Jo-Anne Dobson
Upper Bann · Ulster Unionist Party · Northern Ireland
“I thank Nichola Mallon for tabling this important question today. I understand that, through correspondence with my colleague Andy Allen, and he articulated this earlier, limited resources and challenges are being cited as the reason. Those are not acceptable reasons for young children to be denied access to a drugs trial.”
“I take no pleasure in speaking on the motion today, but I do so as the Ulster Unionist Party health spokesperson. I wish to focus my comments on, as the motion says, the "grave consequences" for the health of our people of Northern Ireland.”
“The GP crisis, as we know, threatens cover across Northern Ireland. That became abundantly clear given the number of Members who wanted to take part this afternoon. With hundreds of GPs considering resigning, that rescue package can no longer become a reality.”
“<BR /> <BR />I want to turn my comments to the present GP crisis and pay tribute to the work of GP representatives. A rescue plan is needed, but, sadly, one is unlikely to come forward any time soon. Shameful.”
“Minister, this is a desperate situation that has caused real anger in Portadown and has the potential to impact on the health of all patients of the health centre, creating a domino effect across practices. Portadown must be prevented from becoming Humpty Dumpty. What is your response to the anger of the patients in Portadown?”
“Minister, I, like Mr Anderson, have met many of these homeowners, farmers and businesses in upper Bann that have been affected, and livelihoods have been put at risk. Many farmers have been there for generations, and they do fear that it is Groundhog Day.”
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“I thank Nichola Mallon for tabling this important question today. I understand that, through correspondence with my colleague Andy Allen, and he articulated this earlier, limited resources and challenges are being cited as the reason. Those are not acceptable reasons for young children to be denied access to a drugs trial. Elections aside, Minister, what guarantee will you give that those children will not continue to be neglected in the weeks and months ahead?”
“I fear, however, that that time has already passed.”
“The GP crisis, as we know, threatens cover across Northern Ireland. That became abundantly clear given the number of Members who wanted to take part this afternoon. With hundreds of GPs considering resigning, that rescue package can no longer become a reality. <BR /> <BR />This is what happens when politics gets in the way of progress and when the political soap opera overtakes the practical job of actually working hard for our constituents. It is abundantly clear that the health service and, more importantly, the health of the people of Northern Ireland have become the main casualties of this political crisis. <BR /> <BR />I said I would take no pleasure in speaking on the motion. I urge an urgent resolution to the crisis at the Bannview practice and open and frank negotiations with GPs and their representatives before it is too late.”
“It is abundantly clear that those actions have failed the people of Portadown, and it is a clear and painful example, as the motion states, of how this Executive, in this instance through the Health Minister, are failing to:”
“<BR /> <BR />I want to turn my comments to the present GP crisis and pay tribute to the work of GP representatives. A rescue plan is needed, but, sadly, one is unlikely to come forward any time soon. Shameful. What is also shameful is the action of the Department of Health and the Health and Social Care Board on the GP cover for the patients of Bannview practice in Portadown. That is an issue on which my colleague Doug Beattie and I have been working tirelessly. The latest twist is that a new contractor withdrew yesterday, days after they were appointed. Indeed, the board and the Minister told us they had been secured. That is why I tabled a question for urgent oral answer this afternoon to the Minister of Health.”
“I take no pleasure in speaking on the motion today, but I do so as the Ulster Unionist Party health spokesperson. I wish to focus my comments on, as the motion says, the "grave consequences" for the health of our people of Northern Ireland. <BR /> <BR />It is, frankly, outrageous that one in five of our population is trapped on a hospital waiting list. It is even more outrageous that we were told last year we would have to wait until January to hear the Minister's comprehensive plan. It is shocking that there was not a plan already in place. However, it is most shocking that, if the Minister releases it, it will happen through a Sinn Féin press release that is paper thin, with no money or resources behind it and no prospect of making any real and meaningful difference to our constituents because of the lack of an agreed Budget. Shameful.”
“Minister, this is a desperate situation that has caused real anger in Portadown and has the potential to impact on the health of all patients of the health centre, creating a domino effect across practices. Portadown must be prevented from becoming Humpty Dumpty. What is your response to the anger of the patients in Portadown? Was the contract signed as a stalling tactic because of the patient rally that had been organised?”
“Will the Minister of Health outline the measures she is taking following the withdrawal of the GP contractor confirmed to accept the contract to run the Bannview Medical Practice?”
“Minister, I, like Mr Anderson, have met many of these homeowners, farmers and businesses in upper Bann that have been affected, and livelihoods have been put at risk. Many farmers have been there for generations, and they do fear that it is Groundhog Day. What can you do to reassure them that they can have the confidence that this review will make any difference whatsoever?”
“<BR /> <BR />All this is in the document that I referred to, which was forwarded by the then Health Minister in 2014. <BR /> <BR />Given the facts that we have known for some years, it is for others to answer why this issue has not been tackled head on and why the draft Programme for Government contains only one reference to tackling poverty and disadvantage, and reducing the negative impacts of alcohol and drugs use, with no specific reference to alcohol-related crime. <BR /> <BR />Looking in on this debate from the outside, I think that the public would be surprised if the Ministers of Health and Justice were not already working together on this issue —”
“A visible presence is extremely important for community confidence and reassurance. However, we need to be conscious that this deflects resources from other areas and uses, all because some individuals choose to abuse alcohol, and it often does not stop there. <BR /> <BR />Looking at the overall impact of alcohol-related harm on the health service, I have seen estimates that the cost is up to £900 million every year, roughly one tenth of the block grant. The annual cost of alcohol misuse to the health and social care sector alone is estimated to be £250 million, which means that alcohol abuse costs every person in Northern Ireland £500 a year. With extreme healthcare costs, this could continue to rise by approximately 9% a year.”
“The link between the overconsumption of alcohol and crime does not need to be proven or recognised; it is a clear fact — ask any of our constituents who contact us, often at the end of their tether, because of problems they and their families are experiencing. Incidents often start as a nuisance, but the problems escalate to more dangerous and potentially life-threatening levels as time passes. <BR /> <BR />I have been assisting communities through the Housing Executive, which has seen instances of alcohol abuse and related crime increase. I pay particular tribute to the assistance the PSNI has provided in those instances.”
“The figures also show that 11% of antisocial behaviour in Northern Ireland was alcohol related. Alcohol was also involved in a startling 59% of all domestic violence when an injury occurred. That should be enough to send a shiver down the spine. <BR /> <BR />I have spoken at length in the House on previous occasions about domestic violence and the devastating impact it has on families, ripping them apart and affecting young people at the very beginning of their lives. In looking at this issue, it would be useful to receive more up-to-date figures from the Justice Minister. However, the point I am making here is that this information has been known for some years.”
“Those are not my words, but those of former Health Minister Edwin Poots when, in 2014, he penned the foreword to 'Every Contact Counts: Improving Access to Treatment for Alcohol Misuse in Northern Ireland'. To significantly reduce alcohol-related crime, as the motion states, we need to know the starting point. This document, albeit that it is from three years ago, contains a number of startling and frightening revelations about the burdens alcohol places on our health service and the justice system. <BR /> <BR />The PSNI confirmed through the Northern Ireland crime survey 2012 that alcohol played a part in 19% of all recorded crime, and my colleague, Doug Beattie, mentioned that. That is almost a fifth. I understand from the most recent statistics that that has changed little in the years since.”
“I also welcome the opportunity to speak tonight as the Ulster Unionist Party health spokesperson. I also welcome that this enables us, as elected politicians, to focus on the issues that directly affect society in Northern Ireland and to put the practical before the political, which is, after all, what we are elected to do.”
“Does the Minister recognise the immense pressure on private residential nursing homes? If even a small number closed, as has happened in my constituency of Upper Bann, the number of respite places available would be greatly reduced. I want to learn more about the actions that she is considering to reduce those pressures. Does she bear in mind the heartache that closures bring to elderly residents and their families?”
“No matter what we say, nothing will be able to accurately reflect the level of outrage that should be expressed at the fact that waiting times are tragically causing patients to come to harm. Does the Minister agree that even the planned single-year Budget for 2017-18 would still cause immense uncertainty and unsustainability for the health service?”
“I think that a good starting point in this process would be to finally publish the childcare strategy. Since May, Minister, you have repeatedly stated in your written answers that you will be presenting the childcare strategy to the Executive in the coming months, and you are not much clearer today either in your answer. Can you confirm exactly when or in what month that will be?”
“The Minister recently sent a letter to schools requesting responses on how they can have better control of their own budgets. Will he detail whether, at this stage, he has any plans or proposals to put to schools? If not, are they at least in development?”
“On behalf of my party, I concur with the Minister's sentiments. I was chatting to Austin just a few weeks ago, and my heart goes out to his family. <BR /> <BR />Can the Minister update the House on what work the Housing Executive is doing to address issues around domestic and sexual violence, especially when children are involved and new housing is urgently required?”
“These are all issues that warrant consideration in looking to future services to prevent the continued rise in the number of people diagnosed with HIV in Northern Ireland. <BR /> <BR />In conclusion, I appreciate that the Minister acknowledges that the PHA, along with stakeholders, undertook a major sexual health workshop last month and that she will consider the outcome of and proposals from it. However, I hope that, in response to today's motion, she will acknowledge the clear need for a renewed and refreshed sexual health promotion strategy that takes on board the recommendations made by the RQIA in 2013 and recognises the need to address the concerning rises in diagnoses in recent years in Northern Ireland. It would also be helpful for us to receive a timeline within which such a refresh and renewal could take place.”
“Amongst its recommendations were the development of standards for services; the development of a managed clinical network; improvements in what they termed, "fragmented" commissioning arrangements; and workforce planning to address staffing levels that were:”
“The report made 16 recommendations in total. It concluded:”
“<BR /> <BR />I want to take a few moments to focus on the RQIA's October 2013 review of specialist sexual health services in Northern Ireland.”
“The strategy's fifth key priority area was HIV and STI prevention, and I understand that involved important work with high-risk subgroups. <BR /> <BR />As the motion states, cracking the stigma around seeking help is one of the major challenges, if not the major challenge, for any strategy. I pay tribute to those working in the trusts to deliver HIV awareness training, which contributes greatly to addressing that stigma. Bearing in mind, however, that one of the key objectives of the strategy was to reduce the incidence of STIs, including HIV, in the 10 years since 2004, we have seen a 47% increase in new HIV diagnoses. That is on the back of an overall reduction of 20% across the United Kingdom. That said, the prevalence of HIV diagnoses in Northern Ireland remains lower than the other regions of the UK.”
“of HIV. Indeed, a renewed and refreshed campaign has been long lacking. <BR /> <BR />In supporting that, it is important to look at the work already undertaken, led by the Public Health Agency (PHA), and what can be learned from that. The RQIA has, since 2013, been calling for the development of a regional clinic network to drive improvements in outcomes for patients and service users. No one is denying the need for a clear strategic direction to be set for sexual health services and agreed standards for service delivery. I hope that this motion brings closer that ambition called for in 2013. <BR /> <BR />In April 2012, the Health Committee received a briefing from the PHA on the sexual health promotion strategy and action plan for 2008-2013. I understand that the strategy was subsequently extended until the end of December last year.”
“I welcome the opportunity to speak on this motion. I appreciate and agree with the call in the motion:”
“For instance, could the South West Acute Hospital, which is a facility that has some problems with recruiting and retaining a sufficient number of doctors, link formally to ensure that doctors are more proactively being sent to train and, hopefully, settle in areas where real demand exists? That is just one option; I am sure that there are many more. <BR /> <BR />I wish the Minister well for her future engagement with Ulster University on this issue.”
“However, increasing a number of medical school places, whether through a new school at Magee or anywhere else, would do absolutely nothing to soothe the current pressures unless it is accompanied directly by an increase in the number of medical training places. That is the crux of the issue: it does not matter how many people we educate through the universities; it all comes down to how many fully qualified doctors a new school at Magee could help to deliver. Of course, with Altnagelvin, the school would have a perfectly reasonable training ground on its doorstep. However, I suggest to the two Departments and Ulster University that, in their early assessments of whether a school would be viable, they should be ambitious about how they could deliver those training places.”
“<BR /> <BR />It would be remiss of me not to mention the particular situation in Portadown. Minister, you will be aware that we received further contact from a GP this morning. There is a very serious scenario unfolding there with a large number of doctors leaving in very quick order. That has left some of the practices looking over a precipice. I am aware that people are talking about managed dispersal. That is probably as impersonal and clinically cold in reality as it sounds. Minister, I would be happy to facilitate a meeting between you and local GPs in the town if you agree to meet them. <BR /> <BR />That is indicative of what happens when we do not properly workforce plan. Today's debate could possibly go some way towards fulfilling a need.”
“The Department and successive Ministers have regularly gone to great efforts to boast of the number of nursing posts created, but they are loath to tell us that there are 920 posts currently vacant. Before we even consider today's issue of a new medical school in the north-west, the Department needs to be a bit more transparent in telling us what exactly the workforce needs are, including what demands there would be for recruitment from a large number of medical school graduates through, for example, Magee, if that were the case. I know from talking to my colleague Rosemary Barton MLA that there are chronic medical staff shortages in much of the Western Health and Social Care Trust. The pressures are particularly acute in general practice, with a frightening amount of County Fermanagh being on the brink of having no GP cover at all.”
“I welcome the opportunity to speak in support of the motion as the Ulster Unionist Party health spokesperson. It is an important issue. Educating sufficient numbers of doctors is essential in ensuring that enough are entering the profession locally. It is widely recognised that our health service workforce is not in a good or sustainable shape. In fact, there has been a total absence of workforce planning in Northern Ireland. That is now directly contributing to many of the pressures currently being experienced. <BR /> <BR />I am sure that many Members are acutely aware of the scale of vacancies across the local health and social care trusts. I have said this before, and I will say it again: a long-term vacant post, whether it is for a doctor, a nurse or an allied health professional, is about as much use as no post at all.”
“The original question was about the time taken to hand over a patient at an emergency care department. Your response to me says that the information is not available. Given that this data is collected in other jurisdictions, why is it not the case in Northern Ireland?”
“I also remember well, and pay tribute to, the personal crusade of Una Crudden as we approach the second anniversary of her death. Minister, you will be aware of the facts of the more aggressive cancers, but what assurances can you provide us with that new drugs developed here in Northern Ireland will be made available to local patients diagnosed with ovarian cancer?”
“I thank the Member for giving way. I am somewhat surprised that the Member mentions our tone. We welcome the findings of the Bengoa report, but we are asking for the details of a costed and funded plan. Surely you agree that that is essential in putting patients first.”
“I therefore urge the Minister to tell us the how, the when and the where to lift that uncertainty and to begin tackling the issue.”
“<BR /> <BR />In conclusion, the future holds many challenges for our people, not least type 2 diabetes, liver cirrhosis, lung and heart disease and, of course, cancer, but the past shows a litany of failed opportunities to support and strengthen our health service. We welcome and will support the amendment from the Alliance —”
“They indicated to me that no monitoring round had been commissioned for January and that, given the overcommitment of the Executive, they did not envisage getting any additional allocations in January. <BR /> <BR />Stable budgets are one thing, but a departmental culture that embraces change and nurtures, rather than suppresses, the talents of healthcare professionals will achieve the best outcomes. As I put it to Dr McBride at Committee, back in June, the Department must loosen its iron grip. Accountability, certainly, but a stranglehold that stifles individual thinking will ensure that real and meaningful change simply drips down slowly — far too slowly. The Minister stated last week that it will take strong leaders to take forward transformation, and I agree. I do not envy for one minute the task of repairing the airplane in flight.”
“So far, we have a 12-month timeline for a 10-year plan, with budgets at worst for one year and at best for three to four. If I could make one plea to the Executive today it would be this: bring forward the detailed, costed plans for reform and back them up with long-term budget, as in other regions. <BR /> <BR />There was initial disappointment that the announcement of the Executive's plan was not met, on the same day, by an injection of funding through the October monitoring round. Officials have since confirmed that the 18 actions are being managed within existing resources. I would, however, be grateful for clarity from the Minister on the comments of her officials at the Health Committee last week.”
“That is 22 months during which patients risk coming to harm. Indeed, the latest information, from July, shows that 1,094 patients were waiting longer than 52 weeks for an allergy appointment, and that is already a centralised service. Workforce planning, long-term budgeting and actions are required to fix a broken service.”
“The principles are well established and widely supported, but the how, the when and the where have not been brought forward. <BR /> <BR />I will give a further example. When I was lobbying earlier this year on behalf of a constituent who needed an appointment with the regional immunology service, the Belfast Trust confirmed to me:”
“It also took pressure off the consultants and their team at the City Hospital, because, when we were attending the clinics in Belfast, immunosuppressive patients were effectively lining the walls waiting on their appointment. That is not a safe environment for patients who are susceptible to infection. <BR /> <BR />If the Minister is going to come forward with the business case, the funding and a plan to establish a centralised — I give this as one example — nephrology service, those plans will need to be funded and carefully planned, and the impact on patients, in the short term and the long term, will need to be taken into consideration. I give that as an example of precisely the level of detail that was missing from the Bengoa report and the Executive's responses.”
“From personal experience, my son was treated in the Royal Belfast Hospital for Sick Children and then latterly in the nephrology unit at the City Hospital. That is a successful unit. Indeed, last year, it equalled the UK record for transplants performed in a single unit in a single day. Once successfully post-surgery and into a management regime of drugs, Mark was repatriated to the care of the Southern Trust at the nephrology unit in Daisy Hill Hospital in Newry, under the expert care of consultant nephrologists Dr John Harty and Dr Neal Morgan and their team. As a family and from our experience, we found this to be an excellent positive change for Mark.”
“There are nine type-1 sites in total, including the units at the Royal Victoria Hospital, and they are all under immense strain as it is. We do not need to think back too long to remember what happened at Belfast City Hospital. In the year before the closure of its emergency department (ED) was announced, the hospital had 45,000 attendances, yet, after it was shut, there was only a minimal increase in capacity at the Royal and the Ulster Hospital. No wonder the four-hour A&E performance in the Royal was only 69%. In the July before the City Hospital's A&E closure, it was 78%. <BR /> <BR />I will give an example of where the present decentralised service relieves pressure on the main specialised unit. That is in nephrology.”
“Following the publication of the two documents last month, there has been some focus on the centralisation of services, so let me make the Ulster Unionist Party position crystal clear. We agree with localising where possible and centralising where medically necessary. What does that look like in reality? It means that we support some services that are being delivered in an unsustainable and unsafe manner coming together when there is a clear and compelling medical case for them to do so, but we will not support the word "unsustainable" being manipulated to suit the Department's agenda, as clearly happened with paediatric congenital heart disease services in Belfast. <BR /> <BR />One example of a service that we want to see kept as it is is the provision of emergency departments.”
“No one disagrees that there is a problem, but most will have been shocked to learn that the Executive did not already have a plan in place to deal with it. Throwing money at it in-year, as happened in recent years, has not worked. Remember that £18·5 million of the £40 million last year was not spent on tackling waiting lists, because health trusts were not given enough time to spend it.”
“For instance, action point 12 announced the establishment of a transformation oversight structure by November. However, the Minister should really have been in a position to tell us, when launching the action plan, who was going to sit on the panel, how they would be selected and their terms of reference — an example of uncertainty and delay that could have so easily been avoided. <BR /> <BR />I still believe, however — and it is a point I have heard made several times since the publication of the documents three weeks ago — that it was galling that the very first action was, by January next year, to:”
“I remember putting it to Professor Bengoa at the summit that reforming the health service was a little like repairing an airplane in flight. He and his panel have provided the Executive with the direction of travel. Therefore, the job of carrying out that reform lies with them. <BR /> <BR />The publication of Health and Wellbeing 2026: Delivering Together, and ‘Systems, Not Structures: Changing Health and Social Care’, marks just that: the publication of two documents. That is why the devil is in the detail, and, as yet, we have not been provided with that detail. I was somewhat surprised just how high-level the Minister's response was. She had the Bengoa findings for 10 weeks, yet even some of her more detailed actions referred only to further exploration and consultation.”
“I welcome the opportunity to move this motion — the first opportunity that Members have to make substantive comments on the issue. I welcome, as I and my colleagues did on 25 October, the publication of the findings of Professor Rafael Bengoa and his panel. We had the opportunity to meet the panel at the health summit in the Stormont Hotel in February, and again for 45 minutes at the beginning of June. <BR /> <BR />The commitment of the expert-led panel was resolute, and I am sure we can all thank them for their many months of work. We welcome their conclusions, which, it must be widely noted, are similar to the findings of the three previous major health reviews in advocating a shift from acute to community care. The one thing that we can, with certainty, learn from history is that we never learn from history.”
“Now that the ice is finally beginning to thaw around support and services for people suffering from chronic illnesses such as ME, what guarantees will the Minister give that the charities fighting so hard will be fully involved in design and delivery?”