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.”
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“The Committee came to the view that the best way to address that was for the tobacco retailers' register to be extended to include e-cigarette retailers so that they also would be subject to regulation. Members certainly felt that that would future-proof the legislation should evidence emerge at a later date of difficulties in enforcing the age of sale provisions for e-cigarettes. <BR /> <BR />In response to the views expressed by the Committee, the Department proposed an amendment that would allow it to amend the relevant provisions of the Tobacco Retailers Act 2014 to apply them to nicotine product retailers as well as tobacco retailers. The Committee was content with the Department’s response and agreed to support an amendment at Consideration Stage.”
“Following our request for evidence, we received 10 written submissions from a range of stakeholders and took oral evidence from the Department, the BMA and Cancer Focus. The written and oral evidence focused mainly on the clauses that deal with the regulation of the sale of nicotine products and tobacco. However, significant comments were also made about smoking in private vehicles carrying minors — a provision that was not included in the Bill. <BR /> <BR />Having considered the written and oral evidence that was received on the regulation of the sale of nicotine products and tobacco, the Committee identified an issue on the enforcement of the age of sale provisions for e-cigarettes.”
“Go raibh maith agat, a LeasCheann Comhairle. First, I want to make a few comments on behalf of the Committee and to welcome the Consideration Stage. It has been debated that the main purpose of the Bill is to make provision to allow the Department to make regulations banning the sale of nicotine-containing products to minors. It also amends existing provisions on primary dental services and other services such as pharmaceutical services, as well as charges for services provided to persons not ordinarily resident. <BR /> <BR />I take this opportunity to quickly provide a brief overview of the evidence taken by the Committee and the key issues that we identified during Committee Stage. The Bill was referred to the Committee for Health for scrutiny on 9 December.”
“Go raibh maith agat, a Cheann Comhairle. I take issue with the Minister's analysis of the impact of welfare reform; indeed, the ultimate result of the approach of some in his party is that they would make more people sick. I want to ask specifically about waiting times: will the Minister consider the imposition of the referral-to-treatment targets that have been put in place in other countries?”
“Go raibh maith agat, a Cheann Comhairle. I thank the Minister for his statement. I very much welcome the progress on the radiotherapy unit as someone who visited the site last Friday. It is incredible to have it on site, and it will have a huge impact in relation to patients in the north-west who have made horrendous journeys for their cancer treatment. <BR /> <BR />Will the Minister provide a bit more detail on the work around suicide prevention? Is he thinking about the zero-suicide model being targeted, specifically when we look at the desperate need across our communities? Are we likely to see an all-Ireland approach?”
“There needs to be a radical overhaul of how we deliver health, and we in our party are up for that challenge and for the political leadership required to deliver.”
“There is a huge debate, and I do not think that anybody in the Chamber or beyond could, hand on heart, say that current spend is having the right or maximum outcome, so a radical reform agenda is needed. <BR /> <BR />We need to look at the opportunities that the streamlining of commissioning will bring. We need to appeal to the Minister's better judgement in and around the better GP prescribing programmes, which have been well documented in the Audit Office reports. We need to stop wasting public money on legal cases, over the ban on blood donations from members of the gay community, for example. <BR /> <BR />Finally, we need to look at the genuine removal of clinical excellence awards: £55 million has been paid out in the last five years, at a time when we cannot pay an extra 1% to our front-line nurses.”
“I thank the Member for his intervention. Indeed, as we move radically to reform the delivery of our health system, we need to do so on the basis of targeting the need that exists. It was very apparent, and I am conscious that I am also a member of the Education Committee, that the responsibility for delays in processing special educational needs assessments lay at the door of the health trusts. There needs to be a direct intervention. <BR /> <BR />I want to make a number of comments in concluding. The system needs radical reform, and we very much welcome the Minister's reform agenda in that regard, but we need to get the meat on the bones. We need to get a sense of what that clear, costed, time-lined action plan will be. The real issue in the delivery of our health service is where current spend goes.”
“There are key questions about the spending plans for 2016-17 that remain unanswered, questions that are of vital interest to Members, healthcare professionals and the wider community. I make reference to one such question. When will we find the pay award for nurses? A total of £28 million is required out of the 2016-17 budget to fund the 1% pay increase. <BR /> <BR />I will make a number of comments as an individual MLA —”
“In the Committee's eyes, the rationale for that approach is really not clear. Surely, if something is a priority, money should be allocated to it. It should not be rocket science, but we need a set of clear priorities in order to do that. <BR /> <BR />Committee members have also been concerned about the areas where savings would be made. There has been a tendency to look for quick savings rather than take a long-term strategic approach. The Committee was firmly of the view that it does not want trusts to cut back on things like domiciliary care packages as a quick fix to balance the budget for 2016-17.”
“<BR /> <BR />We were further advised that information on the Minister's priorities would be set out in the commissioning plan. I make the point that we were told that a draft of that would be forwarded to the Committee for comment by late January/early February. That document has still not been received for consideration by the Committee. That is disappointing, because the commissioning plan is really the key document setting out the services that the Minister wishes to fund in the coming year. For example, Members are very keen — as I am sure that wider society is — to hear how the Department will tackle the significant waiting times for elective care appointments. Again, officials were not able to advise us how much money would be allocated to that issue. They said that it would depend on what savings could be found in other areas.”
“We asked directly for the Minister's priorities. That information is crucial because, obviously, spending decisions should be informed by ministerial priorities. The Member who previously spoke knows that officials were only able to provide us with a very broad-brush picture of the Minister's priorities. I will quote the officials, because they told us that the overall aim and vision is to build a world-class health and social care service, obviously. That should be the collective aim of all of us: to drive up the quality of health and social care for patients. Nobody in this House or beyond would disagree with those high-level objectives, but that does not provide us with the detail of how the £4·88 billion will be spent in 2016-17.”
“I thank the Member for his intervention, and I will develop the points around the real challenge in health: where current spend actually goes. There is no doubt that all of us, collectively, can stand behind the need for a reform agenda which will, I believe, if done properly, address some of the core issues. On the one hand, we have a Department that says it wants to protect front-line services; on the other, it allows trusts to cut the very same services that are required. I will develop that point further. <BR /> <BR />Of key concern to the Committee is the very point that I refer to. How will the Department allocate this budget for 2016-17 across a range of spending areas? It is an important point. When the officials were in front of us in January, we asked directly for that information.”
“There are, however, ongoing cost pressures, which have been referred to. Costs continue to rise each year, and they are running roughly at about 5% to 6%. Typically, they are linked to pay and non-pay inflation. Obviously, they are linked to meeting the healthcare needs of an ageing population and continuing developments in technologies and treatments. That trend is expected to continue as we move forward into 2016-17 and beyond. In order to meet those pressures and supplement the baseline budget allocation, the Department is attempting to identify savings from trusts. It is attempting to look at other arm's-length bodies and its own administration costs, and that is an important point. From what we have heard, that will prove difficult, given the savings that it has already attempted to make in previous years.”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I welcome the opportunity to address the House as Chair of the Committee for Health, Social Services and Public Safety and to contribute to this debate. I wish to make a number of points, and maybe develop a number of points flowing from the spring Estimates debate last evening. Looking at the Budget, and it has been mentioned by colleagues, the Executive have allocated the Department of Health £128 million additional to its 2015-16 position, and that is very welcome news, right across the services sector and the wider constituency.”
“Go raibh maith agat. I thank the Minister for her answer. Specifically in light of policy changes, how does the Department now intend to manage the environmental impacts of wind farm developments?”
“Will she provide any more detail on timelines? I think specifically about the Dungiven-Claudy, Claudy-Drumahoe and Drumahoe-Maydown sections.”
“Go raibh maith agat. I thank the Minister for that and, indeed, for the commitment to address the issues coming from the public inquiry, but I am probably going to pursue this a bit harder.”
“However, at this point, I stress that it is a substantial amendment that will allow individuals to exercise their common law right to opt out of having their confidential information shared, which is clearly an emotive issue. I hope that the House can support the amendment.”
“I remain to be convinced that this is simply operational and can be addressed or tidied up in regulations that may come forward. I am certainly willing to take up the Minister's offer about looking at that. However, I am mindful that the original advice was that we simply could not do this because it was likely to impact on the Data Protection Act. We have moved from that position. I am very clear that opt-out will provide better patient protection. Having that in the Bill, as suggested in amendment No 2, is the appropriate way forward. I am willing, and I am sure that the Committee as a whole will be willing, to explore how those processes and operational issues would be addressed through regulations.”
“Go raibh maith agat, a Cheann Comhairle. I thank Committee members for their commentary. This legislation, which started off by being unclear about what it was setting out to do, has been significantly altered. It is important to reflect on the fact that the Minister and the Department have shifted from the position that opt-out appearing in the Bill would be likely to impact on data protection. I welcome that shift. Nonetheless, it is part of where we are today in trying to make patient protection uppermost in the Bill. I welcome the comments from Fearghal, Jo-Anne and Kieran. It is right that the Committee took a cautious approach, did proper scrutiny and ensured that we followed the correct process on ensuring patient protection. <BR /> <BR />I listened carefully to the Minister's concerns about amendment No 2.”
“It is clear therefore, that the protections afforded to individuals under the Data Protection Act are not equivalent to those that exist in common law. Under the common law duty of confidence, a person can opt out of having their personal information shared, full stop. The Committee firmly believes that this Bill should not create a situation whereby, potentially, an individual's common law right to opt out of having their confidential information shared is lost. We have therefore brought this amendment forward, which means that the committee will not be able to authorise the processing of a person's confidential information if the person has made representations to it. So the Health Committee hopes that other Members can see the importance and merit of the proposed amendment and will give their support to it.”
“However, the provisions in section 10 of the 1998 Act are not absolute and there are scenarios when they can be overruled, for example, if the processing of the information is necessary for compliance with any legal obligation to which the data controller is subject.”
“However, our alternative amendment is before the House today as amendment No 2, and I thank the Speaker for accepting the late amendment for debate. I now want to spend some time talking through the detail of the amendment and what it is designed to achieve. <BR /> <BR />The Committee and the Department are both well aware that a provision already exists in section 10 of the Data Protection Act 1998 to allow individuals to opt out of having their personal information shared if it would cause them unwarranted damage or distress. This would, presumably, apply in cases where the personal information in question was about somebody’s medical condition.”
“<BR /> <BR />The legal advice was provided to the Committee at its meeting on 20 January, some hours after the deadline for tabling amendments had passed. After considering the legal advice, the Committee had concerns that its original amendment, which is amendment No 1 on the Marshalled List, as drafted, was likely to impact on the Data Protection Act 1998. However, we were able to agree on an alternative amendment, which fulfils our original policy intention around opt-out and which will not impact on the Data Protection Act 1998. As such, we believe that our alternative amendment does not pose a risk to the progress of the Bill. <BR /> <BR />The Committee received correspondence from the Minister yesterday, advising that he may oppose our alternative amendment, and we welcome his comments in that regard.”
“<BR /> <BR />The Committee considered the letter and took evidence from a departmental official at its meeting on 7 January, but, in the end, members did not have enough information to be able to form a view on whether the Committee’s amendment might impact on the Data Protection Act 1998. The Committee felt that it was prudent to exercise caution and, therefore, sought legal advice on the issue. Members agreed not to move the amendment at Consideration Stage and to consider whether to move it at Further Consideration Stage after we had considered the legal advice. However, in order to meet the deadline for amendments for Further Consideration Stage, amendment No 1 had to be tabled before the legal advice was received.”
“<BR /> <BR />The Committee was not satisfied with the Department’s response to our concern, which was simply that opt-out mechanisms were already available under the Data Protection Act 1998. The Committee therefore tabled an amendment at Consideration Stage that was aimed at strengthening an individual’s ability to opt out. However, on 5 January, the Minister wrote to the Committee advising that he believed that there were problems with the Committee’s amendment and that it was likely to impact on the Data Protection Act 1998, which is a reserved matter.”
“Go raibh maith agat, a Cheann Comhairle. On behalf of the Committee for Health, Social Services and Public Safety, I welcome the Further Consideration Stage of the Bill. <BR /> <BR />Throughout Committee Stage, members raised significant concerns that the Bill did not provide a mechanism to allow individuals to opt out of having their personal information shared for secondary processing purposes. These concerns were echoed by the Information Commissioner’s Office and the Law Centre. We have to remember that we are talking about information about somebody’s medical condition, their prognosis and treatment and so on, and it was the Committee’s view that there needed to be clear and robust mechanisms to allow people who do not want their information shared under any circumstances to be able to have that wish complied with.”
“However, I urge caution in relation to the potential duplication of reporting arrangements, and I think that all members need to be mindful of it. We need to recognise that the Assembly already has very robust reporting processes, and I refer particularly to the role of scrutiny Committees. I support amendment No 14, but I urge caution that we ensure that this is not about the duplication of existing reporting roles in the Assembly. I conclude my remarks there.”
“I turn to amendment No 13, and there is an important point of context in all of this. As I mentioned earlier, the way in which we have organically developed the concept of shared education has brought its own dynamic to the very good progress that has been made, but, equally, it has brought its own dynamic to, for example, governance issues. The commitment to shared education campuses has brought up issues that need to be addressed through this legislation. I very much agree with going forward with the power to form a company, which is the effect of amendment No 13. <BR /> <BR />Finally, in supporting amendment No 14, I will make a number of observations. The duty to report on shared education is welcome. The amendment specifically refers to educational attainment, and that is the right thing to do as we track progress and monitor.”
“Advice was given that conferring the power may cause concern to some bodies, and there was specific reference to organisations such as NICIE that were funded for a particular remit. I absolutely share the sentiment that we want to ensure access for sectoral bodies, but the amendment does not hit the mark.”
“I again refer to the legal advice that we heard, which told us two things: it is unusual to confer this power, but, equally, there may be specific issues about particular sectoral bodies. It was very apparent that some ALBs are, for example, charitable companies that are limited by guarantee.”
“I share that view, and it is important to reflect that the Committee's sentiment was, in the Chair's words, to ensure that sectoral bodies had equal access. That is an important, principled approach. However, amendment No 12, as currently drafted, does not do that. It is important to reflect on the fact that there is no definition, for example, of sectoral bodies in legislation. When the Committee received legal advice on the matter, it was very apparent, in a number of ways, that it is an unusual thing to do in conferring powers —”
“You would expect all arm's-length bodies (ALBs) to play an important and constructive role in various education concepts, but, given that we are debating facilitating shared education, you would assume or expect all ALBs to be doing that. There is an onus on individual sectoral bodies that, if that approach is not in place, they need to look at their organisation and their constitution.”
“Amendment No 10, as currently drafted, as Mr Lunn said, removes the buzzword "flexibility" for particular local needs and circumstances that are required. It removes that flexibility for schools to be able to respond strategically to those needs. It is important to say that there may also be implications for school partnerships as they develop, specifically focused on local circumstances or needs. I very much welcome Mr Lunn's intention not to move amendment No 10. That gives us all, collectively, the space to explore the wording of an amendment that should be in its place. <BR /> <BR />I will now turn to amendment No 12, which deals with the powers of sectoral bodies.”
“Go raibh maith agat a Cheann Comhairle. I rise as a Member of the Education Committee to make a few comments in support of the Bill and, indeed, acknowledging the work that has gone into it from various sectors and stakeholders to date. <BR /> <BR />My colleague Chris Hazzard outlined our overall approach to the amendments, so I will be specific on amendment Nos 10, 12, 13 and 14. I acknowledge the debate that is taking place on amendment No 10, even at this juncture, and Mr Lunn's intention not to move it today. There is an increasing consensus — it is certainly our view — that amendment No 10 is overly prescriptive. Part of the learning that we all experience about shared education is that it develops organically and is not simply a concept that can be imposed from the top down.”
“— and I suggest to the House today that, if we are genuine about the implementation of Budget reform and, indeed, future Budgets, we should move to a genuine public health model that targets health inequalities to the core.”
“— for mental health is about 25% less than proposed spend by the trusts. Health inequalities remain stark —”
“I reiterate the point about the crisis in nursing pay. We were told — this is an important point — only last week that the 1% pay increase will cost £23 million. Four days previous to that, it was £38 million. The buck clearly stops with the Minister and the Department to find the money. It is not acceptable at a time when we see pressures on front-line staff that, over the last five years, almost £55 million has been paid out in bonuses to senior consultants. Before I hear the retort that that is a contractual arrangement, I remind the House that the court process around those clinical excellence schemes found that those bonuses are quite clearly at the Minister's discretion. <BR /> <BR />Mental health is a major issue. I suggest to the House today that spend on services —”
“I thank the Member for his intervention. Our position has been very clear — Mr McKinney knows that too well — in relation to alternative solutions to the austerity plan that is being driven elsewhere, external to the House, in moving forward.”
“<BR /> <BR />While the Committee welcomes the additional money for Health, we are disappointed at the level of detail available on how the Department’s budget will be spent. <BR /> <BR />I would now like to make a few comments as a Sinn Féin MLA. Workforce planning has been and continues to be a mess. Three-plus years into the Transforming Your Care process, the Minister still cannot tell us the size of the workforce that we require. Nursing is in crisis. There are 784 vacancies — 3·8% of the workforce population — in the nursing workforce. If that pay situation is not resolved, these people will simply vote with their feet and leave.”
“Obviously, that will have an impact in relation to voluntary redundancy packages for some staff. However, there is no allocation for voluntary exit in the 2016-17 budget; instead, it appears that the issue will be dealt with through June monitoring. This seems unusual, given the scale of the reform agenda proposed by the Department of Health. <BR /> <BR />Key questions remain unanswered about the spending plans for 2016-17, questions that are of vital interest to Members, healthcare professionals and, indeed, the wider community. They are questions such as these: when will a pay award be found for nurses in the 2016-17 budget and when will additional training places for GPs be found in the 2016-17 budget?”
“Surely, if something is a priority, money should be allocated to it. <BR /> <BR />Committee members were also concerned that in the areas where savings would be made there may be a tendency to look at quick savings, rather than take a longer-term approach. For example, the Committee was firmly of the view that we would not want to see trusts cutting back on domiciliary care packages as a quick fix to balance the budget for 2016-17. We were also concerned that the Health and Social Care Board and the PHA are charged with scrutinising the trusts’ savings plans, rather than the Department itself, given the recent proposal to dismantle the board. <BR /> <BR />That then brought us to the issue of how moneys for voluntary exit were being dealt with in 2016-17. The Minister has announced a major reform of health and social care.”
“Nobody would disagree with those high-level objectives. However, they provide us with no detail as to how the £4·88 billion will be spent in 2016-17. The officials advised that further information on the Minister’s priorities would be set out in the commissioning plan direction for 2016-17. However, that document will not be with the Committee for comment until late January or early February, which is obviously too late for the purposes of the debate today. <BR /> <BR />Members were keen to hear how the Department would approach the significant waiting times for elective care appointments. Again, officials could not advise how much money was going to be allocated to that issue. They said it would depend on what savings could be found in other areas. In the Committee’s eyes, the rationale behind this approach is not clear.”
“They are typically linked to pay and non-pay inflation; the costs of meeting the healthcare needs of an ageing population; and continued developments in healthcare technologies and treatments. That trend is expected to continue into 2016-17 and beyond. <BR /> <BR />Of key concern to the Committee is how the Department will allocate its budget for 2016-17 across a range of spending areas. When the officials were before us last week, we asked them directly for information on the Minister's priorities. That information is crucial because, logically, spending decisions should be informed by ministerial priorities. However, officials were only able to provide us with a very broad brush picture of the Minister's priorities. They told us that the Minister’s — I quote —”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to address the House initially as the Chair of the Committee for Health, Social Services and Public Safety, and I thank the Minister for providing the chance for the debate. <BR /> <BR />Looking at the 2016-17 budget compared with that for 2015-16, we see that the Executive have allocated the Department of Health an additional £128 million. That is, indeed, welcome news. However, even with that increase, the Department will face a difficult year ahead because of budgetary pressures. Officials came before the Committee last week to provide us with some further information on what the financial picture for 2016-17 is looking like. The cost pressures facing the Department continue to increase each year and are roughly running at between 5% and 6% each year.”
“I thank the Member for giving way. Does the Member agree with me that it is unacceptable that we see upwards of £55 million over the last five years having been paid to senior consultants as clinical excellence awards — in essence, bonuses — at a time when we are faced with a Fire Service that is quite literally struggling to save lives? Go raibh maith agat.”
“— needs to be proofed to do exactly that. I support the motion and I support the amendment proposed by the SDLP.”
“Go raibh maith agat. I thank the Member for his intervention. Yes, he is absolutely right, because part of this conversation is about addressing the fact that this service provides a front-line service. I call on the Health Minister, and have called on previous Health Ministers, to define, once and for all, what front-line services are and to include the role of the Fire and Rescue Service in that. Any such package on any proposed changes to the Fire Service —”
“Injuries are up 43 to 559, the highest they have been in five years, and rescues are up 29 to 208, also the highest in five years. In addition, attendances to road traffic collisions have increased by 34 to 701.”