Jim Wells
South Down · Democratic Unionist Party · Northern Ireland
“On a point of order, Mr Deputy Speaker. In November 1982, I made my maiden speech in the Chamber, and, here we are, 40 years later, and I am making my last speech in the Chamber as a DUP MLA. I was the last person in the Public Gallery when the Assembly collapsed in 1976.”
“<BR /> <BR />Mr Deputy Speaker, I thank you for your indulgence and for your patience with me over many years. Unfortunately, Mr McGlone has just left the Chamber; I was about to thank him. I have enjoyed my 27 and a half years in this Building.”
“I wish that I could, but I have only five minutes. <BR /> <BR />That was so that a very small number of Irish language zealots could go in and register their marriage or civil partnership in Irish or in dual language: £261,000. Did anybody stop to think about whether there was a more cost-effective way of doing that?”
“We are all perfectly happy with a genuine expression of people's culture. That is fine. However, when the language is so cynically used by militant republicanism, unionism has difficulties. Why, for instance, is there no translation into Irish of the words, "United Kingdom", "Londonderry", "Northern Ireland" or "Her Majesty The Queen"?”
“The Member has made the point for me. The official who came to the Committee made it absolutely clear that £261,000 had been spent already. It was farcical to bring that before either the Finance Committee or the Assembly, because the money had been spent and the processes had been set up.”
“If they want the unionist community to accept the Irish language as a genuine cultural expression, they should get rid of the political baggage and extremism, and stop using the Irish language as a political weapon to try to subjugate unionism.”
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“I thank the Member and his all-party group for the evidence and information that they have given us on this issue. I wish his son all the best as he goes through this difficult time in his life. <BR /> <BR />There are many areas between the statement today and the complete change in 18 months' time that will have to be examined very carefully and phased. However, we are dealing with a situation where we can no longer continue to provide a first-class service, given the patient numbers that we have in Northern Ireland. We are not anywhere near the 400 children that we need to provide a first-class service. That is a fact of life and the way that medicine is going.”
“I suppose that it was only a matter of time before someone went down to grass-roots level and asked me questions regarding provision in their area. The preparation for today's statement was based on a much higher level of policymaking based on the overall budget. I will examine the two issues that the Member raises about Strabane and the South West Acute Hospital and write to him, because I really could not have anticipated that such a fine detail question would be asked after a much more broad-brush statement.”
“<BR /> <BR />I think that we have a lot to be proud of in cancer services in Northern Ireland. For the first time this year, we can say that more people with a cancer diagnosis will be alive in five years' time than will have passed on. We have crossed that Rubicon and passed that very important line in the sand, where we are moving towards cancer being a long-term condition rather than a life-threatening illness. There are still many thousands of people in Northern Ireland who are facing a very dark valley as a result of a cancer diagnosis, but things are moving in the right direction. Many outcomes in Northern Ireland are ahead of those in the UK and many parts of Europe. We have a lot to be proud of, and there will be further investment. Therefore, things are moving in the right direction despite very difficult financial times.”
“First, we wish the Member for South Belfast all the best and admire his courage in being so open about having cancer. That has been extremely helpful. <BR /> <BR />As you know, there are new services planned for oncology in Northern Ireland. The acute oncology services that we will introduce in February 2015 will require 30 programmed activities (PAs) of consultant time to establish quality services for patients with complications from cancer or cancer treatment, patients with advanced cancer or those admitted to hospital with a newly diagnosed cancer. That will assist the implementation of NICE guidance and guidance on metastatic malignant diseases of an unknown primary origin. Excuse the complicated language. From 2015, 31 PAs of consultant time are required to ensure effective service delivery, resilience and sustainability.”
“That was quite easily dealt with, but what he has to accept is that, last autumn, after having managed to achieve £490 million worth of savings in the budget through better and more efficient uses of the resources, there was a huge surge in demand that occurred in autumn 2013 and which is still with us. That is the problem. It is not a misallocation of resources but is simply that demand has risen dramatically. As he knows, demand is rising by 6% and resources are rising by 2%. Inevitably, something was going to give, and it gave, as it were, in October and November 2013. So it is not a case of mismanagement, it is simply the case that we had many more people demanding our services, and we had a restricted budget to meet that.”
“As the honourable Member will be aware because he sat on the Health Committee at the time, the previous Minister Mr McGimpsey predicted that there were would be 4,000 compulsory redundancies resulting from the CSR when the DUP and Mr Poots took over. That has not happened. There have been no compulsory redundancies whatsoever, and, indeed, Mr Poots took on an extra 500 nurses. We are about to take on 61 health visitors, and we have increased the number of consultants and doctors. <BR /> <BR />So, the overspend that he is referring to was a mere £13 million, which is 0·3% of the overall budget. The reason for that is that the previous Minister decided to continue with elective surgery so that people who were in misery and having very difficult issues with hips, knees etc got the treatment that they deserved.”
“What simply happened was that the timing was such that an agreement was made with the authorities in the Irish Republic that we would jointly publish this report today. We will address tonight the specific issues that she will undoubtedly raise of behalf of her constituents, but it was just the way that it happened, and there is no cunning plan, as it were, to deal with that. I am quite happy to address her concerns tonight, but, of course, she will have to accept that there will be a huge degree of overlap because the arrangements that we outlined this morning obviously apply in their entirety to patients coming from Upper Bann, as they do for all of Northern Ireland.”
“First, the wishes and views of the parents in Northern Ireland will have exactly the same weight as the wishes of the parents from the Irish Republic. This is meant to be a cooperative model, which will mean that any concerns that they have will be directed to the clinicians, to those in Dublin in Our Lady's and to the relevant Departments. So, I see this as an exciting model that will mean that their views will be at the core of this new arrangement. <BR /> <BR />Also, I know that she perhaps is quite annoyed about the fact that this statement was made on the morning of her Adjournment debate on the same issue as far as Upper Bann patients are concerned. There was no attempt to head her off at the pass.”
“If you announce a policy decision, you have to allow time for people to make their views on it known. However, that does not preclude us going ahead and preparing the way. My understanding is that officials are already meeting to discuss the suggestion that he made. Provided that that can be done in a way that keeps it watertight, from a legal point of view, I do not see any problems with it. Equally, there may well be people who will read the report today and find something that they wish to point out to us or something that they have observations on. Therefore, to be absolutely watertight, we have to ensure that we have 12 weeks of consultation, or whatever period is deemed necessary.”
“First, I will deal with Mr McKinney's first point. As he knows, we have announced a review of the individual funding request (IFR) system. We believe that the report is due back on my desk by the end of November. It will deal with the exceptional holiday criteria for when clinicians ask for specific drugs. Before we go any further, it is important that we look at that. It is only six weeks away and may deal with some of the problems that he and many other Members have with the present situation regarding the 40 cancer drugs. I cannot pre-empt what the review will say, but, given the very short time span, I think that we should look at it before we revisit the model that he outlined. <BR /> <BR />The Member mentioned moving ahead during the consultation period. I think that he will understand that we are bound by certain protocols.”
“A small issue, but certainly an issue if you are a young person, is the lack of Wi-Fi availability after a certain time of night for children undergoing cardiology services in the Royal. That is a big issue to a young person or a teenager, and we will have to look at that. <BR /> <BR />We will do everything we can to facilitate the parents and families in this situation because we know how difficult it will be to ask them to travel to Dublin when they have been used to using the Clark clinic.”
“We are determined to make the practical realities of attending Crumlin as simplified, efficient and caring as possible for parents who already have the huge burden of looking after a terribly ill child. Therefore, the groups established under the IWG report are designed to give those parents the optimal input. Leo Varadkar and I will listen very carefully to parents' recommendations through those groups. Already, the parents have raised with me some very practical difficulties. They have, for instance, to wait for three months before being reimbursed for the expense of going to Dublin or England. There must be procedures that can be established to ensure that that does not happen.”
“I apologise to the Chair, as she raised a similar point about the involvement of the parents. My door is always open to the parents. Indeed, shortly after my appointment, I attended a fundraising event in Banbridge, where I met many of the parents. We have met various groups. I spent most of yesterday dealing with the concerns of parents. I also greatly value the input of Mr Swann, who has a very clearly defined personal experience of the issue. <BR /> <BR />Through the proposed model, we are determined that family representatives will have a voice on the governance vehicle and the family advisory group. We are serious about that because I realise that, for many parents, this is a very difficult decision and a bitter pill to swallow. I accept that.”
“However, serious interventions will be dealt with by Dublin or, if they are extremely complex, by Birmingham or London. So we are moving towards a centralised model. <BR /> <BR />You asked for timelines. We reckon that it will take 18 months to get this all in motion. I can tell you that there is great goodwill from the HSE in Dublin, and we are also committed to it. I regard it as a priority that I will meet Leo Varadkar within the next few weeks so that we can discuss this very carefully. <BR /> <BR />I emphasise that the £80 million includes the £20 million that came from the June monitoring round, which has some conditions attached to it. It is conditional on assurances of steps to be taken to break even and live within our budget. I can tell you that it is an extraordinarily challenging target.”
“I know that that will be welcomed by her community and all those in Northern Ireland, Donegal etc who will benefit from that. I am relieved that we have at least been able to deal with that issue. <BR /> <BR />The hub-and-spoke model was considered before the international working group's report that issued today. I cannot, under any circumstances, ignore the fact that we now have four separate reports, all written by highly acclaimed and knowledgeable experts, that point in the one direction. It would be negligent of me, and I would be ignoring the interests of the patients, if I ignored what those reports say. We will go to a central model, but the Clark clinic will remain open, and services will still be delivered there.”
“<BR /> <BR />As I said to her before, £80 million is not enough for us to meet the widely recognised needs that have emerged in health and social care in Northern Ireland. So, between the board, the DHSSPS finance staff, the Public Health Agency etc, we will sit down to prioritise where we need to spend this money. It is no secret that all five trusts are under considerable pressure at the moment and have exceeded their budgets. We will have to look at that situation and bring it into some form of balance. <BR /> <BR />The only real specific that I can outline — the Chair and other Members for Londonderry have written to me about the issue on many occasions — is that the Altnagelvin facility will go ahead as planned.”
“I thank the Chair of the Committee for going easy on me with questions on my first oral statement. There are so many issues to be dealt with. This will be quite complex because some Members will ask questions on budgets, others will ask about cardiology, and some will mix the two. <BR /> <BR />First, on the budgetary issue, there are no restrictions on the Department in how we allocate the £80 million additional funding. There are, of course, conditions on the £20 million that was allocated in the June monitoring round. As the honourable Member knows, there are quite strong caveats in the mechanism that led to the release of the £80 million, but that is being dealt with by the Executive and DFP.”
“My predecessor and I have been motivated throughout this work by the desire to provide the best possible standard of care for children in Northern Ireland who suffer from congenital heart disease and their families. The simple reality is that we cannot reach these standards alone. That is the clear message from the work of IWG, and I cannot and will not ignore their expertise and experience in reaching that view. Patient safety is central to this decision. I commend the work of the IWG to the Assembly.”
“I urge all concerned to consult it, as it is now live. <BR /> <BR />In the meantime, I have instructed my Department to work with commissioners and providers to immediately plan for the implementation of the service model recommended by the IWG. I will await the outcome of the consultation before making my final decision on whether to implement the model. My decision to proceed with the planning is in keeping with the principle that precautions should be applied, given the vulnerability of the sustainability of the service in the Belfast Trust. <BR /> <BR />In conclusion, the proposed model is absolutely focused on patient safety and the effective delivery of care.”
“<BR /> <BR />Members will recall that my predecessor announced the Belfast Trust’s proposals to consider the possible transfer of children’s cardiac surgery from the Royal Victoria Hospital to the Royal Belfast Hospital for Sick Children, subject to the completion of a risk assessment, and has concluded that such a transfer would be desirable. As paediatric surgical services are due to end on 31 December 2014, I have asked my officials to write to the HSCB for an updated position on the proposed transfer as this would now appear to be unnecessary. <BR /> <BR />I intend to announce details of the public consultation on the recommended model in the near future. I am making the report available on the departmental website today, and I have outlined in the statement the link to it on the Department's website.”
“It is notable that both groups reached the same conclusion, which is that surgery should cease in Belfast and be carried out in Dublin. <BR /> <BR />The HSCB will bring forward detailed investment proposals to further develop a cardiology centre of excellence at Belfast Trust and to strengthen the Northern Ireland network. In that regard, I will ask the HSCB to work closely with the Belfast Trust’s management and cardiologists in developing the investment proposals. I wish to place on record my thanks to the board, the Public Health Agency and the working group for the extensive work that they completed in providing advice to my predecessor.”
“<BR /> <BR />On 25 April 2013, my predecessor acknowledged receipt of the report of the HSCB's PCCS working group, and said that he wished to consider its recommendations before reaching a decision. Subsequent to that, he and his counterpart in the Republic of Ireland commissioned the IWG to carry out its assessment, which I have published today. I, therefore, wish to advise the Assembly that, in light of the IWG’s recommended model, I propose to recommend the PCCS working group's proposals on the following basis: that consideration will be given to the implementation of the recommended service specification in the context of the IWG’s model; and that the working group’s preferred way forward for the future configuration of the service for Northern Ireland should be taken account of in the implementation of the IWG’s model .”
“In that respect, Leo Varadkar and me have instructed our officials to take forward preparation work with immediate effect, with a view to having a clear action plan agreed and in place by the end of December 2014. <BR /> <BR />The current arrangements under the SLAs will remain in place until December 2014. Thus, the immediate impact of the removal of surgery from Belfast will be that, from January 2015, more children from Northern Ireland are likely to receive elective surgery at specialist centres in England, as required, until the appropriate capacity is in place in Crumlin. Interventional cardiology will cease in Belfast from April 2015, and Northern Ireland children will then receive that service in Crumlin, delivered by Belfast cardiologists working as part of the integrated team in Dublin.”
“It is most important that the existing SLAs continue in operation, augmented as necessary, to enhance the current arrangements and are quickly replaced by the single-service model proposed by the international working group. Further implementation will be on the basis of the outcome of any necessary consultation and by early agreement on the resource timelines and service integration requirements. That will be driven and carried out within appropriate structured project management arrangements with all the necessary steering, oversight and consultation structures required, in line with the international working group's recommendations.”
“The HSCB is engaged with the Health Service Executive in the Republic of Ireland about this, to ensure that any additional steps that are necessary to ensure the robustness of the current arrangements are put in place. That only serves to emphasise the critical nature of ensuring safe, effective and robust services in the long term, which I am confident the proposed model will achieve. <BR /> <BR />In the short term, it will be important to ensure a well-managed extension of the current service level agreements (SLAs) between the two providers in Northern Ireland, the Republic of Ireland and, of course, England, where appropriate.”
“Ultimately, it will be for the clinicians to decide whether a child should be transferred directly to Our Lady's Children's Hospital in Crumlin or whether that child should be transferred directly from Belfast to England. A key aspect of the single-service model is that, when it is fully implemented, it will have the capacity to deal with all emergency cases. However, it will be some 18 months before the model is fully in place and operating to capacity. <BR /> <BR />The current arrangements for emergency transfers have recently been the subject of review. There have been two cases recently, one in August and one in September, where it has not been possible for Our Lady's Children's Hospital in Crumlin to accommodate cases for emergency surgery.”
“<BR /> <BR />All other elective surgery is carried out in heart centres in England, namely in London and Birmingham, whilst provision also exists for patients requiring emergency treatment to be treated in Dublin or in specialist centres in England. Again, I would like to express my sincere thanks to the clinical teams in Birmingham and the Evelina children's heart hospital for the service that they provide to Northern Ireland children and their families. <BR /> <BR />With regard to children requiring emergency surgery, I know that Members have expressed concern about the future arrangements for diagnosis of children born in the north or north-west of Northern Ireland, where transfer times to Dublin take considerably longer.”
“First and foremost, we will need to ensure that a suitable, safe alternative is in place immediately after elective surgery and interventional cardiology ceases in Belfast. Currently, a very small number of paediatric cardiac operations and interventional procedures take place in Belfast. Those that do are planned, involve less complex procedures, exclude very young children and are carried out by surgeons who are based in Dublin and travel to Belfast once or twice a month. In highlighting that, I want to put on record my sincere gratitude for their continued willingness to do so over a prolonged and uncertain period. That has been hugely appreciated, not least by the families of the patients they treated.”
“In the meantime, and central to that, of course, is ensuring that, throughout the interim period, we have arrangements in place to ensure that patients receive the best possible care.”
“I will say something further about the consultation in a moment. <BR /> <BR />In implementing this new model, there will be a requirement to plan and take it forward in stages, as some elements will take longer to achieve than others. I know that the immediate concern of patients, their families and their clinicians is around what happens now and in the short term. I can assure you that my Department has been working closely with the Health and Social Care Board, the Belfast Trust and colleagues in the Republic of Ireland to understand what a pathway to implementation may look like, what obstacles would need to be addressed and what investment may be needed along the way.”
“<BR /> <BR />The report therefore gives us an achievable model. It gives us an indication of how to get there, but it does not prescribe the detail about exactly how the transfer should occur, when surgery in Belfast should cease, how Dublin's capacity can be increased or what happens with patients in the meantime. This is for me to agree with Minister Varadkar, and our Departments are working together closely to establish how we can build on the willingness that the IWG encountered during its visit and to plan how to make the model a reality. <BR /> <BR />Minister Varadkar and I have both agreed to accept all the IWG's recommendations and are committed to their full implementation, subject to the outcome of any necessary consultation. We are issuing a joint policy statement to that effect today.”
“Terms of reference would be agreed by the respective health authorities in Northern Ireland and the Republic of Ireland. <BR /> <BR />There are issues for us to work through regarding the practicalities of this recommendation as it has been described in the report. However, we believe that there may be an alternative joint governance vehicle to the IWG model, which would be better suited to our separate clinical and statutory structures but would maintain the principle of placing clinicians and families at the forefront of influencing decisions with real input from patient representatives. My Department and the Department of Health in the Republic of Ireland have reached broad consensus that this vehicle would operate effectively as a clinical network and still deliver the aim of the recommendation.”
“<BR /> <BR />Finally, recommendation 1, which effectively ties the whole model together, relates to the establishment of a single governance committee, composed of patient representatives, senior clinicians including surgeons, cardiologists and nurses, and the Chief Medical Officers and commissioners from both jurisdictions, to address all operational and policy issues. It would oversee the operations of the personnel, facilities and institutions involved in the care of patients of all ages with congenital heart disease. Its scope, as envisaged by the IWG, would be to effectively influence the deployment of capital and personnel resources for the management of patients with congenital heart disease in both jurisdictions.”
“<BR /> <BR />The IWG has recognised the importance of effective emergency transport arrangements to make an all-island service function effectively, and indeed it met transport providers during its visit in April. Recommendation 10 calls for quarterly meetings between the paediatric and neonatal patient transport services in the two jurisdictions. This aims to facilitate and further strengthen safe transfers between outlying areas and the centres in Dublin and Belfast, as well as transfers between the centres. Recommendation 11 recognises the need for the Republic of Ireland to continue to upgrade its paediatric transport services and suggests building on the expert inpatient extracorporeal life support (ECLS) services existing in Dublin to form a mobile ECLS service.”
“<BR /> <BR />This is an aspect of the model recommended by the IWG that I particularly approve of in that it provides families with full participation through their representatives on both the governance committee and the proposed family liaison service. If this is implemented, it will empower families in a way that has not happened before; providing them with an opportunity to ensure that their concerns, for instance, about the provision of accommodation and reimbursement of expenses are fully addressed. <BR /> <BR />There are four recommendations on the specifics of arrangements to ensure integration of services through IT links and case conferences. Those are recommendations 3, 6, 12 and 13.”
“Recommendation 8 seeks enhanced patient and family services in Dublin for all patients and families who do not reside in the Dublin metropolitan area. That would include assistance with travel, lodging, meals and other practical matters. Indeed, many parents have made these points to me about the practical difficulties of dealing not only with a very ill child but with accommodation, food, travel arrangements etc. Recommendation 9 proposes the integration of the activities of clinical nurse specialists and advanced practice nurses in Belfast and Dublin to provide patient and family support, to manage the transfers of patients between Belfast and Dublin and to co-manage clinics.”
“<BR /> <BR />The report also seeks to improve the experience and the involvement of families and their representatives in the proposed model. I have greatly valued the opportunity to meet the parents and family representatives. There are some very caring couples who are doing so much to look after very ill children. They are to be admired and supported. In that regard, recommendation 2 advocates the establishment of a family advisory group with representatives from both jurisdictions to provide direct input to a single governance vehicle, which I will say more about shortly. The family advisory group’s aim will be to give a voice to families and also to serve as a means of providing feedback about how the system is functioning. <BR /> <BR />Family concerns are also addressed in two further recommendations.”
“<BR /> <BR />One of the major concerns expressed in the wake of the previous report was that cessation of surgery would impact on the ability to maintain specialist medical skills in Belfast, which, in turn, would restrict the service available. However, I am reassured to note that the maintenance of those life-saving skills is central to recommendation 4, which advocates the flow of nursing and physician personnel between the two jurisdictions. It is a two-way street, as it draws on the respective strengths of both jurisdictions to form one service — effectively one team serving one patient population. It details how Belfast-based paediatric cardiologists and paediatric cardiac anaesthetists should participate regularly in procedures with colleagues in Dublin, which will ensure that their skills are maintained.”
“<BR /> <BR />Time will not permit that I go through the detail of each and every recommendation with you, but I urge Members to study the report that has just been released. I know that Members will want to take time to read the report for themselves, and it is now available on the departmental website, but I want to draw your attention to some aspects and themes arising from the recommendations. <BR /> <BR />Recommendation 7 of the international working group's report proposes the key change to the current service in Northern Ireland — that those arrangements should be brought to a conclusion and that all paediatric cardiac surgery and interventional cardiology should take place in Dublin, in Our Lady's Hospital in Crumlin.”
“<BR /> <BR />I am satisfied that the international working group has fulfilled its terms of reference, and that view is shared by my counterpart in the Republic of Ireland, Minister Leo Varadkar. <BR /> <BR />The proposed solution provides for a surgical service that would see children treated in accordance with the highest standards of safety. In addition, it points to opportunities for: enhancing the support we make available to their families; involving their representatives, as well as clinicians, in governance arrangements; improving communication and the flow of information between clinical teams in Dublin and Belfast; and further improving the transport service that we provide to get patients to where they need to be as quickly and safely as possible.”
“<BR /> <BR />Like some of the patients’ families and their representatives, I, too, had an opportunity to meet Dr Mayer and the international working group when they visited Northern Ireland in April 2014. Of course, that was in my previous capacity as Deputy Chair of the Health Committee. In doing that, I was impressed by their clear desire to hear about the experiences of the families and listen to their concerns and their commitment to addressing those within their recommendations. Indeed, the report speaks of the willingness of the international working group, observed during their visits in both jurisdictions at all levels, to have a solution at all levels based on political, clinical, policy/management and parental views.”
“From the outset, that work has had the optimisation of the service as its main focus. The recommendation should therefore not be viewed in isolation. <BR /> <BR />I believe that the overall package addresses the range of serious concerns that patients' families, patients' groups and clinicians have made known following previous reviews. They have presented questions and challenges and are to be commended for doing so. In turn, the international working group has taken those views on board, and the Chief Medical Officer has confirmed his view that the proposed approach offers the best opportunity to provide that important service in an appropriate, safe and deliverable framework.”
“The view of the international working group is that the recommendations cannot be easily separated without threatening the viability of the proposed solution. The proposal that paediatric cardiac surgery and interventional cardiology should be provided by a single children's heart centre in Dublin is one of a series of interdependent recommendations that make up the IWG's proposed model.”
“The second was the Health and Social Care Board's PCCS working group review in April 2013, which I mentioned earlier. The third was the Chief Medical Officer's report to my predecessor on the evidential base and clinical practice aspects of congenital cardiac services, which was published in August 2013. The weight of evidence based on clinical assessment is clear. In the interests of patient safety and to ensure the future provision of a safe, effective and sustainable service for those vulnerable patients and their families, it is my responsibility as Health Minister to act on that evidence. <BR /> <BR />As I said, the international working group's report makes a total of 14 recommendations that are interdependent.”
“It was for that reason that I announced on 24 September that the report had recommended that all paediatric cardiac surgery and paediatric interventional cardiology should cease to be delivered in Belfast. That is one of 14 recommendations that, together, make up the working group's proposed model for delivering that vitally important service. <BR /> <BR />The service is important not just for now but for current and future generations of people born with heart conditions, many of whom live a full and normal life into adulthood thanks to the advances made in that medical specialty in recent decades. It is the fourth successive report to recommend that paediatric cardiac surgery should cease in Belfast. The first was the Sir Ian Kennedy review, which was published in August 2012.”
“It was in that context that my predecessor and Minister Varadkar's predecessor commissioned the international working group to assess, in both jurisdictions and on the basis of a single service, the current and projected need for the service; the way in which the service is currently delivered; and the possibilities for configuring the service that could best meet the needs of the overall patient population. <BR /> <BR />All the recommendations in the report are important. Indeed, the international working group has highlighted their interdependent nature. I know that the question of whether surgery would remain in Belfast was of major concern to the patients' families and the Assembly in particular. Like my predecessor, I wanted to end the uncertainty on that specific issue.”
“I have given specific consideration to the report and recommendations of the Health and Social Care Board's PCCS working group of April 2013; the views of the parents' groups, which I very much welcome, such as Heartbeat Northern Ireland, which supported those recommendations; the views of the Children's Heartbeat Trust as appended to the report and recommendations of the Health and Social Care Board's PCCS working group; and the proposed model for the future delivery of paediatric cardiac services that was submitted to my Department by Belfast Trust cardiologists in March 2013. <BR /> <BR />I have met many of the groups involved in the debate since my appointment.”
“<BR /> <BR />In reaching this decision, I have given careful consideration to the report in the wider context of the various reviews and assessments that have been carried out in recent years relating to the paediatric congenital cardiac surgery service in Northern Ireland.”
“In my written statement to the Assembly on 24 September, I announced that the international working group had presented its report to the two Departments, that both were considering the report and that I would subsequently announce our response to the international working group's full recommendations together with the Minister for Health in the Republic Of Ireland, Leo Varadkar TD. Today, I am following up on that commitment. Members may ask why there was a delay between receiving the report and it being published. It is being published as I speak. The reason for that is that, because it was a joint report commissioned by the two Ministers, we had to seek the agreement of our colleagues in the Irish Republic before we could release it.”
“The members of the group were Dr Adrian Moran, the associate clinical professor at Tufts medical school and chief of paediatric cardiology at Maine Medical Center, USA; and Dr John Sinclair, consultant paediatric cardiac anaesthetist at the Royal Hospital for Sick Children in Glasgow. Nursing expertise and advice was provided to the international working group by Dr Patricia Hickey, the vice president of cardiovascular and critical care services and associate chief nursing officer at Boston Children's Hospital.”