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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“The cost of the new hospital has more than doubled since the initial business case was produced. We also know from questioning at the Health Committee that pseudomonas aeruginosa in acceptable levels was present in the water systems at handover. What role did the Department of Health play in the handover? Does the Minister have confidence in the trust to deliver the new capital projects?”
“I thank the Member for giving way. This is an important debate, and it is important to focus on funding, but there is another element involved, which is the lack of a palliative care strategy in Northern Ireland. Does the Member agree that a good palliative care strategy is necessary and that children who suffer from long-term and debilitating illnesses, as well as adults right across Northern Ireland, deserve the opportunity to live well with a care strategy in place? We hope that the Minister will speak to that as well.”
“I appreciate the Minister's standing in today. Will he convey to the Minister of Justice the need to support women who suffer domestic and violent abuse and the need to support organisations such as Nexus, which does so much work in that area? Will the Minister of Justice write to Members outlining her interactions with the Minister of Health about the funding of programmes?”
“Will you accompany the councils to London next weekend to lobby parliamentarians on the issues around the deal? What other suggestions have you for keeping the deal alive so that the Government know precisely how important it is?”
“Thank you, Minister. We appreciate the work that has gone into trying to get the deals back on track. The Mid South West deal was due to be signed with heads of agreement on Wednesday. That shows how far we were along the line with that.”
“This is an important issue. So far, we have discussed only new builds and the capacity of schools. One issue that the Minister's Department has taken up and is doing well on is the school enhancement programme (SEP), which not only creates capacity but enhances facilities. Will the Minister try to ensure that the EA responds to the business cases for school enhancement programmes in a more appropriate manner than it has done? I think in particular of Carrick Primary School in Lurgan, where the process of getting the school enhancement programme has gone on for many years.”
“I simply want to say, Minister, that we support this, and I hope that you manage to enact it.”
“I rise very briefly to give my support to this move. It appears to us that the UK-wide changes are common sense and that extending the range of professionals and services that can offer take-home naloxone to those at risk of an overdose should be widely supported. The ability for people to save lives, with the extended use and the extended provision of those who can use and administer naloxone, is something that we should all support. Today, we acknowledge the lives that have been lost to overdose and remember that each one is a person with a family and a life that has been lost to drugs. That is deeply regrettable. Approving this measure will help the situation, but we should never forget the people who have lost their lives to drugs and the families that have been left impacted.”
“<BR /> <BR />We also believe that the bizarre and, indeed, extraordinary measure taken by the Minister of Health during the consultation period of issuing statements that distanced him from his own consultation has undermined public confidence in the consultation and will make the path to agreeing new public health legislation even more challenging. We are absolutely clear that sweeping powers should not be handed to the Minister to impose restrictions that directly impact on a private individual's family life, education, employment and movement, and we will continue to reject mandatory vaccinations or plans to compel citizens to undergo any form of medical treatment. Any future public health framework for Northern Ireland must be underlined in principle and in law by the principle of informed consent.”
“I will talk about the consultation on public health policy. Given the number of emails received on the consultation and the interest shown in it, it is worthwhile putting on record my position and that of my party on the matter. The consultation seeks to update legislation from 1967. We do not argue that legislation that dates so far back should not be in need of renewal and revision, and, as a party, we recognise the need to act swiftly in times of crisis, but we do not believe that the current proposals strike a fair balance between fulfilling public health objectives and defending personal liberty.”
“We all know that the apprenticeship levy, as was, caused significant consternation for businesses who feel that they contribute a lot but get nothing back. Will the Minister tell the House how much money is involved in that and whether doing it locally, but ring-fencing money for skills, would be of benefit to the economy?”
“The Minister advised me in June that the VAT issue was being prioritised for early consideration by the commissioning and contracting work stream. Can the Minister provide the Assembly with an update on that and on whether the issues have been resolved? In mentioning that, it is clear to me that, if there is additional money that can stabilise it, we should help the care home sector avail itself of that additional money, because we would like to see it being ploughed back into additional provision and care for those who require it. <BR /> <BR />I am glad that the proposer of the motion is agreeable to our amendment, and I commend it to the House.”
“Health and social care trusts are permitted to reclaim VAT on non-business activities, under the provisions of the Value Added Tax Act 1994. The regional residential and nursing home specification and contract, however, which was issued to trusts in 2015, does not permit independent homes to do so. The Minister answered:”
“Financial stability in the sector would be of immense benefit and would place a value on caring and the other work that those in the social care sector do. There also needs to be action to strengthen our domiciliary and social care workforce, such as making it more attractive by improving working conditions, establishing career pathways and providing support for staff. Mandatory training and professional development should be introduced with pay progression linked to skills, experience and qualifications. <BR /> <BR />Finally, is the Minister able to provide an update on VAT for care home operators? I tabled a number of questions for written answer, to which I received responses in June, on Northern Ireland care home operators not being able to reclaim VAT to the same extent as their counterparts in other parts of the United Kingdom.”
“I mention that aspect and included it in the amendment because I know, as the Chair of the Committee said in her intervention, that many of us will have heard from families who are desperate because of the top-ups that are required from part of the independent sector. It is not a choice for families. Often, families just do not have the means to make those top-ups, and we really need to have some means of regulating them, particularly when they can reach extreme amounts very quickly. That is why we tabled the amendment.”
“Proposal 20 of the review specifically recommended:”
“If the Government and the powers that be do not value social care, why should anyone else? <BR /> <BR />The idea of regulating care costs was raised as far back as the Transforming Your Care review led by John Compton. That was when Edwin Poots was the Health Minister, so it is a long time ago. On social care, 'Transforming Your Care' stated:”
“<BR /> <BR />The second issue that I want to highlight is regulation in the care sector. Too often, we hear that social care is not sufficiently valued. It is not helped by how it is funded. Down the years, providers of social care have had little confidence and, at times, uncertainty around that funding. The impression has always been that, when the financial envelope is squeezed, social care is one of the very last areas of the budget that will be considered. Whatever is left at the end of the budget process is what will be available to social care. Rather than being able to plan medium- and long-term care homes in domiciliary care, for example, the sector has had to put up with whatever the Department and the trust gives it. None of that assists in making the care sector an attractive one in which to work or seek to build a career.”
“It ought to be a key objective to free up more capacity and allow the system to operate. The loss of beds impacts on all parts of the system, including waiting times, emergency departments and hospital admissions. It is poor care, too, for those patients who are kept in hospital unnecessarily. Many argue that we do not have enough hospital beds in Northern Ireland in the first place, but we certainly cannot afford to lose 600 beds within the system at any one time. I recognise that there can be difficulties finding replacements for individuals, but the issue needs to be gripped from the centre. It is a straightforward opportunity to transform hospital provision. For anyone looking in from the outside, or from any other walk of life, it is a simple means of making a fundamental impact on the efficiency of the overall system.”
“<BR /> <BR />Back in the spring, the Minister provided me with figures demonstrating that, on 15 March, 628 patients across Northern Ireland had a needless stay in hospital. The real figure might have been higher, as some trusts had only included in the calculation the beds on their largest acute sites, and that was well into the spring, when the annual winter surge of respiratory cases may well have subsided. Having more than 600 hospital beds unavailable is the equivalent of keeping the doors locked at one of our large acute hospitals and at another small one. It is the equivalent of locking the doors at the Royal Victoria Hospital and saying, "We can do no more admissions today." It is an issue that really must be tackled. <BR /> <BR />Hospital staff are forced to go to work each morning with one arm tied behind their back.”
“Thank you, Principal Deputy Speaker. I propose the amendment not to take anything away from the motion but merely to add to it an issue that has come to my constituency office and that Members may have experienced in their personal lives. I thank the proposer of the motion for supporting the amendment, because it is important. <BR /> <BR />I want to highlight a number of things, but, mainly, I want to focus on delayed discharges from hospitals. The amendment addresses the need to ensure that we have appropriate costs for care and VAT in care homes. Nothing highlights the link between health and social care better than the difficulties with delayed discharges from our hospitals: the obscenity of hundreds of beds being out of use for operations in acute care because people who are medically fit remain in hospital awaiting care packages.”
“Thank you. The Member is absolutely right. Anyone who watched the programme on the BBC could not help but be affected by it. It is a shame on us all that so many families are left to cope on their own with so few short breaks. What I find really difficult about that is the difference between trusts in the services that they offer. Some trusts have very few or no programmes for short breaks; others manage quite well. When families move from one trust area to another, they find that their respite care is suddenly removed from them. I have said before and will continue to say that those are the strategic, inherent and inbuilt inequalities in the health system that we really need to tackle.”
“It is welcome that the delivery plan for 2024-25 for the children's social care services strategic reform programme contains plans to, by April 2025, conclude a review of fostering service models to improve performance in foster care recruitment and retention and develop additional short breaks provision. That is not a long time, Minister, and we need action in that respect. <BR /> <BR />A lack of respite services is also placing a huge strain on many families, particularly the parents and carers of children with a disability or special educational needs.”
“People offer to help with emergency fostering when a young person has no other options available to them, but, having been good enough to take that step, the new emergency foster family is sometimes left helpless, unable to obtain the assistance or reassurance that it feels it needs because some of the social workers are, for whatever reason, continuously unavailable. <BR /> <BR />The gap in supply here has had huge consequences, given that four in five children who go into care are supported through fostering. A lack of available foster carers means that some children will experience multiple moves, leading to poorer outcomes for stability, personal health and well-being.”
“<BR /> <BR />I was particularly concerned about the review findings on fostering and, specifically, the recruitment of foster carers. Foster carers play a vital role in supporting vulnerable children and young people, and we commend those who provide high-quality care to our families and communities. Despite rising demand, there is, according to estimates compiled by the Fostering Network, a deficit of almost 300 foster carers locally. As I said, through my constituency service, I have seen some harrowing examples of families that are at crisis point and need foster care. The pressures on the service have knock-on effects on the pathways of the young people and their ability to succeed throughout their lives.”
“<BR /> <BR />The independent review by Professor Jones found that referrals to children's social services are consistently higher in Northern Ireland than they are in England, the Republic of Ireland or Wales. Also, a higher proportion of Northern Ireland's child population are considered to be children in need and have a child protection plan. In recent years, there has been a proportionately greater growth in the number of children in care in Northern Ireland. That should be a stark warning to us all. High levels of staff vacancies are leading to large numbers of cases being unallocated and over 4,000 children and their families waiting after crossing an initial threshold for involvement with statutory children's social care.”
“I apologise for my late arrival in the Chamber. <BR /> <BR />One thing is clear from the contributions: the review of children's services and the debate that we are having will be meaningless and, as Mr McGrath said, just "warm words" if we do not hear from the Minister about the positive action that will come out of the debate. The review report was published about 18 months ago. The Department has been working on aspects of the review, but we really need to hear about decisions. Minister, the message from the Chamber today is about the importance of making decisions for some of the most vulnerable children and families in our community. Members have mentioned many aspects of the review, so I will highlight some issues, particularly those in my constituency that I have found harrowing and very difficult to deal with.”
“Will the Minister tell the House what oversight there was of Dr Watt's practice by medical colleagues and the trust's senior management? Can the public have confidence in 2024 that things are better at the trust than they were in 2016?”
“— the party press officer. <BR /> <BR />First Minister, how can the people of Northern Ireland, who will not be taken for granted on this issue, have confidence when you appear not to know the facts, refuse to be fulsome in your explanation and deny responsibility, apologising only for the press officers and not for the Sinn Féin cover-up?”
“When the Assembly was reconvened, the First Minister promised change. It appears that all that we have are changes in her story. Today, we need the truth, not the denial of responsibility. She claimed that she did not see McMonagle, but she was in a photograph in which he was standing nearby. She told the Committee that she had not spoken to the British Heart Foundation, then we saw her doing exactly that. She tried to create distance between herself and McMonagle, yet we know that she personally employed McMonagle for a short period when he appears to have been —”
“Minister, that is extremely good news, and it shows what a Minister who is prepared to take action on the issue can achieve in a relatively short time. Can you assure us that your officials will work closely with those clubs to develop their business cases so that we can see progress made quickly towards full implementation?”
“— and received a reply, and that shows a significant —”
“Only 30·7% of patients urgently referred for breast cancer treatment were seen by a specialist within 14 days: the target is 100%. Two thirds of women who find a lump in their breast are not being seen within the required time. <BR /> <BR />Money is deeply precious for the capital programme for Health. We have had a debacle around the maternity hospital. On 1 August, I wrote to the Health Minister —”
“However, to demonstrate that really significant need for reform, I will look at two or three of the issues that have arisen as part of my constituency work in the past number of weeks. <BR /> <BR />Recently, the Department of Health published its cancer waiting statistics. Those are indeed really serious and should cause serious thought for everybody in the House. According to the Department, the proportion of cancer patients waiting this quarter to start treatment within 31 days was just over 90%; the target is 98%. Some 35·8% of patients started treatment within 62 days of an urgent referral from their GP; the target is 95%. That is not something that anyone should be proud of. October is Breast Cancer Awareness Month.”
“I rise to speak about recent developments in Health in Northern Ireland. Last week, the Minister published his thoughts on how hospitals should be restructured. Unfortunately, those amounted to little more than a series of high-level principles, with little detail on how that programme would be rolled out. I accept that the Minister said that this would be followed up, but we are now in a 16-week consultation period, and that means that there will be considerable time spent on that rather than getting on with the business of reform. <BR /> <BR />There is absolutely no doubt that our health service needs significant reform, and I welcome Professor Bengoa to Northern Ireland this week and look forward to what he has to say in relation to that.”
“I thank the Minister for his statement. We have waited a long time for the paper. I am grateful for it, and I take your word that it is the start of a process. However, on reading it last night, I found that it is a series of high-level principles rather than any detail on how we will proceed. A number of questions arise about that. You said this morning that there would be further papers: that is really important, but we need further papers that focus on the principles that you outlined in this one. <BR /> <BR />You also said that service reviews would be trust-led: I worry about that, because my experience of trusts is that, at the moment, they will not and cannot cooperate with one another. How do you expect them to cooperate on service reviews and sharing resources? Will you ensure that each of those is led by a consultation?”
“I would like to see the focus put on the trusts as well as Departments.”
“We all watched the programme last week where mothers shared their really difficult journeys with young people in their homes and the lack of respite services. Lo and behold, in my office on Friday, we had another mother sitting in front of me. She said that she moved five minutes down the road, out of her health trust area, into another health and care trust that had no services. The first thing that happened was that her original trust pulled her respite services immediately. We have families at breaking point in Northern Ireland, and it is just not good enough for trusts to offer such a widely unequal variety of services for our children and young people.”
“Since I came to the Assembly I have heard over and over again about collaboration and no working in silos. Folks, the honest answer is that people out there do not really care about any of that: they want action and their problems solved. That is the most important thing that we can focus on today. <BR /> <BR />We should look at cooperation between Education, Economy, Health and Communities to resolve the issue of a legal entitlement to education for young people with special needs up to the age of 25 in order to bring us in line with the rest of the United Kingdom. We should work with the voluntary and community sector to ensure that there are pathways for those young people. <BR /> <BR />In closing, I want to focus on arm's-length bodies and trusts because they cannot be absolved from this.”
“I welcome the Opposition's focus on mental health today. It has been useful, and the tone has been right. I hope that some of those involved in this sphere will take heart from the fact that we have spent the day talking about this important issue. <BR /> <BR />The motion refers to mental health and children and young people's mental health. I will quote the statistic that I quoted earlier: in the Northern Ireland life and times survey 2023, only 50% — only half — of those aged 18 to 24 who were surveyed reported positively about their mental health. That is a very sad statistic about young people in Northern Ireland. Many of those young people are found to have profound levels of anxiety. That is a difficult issue as well. <BR /> <BR />We are focused here on the Children's Services Co-operation Act (Northern Ireland) 2015.”
“I know that the Minister will agree that many of those in our part-time Reserve served through terrible times in Northern Ireland and face great personal danger as they continue, in their ordinary workplace, to serve our community and ensure our safety. Whether the funding is brought about by her or the Chief Constable, will the Minister ensure that there is, at least, a good discussion about a fair allocation being made to those brave officers?”
“Thank you, Minister. NI Water estimates that around 20 million tons of untreated sewage spills into our waterways annually. That includes around 10,000 septic tanks that are on the inner boundary of Lough Neagh. Does the Minister agree that the issue with Lough Neagh is not just for those in the farming community, who are easy to blame in this situation, but is wider and multifaceted and must be tackled in the round? Will he commit to funding the devices that are necessary to allow us to ascertain just how much raw sewage is in our waterways?”
“<BR /> <BR />I have spent some time looking at the statistics and putting them on record in the House, because they are quite shocking. The more that I hear about and look at them, the more that I am convinced of that. It means that we have to tackle not only the awful number of suicides but the general mental health and well-being issues that our population is experiencing. I offer the amendment in that spirit, not in a spirit of hiding from any of the issues, because they are issues that I have spoken about and that I speak to individuals and groups about regularly. I urge the Assembly to consider amending the motion.”
“The data itself therefore needs to be improved as well so that we can better serve people who are experiencing mental health issues. <BR /> <BR />Mental ill health has a devastating impact on the individual, but it is also having an impact on the workforce and on growing the economy. The rise in work-limiting conditions across the United Kingdom in recent years has been driven by sharp increases in reported mental health issues, particularly amongst young workers. The number of workers aged 16 to 34 who report that their mental health limits the type or amount of work that they do has increased fourfold over the past decade. Mental health issues are now the most common cause of work-limiting conditions among those aged 44 and younger in the United Kingdom.”
“In the poorest areas — this ties in with the Minister's focus on health inequalities — it was 27% of the population, which represents a fourfold increase in the past 20 years. <BR /> <BR />Forty per cent of females aged 45 to 64 were prescribed an antidepressant in the past year. There does not appear to be a plan from the Department to address that rise in prescribing rates, so, Minister, that is one of the issues that I would like hear about from you in your response, because those are fairly shocking statistics for Northern Ireland. In 2021, the Office for Statistics Regulation criticised mental health data, stating that it did not serve the public good. Last year, the Northern Ireland Audit Office stated that, as a result, it was not able to conclude whether mental health services were providing value for money.”
“<BR /> <BR />Last week, I had the opportunity to meet representatives of New Script for Mental Health, who have highlighted that one in five adults in Northern Ireland was prescribed an antidepressant last year. That is a shocking statistic.”
“In the Northern Ireland life and times survey of 2023, only 50% of those aged 18 to 24 reported positively on their mental health and well-being. That is such a sad statistic for Northern Ireland. Research has shown that half of adult mental health disorders develop before the age of 18, which highlights the need to prioritise the acquisition of resilience and coping skills from a very early age. The youth well-being survey in Northern Ireland 2020 found anxiety and depression levels here to be around 25% higher than in the child and youth populations in other regions. That reflects a similar trend in Northern Ireland's adult population. Some 29% of respondents to the life and times survey reported that their mental health and well-being had been impacted by Northern Ireland's Troubles.”
“<BR /> <BR />The Public Accounts Committee (PAC) made a number of recommendations to the Department of Health last year on mental health, and only a few have been acted on. The Committee said:”
“<BR /> <BR />Earlier this year, the mental health champion, Siobhán O'Neill, expressed significant concerns about the lack of investment in the mental health strategy, calling it "incredibly disappointing" that the Department of Health had invested only £9 million in the strategy. Around 7% of our Health budget is allocated to mental health, which is well behind the 11·4% in England, 9·4% in Scotland and 13·3% in Wales. While some criticise the broader Executive, it cannot be blamed solely on the Executive; it is also about prioritisation in the Department of Health The idea that the Executive could simply hand over £1 billion for a strategy on top of what Health already receives was never a realistic prospect in challenging financial circumstances.”
“My colleagues and I are contacted regularly about the lack of access to services for ADHD and autistic spectrum disorder, as well as mainstream general adult and children's mental health services. <BR /> <BR />There is little ambition in the recently published 'Mental Health Strategy 2021-2031: 2024/25 Annual Delivery Plan'. The 50-page document contains fewer than eight pages on what is planned to happen this year. What has been achieved so far is welcome, Minister, but it is a drop in the ocean compared with what the strategy envisages. A firm grip needs to be taken on the mental health strategy, with concerted efforts made on its dozens of actions, otherwise it will quickly become outdated.”