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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“We were told that, for 2014-15, there was not sufficient time left in the financial year to do that. However, that should not have been the case for the 2015-16 Budget, given that the Department is fully aware of the pressures that it is facing, including a 6% to 7% increase in demand from the trusts. Therefore, the Committee believes that the Department should be in a position to approach the draft Budget in a planned and strategic manner so that the allocation that it receives is spent on priorities rather than on things that are simply committed to at an early stage of the financial year. <BR /> <BR />The Minister advised the Committee that his top two strategic priorities are the provision of high-quality front-line care and the implementation of Transforming Your Care.”
“Go raibh maith agat, a LeasCheann Comhairle. First, I want to reflect on the Committee's findings on the draft Budget. I particularly want to focus on the issue of strategic priorities. When the former Minister briefed the Committee in September regarding the 2014-15 financial position and his request to the Executive at that stage for an additional £160 million, he stated that the areas of spend that he was going to have to pull back on, which we are now witnessing, were not in any way strategic but were simply based on stopping money where it was not contractually committed. <BR /> <BR />Those remarks made it clear to the Committee that the Department has an understanding that if spend has to be curtailed, there are areas in which it can be targeted that will not undermine its strategic priorities.”
“Go raibh maith agat. I thank the Minister for that clarification. Will he detail how much has been paid to NI Water stakeholders in the course of the mandate?”
“Go raibh maith agat. I thank the Minister for his answer and, indeed, for his guarantee of cooperation. In the light of the revelations, does the Minister now agree that the British Government have a responsibility to ensure that comprehensive resources are available to the Executive to deal with legacy issues?”
“Go raibh maith agat. I thank the Minister. I was not aware of the meeting, but I will certainly take the opportunity to attend now. The trust indicated, in a meeting with me on Thursday, that the savings from such a reduction would be in the region of only £30,000 or £40,000 — quite minimal savings in the scheme of things. I suggest that, in light of that and the upheaval that it proposes to cause to families and their family members, the Minister now halt the reduction to the service.”
“Go raibh maith agat. Given that the Minister alluded to increased administration costs and, indeed, I think, the complexity of governance in the health system, does he intend to make any legislative changes in the review of health and social care?”
“Although the proposed Bill is likely to be straightforward legislation, a number of issues will need to be explored in more detail. The Committee feels that it is essential that it is afforded the time to exercise its scrutiny powers to the full. Therefore, on behalf of the Committee, I ask that the House support the motion to extend the Committee Stage to 8 May 2015.”
“Go raibh maith agat, a LeasCheann Comhairle. The Food Hygiene Rating Bill passed its Second Stage on 11 November 2014. It should, under the 30-working-day rule, complete its Committee Stage on 13 January 2015. <BR /> <BR />The main objective of the Bill is to introduce legislation that will make it mandatory for food businesses to display their food hygiene rating stickers, which will be supplied after inspection by district council food safety officers. That will ensure that consumers are provided with information about food hygiene standards in places where they eat out or shop for food. <BR /> <BR />The Committee, at its meeting on 5 November, agreed to call for written submissions from interested organisations and individuals.”
“I thank the Member for giving way. Would she now agree that what the Minister said about no new admissions is, in effect, closure in another form?”
“Go raibh maith agat. I thank the Minister for, maybe reluctantly, giving way. Can the Minister clarify that during the eight-week public consultation, which some might say is a bit late, admissions will continue?”
“How then can the Department advocate the protection of front-line services when trusts are cutting the very services that are needed to protect and deliver those functions? Last week, the Minister announced, in response to a question from me, that £18 million will be allocated through the monitoring round to deal with trust pressures. I suggest that there is an alternative: use that money to ensure that the Dalriada facility remains open and that the important respite care for patients and families continues. Go raibh maith agat.”
“The cost of carers to the economy in the North of Ireland is £4·4 billion. The respite unit is an essential service, as has been well documented, and it allows MS sufferers and carers to receive that specialist care, which, in turn, importantly, enables them to continue to live independently. Again, that is a key component of the Transforming Your Care agenda. <BR /> <BR />Last week, we debated a motion to ensure that full equality impact assessments are carried out. I accept that the motion today calls for the reversal of this decision. That is right and proper, but the Minister also has a duty to ensure that local trusts are following his direction in terms of the protection of front-line services. That motion was not passed in the House.”
“How can decisions that are not strategic provide better health outcomes for patients and families across the North? <BR /> <BR />The Northern Trust has indicated that it will save £600,000 from the closure of beds in Dalriada. That is a mere drop in the ocean when we look at the current spend on health. As has been stated by a number of Members, the MS regional unit at the Dalriada Hospital is the only dedicated respite unit across the North, and, as Members have said, it provides much-needed support and specialist care — that has been acknowledged — that enables people suffering from MS to have an enjoyable and, importantly, a safe, short break. It is important to reflect on the fact that 75% of people with MS in the North of Ireland receive unpaid care. That is an important commentary.”
“I thank the Member for his intervention. Quite simply, the answer is yes. When Members and those in the wider world look at scenarios in which £34 million goes to senior consultants as bonuses, when they reflect on the fact that between £55 million and £65 million goes to the independent sector every year and when they consider the fraud and waste that the former Health Minister by his own admission acknowledged, they will see that spend is clearly going in the wrong direction. <BR /> <BR />I return to the point that this decision is counterproductive. It is counterproductive because it is contrary to the very vision and implementation of the Transforming Your Care agenda. The Health Minister stated in the Chamber:”
“I preface my remarks by saying that health was protected. In fact, we were quite central to its protection. Do we need more? Of course we need more, but we should reflect on the fact that £200 million was allocated to health, and it was the only Department that was protected. Hard decisions have to be taken, and we need to know whether the budget goes in the right direction. There are many, many questions around the current spend in health. I welcome the opportunity to support the motion, because the decision to close the facility is, at the very best, short-sighted and, at the very worst, counterproductive.”
“I thank the Member for giving way. Does the Member agree that the Minister should instruct and stand over the trust to conduct full impact assessments on these very basic front-line services?”
“Go raibh maith agat. I thank the Minister for a very detailed response. Will she outline what communication has taken place with the local industry on contingency plans?”
“I am pleased to present this petition and I look forward to a positive response.”
“Therefore, Mr Principal Deputy Speaker — Mr Deputy Speaker, gabh mo leithscéal — to deliver care to an ageing population, Transforming Your Care needs to deliver more GPs, practice nurses, district nurses and health visitors, backed up by pharmacy colleagues and members of the allied health professionals in the community. <BR /> <BR />GPs are indeed encouraged by recent investment in premises and they encourage more investment in the hub-and-spoke model. I am particularly pleased that the city side in Derry has been identified as a priority project. However, GPs feel that they are not engaged with the Transforming Your Care process and they most certainly feel that work on the process to shift the base has not followed.”
“The petition calls for general practice to receive 11% of the health-care budget. That shift would enable general practice to deliver shorter waiting times for appointments and more flexible opening hours, longer appointments and consultations, better continuity of care and positive benefits for health services as a whole, and reducing pressures, very clearly, in our hospitals and emergency departments. <BR /> <BR />Funding for general practice in the North fell by £21·2 million between 2008-09 and 2012-13, which is a decrease of 8·2%. That is alongside a 7% increase in activity at general practices last year alone. GP out-of-hours activity has increased by 18% over the last five years.”
“Go raibh maith agat, a LeasCheann Comhairle. I am very pleased to have the opportunity to present this public petition to the Assembly. The petition 'Putting Patients First' is not only a principled approach to how we should and could deliver health care, it also gives voice to thousands of people across the North in their support for their general practices. Over 16,000 people across the North have signed the petition. In order to shift left, from acute to community or primary care and early intervention, it is important that we acknowledge the increasing pressures on GPs and that we equally support the infrastructure to deliver the very services that we all envisage under Transforming Your Care. <BR /> <BR />GPs will be a necessary part of the shift from hospitals to care in the community.”
“— run the risk of failing the very children and young people that we set out to protect?”
“with consideration of data collection. Almost four years on, it has been flagged up today that we need to look at issues like data collection. <BR /> <BR />I suggest to you, Minister, that what was required, and what the Chairperson and Sinn Féin advocated at that stage, was a fully independent, resourced inquiry with full statutory powers. I ask the Minister to reflect on whether that should and could be the most appropriate way forward. Does this report, Minister, in its weakness in terms of accountability —”
“We were told that, in 2011, through a Barnardo's report. In fact, recommendation 3 in the Barnardo's report requested that the Health and Social Care Board develop:”
“Just what, in this report, does any of that? What in the report tackles the issue of accountability or failings in the system? <BR /> <BR />I reflect on page 2 of the statement, and I will ask a direct question about it. Page 2 of the Minister's statement concludes:”
“Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement. I reflect and wish that we were not dealing with this particular serious issue. Let me preface my comments by saying that, in everything that we say in the House and beyond it, we should be mindful that we are dealing with extremely vulnerable children and young people. We should be mindful of that context. <BR /> <BR />However, the Minister's statement was very detailed. In my view, it was also very weak in terms of accountability. I reflect that the inquiry was charged, as page 1 of the Minister's statement states, with:”
“Does the Minister accept that the scandalous amount paid to senior consultants in bonuses would go a long way towards saving Dalriada and many other front-line services? Go raibh maith agat.”
“We hear of £55 million to £65 million paid annually to the independent sector for elective care. We hear of the cost of external consultants and the cost of 191,000 cancelled appointments last year alone. That is a stark reminder of maladministration in the budget and the need to do as the policy says and protect our front-line services in order to deliver better health outcomes for all our communities. I support the motion and oppose the amendment.”
“It is time, therefore, to put up or shut up. If TYC is the policy framework, the Minister must prioritise and implement it in full. If it is TYC, he must ensure that any potential cuts — I use the word "cuts" — across the service are subject to full equality impact assessments to mitigate negative impacts on section 75 groups and to protect front-line services. Let me be very clear about this: screening in and screening out policies are not full equality impact assessment processes. <BR /> <BR />It beggars belief that, when we are faced with extreme cuts, we hear of £34 million paid to senior consultants in bonuses over the last five years. We hear of a 20% increase in administration at the health board, which has 550 staff and a £25 million spend on annual salaries.”
“The Northern Trust proposal to temporarily close 27 intermediate rehabilitation beds, including seven beds in the Mid Ulster Hospital and 20 in Dalriada Hospital, has, quite rightly, received much media comment and public outrage. It should be reversed immediately. The Western Trust proposal to temporarily merge palliative care and the rehab wards of Tyrone hospital has been put on hold. How can we be advancing a policy of Transforming Your Care, which is a shift left of £83 million from acute care towards community and primary care, when we are slashing the very services that are required for delivery? <BR /> <BR />Whilst I agree that trusts have a degree of autonomy, the Minister is ultimately responsible for policy direction and for ensuring that it is delivered across the entire health service.”
“I am glad that the new Health Minister has accepted the need for additional scrutiny and proper oversight mechanisms. Maybe someone had a word with the current Minister. <BR /> <BR />In the draft Budget announced last month, Health, as I stated, received an additional £200 million. The Minister has told us that the monitoring rounds will be about protecting front-line services. However, that is in stark contrast to the policy direction that the trusts have taken, which simply reads as an attack on front-line services. So-called contingency plans include axing 100 hospital beds and the temporary closure of minor injury units. Many in the House and beyond will question the term "temporary".”
“If those pressures were identified in August 2013, why did the meeting with OFMDFM not take place until 6 April 2014? Why was the doomsday scenario paper not brought forward until the summer of 2014? At the same evidence session, the former Health Minister acknowledged that there was, indeed, waste in the system but could not tell us how much waste there was or what percentage of the overall budget was waste. It was also acknowledged that the transitional fund in which all of us had placed our hope for the implementation of Transforming Your Care (TYC), which was costed at £70 million, had actually spent £42 million and was now not even a priority bid. <BR /> <BR />Dealing with the need for proper scrutiny and oversight, the former Health Minister was very dismissive and refused to support the call at that time.”
“That is sizeable shift in bid. What was really going on? In a Committee evidence session with the former Health Minister, the Chief Medical Officer stated:”
“It is also worth noting that the Health Department reported an underspend of £10·2 million in capital terms. DFP's 2014-15 in-year monitoring guidelines explicitly establish that Departments must work on the basis of agreed budgets only. In other words, they must plan on the assumption that bids will not be met through the in-year monitoring process. Although an overspend of £13·1 million represents less than 0·3% of the Department's resource budget, the overspend should be an indication of the difficulties that the Department had in controlling its expenditure in the financial year. <BR /> <BR />When considering the maladministration of the budget, the Department's reliance on bids in monitoring rounds is worth noting. It is also worth noting that the Department bid for £67 million in January, which jumped to £160 million in June.”
“<BR /> <BR />Whilst these and other pressures are acknowledged quite publicly, it needs to be referenced that our current health budget is £4·6 billion. It has been protected through budgetary processes. Health was allocated £80 million in the October monitoring round and an additional £200 million in the draft Budget, which I welcome. We would all like to see more. However, here is the hard question: does our current health budget provide value for money? Is the money going in the right direction? How much waste is in the system? Does our current spend target health inequalities, which, I reiterate for the record, exist most starkly in west Belfast, north Belfast and Foyle? <BR /> <BR />On 31 July 2014, in a written statement, the Minister of Finance and Personnel stated:”
“Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to bring this important debate to the Floor of the House today. I want to start my comments by acknowledging the current pressures in the health service, pressures that, I expect, will continue. They are pressures from a growing and ageing population; increasing pressures on front-line services; increasing demands on emergency departments; a 7% increase in GP activity; a 21% decrease in district nurses; and pressures from a policy of shifting left from acute services to community and primary care with a transitional budget that is not in place and without an agreed strategic framework that will target health inequalities, which will actually increase.”
“However, we want to ensure that, by making the scheme mandatory, we do not impose any unnecessary bureaucracy on district councils in carrying out their duties. <BR /> <BR />We also noted that the proposed statutory scheme remains in most aspects very similar to the voluntary one. It also shares much in common with the Welsh model, in an effort to maintain a degree of consistency across all jurisdictions. However, if there are lessons that can be learned from the Welsh experience, I am sure that the Committee will take those on board so that we can have the best possible legislation in place here. <BR /> <BR />To conclude, the Committee welcomes the Bill's intention to make the food hygiene rating scheme mandatory and looks forward to carrying out detailed scrutiny of the Bill at Committee Stage.”
“It is important that the appeals process is transparent, robust and timely, so that businesses that believe there has been a genuine mistake in their rating score can get it sorted out quickly without it negatively impacting on their trade. <BR /> <BR />We also welcomed clarification from officials who advised that the legislation is not designed to close establishments with low ratings but to help encourage businesses to improve their hygiene standards. To that end, rerating inspections will be available in addition to appeals, and the Committee commends that aspect of the Bill. <BR /> <BR />The third issue that the Committee discussed was the resource implications of the legislation. The rating process will be carried out by district council officers, as is currently the case with the voluntary scheme.”
“The first issue was around the effectiveness of penalties for businesses that fail to display a sticker showing their rating. We were concerned that minimal fixed penalties would not act as much of a deterrent and that some businesses might be prepared to risk not displaying a poor rating. While the option of a court conviction will exist for repeat offenders, we want to ensure that the penalties are sufficiently robust and that consumers will be made aware of those businesses that have not complied with the law. <BR /> <BR />The second issue for the Committee was around ensuring that businesses were treated fairly under the new legislation.”
“The Committee noted that, although the voluntary scheme has been deemed generally successful, it was disappointing that only something in the region of 50% of businesses are choosing to display their ratings. Perhaps understandably, that figure drops considerably among businesses with lower ratings of around zero, one or two. At the time of the Committee briefing in January 2013, it was 22% for those businesses, and that had further dropped to 13% by the February 2014 briefing. Therefore, the Committee is supportive of the need to put the scheme on a statutory footing. <BR /> <BR />During the briefings we held with the Food Standards Agency on the proposed Bill, members raised a number of issues that I expect we will explore further during Committee Stage.”
“There is also an associated cost to the economy of £83 million. Therefore, we are mindful that this is a very serious public health issue.”
“It provides a simple numerical rating, displayed by way of a sticker placed in a prominent position in the premises of the food business. The scheme also operates in England and Wales, although the Welsh scheme is mandatory. <BR /> <BR />The Committee took evidence from officials, prior to the introduction of the Bill, on 23 January 2013 and 5 February 2014, and, from the outset, was broadly supportive of the aim of the Bill. Statistics provided at the Committee briefing in January 2013 gave reasonable cause for concern, highlighting a surprisingly high number of incidents of food-borne illness. The Minister alluded to those. On average, there are around 48,500 cases of food-borne illnesses here each year, 450 of which result in hospitalisation, and, unfortunately, up to 20 deaths.”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. On behalf of the Committee for Health, Social Services and Public Safety, I welcome the Bill. <BR /> <BR />The Committee supports the overarching aim of the Bill, which is to seek to reduce the incidence of food-borne illness by introducing legislation that will make it mandatory for food businesses to display information to consumers about hygiene standards, based on inspections by district council food safety officers. Not only will that provide an impetus for businesses to achieve and maintain compliance with food hygiene law, it will allow consumers to make an informed choice regarding where they choose to eat or shop for food. <BR /> <BR />The food hygiene rating scheme has been operating here on a voluntary basis for over two years.”
“Go raibh maith agat. I thank the Minister for his response. He referred to the incident in Derry, and I want to acknowledge the role that the staff in the Western Trust played on that one. Given the potential worst-case scenario, is there specific public health advice that the Minister would offer the wider public at this point?”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I thank the Minister for what I think is a genuine attempt to develop the Irish-medium sector outside Belfast. I welcome that approach. <BR /> <BR />I know that the Minister cannot deal with individual proposals, but I want to test it a bit. One of the recommendations is about opportunities in Derry city and, particularly, in initiating a process of consultation around the present host options. Will the Minister outline proposals, how that could be advanced or state what his advice is?”
“That statistic also needs to be taken into consideration. <BR /> <BR />What needs to be done? We need to develop screening tests. We need to invest a greater proportion of money in research funding. We need to look at better GP training and comprehensive referral guidelines. We need to look at referral pathways, including direct access to patients' CT scans for GPs. We also need to look at how to develop and roll out innovative referral pathways in the North. I welcome the fact that a pancreatic cancer charity has identified two pilot projects, and it has identified the North as one of the locations for a pancreatic specialist nurse and a community involvement coordinator. I met representatives of the charity in June. I commend its work in this area and its continuing lobbying of the Health Minister and the Public Health Agency.”
“I am aware of and welcome the fact that the Public Health Agency is discussing a generic cancer awareness campaign, but I ask the Minister to consider running a specific pancreatic cancer awareness campaign. What actions will he take to boost public awareness of pancreatic cancer and its symptoms? It is important to reflect on the evidence that was given to the all-party group on pancreatic cancer. One respondent said:”
“I agree with the Member. I will come to that point, because we need to be mindful not only of the facts but of what we do about pancreatic cancer. <BR /> <BR />I go back to the point — I think that the proposer referred to it — that, according to figures from Cancer Research, 48% of pancreatic cancer diagnoses are made through emergency admissions. Even when a diagnosis is made, the patient experience is often extremely poor, and we need to be mindful of that. There is only one specialist pancreatic cancer nurse in the North. We should not be proud of that statistic and should actively strive to do something about it. <BR /> <BR />There should be better public awareness as well as better awareness among health professionals, including GPs and clinicians.”
“<BR /> <BR />The proposer said that the early stages of pancreatic cancer often exhibit no symptoms, which makes diagnosis quite difficult. Treatment depends on the type, location and stage of the cancer. Surgery is often the only way to cure pancreatic cancer completely. However, the condition is usually so advanced by the time it is diagnosed that surgery, as some cancer charities indicate, is suitable for only around 15% to 20% of people. The cancer has advanced so much that surgery is not an option.”
“Research by organisations such as Cancer Research suggests, as the proposer said, that it is set to become the fourth biggest cancer killer by 2030. We have survival rates and a lot of ongoing, good, positive work for most forms of cancer, and thankfully those survival rates have been rising, but the five-year survival rate for pancreatic cancer has simply remained unchanged. That is something that we need to be mindful of when we look at the need for public awareness and much more around that. In effect, it leaves pancreatic cancer with the worst survival outcome of any of the top 21 most common cancers. That is not something that we should be proud of; rather, it is something that we should target for the support, public awareness and resources that are required.”