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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“Certainly, it warned me that there is a risk that some of the things that we talked about today around Daisy Hill and the Mater Hospital may happen, and we need to do our very best to ensure that they do not happen. I have tried to put in place the appropriate resources, particularly in terms of staff. I will certainly make a commitment to do all that I can to ensure that the issue in the Mater Hospital is resolved in the short term and is made sustainable in the longer term.”
“Absolutely. I am certainly committed to doing that and to ensuring that the highest quality of care and safety of care can be carried out in the Mater, Daisy Hill or wherever. I am certainly committed to doing that. He should acknowledge, as I am sure he does, the challenges with recruitment. There is much competition inside Northern Ireland, never mind outside it. I will certainly do my best. <BR /> <BR />As I mentioned before, I had a conversation last week with the Royal College of Emergency Medicine, which has acknowledged — I hope that I can speak for it — the good work that has been done by my predecessors in trying to recruit more people to emergency medicine.”
“Children will be redirected to the nearby Royal Belfast Hospital for Sick Children, which has a dedicated paediatric emergency department, while the Belfast Trust seeks to resolve the concerns identified and recruit senior medical staff. I made the point to Ms Fearon that, if clinicians come to me and my Department and say that a service being run in the short or longer term is unsafe, I have a duty to listen to them and to act.”
“As a precautionary measure, in response to concerns raised by senior medical staff about medical cover in the evening and overnight and the management of paediatric patients, the Belfast Trust has instigated short-term measures to ensure that safe, effective arrangements are in place outside normal working hours and to ensure that children needing emergency treatment get that treatment in the most appropriate place. <BR /> <BR />Belfast Trust emergency departments are managed as a full, joined-up service, and this precautionary measure was implemented on a coordinated basis to ensure continuity of service in Belfast. Overnight ambulance diverts from the Mater are expected to remain in place as a temporary measure.”
“I thought that this issue might come up today because it has obviously developed over the last number of days, so it is the very definition of a topical question. Much as Ms Fearon raised concerns about consultant cover at Daisy Hill, similar issues have arisen in the emergency department at the Mater Hospital. As I said to her, my job — indeed, this goes for anybody who holds this post — should be, I believe, to ensure the highest possible levels of quality and safety in our health and social care services. <BR /> <BR />The Belfast Health and Social Care Trust advised my Department last week of service difficulties at the Mater Hospital emergency department.”
“I am not sure of the exact number, but I know that there is a handful. There are certain advantages there — good geographical advantages, as well — but I certainly do not want to rule out anywhere. There may be other considerations as to the total geographical area that a helicopter emergency medical service might cover. Certainly, your bid for Aldergrove has been heard loudly and clearly.”
“There seems to be common accord for that suggestion, even from Members from other constituencies around the Chamber. I want to leave it to the consultation to look at issues such as where it might be located. I do not want to make a commitment here or there today. I might be tempted to say Newtownards airport, actually. I think that it is incredibly important that, in taking forward such a serious thing which will benefit people in Northern Ireland in the years ahead, we get it right in terms of how it is funded, how it is operated clinically and where it is located. I do not want to prejudge the consultation. I acknowledge that there are certain advantages with Aldergrove, given the collocation with the Police Service of Northern Ireland, which has a series of helicopters there.”
“<BR /> <BR />I encourage everyone with an interest in this to contribute to the consultation, and I am sure that there will be a range of very different views around what it might be. The important thing is that we realise the vision set out by Dr John Hinds and, indeed, by many of his colleagues that Northern Ireland can sustain an air ambulance service and, indeed, that it needs one.”
“In September, I was very glad to announce my commitment to introducing an air ambulance service for Northern Ireland. I think that that announcement has been very well received across Northern Ireland. I committed to carrying out a consultation. I hope to be in a position this week to launch that consultation and that it will look at a range of important issues on which it is pivotal that we come to a conclusion in respect of an air ambulance. Those issues include where it might be based, how it might be funded and to what level it should be staffed with clinical involvement. There is a range of serious issues beyond the basic commitment to do it that need to be ironed out, and I hope that a consultation can do that.”
“<BR /> <BR />We need to be mindful that there are processes that we need to go through in closing down organisations in the public sector, but, as I said previously, I will make sure that whatever can be done without the need for legislation will be done and will be implemented as quickly as possible. The work on the panel's recommendations will take longer, and that is why I have said that that might take half a decade or even up to 10 years. That is work that is very much long term, but, even though it is long term, we cannot lose sight of the need to do it.”
“<BR /> <BR />I put out a road map of reform in the speech I made on getting rid of unnecessary bureaucracy in our system and seeking to configure our hospital services in the most appropriate way to deal with those challenges and give the beneficial outcome of world-class health and social care system to people in Northern Ireland. That is not easy to do. It takes time. I wish that I could make it happen overnight, but I cannot do that. I do not have the magic ability to do that. If I could, I would, and I will not take a minute longer to do it than is necessary.”
“I know that urgent change is required in our health and social care system because of the extent of the looming challenges that we face in health and social care. We know and have discussed at length today the financial pressures that our budget and, indeed, all budgets in this place are under. Coupled with that, in health, we have a growing and an ageing population, which presents a series of challenges. We have a ticking time bomb of unhealthy lifestyles, and even good things like medical and technological advances are putting additional pressures on costs and increasing demand. I know that urgent action is required.”
“The report he produced was very useful, and, whilst I do not think that all of us will have agreed 100% with everything he suggested in it, I welcome the fact that he has acknowledged that the spirit of what he was putting forward has been agreed and taken forward in the proposals that I made. I have had a useful conversation with him, and I have welcomed the comments he made. I am sure that, given the work he has done here and the interest he has, he will continue to take a keen interest in Northern Ireland, particularly in how we roll out the reforms that I have put forward.”
“I met Sir Liam Donaldson at a conference that he was in Belfast to speak at last Thursday. It was organised by the Faculty of Medical Leadership and Management. He spoke in the morning and I spoke in the afternoon, and I had an opportunity in between to have a brief conversation with him. I began by welcoming his positive response to the reforms that I put forward in my speech in Ballymena almost a fortnight ago. <BR /> <BR />Obviously, he gave some comment to the media as well, about which I responded to Mr McGimpsey. I think that Sir Liam has been incredibly positive in his response.”
“If the Member or anybody in the House has ideas or suggestions about how we might resolve the issues at Daisy Hill Hospital, I am happy to listen to them.”
“There were still issues, but I am sure that they would agree that the most important thing is to serve all our people, wherever they are, whether in Newry or Newtownards, and that they have the highest standard of care and safety of care. I would be irresponsible in my job and would be going against my duty if staff were coming to me and saying that there were issues with patient safety and I did not act on that. <BR /> <BR />There are issues and challenges at Daisy Hill Hospital, and I am aware of them. I look to the trusts to work at resolving those issues and I am happy to make my own suggestions if I have them. Indeed, I am prepared to listen to others who come forward with suggestions.”
“It predates my time — both my immediate predecessors are in the House — but work was done to address the overall problems that emergency departments are having with recruitment. It is a very difficult area to work in. We all appreciate and understand that, and it can be challenging to recruit sufficient numbers. <BR /> <BR />I met representatives of the Royal College of Emergency Medicine last week to discuss not specifically the issue at Daisy Hill Hospital but a range of issues. They welcomed the efforts that had been put in over the last number of years to attract more staff to emergency medicine. They did not, by any means, conclude that we were out of the woods or that we had solved all the problems.”
“The Member appreciates that point and she is right to raise it today, but it is unfortunate that others ran to the press within 24 hours, creating additional problems and doing exactly what they were advised not to do. If we are to resolve the issue around recruiting and retaining staff at Daisy Hill Hospital, which I want to do, as does the Member and, I am sure, everybody who represents the area and lives there, it is not helped by scaremongering by some in the press. We should all be trying to collectively work together to address the issues and work with the trust, the board and others to alleviate the problems.”
“<BR /> <BR />The letter that went to Members of this House and, perhaps, MPs as well, was right to point out that, in raising this issue, we are right to be concerned. The letter said:”
“I am aware of the issue that the Member raises. I have spoken to her colleague Mr Murphy about this. I have no desire to see emergency services reduced at Daisy Hill Hospital but, as the Member will appreciate, my priority will always be to try to ensure the highest possible levels of quality and safety in our health and social care services. <BR /> <BR />I know, and the Member will appreciate, that there have been issues around recruitment and retention in the emergency department at Daisy Hill Hospital. The trust has undertaken work to alleviate that, but the hospital has been dealt a further blow by the decision of a member of staff to leave early next year. I know that Members who represent that area, or the area that is covered by Daisy Hill Hospital, were informed of that last week.”
“Of course, it is a great frustration to me that we have wasted close to £200 million of taxpayers' money during the last three years in penalties because of the continued failure to implement welfare reform. That has affected thousands of vulnerable people who have not been able to obtain the operations that they desperately need. Every month, we are losing £9·5 million, which could pay for over 1,800 hip operations or 2,100 knee operations.”
“That elective care work will set out what areas need to be stabilised, how and when that can be achieved, and what it will cost to get performance back to the nine, nine and 13-week positions that the health service previously achieved. I expect to receive the conclusions of that work soon.”
“I have indicated consistently over the past weeks and months that immediate pressures surrounding waiting lists and our emergency departments can be resolved only with the injection of funding as quickly as possible. <BR /> <BR />The Health and Social Care Board and trusts are already putting in place plans should additional funding become available, and that will, of course, be focused on patients with the greatest clinical need. However, even with additional funding, there are limits to what the system can deliver before the end of the year. <BR /> <BR />For the longer term, I have asked the board to examine how we can deal with demand and stabilise waiting times to put them on a more sustainable footing over the next few years.”
“It is certainly something that I will be carefully keeping an eye on as any final recommendation comes to me to sign off on as Minister. Again, this is about getting the best possible service for people in Northern Ireland. It is about protecting what is best and also improving the service that can be delivered.”
“Given that the Member represents a rural constituency, I would think that the issue of rurality is something that she is concerned about and interested in. Allegations have certainly been put to me about whether it serves the whole of Northern Ireland as well as it perhaps does some bits of it. If it is a criticism that has been put to me, I think that that is well worth examining, because, as the Member will know, there are sometimes, particularly in rural communities, hidden mental health problems. There can be suicides. In my constituency, I know of members of the farming community taking their own life. We should seek to do the best that we can to ensure that services such as Lifeline are spread right across Northern Ireland. That is certainly what I want to see as an outcome of the process.”
“Let no one be under any illusion here: this is not about doing away with a Lifeline service. This is about how that service might operate and who might operate it. It is not about doing away with Lifeline and the important work that needs to be done to provide that service for people who are contemplating suicide.”
“Yes, I can. Again, the nature of the campaign and the way in which it was styled was about protecting Lifeline. I want to make it absolutely clear — I have done so previously in the House and will do so again now — that the Lifeline service and brand will remain. As the Member said in his question, this is entirely about getting the best possible service moving forward, getting it better integrated with other emergency services right across the system and extending it out much more into the whole of Northern Ireland, particularly rural areas. As I mentioned, there is an important governance point about the possible perverse incentive that exists. On a governance basis, I do not think that that can be allowed to continue to be the case. The PHA is right to consider that.”
“There have actually been three offers made of an extension to the existing contract. Two offers were turned down. As the Member may know, the contract expires on 31 December. I am glad to say that the third offer of a contract extension, until the end of September 2016, has been agreed. Obviously, that allows for continuity of service while we move to a new model of service delivery.”
“For callers at high risk, helpline staff would directly arrange further care through to emergency mental health services. <BR /> <BR />By splitting the management of immediate helpline support from follow-up support, the proposals avoid a potential perverse incentive, whereby the helpline provider would potentially gain financially from referring a client to follow-up support that it also delivers. That does not imply in any way that Contact NI has sought financial gain in that manner.”
“<BR /> <BR />The proposed model retains the core elements of the existing service, namely the free-to-call crisis telephone helpline, which will be accessible 24 hours a day; qualified helpline operatives who are skilled in talking to people in crisis and have professional skills in listening and in assessing suicide risk; the ability to direct callers to the most appropriate service for their needs; and, finally, follow-on support from locally based suicide prevention organisations, enhanced with complementary therapies and local face-to-face immediate support.”
“I have not held any discussions with the current provider of the service. The Public Health Agency commissions Lifeline and is undertaking the consultation process on the new service model. The agency participated in a Contact NI staff workshop on 10 October to outline the proposals and offered to attend a second workshop, which was subsequently cancelled by Contact NI. Contact NI staff have attended a number of the public consultation workshops organised by the Public Health Agency and have expressed their views at those events.”
“As I said in my original response, all Departments have bought into the strategy and action plan. I know that officials from my Department have been working closely with officials from the Department of Education because of the direct read-across of children and young people who are at school and the impact on their education. I know that work is going on at a practical level, as well as agreement on the strategy and action plan. Following the passage of the Act in 2011, good cross-departmental work has been going on in respect of autism.”
“I am sure that that is replicated around Northern Ireland. I am sure that support is going to those from the health and social care sector, but I will inform the Member of the extent to which that is happening.”
“I do not have the expertise to delve into why there has been a doubling in a very short period. It is a six-year period; it is not a lengthy period. It is a very, very short period, during which we have had a doubling in referrals. Perhaps, the fact that there is increased awareness of the existence of autism is one of the contributing factors; I think that that is fair to say. I am free enough to say that there is, obviously, support and work going on in research. The extent to which my Department contributes to, funds or supports that, I cannot say, but I am happy to write to the Member and inform him of what support we are involved in. I know that we will be supporting in various ways through trusts, the PHA and others and in helping autism charities across Northern Ireland. He and I will know of some that operate in our constituency.”
“People take their positions on opposing welfare reform, but I hope that we can resolve those issues over the next number of days. That will, I hope, free up more resources to go into the front line to deal with waiting lists and other problems. There are consequences of taking the ideological position that some have taken in respect of welfare reform and not living up to the commitments that they made last year: we can see that in autism services, in waiting lists and elsewhere.”
“The Bill became an Act in 2011. Since just before that, as I mentioned to Mr Bradley, the number of referrals of children and young people for assessment has nearly doubled from around 1,500 to close to 3,000 this year, but resources have not increased at a commensurate rate. We need to invest more. I accept the point that Members have made: we absolutely need to invest more in getting staff into the front line. We estimate that around 20 to 23 whole-time equivalent clinical staff are required. The cost of doing that would be around £1 million of additional expenditure, so, when Members opposite roll their eyes about raising issues around welfare reform and the loss of £9·5 million every month, they should consider that £1 million out of that £9·5 million that is lost in one month would cover the increased costs.”
“The Member rolls his eyes, but it is a serious issue. We cannot afford to lose that amount of money that could be going to the front line.”
“It is not that we have sat back and done nothing; it is not even as if, before diagnosis, nothing happens with interventions. More could be done, but to deliver more we need more resources. The Member knows full well the pressure on resources in the Department. I hope that he will also appreciate and understand that the £9·5 million a month being lost through welfare reform penalties because of the failure of his party and others to live up to their commitments on welfare reform is costing —”
“There is much work from community paediatrics, speech and language therapy, occupational therapy, social services and educational psychology as appropriate as an intervention, even in advance of diagnosis. We are working hard to reduce the impact of the long waits by looking and reviewing autism assessment processes, which is quite a long and extensive process. We are looking at what we can do to streamline that as much as possible while still having a high quality of diagnosis. We are also looking at standardising autism service models across all trusts and extending service capacity through the greater integration and alignment of autism services with other child development and young people's mental health services.”
“I do not come to the House to give those figures or statistics with any sense of pride: far from it. The Act has helped, along with many charities working in the field, to raise awareness of autism. It is a positive thing that that has happened. It has created a significant increase in demand: a doubling of the number of referrals. As I said in my original answer, there has been an increase from 1,500 to nearly 3,000 this year. Obviously, that puts an understandable pressure and strain on the resources that I have at my disposal. <BR /> <BR />I accept the point about early diagnosis. Just because an ultimate diagnosis has not happened, that does not mean that there are not supports or interventions — quite the opposite. There are interventions that take place prior to ultimate diagnosis.”
“Therefore, while I am pleased with the progress made to date, there is no room for complacency. I will continue to work with the board and the trusts to tackle the current difficulties and to improve access to services.”
“<BR /> <BR />Many aspects of the strategy are progressing well, with better access to services for people with autism and their families and carers; the appointment of a regional ASD coordinator; and training for front-line staff, education professionals, youth workers, parents and carers. There is also better awareness of support services through signposting by HSC trusts as part of their triaging process. However, it is undoubtedly the case that the unprecedented increase in referrals has created a major challenge for the system. Over the past six years, referrals of children and young people for assessment have nearly doubled from around 1,500 to 2,936 per year. That has inevitably resulted in longer waiting times for the first assessment and ultimate diagnosis.”
“The Autism Act (NI) 2011 required my Department to lead on the development and implementation of a cross-departmental autism strategy. Every Department has signed up to the strategy, and it is an important commitment for the Executive. Although a report is not due until January 2017, given the focus on the issue, I have decided to provide Members with a detailed report on progress against the autism action plan. I have therefore issued a written statement to Members advising that a progress report on the cross-departmental autism strategy 2013–2020 and action plan 2013-16 has been placed in the Assembly Library and has been published.”
“Realistically, it will have to be introduced very quickly after the next election and implemented at the beginning of the next financial year. The 18 months is a practical point. I would like to see it happen more quickly; I wish that I could click my fingers and make it happen overnight, but, unfortunately, it cannot.”
“I used the 18-month figure for practical considerations: it will be the time within which to pass and implement the legislation that will be required to do away with the board. In between, officials have been tasked with scoping out what steps can be taken without the need for legislation to be passed and start to implement them as quickly as possible. That is so that we can have the effect of the reforms that I have proposed, which are about taking out bureaucracy and focusing and encouraging innovation. We can have all of that without needing to pass legislation. Where we need to pass legislation, we will do so. Being realistic about the timescale so close to an election and the dissolution of the Assembly, I do not believe that legislation will be able to be passed by the end of March.”
“I welcomed what Sir Liam Donaldson said when I made my speech, and I welcome the comments that he made last week. He welcomed my decision to get rid of the board, and he did make the points about the timescale. It is significant that he said we absolutely should be getting rid of the additional layer of bureaucracy in our health and social care system that was created, as the Member knows very well, back in 2009, so I welcome what Sir Liam said in respect of that. <BR /> <BR />I made the point about the implementation of possible recommendations that might flow from the work of a panel, namely that they may take between five years and 10 years to be implemented in full.”
“That will require some difficult decisions by me and the Executive, but I hope that, given the extent of the prize and the size of the challenges that are facing our health and social care system, we can all unite as one to lobby for those additional resources so that we can put in place a transformation fund that will make the vision of a world-class health and social care system a reality. I look to the Member as much as I look to any other Member for support in trying to realise that goal.”
“<BR /> <BR />We should be looking for a political consensus, because the prize from that is the crafting, building and putting in place of that world-class health and social care system. We know what we can have in Northern Ireland, and Sir Liam Donaldson pointed to that in his report, and we all want to see that happen. Yes, it absolutely does depend on resources. I do not want to labour the points that I made to Mr Weir, but is absolutely requires resources to make that transformation.”
“No, and we should not be looking for fatal flaws in the plan. We should be seeking to build political consensus. <BR /> <BR />Sorry, I have not had the chance to formally congratulate the Member — I did so very informally earlier — on his victory at the weekend. I will not say too much, given who is sitting directly behind him. I congratulate him and I also congratulate Mr Eastwood, which makes me sound like a famous boxer thanking Mr Eastwood in the past. Taking over the reins of the SDLP so close to an election is like taking over managerial office at a Premier League club that is sitting at the bottom of the table with only about 10 matches to go. I am sure the Member and his party colleagues hope that he is more Tony Pulis than Felix Magath, but time will tell. I wish him well.”
“<BR /> <BR />The voluntary exit scheme, which my colleague the Finance Minister referenced earlier, will see 43 full-time equivalent posts removed from the Department by the end of 2015-16, which will make £0·5 million of savings in-year and £1·5 million recurring savings thereafter. So, on the issue of the board's staffing levels, yes, it has grown in size, but a reduction in the number of staff in the Department has occurred over the same period.”