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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“Again, that is sensible and logical given the Bill's intent. <BR /> <BR />Amendment Nos 3 and 4 refer to the transfer of personal learning plans. The Bill introduces a new duty for schools to complete a PLP for each SEN child, with a very clear focus on learning outcomes. That would go some way towards involving the child and parents. It is important to reflect on the Bill's intent and the context of the legislation. Many Members have referred to a child-centred approach, and that is right and proper. As the Minister has indicated, the SEND Bill is simply a building block. However, it provides us with the legislative changes that are necessary to support the revised SEN and inclusion framework. It is proper that we reflect on the steady increase over the past 10 years in the number of people with SEN.”
“Go raibh maith agat. I speak as a member of the Education Committee in support of amendment Nos 1 to 12, with the exception of amendment No 8. <BR /> <BR />Much has been said on the detail of some of the amendments, but when we reflect on amendment Nos 1, 9, 10 and 11, we see that the movement of "may" to "shall" will effectively enact the regulations under the Bill as it is intended they be. <BR /> <BR />Amendment No 12, again, is effectively about making the regulations subject to affirmative rather than negative resolution. Arguably, that strengthens the scrutiny elements of the Bill. Committee members certainly welcome that as a positive step. <BR /> <BR />Amendment No 2 relates to the duties on boards of governors, with a particular focus to ensure that teachers "take all" reasonable steps rather than simply "reasonable" steps.”
“We will also be very keen to ensure that the new disciplinary processes introduced by the Bill will mean that all cases are dealt with quickly and efficiently. Another area that we will be looking at is making sure that the legislation is future-proof, given that various reports have been produced recently in this field across other jurisdictions.”
“The Committee had various questions on the detail of the Bill but no objections to its overall aims and objectives. As the Minister outlined, the principal objectives of the Bill are, firstly, to modernise the model of conduct used by the Social Care Council to bring it into line with other health and social care regulators; and secondly — and importantly — to extend opportunities for the recognition of the continuous professional development activity of social workers post-registration. <BR /> <BR />There are a number of issues that we will be looking at more closely during Committee Stage. They are likely to be around what the registration of all social workers and social care workers with the Social Care Council will mean in practice, and whether there will be any additional burden on individuals or private companies.”
“<BR /> <BR />Given the time available to the Committee to scrutinise and report on the Human Transplantation Bill and the Health (Miscellaneous Provisions) Bill before the end of the mandate, the Committee took the view that it would not be feasible for it to undertake work on this Bill over the same limited time period. Of course, all three Bills are important, but the Committee was of the view that the Health and Personal Social Services (Amendment) Bill would be our lowest priority. However, we are now at a point where the Bill is having its Second Stage, the purpose of which is for the Assembly to debate the principles of the Bill. <BR /> <BR />As I have said, the Committee heard evidence from departmental officials and the Social Care Council on 23 September 2015. They talked members through the clauses of what was then a draft Bill.”
“Prior to that happening, the Committee had written to the Minister, following its meeting on 18 November, to ask him not to introduce the Bill during the remainder of this mandate. That was on foot of a discussion that the Committee had about its legislative programme. As Members will be aware, the Human Transplantation Bill is currently at Committee Stage, and we are all aware that it is a complex and emotive piece of legislation that will require the Committee's detailed attention between now and the end of January 2016. The Minister had also indicated to the Committee that it was his intention to shortly introduce the Health (Miscellaneous Provisions) Bill, and that, in fact, happened yesterday. Again, that piece of legislation will require the Committee's attention, over a relatively short period.”
“In giving an explanation for that very significant delay, officials referred to the need to address concerns raised by the Department of Justice in relation to the care tribunal and issues raised by the Attorney General; take into account the Westminster Government's response to the Law Commission's review of the regulation of healthcare and social care professions; and progress a number of other initiatives linked to the Social Care Council. Whilst the Committee has no doubt that these were legitimate issues that needed to be addressed, members expressed disappointment during the briefing on 23 September that the Bill had not been introduced at an earlier point in the mandate, given the end-of-mandate legislative pressures, which were apparent even in September. <BR /> <BR />The Minister introduced the Bill last week, on 23 November.”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. On behalf of the Committee for Health, Social Services and Public Safety, I support the Second Stage of the Health and Personal Social Services (Amendment) Bill. <BR /> <BR />The Committee took evidence from departmental officials on the proposals for this legislation in July 2014. At that time, the officials advised that it was the Department's intention to introduce the Bill by November 2014. Nearly a year later, on 23 September 2015, officials came before the Committee again to advise that the Bill had still not been introduced.”
“I thank the Minister for the answer to the question. Specifically, does he agree now that this is perceived as a failure in planning for our ageing population by him, his predecessors or those with departmental responsibilities? Will he clarify whether the halt in the review process will allow readmissions to some statutory care homes?”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I thank the Minister for that update. Specifically, can he give an update on the current business case for the Magee expansion and indeed where he thinks the expansion issue will sit in the restructuring of Departments?”
“Go raibh maith agat, a Cheann Comhairle. As the Minister outlined, an issue was identified with clause 3(4), which had the potential to cause district councils some operational difficulties in operating the food hygiene rating scheme. The Minister wrote to the Committee on 7 September advising members of the issue and of his intention to address it through an amendment at Further Consideration Stage. The Committee considered the proposed amendment at its meeting on 16 September. Given that, as the Minister outlined, it was a technical amendment that had no effect on the policy and would ultimately result in the more effective and efficient running of the scheme, the Committee agreed to note the proposed amendment.”
“I thank the Minister for her statement, and I very much welcome the additional investment into the Department of Health, particularly the £40 million for elective care. Specifically in relation to the crisis in our waiting times, what is the Minister's assessment of what that money can do and how much of a shortfall might be left? Also, in going forward, on the protection of the Health budget, coupled with the reform agenda, does the Minister envisage that that protection of Health will be maintained, or is it likely to change?”
“I thank the Minister for his statement. I note that he has said that there is a strong argument for consistency on this issue. Has there been any evidence at all that the changes in England will lead to increased educational attainment or better educational outcomes for our young people?”
“I thank the Minister and welcome her to her first Question Time. In a similar vein, can she give an update on the development of the park-and-share or park-and-ride sites at Dungiven and Claudy?”
“Go raibh maith agat. I thank the Minister for that, but I do feel that the flaws in healthcare have not, at this point, even been adequately highlighted. Specifically, given that the Minister has a duty of care to those in Maghaberry, does he feel that there now needs to be a review of the relationship between the Prison Service and the South Eastern Trust?”
“Go raibh maith agat. I thank the Minister for that detail. I have been very welcoming of the reform agenda that he is taking forward. The board's figures on waiting times for elective care were published for the period from April to August. The figures showed that all trusts were failing to reach their targets and that one trust was actually 17% behind target. Specifically, how will this reform proposal tackle that very direct need?”
“Go raibh maith agat. I thank the Minister for her answer. Specifically on procurement and tendering, is the Minister minded to look at the Public Services (Social Value) Act 2012 in England?”
“Go raibh maith agat. I thank the Member for his intervention. I was going mention consent in my comments as an MLA. We need to be very clear not only on the issue of consent but on the issue of conflict, as it may arise. I was about to say that I hope that some of the issues that need to be reflected in the Bill will be progressed in that manner. <BR /> <BR />I thank the Bill's sponsor for bringing the Bill to the House today. The Committee notes the Second Stage of the Bill. As a constituency MLA, I look forward to engaging with, and maybe enhancing and strengthening, the Bill as it passes further stages. Go raibh maith agat.”
“It is clear that education and communication are key if any change is to be effected in donor and transplantation rates. Some feel that a cultural change is also needed so that organ donation is discussed openly and frankly, particularly between family members, and the wishes of potential donors may be known, making it easier for next of kin to take that difficult decision if the time comes. <BR /> <BR />The Human Transplantation Bill is an emotive and complex piece of legislation, and, should it pass Second Stage, the Committee will consider all the issues raised and report its opinion to the Assembly.”
“<BR /> <BR />The Committee heard evidence on the cost of implementing the Bill, the cost of dialysis for kidney patients, and the cost of transplant surgery. Initial figures produced by the Assembly Research and Information Service indicate that it would take between £2 million and £5 million to implement the Bill. However, the Bill's sponsor advised that the net benefit to the health service and the local economy of increasing transplants could be as much as a £7·4 million. <BR /> <BR />The Bill proposes to place additional duties on the Department to promote transplantation and to provide information about transplantation through a campaign at least once a year. That is intended to raise public understanding of organ donation and to make it more socially acceptable to discuss the issue.”
“Another issue raised was the role that clinicians play. Are they expected to make decisions that may go against families’ wishes? Importantly, how do they feel about the proposed legislation? Should the Bill pass Second Stage, the Committee will want to hear from those clinicians who will be making the judgements and decisions on the ground. <BR /> <BR />Some Members raised the point that many people view organ donation as a gift freely given and expressed concern that the proposed changes to the law could alter that. Another issue discussed in our evidence session was finance, and the Bill's sponsor alluded to some of the statistics, and whilst it is apparent, no one can put a price on good health. The issue of finance needs to be considered.”
“Other scenarios include those where family cannot be located or where there is disagreement between the next of kin. In those circumstances, who has the balance of power?”
“During our evidence session with the Bill sponsor, a number of members outlined possible scenarios whereby consent might be disputed; for example, where there is a potential donor who has expressed consent to organ donation and has perhaps appointed advocates, but whose family is opposed.”
“<BR /> <BR />We also know that further affirmation will be sought after death unless a person had already taken their name off the register before death. That affirmation can come from family members, advocates or others as outlined in the Bill. Although the affirmation is intended as a safeguard, it has the potential to raise issues. Consent to organ donation is a difficult decision for families to take, particularly at a time of terrible grief and loss, and it is made even more difficult if there are differences of opinion between family members or others involved.”
“Regardless of whether people support organ donation itself or are themselves on the organ donor register, there are differing views on the soft opt-out option proposed in the Bill. <BR /> <BR />Some Committee members have some concerns around the Bill, and there are a number of areas that will need further exploration and clarification. Some of those areas were raised during the recent evidence session with the Bill sponsor. An obvious concern was that of consent. The introduction of the soft opt-out option was discussed, and members spoke of how organ donation is approached in other countries — the Bill sponsor has referred to some of that today — such as Wales, Belgium and Spain, and what levels of success they have had in relation to donor and transplantation rates.”
“We also heard about the results of the three consultations on organ donation that have taken place in the last year — the consultation on the Bill and the two consultations by the Public Health Agency. During the evidence session, the Bill sponsor stated that the majority of respondents to the consultation on the Bill and the PHA's attitudes surveys were supportive of some sort of soft opt-out option. <BR /> <BR />The Committee appreciates the importance of the issue of human organ transplantation, and there is an acceptance that more must be done to improve donor levels and transplantation rates. The Bill has the potential to affect every one of us, and that was emphasised by Committee members. It has to be acknowledged that there are wide-ranging opinions and feelings on the subject of organ donation.”
“We heard at first hand how successful organ transplants not only save lives but enable people to live their lives more fully — for example, by freeing them from the need for dialysis. The Bill sponsor also spoke about the differences between express consent and deemed consent and the role that families and advocates would play in decision-making under the Bill. The Bill sponsor provided the Committee with a range of statistical information, some of which has been referred to today. It is quite stark when we hear that, on average, 15 people die waiting for a life-saving transplant locally each year; in fact, 17 people died waiting last year. That is a stark reminder for all of us.”
“Go raibh maith agat, a Cheann Comhairle. I thank the Bill sponsor for that very detailed overview of the Second Stage. On behalf of the Committee for Health, Social Services and Public Safety, I note the introduction of the Human Transplantation Bill. As the Bill sponsor outlined, the principal objective of the Bill is to save lives — that is very clear — by changing organ donation laws, by introducing a new soft opt-out option with safeguards and by placing an additional duty on the Department to educate the public on organ transplantation. <BR /> <BR />The Committee heard evidence from the Bill sponsor on 4 November 2015, accompanied by the father of a recipient of a successful liver transplant.”
“If this is the right thing to do, I want to offer our support to the Minister. He has long heard from me and my colleagues that we have an overly bureaucratic and complex system, with ineffective and confusing decision-making. Therefore, if it is the right thing to do, whether the statement was made in the House or outside it, you will find an ally in us. <BR /> <BR />Having said that, I ask the Minister, because much has been said about the lack of political consensus, whether this is a genuine break with previous DUP Ministers of Health. Can he accept or will he agree with me, that there was political consensus on the delivery of health three-plus years ago, when we collectively signed up to Transforming Your Care? Where it failed was the Department and previous Ministers not putting the meat on the bones. Go raibh maith agat.”
“Go raibh maith agat, a Cheann Comhairle. I thank the Minister for his clarity and welcome the fact that he intends to meet Amber Rudd again. Do I take that as a declaration of his intent to go in and fight for those people who are clearly losing out?”
“Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his answer. I note that he referred to the lessons learned from Delivering Social Change. Will he outline what the Department is going to do to harness that learning to benefit schools across the North?”
“— to commit to taking action on a proper mental health strategy with decent and fitting investment.”
“— between suicide and mental health. There are clear lessons for all of us in both reports, and I appeal to the Minister, in his response today —”
“As far back as 1999, the Chief Medical Officer recognised that children and young people in the North would suffer significant mental health problems before their eighteenth birthday. <BR /> <BR />A number of recommendations flow from the reports, one of which calls for the mental health budget to be ring-fenced. Another one calls for a mental health champion. I also acknowledge the recent work by Professor Siobhan O'Neill examining the link —”
“I want to make specific reference to the impact on mental health for those who have suffered sexual abuse. In 2012-13, there were 1,948 sexual offences in the North. If the core problem of psychological trauma is addressed at an earlier age, the victim is less likely to suffer the wider health implications that can arise from sexual trauma — another area of work that it would be wise for us to take note of. <BR /> <BR />The Children's Law Centre pointed to research that shows that there has been a significant increase in the number of children and young people with mental health needs. It is estimated that 10% of children between five and 15 years old have a significant mental health issue. In the last 25 years, there has been a 70% increase in the number of teenagers with depression and anxiety.”
“We must also respond to concerns about young people. I quote the Queen's research:”
“The report highlights fragmentation across the system and poor communication between parts of the system, and it states that services have become very separate from each other and are very much working in silos. Care respondents frequently mentioned poor communication between different professionals, specialisms and facilities and often:”
“<BR /> <BR />In recent years, there has been an increasing recognition of mental ill health, and it is becoming a major public health issue. It is now regarded as one of the four most significant causes of ill health and disability. It is estimated that one in four people in the North has a mental health problem. There is evidence that mental health problems are 25% higher here than in England. Despite that, between 2008 and 2014, the actual spend on mental health services by trusts was around 25% less than was previously proposed, while spending in areas like primary care increased. <BR /> <BR />There are key messages in both reports about how we treat people as people. There are concerns, particularly in the Queen's report, about how service users are perceived by the system.”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to speak on this important topic, and I welcome the Minister back to his desk. I hope that we will see some direct action coming from today's debate and the many others that are coming in front of it and behind it. It is important that we move mental health further up the political agenda with a clear strategic investment. It goes without saying that that is long overdue. Two recent reports — one from Queen's University and the other from the University of Ulster — have painted that in stark terms. The report from Queen's does not make easy reading in some regards. It highlights key issues of underfunding, a deeply fragmented system and concerns regarding children and young people's services. As a society, we must take note of that and act on it.”
“Go raibh maith agat, a Cheann Comhairle. I thank the Acting First Minister for that detail, and I welcome the seven proposals and the level of interest. Will the Minister give assurances that the number of jobs and economic opportunities will be key to any decision on the sale of the site?”
“Go raibh maith agat. I look forward to that detail from the Minister. Does she believe that it is highly inappropriate and questionable for Sammy Wilson and Simon Hamilton to have had un-minuted meetings and to have carried out actions relating to the National Asset Management Agency (NAMA) under the radar of their Department?”
“Go raibh maith agat. I thank the Minister for her answer. Given the importance of this to elderly people, is it likely that we will see this funding maintained in the longer term?”
“We need a Minister, for workforce planning and many other issues, to deliver that blueprint. We need a Minister for health, not a Minister for half an hour.”
“I thank the Member for his intervention. He is absolutely right. The very clear message is that, at a time when we need to be supporting primary care, which means addressing issues like recruitment and retention, it seems that the most vulnerable end of the system is being targeted. It is a sad indictment that we do not have a Health Minister at his desk to ensure that those changes to contracts are not implemented here and that we protect the rights and entitlements in the contracts of junior doctors. <BR /> <BR />In conclusion, our health service needs radical reform. That view is not just from me or the Health Committee and most members on it. It has been well documented by many sectors, including professional and staff sectors. The system is complex and overly bureaucratic and it lacks accountability.”
“I suggest that those concerns have, quite simply, fallen on deaf ears. <BR /> <BR />In conclusion, I thank the Committee members and the staff and researchers for their very robust work on the inquiry and recommendations. Three years into Transforming Your Care, the very benchmark of the delivery of TYC, namely our staffing requirement, is not yet resolved. It is simply not good enough that while, over the last three years, 1,620 staff posts were under threat, now, in the last number of months, we have been told that that was simply a working assumption.”
“Both organisations — we should not lose sight of this — referred to a crisis in general practice that cannot be ignored. The BMA and the college of GPs highlighted their concern — again, some Members mentioned this — around the number of GPs. The college said:”
“She also questioned the 50% target for closure of residential homes that was contained in Transforming Your Care and the fact that the report needs to be followed up by actions. <BR /> <BR />I just want to refer to another few points in terms of the review. As many have stated, the review contained 18 recommendations, and much has been said in relation to GPs. Critical to that, however, is the entire primary care workforce. As my colleague Rosie McCorley said, that means addressing issues around allied health professionals and, indeed, front-line community and district nursing. We heard very specific evidence from the BMA and the college of GPs. They certainly threw into question the Department's commitment to the goal of Transforming Your Care in terms of leadership.”
“He questioned whether it was a policy direction or simply an ethos. There was no certainty on what the objectives were. He said that, if the Minister does not want to do his job, he should simply step aside. <BR /> <BR />Rosie McCorley talked about the reality of the health service, which is currently under extreme pressure. Again, there is a lack of clarity on the way forward. All that had been produced over the period of years was the planning framework. She questioned why so much more had not been implemented. <BR /> <BR />Jo-Anne Dobson referred to the fact that, given the last number of weeks and our in-out Minister, it is no surprise that the former former Health Minister finds it acceptable not to turn up today and respond to the needs of our staff.”
“<BR /> <BR />Michael McGimpsey said that the system does, of course, need a lot of planning and that part of that engagement has to be proper and meaningful engagement with staff. He specifically referred to the regional planning group, which had excluded the staff side, and called for immediate and proper re-engagement with the staff side. <BR /> <BR />Kieran McCarthy talked about the extreme difficulties that the health service was experiencing, and said that what is happening in our health service is actually a shambles. He stressed the need for staff involvement in workforce planning. <BR /> <BR />Daithí McKay is surprised that the Department has not carried out an estimate of workforce requirement. That is a critical piece of learning that has come from the review and the need for a common understanding around Transforming your Care.”
“Go raibh maith agat, a Cheann Comhairle. I first want to thank the Members for their contributions today. Suffice to say that all of the Members who spoke reflected on the fact that we have an absentee Health Minister. Particularly in the hugely important and very human remit that is health, it is nothing short of a disgrace that, when we are debating critical issues like workforce planning, we have no one to act, listen and respond accordingly. <BR /> <BR />First of all, I want to refer to a number of Members' comments. Fearghal McKinney highlighted the lack of strategic planning in relation to Transforming Your Care, its implementation and its investment, and referred to the clear consensus that we were actually moving towards a plan that was not being implemented.”