Diane Dodds
West Belfast · Democratic Unionist Party · Northern Ireland
“Minister, that is a brilliant segue into the question that I will ask. Just over 5% of women who are now seen within the 14-day target for a suspected breast cancer in Northern Ireland. That has happened since the list was regionalised. I get the fact that cancer cases are rising, but —”
“Minister, for Members and those who are listening to the debate, it is important that you tell us what "actively being considered" means on a day-to-day basis.”
“Thank you, Minister. The Muckamore inquiry report demonstrates a shameful period for our health service, and no one involved can, in any shape or form, come out of this with any kind of credibility.”
“Let me be clear: experimental treatment on children that can have lifelong implications is unconscionable. Children of 11 or 12 are in no position to give clear consent to the use of such drugs, especially when those administering the treatments had them banned because of the lack of evidence on their long-term impacts.”
“Once again, I will speak in the House about puberty blockers and the nationwide trial run by King's College. I now understand that the Government will issue new guidance that will allow such a trial to go ahead.”
“It is now anticipated that more than eight out of 10 couples in which the woman is under 40 will conceive naturally, but that leaves two out of 10 who will need additional interventions. Over a lifespan, that is a fairly substantial number of people.”
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“Minister, Northern Ireland cannot afford losses on such a scale. I know that you are vexed by the significance and extent of the problem. Those who made the decisions about the handover of the contract and decided to proceed need to be held accountable. It is long past time for things to change. You have the opportunity to bring about that change through a full, robust inquiry into what happened so that we do not continuously repeat the mistakes of the past.”
“We cannot contemplate any further remedial work to already expensive facilities. There is no room for any more mistakes and no appetite for wasting significant further sums on avoidable repairs.”
“Estimated costs for the maternity and children's hospital have already jumped by more than £400 million, with a significant distance yet to travel. With the new regional children's hospital being embarked on, it is imperative that the trust ensures that the design of the water system in that facility is absolutely right. It must reflect the most up-to-date standards available. No further contracts should be entered into without every i being dotted and every t being crossed.”
“Previously, the handover of the critical care building on the Royal Victoria Hospital site was delayed after the contractor found microbial-induced corrosion in its water systems. <BR /> <BR />The Northern Ireland Audit Office's major capital projects follow-up report, which was published in February, found that the Northern Ireland public sector's current portfolio of major capital projects will cost £2·45 billion more to complete than originally estimated. It also reported that, for the seven flagship projects that were announced back in 2015, the total cost overruns are now close to £1·94 billion. Only one of those projects has been delivered. Key decisions on large-scale projects can have very significant consequences. Northern Ireland cannot afford for them to be mishandled.”
“What oversight was there from the Minister, his predecessors and senior officials? Did they raise concerns at any point? Does the Department believe that there is an acceptable level of pseudomonas? I will also ask colleagues on the Health Committee to support recalling to the Committee those officials who appeared before us on 26 September. There may be merit, too, in inviting representatives of the water safety group to give evidence. <BR /> <BR />The trust seems to be clinging to its contract with the company as a defence for not taking any further action, but there is always scope to act in such circumstances. The emergence of pseudomonas changed the landscape, and the trust should have acted immediately.”
“It is difficult to argue — I trust, Minister, that you agree — that that is best, or even normal, practice. A full independent inquiry should take place, outwith the Belfast Trust and those who participated or acted in a professional advisory capacity in the decision-making. I am also keen to know about the extent of the risk assessment that was carried out by the trust prior to the handover of the building. If the Minister is willing, it may be instructive to share that with Members and, perhaps, place it in the Assembly Library. Similarly, Members might benefit from the Minister sharing the minutes of water safety and usage group meetings over the past number of years. <BR /> <BR />I am also interested in the role of the Department. What advice was offered by the health estates team?”
“I am interested in the governance processes of the Belfast Trust and how the concerns of an assurance group, such as the water safety group, are communicated through trust structures to senior management and the trust board. Does the Minister have a clear understanding of the concerns that it articulated and of whether they were reported appropriately, through the relevant structures? When doing the publicity for the handover of the building, were the trust's chair and the rest of his board fully informed of the concerns that had been raised ? Again, perhaps the Minister will clarify that in his response. <BR /> <BR />Interestingly, the same firm of legionella specialists that acted as independent consultants for the handover of the building has been asked to co-lead a trust-instigated review to examine that.”
“On the contrary, the Health Minister confirmed, in responses to questions for written answer that I subsequently tabled, that the water safety group was not involved in the handover, and, indeed, did not support it. Will the Minister explain how Health Committee members came to be advised that the water safety group had been involved? <BR /> <BR />The water safety and usage group had actually suggested a period of steady state running, with sampling of all water outlets to test for pseudomonas. The group also previously agreed that the assurance sought from the contractor ought to be that the building's water system was free from waterborne pathogens.”
“The session is available to view on the Committee page of the Assembly website. In response to queries about the expertise of those signing off the handover, the Committee was advised:”
“<BR /> <BR />We need to fully understand what is going on. There needs to be a rigorous in-depth examination of the actions of the Belfast Health and Social Care Trust since the emergence of pseudomonas infection in the new maternity hospital two years ago and of the process of its handover from the contractor in March. Shortly after the trust took charge of the building, pseudomonas was confirmed at a significant number of water outlets, rendering the hospital unsafe and requiring significant reparative work. Indeed, an answer to a question for written answer that I received today indicates that, in fact, 459 different water outlets are affected, which is 36% of the total number of water outlets in the building. <BR /> <BR />On 26 September, the Health Committee took evidence from senior Belfast Trust officials.”
“They are estimated to extend to more than £400 million extra. The cost of the maternity element has practically doubled, with, as of earlier this year, £97 million having been spent, and that was prior to the most recent difficulties with the discovery of pseudomonas in the water system. Overall, for both facilities, more than £184 million has been paid out, yet work will not commence on the site for the children's hospital before next year, and it is not expected to be operational before 2030 at the earliest — a decade late. The estimated cost of the children's hospital component has already doubled to more than £590 million. You said yourself, Minister, that that is an "eye-watering" sum, and I know that you understand that it puts intolerable pressure on your Department's capital budget.”
“Thank you, Madam Principal Deputy Speaker. The motion is wide-ranging and covers a number of elements of the problems that we face in the health service. However, I will concentrate my remarks on the maternity and children's hospital project. We are all supportive of the ambition to have a new children's and maternity hospital that is fit for purpose. Such projects are essential to have a health service in Northern Ireland that is ready to deliver for new parents and babies and the very sick children from across the Province who are cared for on site. <BR /> <BR />I am, however, worried by a number of issues in relation to the new-build project, and I hope, Minister, that you will be able to provide answers and clarity. The increases in the costs of the project have been astronomical.”
“She clearly said about the debate in Parliament this week that there is a real fear for people with disabilities. She expressed fears about the lack of protections and raised issues to do with coercion of the most vulnerable at a most vulnerable time in their life. <BR /> <BR />I conclude my short contribution —”
“I know that supporters of the Bill in London will point out that it is about people with a terminal diagnosis and that very tight timelines are involved, but I point out that, in every jurisdiction in which such legislation has been introduced, it has been gradually widened and widened so that it includes for consideration a very wide variety of conditions. The legislation in Canada is a — I was going to say "good example" — terrible example of such legislation. Clearly, protections in the Bill that will be discussed on Friday are not adequate. Some are already seeking to widen the Bill so that it includes the notion of intolerable suffering. To me, that is simply intolerable. I also reinforce the view of disability rights campaigner Tanni Grey-Thompson.”
“I absolutely agree. I also do not want to see this descend into any kind of angry debate. It is a really important issue for us to consider. I am, however, firmly of the belief that both lives matter. That is hugely important to me. <BR /> <BR />I am also interested in this debate in the context of the debate that will take place later this week in our national Parliament. The Committee on the Rights of Persons with Disabilities has taken a stand against the so-called right to euthanasia, which, according to it:”
“I understand that the Member is pro-choice. That is your right and your choice. I am firmly on the side of the children who are in the womb: those who are preborn and have the right to life. In all of these issues, we must consider the right to life of the mother and the child.”
“The Committee further explained that such abortion is often based on an inaccurate diagnosis and that:”
“It vexes me greatly that Northern Ireland, once the safest place for the preborn, is now one of the most dangerous for the preborn in Europe. That vexes me greatly. The UN Committee on the Rights of Persons with Disabilities has stated that the abortion of children because of a disability violates the UN Convention on the Rights of Persons with Disabilities. The Committee declared:”
“I am glad to support the amendment. I take issue with the Member who spoke previously: this is not a cynical intervention. If we are serious about protecting people with disabilities, we will be serious about protecting them from when they are preborn through to their final breath. A society will always be judged on how it protects its most vulnerable. I am glad that the DUP is a pro-life party and that we take a view on issues regarding life and the sanctity of life. We support the right to life from the womb right to the final breath. Therefore, the conversation in the Chamber today is important. Our amendment, in that context, is equally important, clearly outlining our view that all life, including that of those who have a disability, is important. <BR /> <BR />Our amendment focuses on the issue of”
“I thank the Member for giving way. <BR /> <BR />What you describe is a situation that came to me this morning. A small business owner in our constituency came in great distress to say that she now has to apply additional taxation due to EU tariffs, because her goods arrive from another country via Great Britain. The root cause of that is the application of EU law in Northern Ireland. Does my colleague agree that that is undemocratic in the extreme and that we will continue to stand against it?”
“Will the Minister assure me that he will work on that postcode lottery for respite services across Northern Ireland?”
“Minister, I thank you, because you have reacted to a pretty appalling situation across Northern Ireland. My question is on the differentials between the offerings in different trust areas. I have been involved in a case in which the parents moved from the Southern Trust, where they had overnight stays, to the South Eastern Trust, five minutes down the road, where there was no provision. Their overnight stays in the Southern Trust were withdrawn, and, when they moved back, of course, they were at the bottom of the waiting list for social work interventions and for overnight stays.”
“There is also a lack of knowledge on the impact of the menopause and pregnancy on the likelihood of heart disease in women. The report calls on cardiovascular health to be a key component of the women's health action plan. <BR /> <BR />I also recommend to Members the event in the Long Gallery on cardiovascular disease led by the Heart Failure Warriors coalition. In particular, you may have noticed the story of Nicole and Farrah, twin sisters who live in two different trust areas in Northern Ireland. One has had good aftercare after a diagnosis of heart failure, but the other has had no aftercare. That highlights the postcode lottery with services in Northern Ireland.”
“It provides recommendations for closing that heart attack gender gap, which will improve outcomes and quality of life for women with heart disease in Northern Ireland. <BR /> <BR />It is estimated that 26,000 women in Northern Ireland are living with coronary heart disease, which kills twice as many women each year as breast cancer. That is a statistic that I was not aware of, and it is really quite startling. In the region of 2,000 women will die annually in Northern Ireland from heart and circulatory diseases. There is insufficient awareness of a woman's risk of heart disease and heart attack, which negatively impacts on women's prospects of recovery. Women are more likely to receive a delayed diagnosis or misdiagnosis after a heart attack and are less likely than men to receive timely, optimal care.”
“The British Heart Foundation's 'Bias and Biology' report was launched in Parliament Buildings last Wednesday. The report highlights a very important element of healthcare in Northern Ireland: the systemic gender inequalities that exist across the cardiac care pathway.”
“— and my colleague Mr Frew stands ready to do so, if you are not.”
“Minister, you should move to legislate for the recommendation of Justice O'Hara's report —”
“We went on to say that we would continue to engage with professional interests and other stakeholders on the crucial aspects of the proposed legislation. Colleagues, that remains our position. We really thought that, by now, we would have seen that proposed legislation.”
“We also need to acknowledge that modern healthcare is incredibly complex, that the risk element is high and that not all decisions will have a successful outcome. <BR /> <BR />In response to the consultation on a duty of candour, in 2021, the DUP welcomed Justice O'Hara's report and asked for it to be implemented in full. On the individual duty, the DUP said:”
“<BR /> <BR />Let us also be clear that our healthcare workers are not only highly skilled and trained but committed and caring individuals who go above and beyond to give exceptional care to their patients. They operate in a fast-moving and extremely challenging environment where they are often understaffed and under-resourced. We should pay tribute to their professionalism and care for their patients. On Friday, I met the Royal College of Nursing (RCN). It is clear that there is anxiety among staff as to how an individual duty would work in practice, given the level of risk that they operate under daily. As we discuss the motion, we need to acknowledge that the overwhelming majority of healthcare professionals do their best and serve the public in a difficult environment.”
“Today, I think specifically of the husband and family of Erin Harbinson, who passed away recently after a battle with cervical cancer. Erin's smear was misread in 2012, 2015 and 2018. Erin was diagnosed in 2021 and received her smear audit only in 2023 — one month before the trust had to issue the 17,500 letters. There should also be an independent inquiry to establish the facts around that. <BR /> <BR />Families have been left deeply hurt, traumatised and grieving but with prolonged fights in order to ascertain the truth. When we consider all of that, it is understandable that relatives of patients so grievously impacted should be asking for a statutory and legally enforceable duty of candour. Honesty, integrity and transparency with patients and families are key in establishing trust in our health service.”
“In a response to my colleague Joanne Bunting on 26 September of this year, the Minister indicated that 11 of the actions relating to a duty of candour arising from Justice O'Hara's report had been put into a Being Open framework policy that is currently under development. I hope that, today, he hears our frustration at the fact that there are no conclusions to this. It is hard to tell what progress has been made; maybe he will outline that in his response. <BR /> <BR />As a Health Committee, we have met relatives of the deceased patients of Michael Watt and have taken evidence from those involved in the infected blood inquiry. I also reference the 17,500 women in the Southern Trust who have had smear tests reviewed because of underperformance in the reading of such tests. The trust was aware of those issues since 2008.”
“I thank the proposers of the motion and the amendment for the opportunity to contribute to a very important debate. Since joining the Health Committee in February of this year, I have met and talked to a wide range of individuals who have been dreadfully let down by the healthcare system in Northern Ireland. They have found it impossible to get answers, but, for many, knowing the truth of their loved one's situation is of paramount importance. It is harrowing for those who have lost loved ones to have to fight long, protracted legal battles in order to get truth and accountability. <BR /> <BR />In the hyponatraemia inquiry, which reported in 2018, Mr Justice O'Hara spoke of:”
“Thank you, Minister. Like previous contributors, I am glad to see the prioritisation of Health. I particularly look forward to seeing how the Minister will help healthcare workers maintain the parity for which they fought for so long. Will you require a plan from each Minister as to how they will live within their budget? If so, can we see those plans for the sake of transparency?”
“Thank you, Minister. In Northern Ireland, over 220,000 people provide unpaid care for ill and disabled family members. They save the Northern Ireland Executive up to £5·8 billion a year, yet they are not specifically mentioned in the Programme for Government. Will you ensure that these people, who provide such a valuable contribution to Northern Ireland, have more recognition in the Programme for Government?”
“In many ways, Minister, we talk a lot about inclusivity in the House, but the Bill is a real move towards inclusivity for a section of our community that has often found itself to be invisible. Given that you talked about the cross-cutting nature of the Bill, what commitments have you had from the Finance Minister about providing funding for the necessary increase in interpreters and from the Education Minister about improving the lives of young people who suffer from those challenges?”
“Minister, on the back of the last question, we have a serious issue in the Southern Trust, where maternity services, not just at Daisy Hill Hospital but in Craigavon Area Hospital, are in jeopardy. That raises a fundamental question for you, your Department and, indeed, the trust. It cannot all be left at the door of the trust. I accept that you feel that it informed you late of the difficulties that it is having. Apart from having meetings, what specifically can you do and what actions can you take to ensure that the situation with maternity services at Daisy Hill and Craigavon — I am told that both are in a serious situation — is resolved immediately? That is the stabilisation bit for women in the area that I represent.”
“I encourage you, on behalf of women not just in Banbridge, Lurgan, Portadown and the area in between that I serve as a constituency representative but across Northern Ireland, to act decisively to turn around this appalling situation and make sure that women get the health service in relation to breast cancer that they deserve.”
“The review of breast cancer services is long overdue. I hope that no time will be wasted in bringing forward that review and its conclusions so that we can better serve women in Northern Ireland. Every effort needs to be made to fill outstanding vacancies in the Southern Trust. We need to make sure that breast cancer services operate at their optimal capacity. That will include other providers, including external providers, if they can assist us with waits in the Southern Trust or other trusts across Northern Ireland. One thing is sure: no stone should be left unturned to turn around that absolutely appalling situation. <BR /> <BR />I know that you, Minister, will be alarmed by the statistics that emanate from your Department, and I know that you have announced a review.”
“There is nothing for any of us to be proud of when we hear them out loud. The statistics for the Southern Trust or, indeed, any other part of Northern Ireland cannot be defended in any way. No one in the House should even begin to try.”
“If UK survival rates matched the best in Europe, thousands more people who are diagnosed each year would survive their cancer for at least five years. As well as showing considerably poorer survival rates for bowel, prostate and cervical cancer, the comparison shows that survival rates for breast cancer are lagging up to 10 years behind. <BR /> <BR />When researching and working on today's debate, I was absolutely astounded by those figures.”
“Supportive care, including psychological, spiritual and emotional, is required for those navigating a breast cancer diagnosis and for their families. We are fortunate that so many of our third-sector organisations help with that. Studies show that increasing physical activity can significantly reduce the risk of cancer by as much as 20%. Soberingly, more than one in two of us will be diagnosed with some form of cancer. <BR /> <BR />Macmillan Cancer Support published analysis earlier this year revealing that cancer survival rates in the UK are as much as 25 years behind other European countries. The UK's survival rates for several common types of cancer are now only reaching what countries such as Sweden and Norway achieved in the early 2000s, and sometimes even earlier.”
“Its three key pillars of action were health promotion for early detection, timely diagnosis and comprehensive breast cancer management. Those are relevant for everywhere in Northern Ireland. Breast cancer is the most common cause of cancer among women globally, and it represents approximately a quarter of all cancers that occur in women each year. With one in six cancer deaths in women worldwide, breast cancer is also the leading cause of cancer deaths across the world in women. <BR /> <BR />We can all play our part in seeking to prevent future generations from experiencing breast cancer to the same extent. We need to dispel the myths and fears, counter any misinformation, and educate and help women to feel empowered to seek help.”
“We are fortunate to have a wealth of excellent charities and third-sector organisations operating in this field and supplying many vital services. In the Upper Bann constituency, over 100 women will be diagnosed with breast cancer each year, with well over 1,000 living with breast cancer, and approximately 20 will die from breast cancer each year. For Northern Ireland as a whole, an average of just under 1,500 women and 11 men are diagnosed with breast cancer each year. One in eight women is expected to face a breast cancer diagnosis during their lifetime, and, on average, more than 300 women die in Northern Ireland each year as a result of breast cancer. <BR /> <BR />The World Health Organization launched a global breast cancer initiative in 2021 to try to reduce mortality rates by 2·5% per year by 2040 and save 2·5 million lives.”
“That compares with 82·6% in the Western Health and Social Care Trust area over the same three-month period. Shockingly, and I widen the debate, in the Northern Health and Social Care Trust that figure was only 7·7%, and in the South Eastern Health and Social Care Trust, it was 4·8%. Only 4·8% of women who discover a lump in their breast are seen within the required time. I think that we will all agree that, when we consider those statistics, women are being very badly served by that part of our cancer services. It has become a postcode lottery, and that is simply not good enough. This is a time-critical service, and this is not good enough. <BR /> <BR />I am grateful to Cancer Focus NI, which assisted me in calculating the prominence of breast cancer locally.”
“That performance trails significantly behind those of other parts of Northern Ireland. I appreciate that, in relatively small services, sometimes the illness of a key member of staff, a retirement or a resignation and the failure to appoint a replacement can have a significant impact. We must have the review as quickly as possible so that we can best serve women in our area. <BR /> <BR />Another departmental target for breast cancer is that all urgent referrals should be seen within 14 days. Those are women who have found a lump in their breast and have been referred for an urgent appointment by their GP. The most recent data for those cases was published on 26 September, and it covers the three months from April to June 2024.In the Southern Trust, only 10·8% — one woman in 10 — were seen within the target time.”
“That is the length of a pregnancy, sitting waiting on surgery after you have been told that you are a red-flag case. If ever there was an example of why we need to sort out waiting lists and allow all patients the same access to services, surely that must be it. <BR /> <BR />A number of different departmental targets on breast cancer have been in place for many years. One target is that at least 95% of patients with a suspected cancer who are referred urgently by a GP should begin their definitive treatment within 62 days. Again, the figures have been very poor in the Southern Trust area. For quarter 3 of 2023, the percentage of people who were beginning that treatment within 62 days was recorded as being between 10% and 30%. For the following quarter, it was 29%. In the first two quarters of 2024, it was only 22% and 36%.”
“For those who are waiting for an initial outpatient assessment with breast surgery sub-speciality in the Southern Trust area, the wait is five weeks for cases that are deemed to be urgent and 24 weeks for routine cases. Therefore, in this week of October 2024, if a woman requires surgery that is not deemed to be urgent, that surgery will not take place until the end of March 2025. That is a sobering statistic for the House to consider. <BR /> <BR />For treatment that is subsequent to the first assessment, the wait for routine cases is 191 weeks, but the wait for urgent cases is 172 weeks. Appallingly, the waits for the most concerning cases, which are those that the consultant deems to be red-flag at assessment, are taking, on average, 39 weeks. That is absolutely unacceptable. Indeed, it is disgraceful.”
“When caught in its earliest, localised stages, the five-year relative survival rate of breast cancer is 99%. Northern Ireland should be striving for outcomes that are in line with the very best anywhere in the world. <BR /> <BR />I welcome the Health Minister's recent commitment to move towards a more common approach for breast cancer referrals. It is important that all women have the same opportunity to be assessed and treated as early as possible. It has been clear for some time that there are significant variations across the different trusts. From my constituency perspective, the Southern Health and Social Care Trust has struggled. Yesterday, I took the opportunity to look up the most up-to-date statistics on the My Waiting Times NI website.”
“Thank you, Mr Deputy Speaker. <BR /> <BR />October is Breast Cancer Awareness Month, so I am very glad to be able to bring the topic to the House this afternoon. Sadly, everyone in the Chamber will know someone who has been affected by breast cancer. It is a disease that can terrify women, but it is important that we continue to promote the message that early detection and treatment save lives. Breast cancer is the most common cancer globally, with around 2·3 million cases every year. It represents one in eight cancer cases in both sexes and a quarter of all cancers in women. Mortality can be as high as 70% in some resource-constrained settings around the world, but early detection methods continue to increase the chances of survival.”