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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“Nor is he at his desk to respond to the clear recommendations that the Committee brings forward today. <BR /> <BR />I ask the Assembly to support the motion. Go raibh maith agat.”
“The Committee therefore recommends that the Department produces an estimation of the percentage increase or decrease in the workforce required to implement Transforming Your Care. <BR /> <BR />Speaking as a constituency MLA, I would say that workforce planning is central to implementing Transforming Your Care. Staff are our most valuable resource. They are the foundation of our health service, and we need to work with them to bring forward the improvements and changes we all want. <BR /> <BR />This, today, is another sad indictment of the fact that we do have the DUP in the Chamber to listen but we do not have the DUP Minister at his desk, when evidence after evidence tells us that in terms of our staffing requirement we are heading for the rocks.”
“Given the increasing growth in demand for services over recent years, we welcome the fact that the Department is not working towards a 3% reduction in staffing as a target required to implement Transforming Your Care. However, we find it somewhat surprising that the Department was not able to advise us exactly how and why that figure was ever in a public consultation document on Transforming Your Care. <BR /> <BR />Given that it is now more than three years since the publication of Transforming Your Care, and the number of workforce reviews that have been carried out, the Committee finds it difficult to understand why the Department is unable to provide a figure for the size of the required workforce.”
“In correspondence with the Committee, the Department advised:”
“The Committee wrote to the Department on two occasions to ask how the 3% figure had been arrived at, but, as yet, has not received a clear answer. The Committee asked again, in a further evidence session with the board itself, and was surprised by the response from board officials that they simply did not know where the figure came from. <BR /> <BR />When the Committee asked the professional bodies that gave evidence whether a 3% reduction in the workforce was feasible or realistic, the unanimous opinion was that it was neither. In evidence sessions with the Department, it became apparent that not only was the 3% reduction no longer a working assumption but that it was likely that an increase in the workforce would be required. However, the Department was unable to give an estimation of the size of that increase.”
“That assumption was contained in the public consultation document on Transforming Your Care, which clearly stated that a 3% reduction in the workforce, representing 1,620 staff, would be required for implementation. However, during an evidence session with the Department, the Committee was advised that the 3% figure had only been a working assumption at that time. It had been produced by the Health and Social Care Board, and the Department could not provide details of how the figure had been calculated.”
“The Committee is deeply concerned that, while a number of successive reviews have recommended an increase in GP training places, this quite simply has not been implemented by the Department. The Committee therefore recommended that the Department implements the recommendation of the most recent review to recruit an additional 15 GP training places. <BR /> <BR />Secondly, I wish to highlight the Committee's concerns about the projected size of the workforce under Transforming Your Care. Specifically, the Committee wished to scrutinise the Department's original assumption that the implementation of Transforming Your Care would require a 3% reduction in the overall workforce.”
“<BR /> <BR />I would like to refer to the situation regarding recruitment and retention of GPs. There have been 18 recommendations as a result of our inquiry. This was highlighted in the evidence from the BMA, and the Committee heard that GPs are increasingly choosing to leave or retire due to unreasonable workloads. The BMA advised that it has no evidence that investment has been shifted from hospital settings to primary care. It pointed out that there has been no additional investment in GP training places to allow for GPs, as a workforce, to take on new work that has traditionally been carried out in secondary care settings, as envisaged by Transforming Your Care.”
“The review looked at the difficulties around recruitment and retention of staff and whether those issues were being addressed by the Department at a strategic level. We also examined the Department's approach to involving staff, professional bodies and staff-side organisations in workforce planning and whether that approach has been appropriate or, indeed, effective to date. <BR /> <BR />In the course of the review, the Committee took evidence from a wide range of professional bodies representing staff across the health and social care sector, the unions, the health and social care trusts, the Department and the regional workforce planning group that it chairs. We also did a videoconference with officials from the Scottish Government, who provided us with very interesting assumptions on workforce planning.”
“The strategic implementation plan for TYC acknowledges that achieving that shift left will require substantial workforce planning to ensure that the appropriate staff are in place to deliver that new model of care. Therefore, in light of the importance of workforce planning for the implementation of Transforming Your Care, the Committee decided to conduct a review of the workforce planning model in that context. We wanted to find out what level of progress had actually been made on workforce planning at regional and trust levels. We were also very interested in scrutinising some of the original assumptions in relation to workforce planning, specifically the notion that implementation of Transforming Your Care would require a 3% reduction in the overall workforce.”
“Go raibh maith agat, a Cheann Comhairle. I welcome the opportunity to take the motion to the Floor of the Assembly today on an important piece of work around staffing requirements and workforce planning in the delivery of health and social care. <BR /> <BR />Since the publication of Transforming Your Care in December 2011, the Health Committee has carried out extensive scrutiny of various aspects of the policy and the proposals for implementation. We have looked at Transforming Your Care through the lens of health inequalities, learning disability, supported living for older people, outcomes frameworks and, most recently, workforce planning. <BR /> <BR />Transforming Your Care aspires to place the individual at the centre of health and social care services, with a shift left from hospital-based services to more community-based services.”
“Go raibh maith agat. I thank the Minister for the detail in his answer. What specific role does he have in ensuring that schools adhere to employment legislation?”
“It is right that we move to models of early intervention and diagnosis. However, we need to see better formal working relationships between Health and Education. In my view, that should be in the nature of a formal duty on both Departments to cooperate.”
“On 31 March 2015, there were 1,383 children on waiting lists for a diagnosis of ASD — a stark reality for all of us. We are told that in 2008-09, £1·64 million recurrent funding was provided for children's autism services and that a further allocation of £250,000 was made in 2013-14. <BR /> <BR />The Special Educational Needs and Disability Bill reflects on the time limits to issue a final statement, but the stark fact remains that in 2013-14, 59% of statements were made after the statutory period of 26 weeks. That means that somewhere in the region of 1,317 children were waiting longer than the statutory time for an assessment. To back that up further, a 2010 survey found that only 14% of teachers believed that there was a coherent approach across Health and Education in supporting children with SEN. <BR /> <BR />I support the motion.”
“The estimated prevalence among school-aged children of autism, including Asperger's, increased by 67% across all health and social care trusts between 2008-09 and 2013-14. Indeed, the school census figures for 2014-15 found that 6,045 children were identified with ASD. <BR /> <BR />The proposer of the motion referred to the significant difference between genders, with males almost five times more likely than females to be identified with ASD. However, analysis has indicated that the female ASD population has increased in recent years at slightly higher rates than that of males. The same analysis shows us that the rate of ASD for the 10% most deprived areas stood at 2,818 cases per 100,000 of the population, a third higher than the so-called regional rate.”
“<BR /> <BR />During the quarter ending 30 June 2015, 682 children had been referred for an assessment for autism spectrum disorder. That was an increase of 18% on the previous quarter.”
“It is our view, however, that that needs to go much further. There needs to be a formal duty of cooperation between Health and Education to deal with special educational needs. Put frankly, there are too many gaps in the sharing of information between the two Departments that are impacting on children and families. <BR /> <BR />Clause 4 of the SEND Bill gives us an opportunity to do just that. It places a duty on the Education Authority to request help from health and social care bodies when it is considered necessary. It is my view that that needs to be much stronger and should, ultimately, place a formal duty on both Departments to cooperate. I say that because the majority of the delays in the statementing process lie at the door of the health and social care trusts.”
“Go raibh maith agat, a Cheann Comhairle. I welcome the opportunity, as a member of the Education Committee, to speak in this important debate. I acknowledge and thank the proposer of the motion for tabling it. It is very clear in highlighting the prevalence of autism and how it has increased, and rightly notes the importance of early intervention. <BR /> <BR />The motion calls on the Minister of Health:”
“Can the deputy First Minister update us specifically on the pitches project for Derry, which will help redevelop the Brandywell Stadium?”
“Go raibh maith agat, a Cheann Comhairle. I thank the Minister for his answer to that, and I welcome the good news for Derry in relation to this.”
“I support the call in the motion to scope out the benefits and outcomes of a city deal proposal for the north-west.”
“It is expected that the first wave of city deals will create 175,000 jobs over the next 20 years. <BR /> <BR />If the devolved powers that would be required for a city deal include tax takes, it is difficult to see how they can be devolved to a city or region in the North when the North itself does not have devolved fiscal powers. Focusing on business rates, there have been concerns about how this would work for us. I do however say that what we need to do is scope out what city deals mean.”
“Twenty-seven city deals have already been created; 26 in England and one now in Scotland, which was given to them after the referendum. Some of the larger cities there have populations of upwards of 1 million people, and some city regions have populations of over 2 million. Because of this, their revenue-generating powers are substantially stronger than what we have in the north-west. More money is available for capital and investment projects than we could possibly hope to raise. Our rates levels are low compared with those of other regions. There is obviously pressure on us as a society, and in the north-west individually, to keep them low and to provide rate relief. Again, this situation limits revenue-generating capacity. I want to make this point because where they have succeeded in England, they have succeeded well.”
“That giving-back element could be anything from directly elected mayors to placing more autonomous powers, functions and decision-making capabilities elsewhere. With the One Plan process, which the proposer referred to, and now indeed the new community planning process — whilst it is not perfect and is certainly time-consuming — we have a model towards greater participation in decision-making that encourages a balance of elected representatives, members of the public, the community and voluntary sector, the public sector and the private sector. There is a developing remit there for more of a partnership. <BR /> <BR />Let me make this second point: no new public money is being attributed to city deals. Thirdly, the population in Derry and the north-west is very small in comparison with the other city regions in England.”
“<BR /> <BR />City deals are basically contractual agreements between the Westminster Government and local councils. They have, no doubt, provided councils with some devolved powers, although what is devolved in each city has been very much discretionary. The contract means that there are offers and demands on both sides. I do not think that we can lose sight of that as we explore this concept. <BR /> <BR />The devolved powers have allowed councils to make demands about public spending, growing businesses and growing the economy. Of course, we are prepared to look at any genuine attempt to see investment in Derry and in the wider north-west, but the city deal is the contract, and it is a contract with a Tory-led Government. That will require us as a society to give something in return.”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I welcome the opportunity to contribute to the debate. I make no apologies for enjoying the fact that we have an opportunity to debate the needs in Derry and the wider north-west and, indeed, solutions to how we tackle the very apparent regional disparities that exist in my city and the wider north-west. I agree with the proposer of the motion that we need delivery — certainly, people in my city and beyond require that delivery — and that we should not look a gift horse in the mouth. However, we need to ensure that that gift horse has teeth; we need to ensure that that gift horse can deliver. I say that in support of what the motion is calling for in relation to scoping out its proposal for a city deal, but I want to make a number of observations.”
“Go raibh maith agat. I thank the Minister for that answer. Does he now share the increasing concerns that Maghaberry is not fit for purpose?”
“<BR /> <BR />I call on the DUP's former Health Minister to get back behind his desk to deliver for the people who elected him and for those who are crying out for intervention and decisions.”
“That young woman's life has been on hold since Christmas and whether she will be able to have children in the future is not clear. How is any of that showing strategic leadership or intervention? <BR /> <BR />Decisions are required on the 1% pay increase for our front-line staff. <BR /> <BR />The situation has become farcical, but for many patients and others who depend on the health service, it is not farcical; it is a calamity. A system that requires tough decisions now has an empty desk. We need a Minister for health, not a Minister for half an hour. Much has been said about welfare cuts in this debate on health, but is the former Health Minister saying that we should take money from the most vulnerable and the disabled to pay for our health service? That is shameful.”
“They need clarity on and intervention in the future of that vital resource. <BR /> <BR />People in my community were on the streets on Friday night, protesting about a cut to the Divert project, which deals with substance misuse and young people. All of those issues need intervention and strategic decision-making. <BR /> <BR />On Wednesday of last week, I attended the Transforming Your Care policy forum, where a packed room of medical professionals called for leadership and reform of the system. Only last week, GPs referred to the system "heading for the rocks" and demanded 400 training places and reform of the system. <BR /> <BR />On Friday, I spent some time with a young woman who is in severe pain and faces at least two hip operations but does not know when they will happen.”
“I thank the Member for his intervention. He is absolutely right. Whilst there has been progress on agreeing the Dublin/Belfast model, progress is urgently required to establish the investment needed in the Clark Clinic and to look at the network in Dublin. Again, I stress the urgency of those decisions being taken, because, if we move to a second tier of children facing their operations in England, we will have taken a step backwards. Yes, absolute clarity and action are required on that. <BR /> <BR />I also visited William Street and Rectory Field care homes in Derry, where one elderly lady had been moved from another home. She was in tears as she asked me about her future. <BR /> <BR />Lifeline received 92,266 calls in 2013-14. There are huge changes proposed to the delivery of that model.”
“The system, as it is currently configured, moved the former, former Health Minister to say that commissioning was a "barrier to innovation". That is severe criticism of the system that we have and shows the absolute need for reform. <BR /> <BR />Over the last 12 days with no Minister at his desk, I have met people from many sectors and individuals who have depended on ministerial decisions. The all-Ireland network for children's heart services needs investment in the Clark Clinic. The majority of children are still going to England for surgery, and the business case is on his desk, so who is making that decision? <BR /> <BR />I visited William Street and Rectory Field —”
“On 21 May 2015, the former Minister told us that health and social care could not stand still, that major reform was required and that a strategic leadership group was being established. Last week, the former, former Health Minister described what was happening as "ugly" and not tidy. How is that advancing reform or doing what is right? <BR /> <BR />It is well documented that our health service needs radical reform. There is duplication in commissioning, a lack of accountability and a lack of clarity in decision-making. The system, as it is configured, means that the Department can say that it wants to protect front-line services, but the same Department allows the trusts to cut the very services needed to provide front-line services.”
“It is false to say that an empty chair or having a Minister for only half an hour is not impacting decisions. The fact that we have a captain who jumped ship — who has put the DUP's electoral fortunes over his party and over lives of our citizens — is quite shameful. <BR /> <BR />On 11 May 2015, Simon Hamilton said that he would continue to drive the "momentum for change" across the health service. He said:”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to move the motion. However it is unacceptable that, as we speak, there is no Health Minister at his desk or, indeed, in the House to answer the difficult questions that are required in relation to leadership across the delivery of health and social care, to provide that leadership to the people who elected him to lead, and to the many, many people across many sections of society whose health decisions are literally in his hands. As we have this debate, that is little comfort to the 373,000 people who are waiting for their first outpatient appointment, many of whom are in severe pain. <BR /> <BR />Health has the biggest budget of all the Departments. It has a budget of £4·6 billion and employs almost 55,000 people. Simply put, it affects all of us in our daily lives.”
“Go raibh maith agat. I thank the Acting First Minister for that. Can she assure me that any new gender equality strategy will take proper account of UN Security Council resolution 1325 and the gender principles for dealing with the legacy of the past?”
“<BR /> <BR />There are a number of issues of concern in relation to this legislation that need to be explored in much greater detail: issues around public interest, social well-being, safeguards and others. Given the complexity of these issues and the sensitivities around sharing identifiable information without consent, the Committee feels that it is essential that it is afforded the time to exercise its scrutiny powers to the full. I therefore ask on behalf of the Committee that the House supports the motion to extend the Committee Stage of the Bill until 20 November.”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. The Health and Social Care (Control of Data Processing) Bill was referred to the Committee for Health, Social Services and Public Safety on 30 June for Committee Stage. The Bill should, under Standing Order 33(2), complete its Committee Stage on 6 October. The main objective of the Bill is to provide a statutory framework and safeguards to enable the use of identifiable health and social care information for medical or social care purposes that would improve health and social care or are in the public interest, without the consent of the individuals whose information may be used. At its meeting on 9 September, the Committee considered the 23 written responses to its call for evidence. It also considered the stakeholders from which it wished to take oral evidence.”
“— of referral-to-treatment times. I support the motion and the amendment.”
“<BR /> <BR />In conclusion, I want to refer to the costing of such a scheme. We hear much about constraints in the system. The real debate in our health service is clearly the lack of a Health Minister to take decisions, but, equally, where our spend goes. We need to reflect on the fact that, every year, between £55 million and £65 million goes to the private sector for elective care. Surely, some of that money could assist with the establishment —”
“That system is used in Scotland and in England, where the target is that patients should expect to wait 18 weeks between being referred by a GP for an outpatient appointment and beginning treatment. Denmark also operates that type of target. Indeed Portugal is looking to move towards that system. <BR /> <BR />So, what do we have here? We had a Department of Health and a Minister who indicated that a move to a target-based approach was highly desirable. We do not know today, by the empty chair that has been referred to, whether it is still highly desirable or will, indeed, be actioned. They recognised that it would provide better patient experience, something that we all want to strive towards, and it is regarded as international best practice. It also removes the potential perverse incentives for delays at all stages of the journey.”
“<BR /> <BR />We took evidence from Scotland, Portugal, England, New Zealand, the Twenty-six Counties and Scandinavia, and whilst we can all reflect on the constraints that exist in the system and many other systems, it seems to me that a practical way to deal with our waiting times is the use of a referral-to-treatment target. We have heard much evidence about this, and, in my view, it would ultimately lead to a more efficient spend on elective care. <BR />It would, however, mean, as I said earlier, having leadership and decison-making processes; it would need to be accompanied by new arrangements for managing the performance of trusts against those targets.”
“It is stark when we reflect that, in June 2013, there were 373,000 people waiting for their first outpatient appointment. As the motion states, that is equivalent to 20% of the population in the North. The Health Committee recently concluded a review into waiting times for elective care. We brought five recommendations directly to the door of the Minister. Today, that door is closed in our face. It is impossible for us as elected representatives, for people in the Public Gallery or for the people outside this Chamber to even get a sense of how those recommendations are being acted on or will be implemented.”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to speak on this hugely significant issue for many people across all sections of our society. <BR /> <BR />I share the frustration of some Members who have spoken, and I share the anger of the wider public that, as we debate this hugely important issue for society, the DUP Health Minister, instead of treating this issue with the accountability, leadership and direction it requires, has treated the issue with contempt by being neither at his desk to take decisions nor in this Chamber to outline his response to these criticisms today and to this very important debate in a way that delivers for the people who elected him to deliver and show leadership. <BR /> <BR />I support the motion and the amendment.”
“<BR /> <BR />In conclusion, I want to reflect on a number of comments that may validate the child development approach. The Early Intervention Strategic Partnership that I am involved in in my constituency is very clear. It is not only about children being in accessible and affordable childcare. We must see that as part of the nurturing and development of children, and we must have quality assurance of the kind of childcare that they receive as a continuum leading into preschool. If we look at an early intervention model, it is critical that we look at the nought-to-three age group — even before children hit preschool. There is a strong theoretical argument for stimulating and engaging the care of babies in particular to increase their cognitive and emotional skills for life. Therefore, the quality of childcare matters.”
“How childcare is made accessible and affordable to those on minimum or low wage is critical, and any action on that should also be proofed to make sure that it does not disincentivise women from returning to work after having children. <BR /> <BR />I want to reflect on the Department of Health for a minute. When we look at the whole area of childcare and early child development, we need to look at having a better interface and, in fact, a formal duty of cooperation between the two Departments. In 2012-13, family and childcare expenditure was £196 million; in 2013-14, it was £200 million. The World Health Organization has told us that early intervention must be in and around 6% of the overall budget. My understanding is that it is currently in and around 3%.”
“Poverty must be the starting point. The DSD figures show the stark reality of a growing population of children living in poverty. <BR /> <BR />We also need to make available robust data on affordability. We need statistically reliable survey data, with proper sampling, to show robust analysis for smaller vulnerable groups. In essence, what childcare are they obtaining, what is it costing and how does it affect the remaining disposable income? Any strategy claiming to be affordable but lacking monitoring data for groups in need does not make sense. We need that longer-term approach to be taken to plan for population increases and shifts and to respond to increased needs in a coordinated and strategic way, not piecemeal.”
“Go raibh maith agat. I thank the Member for her intervention. Had the Member reflected properly on the comments initially, she would have realised that I was outlining that that is not what our model should become. I am very clear. Whilst we look at a move to increase childcare provision, which is right and proper, we cannot do so in the absence of addressing the developmental needs of the child. Whilst it is right and proper to look at increasing provision that will free up our people in society, male and female, to go back to work, we cannot do that in the absence of dealing with the challenges that exist in society through the developmental needs of the child. Particularly at a time when public funds are limited, in my view, the developmental needs of the child need to carry much more weight and be of a higher priority.”
“Again, I think there are very few in society who would not advocate that kind of approach. It is important to reflect on the fact that it needs to be much more than that and much more than an approach simply to childcare provision. In my view, child development must be the concept and, indeed, child poverty must be the starting point. It seems to me and to many that a cheap, safe or convenient, almost child-parking, facility might suffice to free up parents to go to work but would do very little to meet the developmental needs of the child. At times, those two policy directions, if you like, might conflict.”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to contribute to the debate. It is important, and I think that there are few in society who would not advocate an increase in childcare provision. <BR /> <BR />The motion calls for what the Member who spoke previously referred to as the:”