Maeve McLaughlin
Foyle · Sinn Féin · Northern Ireland
“However, as the Minister outlined, the Bill widened somewhat as a result of its passage through the Assembly, with the inclusion of the provision on smoking in cars carrying minors, the promotion and reporting of organ transplantation and organ donation, and the study by the Department on a levy on sugar-sweetened drinks.”
“Our amendment, which has been further amended by the Minister, provides an evidence base of the impact and details how a levy on sugar sweetened drinks would be administered, and I welcome the fact that it has progressed to Final Stage.”
“Go raibh maith agat, a LeasCheann Comhairle. On behalf of the Committee, I welcome the Final Stage of the Bill. <BR /> <BR />The objective of the Bill, as the Minister outlined, is to modernise the model of the code of conduct used by the Social Care Council to bring it into line with other health and social care regulators.”
“<BR /> <BR />The Committee considered the provisions on transplantation and organ donation as part of its scrutiny of the Human Transplantation Bill. The majority of the Committee supported the duty to promote and report on transplantation and organ donation.”
“This is simply to protect children from the effects of second-hand smoke or from even taking up smoking. The stark fact remains that 2,300 people die every year in the North from tobacco-related illnesses.”
“However, stakeholders were content with the provisions as made. <BR /> <BR />There was significant comment on what was not included in the Bill: the banning of smoking in cars carrying minors.”
The complete record
Every one of 502 lines we hold for Maeve McLaughlin, in date order, each linked to its source. Free to read, in full, without an account. Page 10 of 11.
“Go raibh maith agat, a LeasCheann Comhairle. I thank the proposer of the motion for bringing what is an important topic to the House today. I welcome the opportunity to participate in the debate. <BR /> <BR />It is appropriate that we do all in our gift to raise public awareness of pancreatic cancer in the first instance. It is important to point out that is not a rare cancer. The proposer of the motion reflected on a number of the statistics. The latest available figures that I have looked at show that there were 244 new cases and 243 deaths recorded in the North in 2012. None of those statistics suggests that it is a rare cancer. The proposer pointed out that it is responsible for almost 6% of cancer deaths in the North.”
“I thank the Minister for giving way. I ask him to address the issue of the perverse incentives that exist. The Minister, as a former member of the Committee, will know that evidence was given to the Committee that NHS appointments are sometimes cancelled and that there is often a perverse incentive for the same consultants to do work in a private setting. In some cases, as many as 30 hip operations can be carried out in an independent setting on a single day whereas, on the same day, there will be only five in the health service. Go raibh maith agat.”
“I thank the Member for giving way. I ask him to consider that the referral-to-treatment time part of the issue has not yet been costed. Maybe the Member will agree that that should be the first stage. Indeed, the £14 million that was received as part of the monitoring round for elective care should support the process of establishing referral-to-treatment time targets.”
“Given the evidence presented by the waiting times experts on the benefits of referral-to-treatment time targets and the Department’s position that such a move would be desirable, the Committee recommends that they should be introduced in the North and looks forward to receiving the Minister’s response to that recommendation.”
“However, the Department was not able to provide us with an estimate of how much it would cost to implement, because such a costing has not yet been undertaken. <BR /> <BR />Whilst the Committee is fully aware of the financial pressures that the Department faces, it is of the view that investment in referral-to-treatment time targets would ultimately lead to more efficient spend on elective care. It may also lead to less reliance on the private sector to deal with backlogs, which could also lead to cost savings in the long term. It is important to point out that we have to remember that the Department is spending between £55 million and £65 million on private sector elective care every year. Surely, some of that money could be used instead to bring in referral-to-treatment time systems.”
“However, the Department outlined three main challenges associated with moving to referral-to-treatment time targets: policy, resource and technical feasibility. <BR /> <BR />The Committee acknowledges that measuring referral-to-treatment time targets is indeed a complex task. However, given that those issues appear to have been overcome in England and Scotland, it would seem reasonable to believe that the Department would be able to learn from the English and Scottish experiences through engaging with their counterparts in the relevant Departments. <BR /> <BR />In terms of resource, the Department explained that referral-to-treatment time targets would take years to put in place and would involve expenditure.”
“They understood that it instinctively feels right to measure the patient's journey from the patient's perspective, because what matters to the patient is the time is takes to get their problem sorted out and begin their treatment. <BR /> <BR />The Committee discussed the possibility of introducing referral-to-treatment time targets with departmental officials during the review. We were pleased that the Department told us that it saw a move to referral-to-treatment time targets as highly desirable. The Department recognised that it would better reflect the patient experience, it is regarded as international best practice and it removes potential perverse incentives for delays at stages of the journey, which are present at the moment with stage-of-treatment targets.”
“Referral-to-treatment time targets are used in Scotland and England, and the target is that patients should expect to wait 18 weeks — four and a half months — between being referred by a GP for an outpatient appointment and beginning treatment. Denmark also operates that type of target, and Portugal hopes to move towards that system. <BR /> <BR />The general opinion among the experts who gave evidence to the Committee was that referral-to-treatment time targets are a good idea. They give patients a clear sense of how long they should expect to wait to receive treatment for their condition. For example, an official from the Scottish Government explained that one of the reasons why the referral-to-treatment time targets were introduced in Scotland was that they were popular with medical staff.”
“<BR /> <BR />At the moment, the North of Ireland does not have a system of referral-to-treatment time targets whereby the complete journey time from GP referral to start of treatment is measured and a target set for that journey time. Rather, our health service measures separate parts of the patient's journey, such as the waiting time for a first outpatient appointment, the waiting time for a diagnostic test and the waiting time for an inpatient admission. However, those parts of the journey are not linked up, and the waiting time for a review appointment is simply not measured at all. That means that currently there is no way to measure the time it takes from when patients are referred by their GP to when they begin treatment.”
“In doing so, we learned about the variety of approaches in places such as Portugal, Scotland, England, New Zealand, Scandinavia and the Twenty-six Counties. <BR /> <BR />The review has produced five recommendations that cover the following issues: how waiting times should be measured; the types of targets that should be put in place; how targets should be enforced; and the use of the private sector. All those issues will be covered by my Committee colleagues later in the debate. However, I wish to focus the remainder of my remarks on the Committee's first recommendation — probably the most fundamental recommendation — which is that the Department of Health should introduce referral-to-treatment time targets.”
“Given that context, the Committee believed that it would be timely and relevant to carry out a review of the Department’s approach to managing waiting times for elective care. The terms of reference for the review were to assess the effectiveness of the Department’s current approach to reducing waiting times for elective care and to identify effective approaches that have been used in other countries or regions that could be applied here. <BR /> <BR />In gathering evidence to inform the review, the Committee was very outward-looking in its approach. We took evidence from a range of expert witnesses, including academics and government representatives from a number of European countries.”
“It is important to point out that many people waiting for elective care endure significant levels of pain, even disability, which impacts on their ability to work and to manage daily tasks, which, of course, then impacts on their mental health. <BR /> <BR />Since the start of this Assembly mandate in 2011, the Department has submitted bids at nearly every monitoring round for money to reduce waiting times for elective care. Some of that money is to pay for more in-house provision, while some is used to pay private sector providers to treat health service patients. A significant number of bids has been met since 2011, indicating that reducing waiting times is of major importance to both the Department and the Executive.”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to move this important motion. The Committee for Health, Social Services and Public Safety identified, as did many others in society, the issue of waiting times for elective care as one of our strategic priorities for 2013-14. Long waiting times for elective care have been an issue of concern for the public, the Department and the Assembly for more than a decade. <BR /> <BR />Elective care is a wide-ranging issue and covers outpatient appointments, surgery for procedures such as hip replacements, treatment of skin diseases and neurological conditions. While those procedures are classified as elective, that does not mean that they are not serious.”
“Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement today. I welcome the additional £200 million for health, which represents a 1·7% increase in real terms. However, given your own Minister's comments in the previous two monitoring rounds on the management of the health budget, what additional oversight mechanisms will there be, including the instruction that full equality impact assessments be carried out, to protect front line services across the trusts?”
“Go raibh maith agat. I thank the Minister for his statement. I note that the Minister has referred to engagements with officials in DE and DES in relation to cross-border pilots, and I note the Minister's comments on some questions previously. Given Minister O'Sullivan's indications around a cross-border learning zone in the north-west, can the Minister throw any more light on that in relation to Derry, Letterkenny and Strabane? Indeed, what will a cross-border learning zone mean or entail?”
“Your statement specifically suggests that it does not prescribe the detail of how exactly the transfer would occur, when surgery in Belfast would cease, how Dublin's capacity can be increased and what happens with patients in the meantime. What assurances can the Minister give, given that there will be a consultation period?”
“<BR /> <BR />Moving on to children's heart services, what I am hearing today is a shift from the hub-and-spoke model to an all-Ireland single heart centre based in Dublin. Can I confirm that the hub-and-spoke model is now not in place and that it is a single centre? You said in your statement that the overall package addresses the range of serious concerns with patients' families. How will that take place? Can we have more detail on that?”
“Go raibh maith agat. I thank the Minister for his statement. As this is his first ministerial statement, I congratulate him on his elevation. It was remiss of me not to do it yesterday. <BR /> <BR />There is a lot of detail in the statement, but two important issues are covered, specifically in relation to the breakdown of the budget and the very welcome news around the radiotherapy unit and the cath lab. I am delighted that that is planned. Has DFP put any conditions or restrictions on how the £80 million will be spent, or will priority be at the Minister's discretion? Can I confirm how much of it will be allocated towards public health, given the policy direction on early intervention and prevention?”
“It is very apparent that the Scottish Government's focus has been on health inequalities and preventative spend. Communities there have had up to 20% of the budget in terms of delivering and reshaping care for their older people. There are clearly lessons for the North of Ireland in protecting, promoting and enhancing choice for our older people and communities. <BR /> <BR />This was an important piece of work that the Committee undertook in terms of our scrutiny role in Transforming Your Care. It was very apparent that, whilst we talk about an ageing population and we know the statistics for 2020, we had no clear forecast model or planning in place to deal with that eventuality, now or in the future. I ask the Assembly to support the motion and the recommendations in the report. Go raibh maith agat.”
“The Committee therefore recommends that the Department should begin forecasting the need and demand for supported living places over a 10-year period. The indicative forecasts should be kept under review, and they should be reassessed when decisions are being taken to build new facilities. We also recommend that the Department should begin collecting data on the number of older people supported in their own home through domiciliary care who would be suitable for supported living models, in order to provide a fuller understanding of need and demand. <BR /> <BR />I will conclude by adding a few remarks of my own as a constituency MLA. I returned last week from a visit to the Scottish communities, health and well-being projects in the greater Glasgow area.”
“However, of particular note, the Department could not provide figures for how many people were in this position — in other words, how many people receive domiciliary care in their own homes who could also be supported in supported living accommodation. The Committee, therefore, was not convinced of the Department's arguments as to why long-term modelling is currently not being undertaken. We believe that, given the known projections around the ageing population, it should be possible to work up projections around the percentage of older people who could potentially choose to be suitable for supported living. <BR /> <BR />The Committee does not accept that the current approach of planning for individual facilities over a three-to-five-year period is sufficient. In our view, a more long-term approach is required.”
“The Department further advised that, under the Supporting People programme, seven more facilities to cater for 155 tenants will be opened within the next three to five years. This seemed a very modest provision to the Committee. We challenged the Department as to whether the 155 places in the pipeline represent what is required for our ageing population, as opposed to what is required based on need. The Committee also made the point that, given that the majority of current facilities are at full occupancy, the creation of only seven new facilities may not offer all older people a choice of moving into one. <BR /> <BR />The Department advised us that it needs to plan for nearly full occupancy to make facilities financially viable, and added that people may have to wait for a short time at home for a place to become available.”
“The Federation of Housing Associations also made a similar point and stated that there needs to be more long-term planning around supported living, beyond the current three- to five-year cycle of the Supporting People programme. <BR /> <BR />Towards the end of its review, the Committee again raised the issue of long-term planning with the Department. This time round, however, the Department argued that long-term modelling was not desirable because there was too much risk of creating overcapacity and potential voids. Officials reasoned that the current planning structure used in the context of the Supporting People programme, whereby plans are made to build specific facilities in specific locations over a three- to five-year period, is sufficient.”
“Officials also stated that, even though we know the older population is increasing and will increase further, this cannot be used as a basis for working up figures for what the demand or need for supported living might be. The Committee found that quite confusing. <BR /> <BR />The Committee, therefore, queried this line of reasoning, and we were not alone. The Older People's Commissioner told us of her concern that there does not seem to be any publicly available departmental planning or modelling data for supported living. She argued that planning was essential in the appropriate provision of services for older people. The Older People's Commissioner also made the point that any planning that does exist appears to be short-term in nature.”
“<BR /> <BR />The first is planning and projections for supported living facilities. One of the issues that the Committee saw as a priority was whether there are, indeed, long-term projections for the need for supported living facilities for older people. When we initially discussed this with the Department, we were somewhat surprised when officials advised that they did not have long-term projections and did not recognise a need for such projections. Officials argued that it was not necessary to have an exact view of how many facilities might be needed, but rather individual choice in terms of care options was more important.”
“That, in our view, was quite a bold statement, and the Committee decided that it wanted to drill down further, given that what is being envisioned appears to be quite a radical shift in the types of services being offered to older people. <BR /> <BR />Furthermore, given that the future of statutory residential homes is a live issue, the Committee believed that it would be a good time to carry out a review into exactly what the supported living options for older people are. The Committee's report, therefore, contains 11 recommendations, some of which my colleagues will cover in some more detail. I wish to focus the remainder of my remarks on three particular recommendations, which all concern the requirement to better forecast and plan the need and the demand for supported living places for our older people.”
“In September 2013, the Committee for Health, Social Services and Public Safety agreed that the scrutiny of Transforming Your Care (TYC), the implementation of Transforming Your Care and its impact on older people would be one of our strategic priorities for the 2013-14 Assembly session. The 'Transforming Your Care Strategic Implementation Plan' states that, for older people, one of the significant changes and benefits over the next three to five years will be an increase in community-based alternatives to residential care, which will involve different styles of independent living. The plan then went on to state that, due to the improved availability of these types of community-based alternatives, it is expected that the demand for statutory residential homes will further decline.”
“Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement. We need to reflect on the contradictory nature of some parties voting against vital investment, particularly when we look at the area of health. That said, the Minister alluded to the strategic decisions and direction that were needed on health. How will the £60 million allocation be prioritised in terms of Programme for Government commitments and, indeed, monitored, given the Minister's comments in June around the concern of the management of the current health budget?”
“Go raibh maith agat, a LeasCheann Comhairle. What measures can be or are being taken to ensure that the proposed changes will not have any unintended negative consequences for schools?”
“Go raibh maith agat, a LeasCheann Comhairle. I thank the deputy First Minister for his response, and I welcome the additional focus and the focus on Derry and the north-west. What progress is being made in relation to the Ebrington and Fort George sites?”
“Go raibh maith agat. I note the Minister's response, but surely he has an opinion on how this process would actually contribute to confidence-building on policing in the nationalist community?”
“Go raibh maith agat. I thank the Minister for his answer to the question. In relation to the Department's duty of care, will the Minister give an assessment to the staff and the patients of the Royal Hospital on trolley waits last evening? Go raibh maith agat.”
“I thank the Minister for that response, which specifically points out, quite rightly, that these are not just local concerns but are right across sectors. Is there an update on the progress of the timetable for the transfer of functions?”
“Education must be centred on access for all our young people to high-quality education that is educationally sound and sustainable as well as economically viable. Therefore, decisions around educational changes and choices must continue to be centred on children and not institutions.”
“The assertion that has been made that the Collegiate School is the most oversubscribed school is true of only one of the past five years, which was 2013. <BR /> <BR />I want to pick up on a comment that Mr Lunn made, suggesting that a fully mixed-gender educational provision would not provide better educational outcomes. I do not know where that has been evidenced anywhere. I know that Mr Lunn has relayed that information, but nothing that I have heard today backs up the claim that any evidence-based approach to this development proposal would produce an inequality. Nothing I have heard today from the Benches opposite backs up the idea that these development proposals would produce that inequality. I ask the DUP this: where are the facts? Its Members have commented that this would produce an inequality.”
“As has been pointed out, the board and the CCMS have statutory planning responsibilities, and it is important to reflect that developing sustainable educational provision must involve meeting the needs of all the population, not just one part of it. <BR /> <BR />As has rightly been pointed out, the WELB has published its development proposals. They would, as has been reflected on, mean the closure of Collegiate Grammar and Portora Schools by September 2015, and they introduce a notion of facilitating the creation of a single, co-educational, non-denominational voluntary school. It is important to note today that the correspondence that we have received indicates that Devenish and the governors of Portora support the amalgamation of the two smallest grammar schools to form that co-educational institution.”
“Go raibh maith agat. As a member of the Education Committee, I support the proposed amendment. Some Members quite have deliberately attempted to suggest that the wording of the amendment was either mischievous or confusing. It is neither of those things. It simply requires that the development proposals ensure access to high-quality education for all our young people in our communities, as any development proposals should. <BR /> <BR />The motion rightly commends the excellent exam results this year. I think that we should acknowledge those results and congratulate all the pupils and schools for their hard work and successes. There is no mischievousness, lack of clarity or confusion in the fact that the proposed amendment rightly includes the provision for a new build at Devenish. That is clear. There is no confusion there.”
“<BR /> <BR />However, despite the constraints that Derry and the north-west see, there exists a range of knowledge-based assets with significant growth sectors: health technologies, stratified medicine, software engineering, ICT, renewable energies and sustainable technologies. It has been well recognised that the city is at the heart of international telecommunications awareness, has an enhanced positive reputation resulting from the City of Culture, and a young population. <BR /> <BR />I ask the Minister to reinstate his support for the business plan, commit to the expansion of the University of Ulster at Magee campus and ensure that the project, as agreed, becomes a departmental priority.”
“It is important to point out that, as it stands, Derry has the lowest level of higher education (HE) provision of any major city on the island of Ireland, and that is lower when compared with similar-sized cities. Derry's students represent 2·9% of the resident population, while those in Belfast, Cork, Limerick, Dundee or Lincoln make up 9·6%, 15·8%, 20·6%, 14·1% and 13·6%. I suggest to the Minister that the expansion of the university fits with all the key strategies and plans for the North, such as: the Programme for Government, the economic development strategy, the draft innovation strategy, the MATRIX report, the One Plan, the EU higher education area, the DEL higher education strategy and many more.”
“There is a commitment to the One Plan, and it is the same commitment that we used for the City of Culture, the Foyle valley gateway master plan, the Brandywell and early intervention city status. <BR /> <BR />There are very clear targets in the One Plan. For the record, they are the expansion of the university at Magee to 9,400 full-time equivalents, including 6,000 full-time undergraduate students over the 10-year period to 2020. They are also about securing a 1,000 increase in the maximum student number (MaSN) by 2015, doubling the MaSN by 750 full-time undergraduate students to 1,500 over the 10-year period to 2020 and, equally, accelerating the development of the C-TRIC facility. <BR /> <BR />The other challenge that has been left to us is to demonstrate that the expansion of Magee will benefit the entire North.”
“I welcome that clarity and ask the Minister to reinforce that position in his comments today. <BR /> <BR />The university has also restated its commitment to the project, as has Martin McGuinness, who recently met with the business community and the University for Derry lobby group and stated his full support for the Magee campaign. <BR /> <BR />For a minute, I want to consider the Programme for Government commitment to the Magee expansion. We may differ on that and may argue about whether it needs to be stronger, but the key commitment is to develop the One Plan for the regeneration of Derry. The Magee expansion is a critical catalyst project in the One Plan. So, let us clear up any confusion that may exist.”
“He also stated that his Department would:”
“Importantly, we also asked how a project could be stalled when the business case had not even been received. That was followed by a delegation to the Minister from the civic, political and business leadership of the city. At that meeting, the Minister clarified that he would receive the business case and would not rule out a bid for expansion going forward. Following that, the Minister's office issued a statement, in which he stated that he was:”
“The city, thankfully, is now very clear on that, and a new education and skills implementation group has been established to take forward the skills escalation strategy and, of course, the Magee expansion. RSM McClure Watters has been appointed to develop the business case, which Derry City Council, in partnership with the University of Ulster, has commissioned. Phase 1 of that business case, which covers the needs analysis, is with the Minister, and the complete and final business case will hopefully be with him in October or November. <BR /> <BR />Therefore, the Minister provoked a strong reaction in August when he said on the airwaves that the Magee expansion was shelved for the foreseeable future. We rightly challenged that and asked this again: why Derry?”
“Go raibh maith agat. I welcome the opportunity to discuss this topic, which is another important issue in connection with the expansion of the University of Ulster's Magee campus. I suppose that it is important to point out that, since I brought a similar motion to the House in June last year, there have been quite positive developments in the issue on a number of fronts. The Minister for Employment and Learning gave clarity on the need for a business case, which was causing some confusion in the city and beyond. At that stage, he stated:”
“So, the roll-out of the cardiac scheme is good news for patients suffering the most severe form of heart attack. The next phase was due to go ahead this month. Anything less than 24/7 would mean a secondary service for the north-west region and seriously undermine delivery there. I support the motion and urge the Minister to proceed as planned with those two vital services for the north-west.”
“I am sure that the public, when they reflect on this debate, will see how the health budget is being spent to date, with £34 million going to consultants for bonuses and £60 million going to the independent sector annually for elective care, and struggle with the fact that we cannot find £1·1 million for a vital project that is already on stream. <BR /> <BR />On 30 September last year, the Minister announced the roll-out of the regional cardiac service for heart attack patients. As Mr Ramsey said, only on Friday, we heard the story of a local person, Christie O'Donnell, who felt unwell and drove to Altnagelvin to be informed that he was having a heart attack and would undergo surgery within an hour. I acknowledge the front line staff and others who made that happen, because we do not often hear good stories about the service.”
“We see it in the current discussions on an air ambulance, and, hopefully, we will see it when we reflect on the need for an all-Ireland addiction strategy. <BR /> <BR />As someone who took part in the launch of the construction of the radiotherapy unit during the summer, I can assure the House that the unit is being built, the equipment has been bought, and it will become operational. However, as some Members pointed out, it is not useful to hold up a potential £1·1 million cut across the radiotherapy unit. That creates negative commentary and would or could impact on recruitment.”
“<BR /> <BR />It is clear that, on that issue, an outcome was agreed and a consensus was reached that the people of the north-west deserve, which will ensure that there is a fully functional radiotherapy unit that will serve the needs not only of the Western Trust area but of Donegal. It is correct and apt to point out that cancer remains a leading cause of death across the island, and it does not respect class, creed, gender or borders. In some ways, the radiotherapy unit has set a model of best practice on the island in looking at how we deliver health across the island. Increasingly, we are seeing this mindset in the delivery of health care across the island. We see it with the current debate on children's heart services.”
“Go raibh maith agat. I thank those who tabled the motion and welcome the opportunity to speak in this important debate. The motion quite rightly recognises the importance and status of Altnagelvin and its regional capacity to deliver excellent health care in the north-west. I fully endorse those comments. The motion calls on the Health Minister to ensure that the radiotherapy unit and the cardiac centre at Altnagelvin proceed as planned. As someone who is familiar with the campaign for the radiotherapy unit, as many others in the Chamber are, I acknowledge the role played by individuals and groups, particularly the local Pink Ladies group, in making a very strong case not only for Derry but for the wider north-west region.”