Simon Hamilton
Strangford · Democratic Unionist Party · Northern Ireland
“I have emphasised to the Member and the House before, that, whilst I accept that those are not good enough — that is why we have been developing the plan — there are alternative technologies in place that can present opportunities for those who just cannot get acceptable speeds.”
“I thank the Member for his intervention. There are some initiatives that I believe will help and act as a driver to improve broadband access. One such intervention is the broadband universal service obligation (USO), which is being taken forward by Her Majesty's Government.”
“I thank the Member for his question. However, he is conflating two issues. I wrote to his party leader, and indeed to all Assembly party leaders, before making the announcement that I did last week about wanting to publish the details of the businesses in receipt of the non-domestic RHI scheme. It was my intention to do that tomorrow.”
“<BR /> <BR />The Chancellor, in his autumn statement, made some more funding available for telecommunications, and my Department is studying that and seeking to avail itself of that to the fullest possible extent.”
“In addition, my Department is managing a contract for the delivery of the superfast rollout programme, which, by 31 December, will provide access to superfast broadband with speeds of at least 24 megabits per second to a further 38,000 premises, both business and residential, across Northern Ireland, including in the Newry and Armagh cons…”
“I signalled the intention to do this a few weeks ago. The Member and the House will know that inspections of all installations would have taken place over the 20-year lifetime of the RHI scheme.”
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“Following the decision made by Four Seasons Health Care to close some nursing homes, I asked the Health and Social Care Board to halt and review the current process examining the future role and function of statutory residential care homes as a precautionary measure. I want to develop a broader understanding of the issues facing the residential and nursing home sector and their implications before making any final decision on the future of statutory homes. It is also right to pause, reflect and give careful consideration to issues arising in the independent sector.”
“The Public Health Agency, as I said, has also been in touch with the Health Service Executive in the Republic of Ireland to ensure that appropriate guidance and information is disseminated on both sides of the border.”
“It is standard practice in such situations — it does not matter what the virus, condition or illness might be — for officials in my Department to be in touch, as they have been in this case, with their counterparts in the Department of Health in Ireland to ensure that any queries regarding the issue are discussed as required. It is important to stress that it is not a Northern Ireland response or an Ireland-wide response that is required: this is international. The response of the UK, as a whole, is being led by Public Health England (PHE). The Public Health Agency's health protection service is working very closely with colleagues in Public Health England and contributes to the twice-weekly teleconferences organised by Public Health England.”
“Anyone who has been in an affected country needs to be particularly mindful of the signs and symptoms of the infection and, if necessary, contact their GP, who will offer the appropriate advice. Updated advice on the Zika virus can also be accessed though the Northern Ireland Direct and PHA websites, and I encourage anybody who is travelling to those areas to consider that advice very carefully.”
“The Public Health Agency is understandably and rightly advising people, in particular pregnant women and those planning pregnancy, to consider avoiding travel to any country or area where Zika virus outbreaks are reported. Outbreaks have been reported in a number of countries in south and central America, and all travellers to affected countries should ensure that they seek travel health advice from their GP or, indeed, a travel clinic well in advance of their trip. <BR /> <BR />A possible link between exposure to the Zika virus during pregnancy and microcephaly and other congenital malformations has been identified and is being investigated. Women returning from the affected countries should avoid getting pregnant for 28 days.”
“Almost all cases of the virus are acquired through mosquito bites and not through human-to-human contact, although a very small number of cases have occurred through sexual transmission. At the moment, the key actions for Northern Ireland are to ensure that travellers to and from infected areas, especially pregnant women, receive appropriate advice and that clinicians are aware of the symptoms and, where appropriate, the actions to be taken for returning travellers.”
“The Public Health Agency is leading the response to the Zika virus in Northern Ireland. It issued advice to health professionals in December 2015 and again in February of this year. The PHA also issued a press release in early February giving advice to pregnant women, as well as providing up-to-date information on its website. <BR /> <BR />It is important to note that the Zika virus is an infection transmitted by mosquitoes that are not native to Northern Ireland and, therefore, the public health risk posed by the Zika virus in Northern Ireland is extremely low. It is no greater than the risks posed by other mosquito-borne infections such as malaria, for example.”
“I am happy to come back to the Member with any information that I might have, or, if it is in the domain of the Minister of Education, I will ensure that he passes it to the Member.”
“I do not think that I have information about what is happening in schools. It may be something that the Minister of Education has better information on. I am certainly happy to go away, get that information and give it to the Member in due course. <BR /> <BR />As with a lot of public health messages, the earlier, the sooner and the younger people get the message — in an appropriate manner, because we do not want to scare people unnecessarily, particularly young people — that looking after your health in every aspect is incredibly important, the better. I am very keen to work with schools, and the Public Health Agency does that in a range of ways, as do the board and the trusts as well.”
“We are not doing these tests just for the sake of it; this is about saving people's lives, and we will make every effort that we possibly and reasonably can to increase the uptake of the tests because they are so critical.”
“Focus-group work has been carried out with those who attend and also with those who do not, particularly, to find out why they do not attend and what we can do to further tailor the service and make sure that any fears or concerns that they might have are alleviated. One interesting piece of work that the Member might be interested in is that the PHA has been working with the Women's Resource and Development Agency to particularly target those groups that have lower rates of attendance for tests, in order to see what the particular issues are and what can be done, through that network, to get more people to come forward. <BR /> <BR />At the end of the day, this is an exceptionally important public health message.”
“When I saw the question come forward from Mrs Cameron, I was interested in that as well. How well are we advertising the need for people to go for their tests when called for? It is good to see that there has been an increase, but we are still not quite at the 80% target. There are some age groups that are well in excess of that target; in particular, younger people of around the ages 25, 30 and 35 are now exceeding the 80% target. <BR /> <BR />A range of advertising and promotional work goes on, which is monitored on a regular basis by the Public Health Agency (PHA). It involves the usual things that you would expect: information leaflets, videos and a dedicated website.”
“It is just the case that we will not be doing that, universally, for everybody under 25. However, in cases where people present themselves and their GP thinks it appropriate, they can get smear tests.”
“It used to be that those aged 20 or over would get a smear test, but that rose to 25. Scotland reduced the age to 20, but I understand that it is also going back up to 25. It may be worth saying that, if GPs are worried about exceptional cases — there will always be exceptional cases of people who present with abnormalities — they can and should, if they deem it clinically appropriate, contact their local screening laboratory to arrange a screening test. In essence, what I am saying is that no one under the age of 25 who has concerns about abnormalities should fear going to their GP and presenting their symptoms. They can get cervical smear tests performed, even though they are under 25, because the doctor has clinically decided that that is appropriate given their set of circumstances.”
“I thank the Member for her question. I know that she has long taken an interest in and been a champion of this issue. In January, the UK National Screening Committee, from which we take advice on screening matters, recommended the introduction of human papillomavirus testing as the primary screening test for cervical cancer, and the Public Health Agency in Northern Ireland has undertaken a scoping exercise on its introduction. We will assess its findings as part of the scoping exercise, and I hope that this work will come forward with conclusions very soon. I hope that we will also introduce the HPV test, which would be good news for people in Northern Ireland. <BR /> <BR />I think that the position of women under the age of 25 has changed recently, although the Member will be more familiar with this than me.”
“I am pleased to say that, over the past ten years, there has been an increase in cervical screening coverage rates in Northern Ireland. In 2005, the coverage rate was 71%; by 31 March 2015, the rate was 77%. The target coverage for cervical screening is 80%, and, for some age groups, that is being met. Work is ongoing to improve the uptake in all age groups by promoting and supporting informed decision-making. It is vital that people participate in cancer screening programmes when invited, because they are important public health initiatives aimed at reducing deaths from cancer in our population.”
“I think that the panel, in looking for efficiencies, should look at how we can better deliver the elective care that our population needs. If we had a more efficient system, it could be done much better.”
“There is a range of specialisms and activities that some 60,000 to 70,000 people will benefit from. That will by no means solve the problem, but a sizeable chunk of it will be dealt with. Obviously, more people will join waiting lists in the intervening period, and that is why it is incredibly important that we continue to keep up that level of investment in elective care into the next Budget period. <BR /> <BR />The expert panel will not look at this issue particularly. This is a significant week for the panel and its work: we have our summit tomorrow, and I hope that that might find a way forward through an agreed set of principles. I hope that the outcome of all that work is that we agree to create not only a better but a more efficient health service in Northern Ireland.”
“I thank the Member for his question. I think that, in my initial public pronouncements on the £40 million of expenditure, I underestimated the number of people who would receive outpatient appointments, as well as the number of inpatients, day cases and other treatments. I said that up to 40,000 people might get outpatient appointments, with about 15,000 getting treatments, but it looks like it will be a much higher number: between 60,000 and 70,000 patients across a range of specialisms. As I said, it will include outpatients, inpatients and day cases. <BR /> <BR />There will also be allied health professional activity, so people will get appointments with physiotherapists, occupational therapists and others, and there will be many diagnostic tests, scans and so forth.”
“I am content to have a conversation and to consider targets that other jurisdictions have to see what they have put in place, what impact they have had and whether they are a more accurate measure of the reality of the situation. I am not saying specifically that that is the case in this instance, but a lot of the targets that the health and social care system has to achieve are not always up to date or clinically that beneficial. I am more than happy to have a conversation and to look at other ways in which we might measure targets for waiting times.”
“We have at least now moved forward and beyond that, hopefully, and that has freed up a welcome injection of £40 million into waiting lists in Northern Ireland, which, as I said, will ensure that some have already got their treatment, some are getting their treatment and some will get their treatment in the next number of weeks. Between 60,000 to 70,000 patients across a range of specialisms will get the help and care that they need. <BR /> <BR />I am content to consider ways in which we can look at targets. Targets are important, but sometimes we focus a little too much on them and not enough on the qualitative rather than the quantitative aspects.”
“The Member may take exception to what I said, but I certainly take exception to what she said about the approach of the DUP or, indeed, that of any other party in the House in seeking to move forward on welfare reform legislation that we were not necessarily happy with either. We fought the fight at Westminster against it when others were absent and then sought to deliver the best possible deal for Northern Ireland. I do not accept the criticism that that has made people sick. I do not want to get into some sort of argument with the Member opposite about the fact that they ultimately signed up to that welfare reform legislation.”
“They went decisively in the wrong direction, I have to say, around the time when the tap for the independent sector contract and the ability to fund more in-house activity was turned off by my predecessor because of the difficult financial circumstances he found the Department to be in. <BR /> <BR />I do not find the waiting lists acceptable, but they are another example, I hope, of where we are now thankfully investing some £40 million to help between 60,000 and 70,000 patients. I expect the Member and his constituents and, indeed, other Members and their constituents to start seeing the benefits of that. If they have not already started to see them, they should start to very soon.”
“The Executive lost around £200 million from their coffers over the last three years because of our inability to agree welfare reform legislation in this place. Whilst I do not think that my Department would have had dibs on all that money, if we had had our share commensurate with the rest of the Budget, which would have been close to half, we would have made a significant dent in those waiting lists. <BR /> <BR />It is interesting, when you look at the figures, to note that we had been making significant and positive progress on eating into waiting lists over the last number of years.”
“I repeat the point that I made in my original answer to the Member: I do not find the waiting lists acceptable. They are far too long, and I look to the board and particularly the trusts to deal with the very long waiting lists that they have. To be fair, this has been occurring against the backdrop of various things that have been happening, not least the pretty significant increase of 14% in the last number of years in referrals for outpatient appointments. There has been a huge increase in that at the same time as the budget of my Department has been under pressure. <BR /> <BR />I do not find the waiting lists acceptable, but neither did I find acceptable the fact that we were losing tens of millions of pounds every month because of our failure — I am sorry: the failure of some to move forward with welfare reform.”
“I expect this to benefit the many thousands of patients who would otherwise be waiting. <BR /> <BR />Since November, significant efforts have been made across the health and social care system, within a very tight time frame, to secure additional outpatient clinics and treatments in trusts and to put in place appropriate arrangements with independent sector organisations to transfer suitable patients for assessment and/or treatment. Of course, this is just a start, and much more additional funding will be needed to get us back to where we were. However, we are now moving in the right direction, and I hope that patients, particularly those waiting the longest, will see the benefit of this as soon as possible.”
“Provisionally, at the end of December 2015, 32,544 patients were waiting longer than 52 weeks for a first outpatient appointment. I wish to make it clear that I find those figures totally unacceptable. It is regrettable that more people are waiting longer due to the financial constraints that led to the decision to suspend independent sector and additional in-house activity last year. It was extremely frustrating that, this year, £9·5 million from Northern Ireland's public finances was being lost to Westminster each and every month as a result of welfare reform being blocked. Such a sum could have funded many thousands of assessments and procedures. However, I welcome the allocation of an additional £40 million from the November monitoring round that will go towards tackling waiting lists.”
“We need to make sure that this would improve the situation rather than confusing things and adding to the myriad commissioners and champions that we already have across the public sector.”
“I thank the Member for his question. I am aware of the suggestion that has been made by Action Mental Health and other mental health charities in recent times. To be honest, I have not met the range of charities to discuss the proposal and hollow out what they mean by a "mental health champion" and what that person might specifically do. I am happy to have that discussion and am sure that Members will encourage me in doing that. We need to be careful of appointing someone into a role that would cover everybody with mental health conditions in Northern Ireland. There is a breadth of mental health conditions for which people are already receiving support through, for example, the work of the Victims' Commissioner, the Commissioner for Older People or other public bodies and appointees.”
“It will be a long and probably quite slow and, at times, frustrating journey to make the vision in the Bamford report into a reality. What is significant is that, since that report, we have increased expenditure on mental health services by over a quarter, from roughly £200 million annually to a quarter of a billion pounds. It is significant that there has been a switch away from spending money on looking after people in hospitals or in institutions, many of which were no longer fit for purpose, to spending it in communities. Before Bamford, in 2004-05, we were spending 46% of that money in a community setting, but that has now increased to about 57%. That is as significant as any increase in expenditure would be. We are spending the money looking after people in their community and close to their home and their family.”
“I thank the Member for his question. Over the last number of days, as a result of both criticism of mental health services in England and investment in mental health services in England, an interesting public debate, led in part by the Prime Minister, has been going on. This has, again, brought to the fore the need to discuss mental health and try to destigmatise it. In an earlier debate today, Mr McCarthy referred to mental health services as having been for many years the "Cinderella service" of the health service. That is a reasonable description. <BR /> <BR />I am not saying that we have, by any means, made everything perfect or right, but the Bamford review and report and the recommendations that flowed from it were a watershed moment, in many respects, for mental health in Northern Ireland.”
“<BR /> <BR />I mentioned some investment, particularly the £1·6 million that went into making sure that we were delivering what are referred to as directly enhanced services, which are about 12,000 sessions that are done a year, particularly counselling sessions with those who are suffering from depression. There are a lot of things going on. <BR /> <BR />The Member asked specifically about spaces and perhaps blind spots in particular trusts areas. I am happy to reflect on that and come back to her with any details that I might have.”
“The Northern Trust area as well. There is obviously a range of pressures, not just in that area of the Department and the health service's work but in a range of different areas. <BR /> <BR />It is not that I do not recognise that there is an issue or that I am saying that there is not a problem in the area. It is also not the case that we are not seeing some improvement year-on-year. As I mentioned in my answer, 64% of patients were waiting longer than 13 weeks in December last year, and that has now fallen to 50%. I am not saying that that is in any way an acceptable level, but it is a measure of some improvement and reflects some additional investment that has gone into the area, particularly through the creation of talking-therapy hubs in many parts of Northern Ireland, including in areas that cover the Member's constituency.”
“I agree and accept the point that the figures for the length of time over 13 weeks that people are having to wait for psychological therapies and adult mental health services that the Member has specifically enquired about are not acceptable and are worrying. I am happy to look at whether we can furnish the Member with more specific information about her constituency or, indeed, some subset of the Western Trust area.”
“As at 31 December 2015, 50% of patients who had waited longer than 13 weeks to access psychological therapies were waiting to be seen by adult mental health services. The equivalent figure on 31 December 2014 was 64%. Therefore, although the figure is clearly too high and further work is needed, I am pleased to say that we have been able to make some progress in addressing the pressures on our adult mental health services waiting lists. As part of that work, I recently allocated £1·6 million to the Health and Social Care Board (HSCB). That will provide a much-needed boost to the provision of specialist mental health/psychological services for individuals with complex mental health problems and directly enhance services to help general practitioners avail themselves of talking therapies for patients with depression.”
“I do not think it is appropriate for any Minister to presume the mind of the Assembly when they start to apply resources — in my case, those are limited resources, and I am sure the Justice Minister would agree that they are limited in his Department — without having the Bill passed. I assure the Member and the House, as I did in group one, that, when the Bill is passed, we will consider putting in place an implementation timetable and to start to apply resources to it accordingly, perhaps in a phased way, to make sure that we get aspects of the Bill implemented as quickly as possible. <BR /> <BR />I am pleased to commend the amendments tabled in my name in group two to the House.”
“I am also bringing forward a number of other amendments that will collectively limit the powers conferred on the Department to make further provision in regulations. I will take this opportunity to remind the Chamber once again that that approach will increase the risk of needing a further Bill to amend what, hopefully, will be the Mental Capacity Act. <BR /> <BR />Mrs Dobson raised cost. I refer to the comments that I made in response to the group one debate. We have significantly reduced the cost of implementing the Bill from original estimates to estimates that are much lower but still quite high. Yes, it is an expensive Bill to implement, and I have been clear about that from the very outset. But I think it is right that we continue to press ahead with the legislation.”
“That was a bit of light relief for a moment or two in this very heavy debate. I was starting to enjoy that a little too much. <BR /> <BR />I thank all the Members who contributed to the debate on the second group of amendments. The amendments are largely technical and consequential and have not, therefore, required a great deal of explanation, with the exception of perhaps clause 288. I thought there was a risk that we would get through this group of amendments without the Chair of the Committee referring to such a clause as a Henry VIII clause. He has known me long enough, and he knows me well enough, to know that I have no autocratic tendencies at all. It would not be the sort of thing that I would be looking to do, which is why I am content that clause 288 should not stand part of the Bill. We are going to oppose it.”
“<BR /> <BR />Mr Principal Deputy Speaker, you and Members will be glad to hear that that concludes my contribution on the second group of amendments regarding subordinate legislation-making powers, changes to the Mental Health Order and technical matters. I look forward to hearing Members' views.”
“applies to people under 18 and not under 16, as requested by the Committee. <BR /> <BR />Amendment No 476 replaces references to "a place of safety" in article 129 of the Mental Health Order with the term "an appropriate place", in order to avoid confusion with the new "place of safety" regime in Part 9 of the Bill. Amendment Nos 477 to 480 are consequential. Amendment No 487 removes the words "any police station" from article 129(7) of the Mental Health Order so that it will no longer be possible to take a child under 16 to a police station, as both stakeholders and professionals alike agreed that that is not appropriate and, indeed, that the provision is rarely used. <BR /> <BR />Other minor consequential amendments are brought forward by amendment Nos 485 and 488.”
“The effect of the amendment is that any future registration and inspection of private hospitals must be done in accordance with the provisions of the RQIA 2003 Order. Members will wish to note that there are currently no private mental health hospitals in Northern Ireland. I am simply tidying up provisions so that they are dealt with under one piece of legislation. <BR /> <BR />That is also the intention behind amendment No 473, which is in part linked to the new clause 277A, which is amendment No 341 in group 3. We will discuss that amendment in more detail when the debate on group 3 arises. What is worth mentioning now, however, is that amendment No 473 ensures that the duty in article 118(4) of the Mental Health Order to maintain a register of people:”
“Those functions were transferred from the Mental Health Commission to the RQIA in 2009 but, at that time, were not amended to take account of the wider functions conferred on the RQIA by the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. <BR /> <BR />The purpose of repealing Part 6 of the Mental Health Order is to address overlaps and to make provision for all of RQIA's functions in one piece of legislation, that is, in the RQIA 2003 Order. Amendment No 472 addresses a dual registration problem relating to private mental health hospitals. Currently, they must be registered under Part 7 of the Mental Health Order and Part 3 of the RQIA 2003 Order.”
“<BR /> <BR />It is also worth pointing out that amendment No 395, although minor, ensures that any references in the Bill to "prescribed" attracts the same definition as that for regulations. <BR /> <BR />I conclude my comments on the second group by detailing those amendments that relate to the Mental Health (Northern Ireland) Order 1986. Again, there are some minor technical changes brought forward by amendment Nos 471, 474, 475 and 482. Amendment No 472 relates to the repeal of Part 6 of the Mental Health Order, which sets out the functions of the Regulation and Quality Improvement Authority.”
“The aim of the amendment is to ensure that any regulations relating to clinical trials that are not to be treated as research for the purposes of Part 8 must be prescribed by regulation, subject to negative resolution rather than by way of an administrative designation. <BR /> <BR />Amendment Nos 322, 323, 325, 326 and 402 are purely technical in nature, clarifying policy intent, which we will not go into. <BR /> <BR />Amendment No 386 makes the regulation-making power in paragraph 14 of schedule 7A, which deals with supervision and assessment orders, subject to affirmative resolution, as some regulations could have a significant policy impact. <BR /> <BR />Amendment No 402 clarifies that the principles in Part 1 apply to regulations made under the Bill.”
“A power to make transitional, transitory or a saving provision, by regulations in connection with the commencement of the Bill, has been moved to clause 294 and does not now include a power to amend or modify other primary legislation. <BR /> <BR />Amendment Nos 379 to 385 and 387 to clause 289, are largely consequential on the changes to clause 288, and the Department's acceptance of the recommendations in the report of the Examiner of Statutory Rules. <BR /> <BR />Moving on to other subordinate legislation-making powers, amendment No 138 gives effect to comments made by the Examiner of Statutory Rules on clause 131, which deals with research. I thank the Examiner for that advice.”
“In summary, those amendments insert a new clause 58A to replace — but to mirror the effect of — subsection (3) of clause 288, as originally drafted. That power continues to be required. My Department must be able to modify provisions in Part 2 of the Bill to deal with cases where an intervention is proposed in relation to a child under 16, who will actually be 16 when the intervention is carried out. It also gives my Department a power to make regulations for the rectification of reports made under Part 2 that have been found to be incorrect or defective, within a prescribed period. It is important that that power be retained. <BR /> <BR />A power to make regulations amending other primary legislation in consequence of the Bill only is now contained in clause 290.”
“I have, therefore, been asked by the Committee to bring forward a more limited version of clause 288. Before turning to my proposals, I want it to be clear that the rationale for clause 288, in its original form, was to deal with the unknown unknowns, that is, any unintended consequences that the introduction of such an innovative framework might have. <BR /> <BR />The amendments that I now propose provide a compromise, given the Committee's clear stance on that issue. However, I should make Members aware, as I did the Committee, that they will increase the risk of needing a further Bill in the future. The relevant amendments are amendment Nos 69, 379 to 383, 385, 387, 388, 398, 404 and 405, all of which are consequential to my opposition to clause 288.”
“Amendment No 31 is, therefore, not required, and I urge Members to oppose it and instead support amendment No 30, which already deals appropriately with the issue. <BR /> <BR />I now want to turn to one of the more significant amendments that I propose to make. The Committee made it clear to the Department that it was not prepared to support clause 288, which confers powers on the Department to make further provision in regulations. Members were concerned that the powers conferred were too wide.”
“Any ambiguity over whether those regulations will be made is, therefore, removed. With this in mind, I would like to draw Members' attention to amendment No 10 again, which has been tabled by Ms McCorley and others. I referred to this during the debate on the first group of amendments. It should now be clear to the House that amendment No 10 is not required. I would, therefore, ask for amendment No 9 to be supported and for amendment No 10 to be opposed. <BR /> <BR />A similar issue arises in relation to amendment Nos 30 and 31, which relate to prescribing healthcare professionals permitted access to someone who is subject to a community residence requirement. Again, my tabled amendment No 30, removes any ambiguity around the need to make these regulations: they must be made.”
“<BR /> <BR />Amendment No 384 is a consequential technical amendment on foot of the amendment to clause 205, which I will discuss in more detail when the debate on group 4 arises. <BR /> <BR />Amendment 417 to paragraph 20 in schedule 1, clarifies the circumstances in which an interim authorisation may be made. Amendment Nos 53 and 54 are consequential to that amendment. <BR /> <BR />I now want to turn to the amendments in this group that relate to subordinate legislation-making powers. Amendment No 9 relates to clause 14. Clause 14 defines what is meant by formal capacity assessment and includes a regulation-making power to prescribe in regulations who is deemed to be suitably qualified to undertake that assessment. The amendment clarifies that only someone prescribed by the regulations can carry out the assessment.”