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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“Our amendment, without doing damage to the original motion, simply includes the crucial east-west dimension with Great Britain. We firmly believe that cooperation and collaboration is the best way forward. In tabling this amendment, we also felt that we should not lose focus on global cooperation and the benefits that we get from being part of UK-wide structures and networks with global outreach. <BR /> <BR />Last week, at the Cancer Focus event, I had the opportunity to speak to Professor Mark Lawler, and we discussed some aspects of cooperation on cancer research. Professor Lawler impressed on me the importance of a cancer research strategy for Northern Ireland. Minister, I hope that you take cognisance of that.”
“Thank you, Mr Deputy Speaker. Before we get on to the meat of the amendment, I want us to focus on the real enemy here, and that is cancer, which affects everyone, regardless of race, creed or religion. Macmillan Cancer Support estimates that cancer kills 167,000 people throughout the United Kingdom every year. That is a colossal death toll. In proposing our amendment, we fully recognise that there is clearly work to be done across all jurisdictions in the British Isles: in Northern Ireland, on mainland Great Britain and in the Republic of Ireland. I hope that, on this subject, we can park the more political aspirations and, whatever our views, welcome cooperation across those jurisdictions in the fight against cancer.”
“— to scrutinise. We need to see the plan.”
“— we will not see an improvement in Health unless we see reorganisation, and we currently have no plan —”
“No, I want to finish. The Department of Health needs to tell us how it will make progress on the stroke strategy and address the crisis in children and young people's services. <BR /> <BR />In April, I asked the previous Minister of Health when he would bring forward his plan for the reorganisation of the health service. He told me on 15 April that he would do it in a couple of weeks. Obviously, he has left office, and I have invited the current Health Minister to bring forward that plan, but —”
“<BR /> <BR />Those individual pieces of legislation are, however, just part of a wider, very complex picture for the Department of Health. The Department of Health has told us a lot about what it cannot do, but it needs to start to tell us what it can do with its substantial budget. It needs to tell us how it will prioritise waiting lists. It needs to tell us how it will prioritise the cancer strategy and red-flag patients who cannot get appointments.”
“Again, I have a word of warning about the timescale. The adult safeguarding Bill has grown out of the Commissioner for Older People's investigation into Dunmurry Manor. The consultation on that dates back to 2020, and, therefore, we need to get a move on to make sure that the adult safeguarding Bill sees the light of day and that we are able to scrutinise it appropriately. <BR /> <BR />I will reinforce what my colleague said about the duty of candour. I was pretty appalled yesterday to listen to the Health Minister go on about everything and anything except a duty of candour. It arises out of the really sad circumstances of the deaths of young children in Northern Ireland, and there is a duty on the Health Minister to start to seriously look at it in a legislative way. It is not something that we on these Benches will give up on.”
“I guarantee that we will scrutinise that Bill, because we want to ensure that its powers are appropriate and are organised appropriately. <BR />There is a bit of concern around the timescale for the public health Bill. The previous Minister, Minister Swann, indicated that we would see the public health Bill in June: we have no indication from the current Minister whether that will be the case. It will be fairly complex legislation that will have to go through consultation etc, and, if we are to make moves in relation to the public health Bill, we need to see it fairly quickly. <BR /> <BR />I welcome the adult safeguarding Bill. It has always been the DUP position that we need a legislative approach to protection and safeguarding that prioritises the prevention of harm and affords disabled persons the dignity that they deserve.”
“Like many others here this morning, I welcome the legislative programme. People across Northern Ireland will be glad to see the work that the Assembly is doing and will recognise that this is, potentially, a first start at getting the Assembly moving on issues that really matter. <BR /> <BR />I particularly welcome the Health Minister's intention to introduce a public health Bill. As was noted in the statement, the current public health legislation dates from the 1960s. We do not have to look too far back to understand how inadequate that was in dealing with an unprecedented pandemic. We need to see a public health Bill that addresses some of those issues. There has been discussion about the public health Bill in the Health Committee, although we have not seen any drafts or been given any detailed information.”
“I am glad that the deputy First Minister was there to represent Northern Ireland. However, the First Minister was absent, and it gives the lie that she is "a First Minister for all". Was she absent because, as someone who regularly eulogises IRA terrorists, she was ashamed to stand with real soldiers who fought for liberty and democracy? Was she absent because she was ashamed of the Southern Government's neutrality in the face of Nazi atrocities? Either way, she should be ashamed of letting down the people of Northern Ireland.”
“— of GP practices have them, and only 8% have full multidisciplinary services. When will you rectify that, and do you acknowledge that doing so is fundamental to transformation?”
“— initially as a consequence of money from the DUP confidence-and-supply agreement. So far, only 30% —”
“It is unfortunate that, at a time when we know that the health service needs significant reform in order to provide better outcomes for patients, we have had a history of what has happened since 2016 from the Minister. There are many points from your answer, Minister, that I could pick up on, but I will I will pick up on one: multidisciplinary teams were set up —”
“Thank you, Minister. The Department of Health has indicated that it has a long-term desire to reform and reorganise. Will the Minister outline what bids she has received for that reform and reorganisation?”
“Will you be able to publish your plan in a couple of weeks?”
“Thank you, Minister. Everyone in the House, including on this side, wishes you well and wants to see really strong, good outcomes for health and our community right across Northern Ireland. However, I have been reflecting on what you said: much of it is about what you cannot do because of the budget, and there is not so much about what you can do with the budget. Across the House, we would like to know when we will see detailed spending plans from the Department for the 52% of the block grant that you already have. <BR /> <BR />On 15 April, I asked your predecessor when he would publish his plan for the reconfiguration of hospitals and services. His answer was that it would be in a "couple of weeks". I know, Minister, that you are new in post, but you have served a significant number of weeks of an apprenticeship.”
“— cognisance of that. Can the Minister tell us what he can do, with the Education Authority, to shorten that time frame in order to allow schools to proceed to the point where they are eligible for funding?”
“Thank you, Minister. You referenced that we recently visited some schools in Upper Bann, one of which was Carrick Primary School. You rightly talked about 21 languages being spoken in a really diverse, inclusive school. However, that school has been waiting for five years for a business case for a school enhancement programme, and that is clearly an unacceptably long wait. I know that you took —”
“I thank the Minister. It is really important that, in this aspect of the economy, Northern Ireland does not lose its competitive edge. It is equally important that consumers are not left to pay for climate change targets that are set in the House. What new programmes has the Minister bid for, and what bids have been accepted in relation to climate change targets?”
“— we will still have difficulties in secondary care.”
“From talking to GPs and their representatives, one of the things that we absolutely understand is that, if we are not going to transform primary care —”
“That was six weeks ago, and we still have no plan. <BR /> <BR />The multidisciplinary primary care teams, including social workers, physiotherapists and mental health practitioners, are key to the transformation and are part of the Bengoa Delivering Together programme. Initial funding for those teams came from the DUP confidence-and-supply agreement, and they were to be rolled out Province-wide. It is hard to fathom that something so fundamental to transformation has been allowed to wither on the vine, with all the difficulties that that contributes to general practice. Again, that is an investment that should have been prioritised and elevated above other projects or schemes that are not fundamental to transformation.”
“In the House on 15 April, I asked the Minister when he would publish his plan for the reorganisation of hospitals and services. He replied that he would bring it forward:”
“I certainly agree with the Member. One of the things that we have managed to avoid in the House, particularly during the period of COVID, has been playing politics with health. We are in a place that is deeply regrettable, and we need to see detailed plans on how the significant budget will be spent. <BR /> <BR />On top of that, Ministers and other Assembly Members struggle with the fact that the Health Department assumes that it will be given an automatic increase year-on-year-on-year. We need to deal with that, and, on the Member's point, we need to actually get to the stage where we see significant transformation in health. For significant transformation to occur, there will have to be a re-prioritisation of how we deliver health, so we need to see the Minister's plan.”
“<BR /> <BR />In his letter to the Health Committee yesterday, the Minister pointed to various elements of health delivery that may be impacted on by the Budget, but he did not prioritise any of them, and the Health Committee has not yet seen the detailed spending plans for Health. The Minister indicated that £135 million could make a real difference to waiting lists, but he can invest that sum if he chooses, by prioritising it over other spend in his Department from his multi-billion-pound annual allocation.”
“That inevitably brings us to two significant questions: where will the additional money come from, and how can the Minister and, indeed, his party, say that he will not vote for the Budget, will resign and will install a colleague who will then have to implement the Budget? These are strange times. The previous Member to speak might have been accurate in her diagnosis of the problem. <BR /> <BR />Some of the material from the Department of Health has been a little disingenuous, seeking to compare the starting position for 2024-25 with the overall closing position for the previous year. The Minister and his officials are well aware that significant allocations will be made over the year in monitoring rounds; indeed, the Minister's proposed amendment seems to satisfy that assumption.”
“Incidentally, the Committee took significant exception to some of the Minister's correspondence to the Committee being briefed to the media before it was released to the Committee. I understand that only an additional £958 million was available, so we were never going to reach £1 billion additional for Health in one year. Did the Minister seriously think that he would get £800 million out of £958 million, with all the pressures that there are in education, the economy, infrastructure and other sectors? It is difficult for the Minister to claim that others have not prioritised Health when he received the majority of the additional funding available and when Health obtains a majority of every pound allocated by the Executive. Indeed, the director of public spending at the Department of Finance said:”
“Having listened to the debate, I think that all of us in the Chamber, particularly those on the Health Committee, would like to see a slightly easier Budget for all Departments but particularly for Health. We are aware of and acknowledge the people who are on long waiting lists and the number of people who require urgent treatment. In reality, however, we also know that the cake is only so large. We have other Departments with pressing priorities. While it is a challenging Budget for every Department, it is beyond dispute that Health gets over 51% of the total Budget. <BR /> <BR />The Minister of Health stated, in correspondence to the Committee, that he wanted an extra £1 billion but would settle for £800 million.”
“Thank you, Madam Deputy Principal Speaker. Sorry, I probably got that all wrong again. <BR /> <BR />Minister, most people will acknowledge that you have said that people were failed by the system and that you are sorry and hope that it will never happen again. However, we have to take concrete steps to make sure that it does not happen again. One of those concrete steps is a statutory duty of candour. I have asked you about that in Committee, and it came up during the hyponatraemia inquiry in relation to the case of Claire Roberts. Will the Minister outline to the House where we are with the statutory duty of candour? Can we expect to see legislation on that in the near future?”
“Minister, my understanding is that the health service got almost 50% of the allocation of additional money. In the first debate in this Assembly mandate, you promised us an update on the elective care plan. A few weeks ago, you promised me that, within two weeks, you would deliver the plan for the reconfiguration of hospital services. As of this morning, we have no paper from the Department of Health on the Budget for discussion tomorrow. Minister, we would like to see a plan to deal with the issues within the resources that you have.”
“Our young people have to deal with those harms. It was brilliant to hear their voices and understand that. I look forward to working with them as we move forward. <BR /> <BR />I confirm our support for Northern Ireland's inclusion in the Bill. I would like to hear the Minister address in his response some of the issues that are pertinent to the working of the Bill.”
“It is important that we are honest with people in Northern Ireland and that we understand that as well. <BR /> <BR />I pay tribute to the Youth Assembly for its conversations around the Bill. It is really important that the voice of young people is heard in all these things. It is really concerning that some schools that I visit report such an increase in vaping among young people.”
“We need to know the content, we need to know the flavours, and we need to know how this will come forward. We do not want, in 20 years' time, to be talking about the harms of vaping in the same way that we talk about the harms of tobacco. That is very important. It is also particularly important that we get some sense of those regulations. I suspect that they are some way down the line, so we will be passing something that deals with smoking but does not really deal with vaping, in the hope that those regulations will come forward. <BR /> <BR />In closing, I ask the Minister whether he and his officials have considered the applicability of the Bill in Northern Ireland, given the fact that the Windsor framework has stopped legislation on Rwanda and on aspects of the Northern Ireland Troubles (Legacy and Reconciliation) Act 2023.”
“As Colin McGrath said, if the Bill is successful, we need to understand how we will work out in years to come whether a person is 29 or 30, or that 30-year-old is asking a 29-year-old to buy cigarettes for them. That is really important, because legislation is only useful if it is workable, and we need to work out that conundrum. We also need to remember that asking for proof of age is one of the greatest triggers for violence and abuse of retailers. Often, young people work in local shops, and they will have to take that abuse. We really need to work on that element of the Bill. <BR /> <BR />The other element of the Bill that gives us some concern is the issue around vapes. This is a new industry, and it needs to be regulated. That is very important. So far, the Bill does not really lend itself to a great deal in that respect.”
“There are some doubts at the moment as to whether the Bill as drafted meets those requirements. Concerns have been raised by retailers and shopkeepers that they could be criminalised under the new smoking ban and unfairly deemed to have permitted sales to those covered by this generational problem. Given that the overwhelming majority of cigarettes are bought from local shops, we need to be clear on enforcement, and we need to make sure that we do not criminalise the retailer. I am glad to hear that some work has been done on clause 53 of the Bill, because I think that that is very important. <BR /> <BR />Age verification is another issue that will have to be looked at.”
“We are indebted to around 600 smoking cessation specialist services that provide their services free of charge to people across Northern Ireland, because it is a difficult addiction to break. We need to help people to do so and work in that particular area. <BR /> <BR />The Bill as drafted has significant challenges. I hope that, as it progresses through Parliament, some of the issues will be dealt with in the scrutiny of the Bill. Our parliamentary team will work to try to use their influence in relation to that. As I have previously said, a generational smoking ban is well intentioned, but its success will ultimately rely on implementation and enforcement arrangements that can work and that do not unduly restrict the rights of retailers and consumers.”
“Those are very stark statistics for us to reflect upon. Research also suggests that the life expectancy of each smoker is shortened for each cigarette smoked. Smoking also affects others, whether it is an unborn child or those who inhale second-hand smoke through passive smoking. <BR /> <BR />Yesterday, it was a delight to welcome to the Assembly Cathy Brokenshire, who is visiting us in Northern Ireland. Cathy is the wife of the late James Brokenshire, who died from lung cancer despite never having smoked in his life. I look forward to the autumn, when we will bring an event to the Assembly to discuss the harms of smoking, lung cancer and, indeed, passive smoking. It was a real honour to be able to facilitate that visit yesterday. <BR /> <BR />Smoking also results in high costs to the health and social services sector.”
“I offer my support and that of my party for the extension of the Tobacco and Vapes Bill to Northern Ireland. It is important that we are part of the UK-wide legislation. All of us in the Chamber today will unite around the aim of having a smoke-free society in Northern Ireland, but, as the Member who spoke previously just illustrated, it is vital that the legislation that is brought forward to tackle what is a very great harm in society is properly assessed and is fair, deliverable and workable. <BR /> <BR />We all know the harm that is caused by smoking. The report published by the Northern Ireland Audit Office in January this year reiterated that smoking is the main cause of illness and early death in Northern Ireland, contributing to around 2,200 deaths each year and one in four of all deaths from cancer.”
“That is, indeed, good news, Minister. It really recognises the importance of the grassroots game. Another developing aspect of the game is women's football. There is an urgent need, just as there was in rugby, which got a significant amount of money, to upgrade changing facilities etc. Will you be able to address that issue as well?”
“For too long, those people have suffered from a lack of information, obstruction and prevarication from the world of medicine. They have waited a long time for the outcome of the inquiry. Hopefully, today, they will hear from the Government about a full compensation scheme. We think of those who have been impacted and, indeed, those who have not lived to see this day. Hopefully, it will be a satisfactory day, when people will get answers and the Government, medicine and the National Health Service will learn lessons on how to prevent this happening again. It has been a stain on our Government and health service for too long, and we hope that there will be a satisfactory conclusion.”
“Today is an important day across the United Kingdom, because many thousands of people will hear the outcome of the infected blood inquiry. Across the United Kingdom, 30,000 people are estimated to have contracted HIV or hepatitis C after being given contaminated blood products in the 1970s and 1980s. Five thousand of those people will have suffered from haemophilia or associated bleeding disorders. It is estimated that almost 3,000 have died before hearing the outcome of the inquiry. <BR /> <BR />All those who have been impacted will be anxious. In the words of a colleague and campaigner, Nigel Hamilton, they are also:”
“— and it is important to remember that. <BR /> <BR />Thank you, Mr Deputy Speaker. This is a hugely important motion, and I hope that those involved in delivering the service understand that we support them.”
“I accept that trusts have done an enormous amount of work to ensure that those GP surgeries continue, even though contracts have been handed back. That is massively important. <BR /> <BR />There is also the issue of having accountability for GPs, so that we can understand that the services offered are the same and do not encounter a theme that has been commonly expressed in the Chamber today: the inequality of service across Northern Ireland, which is intolerable. <BR /> <BR />The Deputy Chair of the Committee, Danny Donnelly, talked about the workforce strategy, the plan to retain GPs in general practice and the need to improve core funding. Other colleagues talked about it being important to remember that many in our community have absolutely positive experiences of visiting their GP —”
“I have no wish to bring politics into this, but I remind Mr Chambers that the initial funding for multidisciplinary teams came from the additional billion pounds that was found in the DUP confidence-and-supply money. It is really important to remember that. I want us to continue to fund those teams, and I will support the Minister in his bid to do so, because they are fundamental to resolving the issue. <BR /> <BR />Linda Dillon talked about the importance of primary and social care and of taking a holistic approach to well-being in our community. That is important. Well-being is underrated as a value, and it is really important for us to remember that. <BR /> <BR />My colleague Deborah Erskine made really important points about the impact of the crisis in GP surgeries in rural communities and access to those services.”
“<BR /> <BR />Liz Kimmins mentioned the experience of patients and the need to respond to them before conditions become so bad as to be intolerable for them to bear and to cause the time spent in hospital to become much longer. She talked about a permanent solution for the GP indemnity issue and the importance of the community and voluntary sector. Nuala McAllister talked about the impact of handing contracts back and the large number of services involved across primary care. <BR /> <BR />Mr Chambers was a little perturbed that the motion was too late. I think that the motion is very timely, because we are here talking about the importance of primary care, GPs and supporting those services. I wish the Minister or his successor well in achieving suitable and practical solutions for GPs. Mr Chambers also talked about multidisciplinary teams.”
“<BR /> <BR />We support Colin McGrath's amendment, despite the misnaming of Northern Ireland in the midst of it. It is important to remember that we need to embrace change for there to be transformation. If we do not embrace change, services will collapse — we are seeing that — and we will then be transforming services on an ad hoc basis that suits nobody and will not give us a proper vision of primary care. Mr McGrath is fortunate that his constituency saw the roll-out of a fully staffed multidisciplinary team. That is important, because, in Northern Ireland, fewer than 8% of those teams are fully staffed and equipped. We need to look at how we can manage to do that even though the budget is challenging.”
“<BR /> <BR />While the motion focuses on GPs and GP practices, primary care is about so much more. It is about community pharmacies and mental health support services. It is about the community and voluntary sector, which does sterling work. Many of those organisations work quietly, bit by bit, with the most vulnerable people in our society. That is also very important to remember. <BR /> <BR />I turn to some of the contributions to the debate, because an important theme runs through them. When proposing the motion, my colleague Mr Robinson described and emphasised the importance of primary care, adequate funding and multidisciplinary teams and of having a workforce strategy so that we can have a plan and measure against targets along the way to see how we are doing. He talked about the retention of GPs in the system and training for GPs.”
“However, if we do not transform primary care, we will not achieve a knock-on effect in secondary care in elective and other procedures. On that basis, it is good for the House to talk about the challenges that face primary care and those involved in providing it. <BR /> <BR />Sometimes, we think of this being an almost monumental challenge that we cannot overcome, but there are simple things that we can do that will help us to get to that transformation position. Many Members from across the Chamber mentioned funding. I am sure that some might take exception to this, but two million of us are registered with GPs, yet they receive 5·4% of the healthcare budget. We will have to rebalance that and look at it for the future. That is important in transforming the service.”
“We need to plan for the future and have a proactive vision of what a really good primary healthcare system can look like. As things stand, however, we know that patients are not being assessed in a timely manner. The workload for GPs is continually expanding, and there really are not sufficient staff to run the service at its optimum. <BR /> <BR />When thinking about the debate, I thought about the general point that I wanted to make. We have talked a lot about transforming our health service. I think that it was Colin McGrath who quoted Bengoa. There is no doubt that there are big, fundamental issues that we need to work at in transforming services for the community, whether for cancer patients, stroke patients or whomever.”
“<BR /> <BR />There has been much talk in Northern Ireland recently about the Covid-19 inquiry — the Minister has borne the brunt of that, as have I — but the best thing that we can do coming out of that is to give our GPs, constituents and community a health service that is fit for purpose. Minister, you have the support of the Health Committee in doing that. It is important to remember that when we have these debates. <BR /> <BR />The challenges in primary care and general practice are enormous. The service that the public receive and the environment in which GPs and some public servants work have fundamentally changed over the past 10 or 20 years. Minister, I absolutely accept your assertion that we are not going back.”