheer numbers coming through the clinics, the GP surgeries and the hospitals that are causing our problem, and the stats show that. It does not take a genius to work out that, if demand continues to rise at GPs — they have confirmed that — at clinics and at hospitals, and there is more out-of-hours demand, we will inevitably require more money to do it. You can achieve only so much in the way of efficiencies before you end up needing more money. "More money" sounds dramatic, but is only something like 2·2% of the entire budget that we are looking for as extra resource and is not a huge amount in the overall scheme of things. It seems a large quantum because you are dealing with Health, which is the biggest-spending Department in the Northern Ireland Executive.”
“The honourable Member for South Belfast is correct: we must always look for value for money in expending such a huge budget. As my predecessor said just before he left office, "Is every penny being spent absolutely correctly? No, there will always be opportunities for savings". However, remember that he, in his first three years of the CSR, took £490 million in savings out of the system and transferred it to front line care and more important matters in the budget. This year, we have pledged ourselves to £170 million of efficiencies, and that has caused each trust and the board to examine every aspect of expenditure. <BR /> <BR />There are certainly more efficiencies to be made, but I do not believe that that will solve our difficulty.”
“<BR /> <BR />There are radical changes ongoing in the health service; for instance, the Transforming Your Care initiative, which requires highly qualified administrators to carry out that change. So whilst we are dedicated in this incoming year to looking at admin charges, I do not think that that is a silver bullet. <BR /> <BR />It is clear that the problem is increased demand: 6% as far as the clinical aspect is concerned. I met the Ambulance Service on Friday in Limavady and their stats show a 5% increase in demand for their services, so there is no great science involved here. The difficulty is that as society ages and we become more infirm, demand rises. The result is a huge pressure on budgets. I do not believe that it is inefficiency; I believe that it is simply the effect of demand.”
“The Health Committee, when I was Chair, looked at the issue of administrative costs in the health and social care system in Northern Ireland. The figure that they came up with was 4·1% on a £4·65 billion budget. That compares very well with health authorities in the rest of the United Kingdom and, indeed, internationally. <BR /> <BR />Any organisation that is administering such a large amount of money and can keep its admin costs down to that level is relatively efficient. However, even if we were to take a percentage point out of that, which would mean a radical downscaling in admin staff, that would not come anywhere near what we need to achieve to balance the books for this year.”
“That has remained the situation: we are getting more and more demand, and yet our bottom line in increasing budget is only 2%. That is the pressure that is beginning to tell. Efficient, well-managed trusts are telling me that they are finding it very hard to manage. They believe that it is not inefficiencies; it is simply the sheer number of people presenting for treatment.”
“The Member is correct. The current reported deficits for 2014-15 amount to £133·3 million. Clearly, some of the £60 million and £20 million will have to be used to address those issues. Also, the trusts have been told in no uncertain terms that they must balance the books for this year. That will be extremely challenging. <BR /> <BR />In my previous capacity, I regularly met the chairs or chief executives of the trusts. In the first three years, they were somewhat relaxed about their budgetary situation and said that whilst it was challenging, they were going to meet their targets. This year, they are telling me that it is extremely difficult. <BR /> <BR />The reason for that is not inefficiencies as such; it is this radical change in demand that we first saw coming into the system in autumn 2013.”
“There are also substantial pressures in 2015-16 in relation to demographic changes, National Institute for Health and Care Excellence (NICE) drugs, elective care, mental health and learning disability resettlements.”
“My Department has faced considerable financial challenges in 2014-15, with £160 million of additional resources estimated to be required to balance the books. Some of these have been addressed through the £80 million of additional funding that we received at the Executive on Thursday, but some £70 million remains to be managed. <BR /> <BR />The situation does not get any better in 2015-16, with additional pressures in the health and social care system of over £300 million on top of those pressures carried forward from 2014-15. Those will be dealt with through non-recurrent measures. The largest inescapable pressure in this is additional pension costs, estimated to be in the region of £90 million.”
“However, we still have a long way to go to achieve the right balance of the funding of that organisation, which is so essential.”
“The intranasal flu vaccine has helped Northern Ireland to achieve a higher than average uptake of flu vaccine for children, and those programmes will be able to continue. <BR /> <BR />Developments in core screening services will include the appointment of additional staff to meet increased demand in diabetic retinopathy; extension of the age for bowel cancer screening from 71 to 74 years; testing for HPV and cervical cancer screening; appointment of staff to provide quality-assured newborn blood spot screening; and the completion of the introduction of enhanced screening for women at a high risk of breast cancer. There will also be specialist nurses for homelessness and for the black and ethnic minority communities. <BR /> <BR />So there will be positive initiatives within the PHA.”
“I am totally committed to the principle that we need to educate our public better in managing their own health. As a result of the agreement last Thursday, a number of services will be continued or expanded. There will be new developments in obesity services, such as the food in schools programme, to increase the levels of consumption of fruit and vegetables in primary-school children, increase access to physical activity programmes and see the development of further community-based initiatives to develop the skills of individuals and families to grow and cook healthy food. <BR /> <BR />On the flu vaccine, the number of people in the at-risk groups for flu has also been increased beyond the initial planning assumptions.”
“There will also be a continuation of diabetes self-management pilots, which are aimed at reducing the need for patients to attend outpatient appointments and which reduce insulin prescribing costs and avoid emergency department admissions. <BR /> <BR />On the capital side, we are continuing with the building of new facilities at Banbridge and Newry, so investment is ongoing. Transforming Your Care continues throughout this, albeit in challenging times. As Members will know, we have made various monitoring round bids for this, and we have not been as successful as we would like to have been.”
“Included in the October monitoring round was a bid of £2·6 million and a proposed investment of £2·4 million. The proposed investment of £2·4 million reflects the ability to spend within the remaining months of 2014-15. These resources will be directed at developing a wide range of early intervention and prevention initiatives, including the treatment of atrial fibrillation, which would enable some 444 strokes to be avoided. There will be a range of investment in what are known as FREDS, including fall prevention, patient education on diabetes, strokes and early supported discharge (ESD), GP education and diabetes investigations. There is also the intention to develop GPs' ability to diagnose and commence treatment without a secondary referral.”
“That will secure the specialist skills available in Belfast going forward within the single model. <BR /> <BR />I agree with the Member in congratulating the previous work done in that hospital, but this is not the end. The very high level cardiac interventions will be done in Dublin from when the model is finished and rolled out. It is a different model, but we still place enormous store by the facilities at the Royal.”
“I concur with the Member on the excellent work done by the charitable sector in this field. It has been very articulate and forceful in representing the needs of parents and their children. <BR /> <BR />I emphasise that the statement that I have made this morning does not mean the end of paediatric cardiology services in the Belfast Trust. The IWG recommends that the single, all-island model will provide for a fully integrated team from Belfast and Dublin, with Belfast continuing to provide surgery for young adults and the adult population. I will go further by saying that I want to strengthen Belfast as a centre of excellence for cardiology. I have asked the board to bring forward investment proposals to secure this and strengthen the regional cardiac network at the same time.”
“We are trying, through the use of trust resources, to put as many people through as we can, but the waiting list is challenging, to put it mildly, and will cause us considerable anguish over the next few months.”
“We have already 20,000 people in the system at the moment who are waiting, and that is 1,000 people for every constituency, so I have no doubt that every Member in the House will start receiving letters. However, we simply have to devote the resources to where they are most needed. <BR /> <BR />Elective care tends to be life-enhancing rather than life-saving. I realise that many people are in considerable pain because they have not had their hip, knee or whatever done, but that is the situation that we are in. My predecessor had to issue information to the private sector telling it that there would be no further referrals apart from those that are in the system. So that, unfortunately, is the price we pay for the huge increase in demand that there has been.”
“I was expecting the honourable Member to ask that question. This is a very difficult issue. He has to understand that 63% of the health care budget in Northern Ireland is tied up in salaries, wages and pensions and that another £500 million of the budget is tied up in various contracts. We cannot legally touch those during any financial year without being taken to court and losing. Therefore, the actual aspect of the budget that I have, and that Edwin Poots had, that can be controlled effectively is a very small overall proportion. <BR /> <BR />One of the areas where we can, as it were, turn off the tap of expenditure is elective care, particularly when it is contracted out to the private sector. It is not a position that any of us wants to be in, and yes, waiting lists will undoubtedly increase.”
“That is why I have made it a priority to go down to Crumlin to make an assessment for myself, and that is why I will be keeping a very detailed overview of the entire process over the next 18 months.”
“I have said that there are many, many issues on my desk, and I regard this as being one of the top five. Therefore, I am going to take a deep personal interest in this to make certain that our children are not impacted by it. I have met too many loving, devoted parents throughout Northern Ireland who are caring for terribly ill children not to make certain that I will make this a personal priority. Frankly, I know that if I do not, the Member will be snapping at my heels daily — the quiet, reserved individual that he is — to make absolutely certain that I get this one right in conjunction with my colleagues in the Republic. That is why I am going down to see Leo Varadkar.”
“I will be liaising very closely with parent groups and the Member as we go through this difficult process to try to ensure that the movement from one situation to the other is done in a way that will have the least impact on vulnerable children. The pathways is one of the issues that will have to be looked at. At the end of the day, I hope that he accepts that we are doing this with the primary motivation of providing the best possible service for our children. <BR /> <BR />We are pretty certain that the SLA for elective surgery in Belfast will end in December 2014 — two months' time. All other SLAs will continue until the new international working group model is in place. Those include defined pathways for each child. I accept that the gap will be difficult to manage.”