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 know that I am not alone in the Chamber or outside the Building in being a member of a family ripped apart by cancer. However, there have been many wonderful medical advances since then, and being diagnosed with cancer need not be the death sentence that it was for my grandmother and those of her generation. <BR /> <BR />Until fairly recently, we were starting to look more optimistically at the future. Media reports of revolutionary advances in cancer diagnoses and treatments have become commonplace. Often at the centre of those were experts from our academic institutions: Queen's University, for instance, became a world leader in research, and, earlier this year, scientists from Randox revealed their major development of a blood test to check for bowel cancer, a disease that kills hundreds of local people every year.”
“<BR /> <BR />There are few issues as emotive or as much of a touchstone as how the health service responds to the needs of people who have been given a cancer diagnosis. Cancer is a vicious disease and its impact is indiscriminate: it affects the old, the young, the healthy and the vulnerable. No other word strikes fear into the hearts of families in the way that cancer does. <BR /> <BR />I dedicate my comments to Anna May Evans, a lady whom I never got to know, who died of cancer at the age of 41. I was two years old and my sister was a baby when our young mum of 21 was left with not only two young daughters but five brothers and sisters to look after. As a result of cancer, I was not able to know and love my grandmother.”
“I welcome the opportunity to open today's debate on this incredibly important issue. From the outset, I express my anger and deep sense of frustration that the Minister has again decided that the political desires of his party are more important than the health of our people. How dare he. How dare he treat with such contempt the Assembly and, more importantly, local people with cancer and everyone else who is facing delays. Aside from whatever games he and his party are playing, I have no doubt that they will come to regret that approach as the problems across our health service continue to deepen, and more and more innocent people come to harm as a result of their insolence. No matter how long Mr Hamilton's political career lasts, I suspect that these days and weeks will define it for many.”
“No, I did not hear your comments earlier, and, as an MLA from a rural constituency, I am interested to hear your opinion. It is widely known that local intelligence can lead to criminals being caught. What is the Minister's message to farm families, who often feel let down by the follow-up service after a theft on their farm? What more does he feel needs to be done to improve outcomes for the victims of rural crime?”
“Will the Acting First Minister explain why £78 million of the £80 million set aside for the social investment fund is unspent? What is the Minister's message to the groups that are in limbo and awaiting funding in my constituency of Upper Bann?”
“Will you give a guarantee to look at how your Department provides help and guidance to young farmers? After all, they are the next generation of farmers across Northern Ireland and they deserve support at this time of crisis like never before.”
“Perhaps your contribution to the debate could also highlight what action you have taken on the issue. I have also been working alongside the chief executive of the Southern Trust on the issue and would welcome an update from the Minister today. <BR /> <BR />I want once again to focus on young farmers, like Jonny Matthews and James Stewart, who presented to us at Committee. They have come through CAFRE and are waiting in the wings to take over as heads of holding. They need to be given hope for a sustainable and profitable future in farming, now so more than ever. <BR /> <BR />Minister, we are all aware of your Department's drive towards online documents and forms. However, a short search through the DARD website shows that you do not have a dedicated section of advice and guidance for young farmers: 100-page PDF guides do not work.”
“Mr Haldane was a guest of the Portadown Chamber of Commerce, and I put on record my praise for the chamber for securing the attendance in our constituency of one of the world's 100 most influential people. It is beholden on all of us to use the influence that we have to help our industry through the present crisis. <BR /> <BR />At Committee last week, Minister, I asked for further clarity on the EU aid package and on what the reality of that announcement will mean to our farmyards. I am sure that Members would welcome any further light that you can shed on that today. Again, Minister, when we met alongside my party colleagues, Tom Elliott MP, Jim Nicholson MEP and Councillor Rosemary Barton, I raised my serious concerns around mental health issues in rural communities.”
“I pay tribute to the farmers who refused to be put off and met those in positions of responsibility to press for that action. <BR /> <BR />On Friday, I got the opportunity to relay the concerns of local farming families to the Bank of England's chief economist, Andy Haldane. We discussed the potential impact of possible interest rate rises, and his suggestion was that the rate, far from rising, could fall further. That would certainly be welcome news, not only for mortgage holders but for our farming families.”
“I would like to focus the remainder of my contribution on the young farmers who will become the next generation of farmers in Northern Ireland, because, during recess, it was a young farmer — Johnny Matthews — who contacted me to raise his grave concerns. That resulted in a meeting in Donaghcloney, which was attended by over 60 farmers from across Northern Ireland, after which Edwin Poots and I requested the Committee's recall. <BR /> <BR />I do not propose to go over the timeline of meetings, protests, letters and announcements that followed, whether here, in London or in Brussels. However, the measure of all those efforts must be seen in the farmyards, if we are to help farming families and retain the rural way of life for Northern Ireland as we know it.”
“I thank the Member for giving way. We do not hold the Agriculture Ministry, but I think that you will find that we have worked hard on the issue. <BR /> <BR />On the next day, the Minister firmly rejects what is probably the single biggest support measure that could be delivered. Of course, the Minister will no doubt say that she cannot issue advance payments as this year's applications require additional time to process. However, the Department has known for some time that this year's applications would be different, so it clearly failed to plan for them. <BR /> <BR />Another good example is the fact that, after months have passed since the application deadline, the Minister still refuses to indicate, even approximately, what the young farmers' top-up rate will be.”
“I think that it is shameful that the Minister, who claims to realise the scale of the crisis in the sector, did not even take the time to consider it. There has been no clearer example of how out of touch the current Minister really is with the scale of the problem, and the industry is, understandably, in uproar. On one day, the Minister stands up, pledges full support and promises that every issue will be explored —”
“That is why I tabled the amendment in my name and that of Robin Swann. Maybe it was his party's hastiness in submitting the motion, or maybe it is the case that he simply accepts the Minister at her word. Either way, it would be wrong of us not to raise the issue. Let us not forget how significant 70% advance payments from next month could be. They would provide immediate financial support for farmers facing some of the most challenging circumstances of their lifetime. <BR /> <BR />The Ulster Unionist Party has called for advance payments for many years. However, successive Agriculture Ministers simply said that that could not be delivered because the European Commission would not allow it. Now that the Commission gives us the opportunity on a plate, the Department rejects it.”
“I would like to start by declaring that my husband is a beef and cereal farmer. I very much welcome the fact that the motion has been moved and the opportunity to speak to it, although no doubt it will confuse people further as to what exactly the DUP is doing with its games in the Assembly. If they are not games, why did no one contribute to our debate last week on the waiting times that affect one in five of our constituents? <BR /> <BR />There can be no doubt that the crisis facing all sectors of our farming industry, from vegetable to sheep and from beef to dairy, is the greatest threat and challenge to our rural way of life in Northern Ireland for many decades. I agree with much of what Mr Irwin's motion says. However, I thought it an oversight that he left out the issue of advanced payments.”
“I thank the Member for giving way and for his comments. I was restrained, you are right, but my focus was primarily on waiting times. The fact that we have had three successive Ministers and the waiting times are at such a crisis point speaks volumes.”
“— to meet and organise and do it for the public good as soon as possible.”
“We need to ensure that the workforce planning is working as it should, especially so that major consultant posts are not lying vacant through lack of forward planning. We need to ensure that the service exists to primary-level care so that people are showing up at hospitals only when they absolutely need to. I know that that can be difficult, but we must work on those issues. <BR /> <BR />In conclusion, NHS health staff who have been left completely emotionally drained and demoralised are not to blame for the current problems. In fact, I believe that they are the last remaining defence against total collapse. These pressures, combined with the cavalier attitude of the former Minister, the board and some of the trusts, are contributing to worse morale. I urge the next Minister —”
“Try telling that to the young woman who is facing delay with her breast cancer treatment or the grandfather watching his grandchildren, knowing that he may not be around to see them grow up. I am in no doubt that every MLA in the House will be coming down with case files of absolutely desperate constituents who have been told that they have to wait for what seems like an unbelievable length of time. I know that I am. These cases tug at our heartstrings as they are shocking and appear completely irrational. I also continue to receive contact from health service staff who find spiralling waiting times totally unconscionable. If we do nothing, waiting times will only grow and grow, and patient safety will become further compromised.”
“We are dealing with matters of life and death, but the most frustrating thing is that we are simply being asked to accept it.”
“Indeed, earlier this year, in a leaked document from the Health and Social Care Board, there was a direct warning:”
“<BR /> <BR />Another contributory factor affecting diagnosis rates is the significant deterioration over the past five years in the average number of weeks that patients are waiting for either a CT or MRI scan. For instance, the average wait for a CT scan has jumped from 4·1 weeks to seven weeks in Belfast and from nine weeks to 16 weeks in the Southern Health Trust. <BR /> <BR />Only a few people should expect to wait more than four hours in A&E. Only the slightest ailment should deserve a waiting time of six or 12 months to be seen by a specialist. Cancer rips the heart out of our families and shows no mercy whatsoever. The fact that right now, as we stand here today, people are having their health compromised should be enough to shame the Health Department and the Health and Social Care Board into action.”
“<BR /> <BR />Another area is the diagnosis and treatment of cancer. The official target for an urgent referral for suspected cancer is that 95% of patients should begin their treatment within 62 days. Yet figures earlier this year revealed that only 72% of patients were seen within that time frame. In addition, the target waiting time for a first assessment with the breast cancer specialist is 14 days, so all urgent breast cancer referrals should be seen within that time. However, only 82% were. Whilst those figures may sound alarming, breast cancer diagnosis and treatment is not one of the worst performing areas. There are a range of other areas, not least urology, facing very serious delays.”
“The longer the current situation rolls on, the more uneven and unequal access to healthcare in Northern Ireland becomes. Take our A&E attendances, for instance. During 2014-15, only 73·8% of people attending the main emergency care departments were treated and discharged or admitted within four hours of their arrival, despite the target being 95%. Indeed, even in my local hospital, Craigavon Area Hospital, where the pressures are by no means as severe as they are in some areas, only 78·3% of patients were seen within four hours. Almost 17,000 people had to wait longer. <BR /> <BR />It is often said that how our A&E departments are performing is a barometer for the wider state of the NHS. Last year's performance, which was a deterioration on that of the year before, demonstrates that the crisis facing our hospitals is continuing to worsen.”
“<BR /> <BR />People who go through their GPs and are referred to a hospital or specialist now face one of two choices: they can either wait the six, 12 or 18 months, which is becoming the norm, or they can go private. Of course, not everyone can afford to do that. For instance, the price of a primary knee replacement only a few years ago was over £7,000, and the equivalent price on the NHS was only £2,000. Many people simply cannot afford those costs and are therefore left with no choice but to wait, often in excruciating pain. As they are waiting, visits to their GP are regular and their prescriptions are never ending, all the time costing money that would not need to be spent if only they could be seen within a reasonable time. <BR /> <BR />The consequence of lengthening waiting times is a truly vicious and painful cycle.”
“This is a very real concern that is often overlooked in the debate about waiting times. There are a number of factors that, collectively, are contributing to the crisis in our waiting times. The most significant, however, was the decision to suspend referring patients to the independent sector. I understand the growing alarm at the spiralling cost of using independent providers; indeed, I remember joining others in speaking out against those rising costs. However, by taking such a conclusive stance and freezing all that work, it was inevitable that lists would take a nosedive. Unfortunately, that decision has had a major and undesirable consequence.”
“These delays are affecting a range of specialities, but a stark illustration is that 50,000 people are waiting for surgical appointments, often in debilitating pain and with increasing anger. Over 20,000 have been waiting for either trauma and orthopaedic (T&O) surgery or general surgery longer than the maximum 18-week waiting time. A frightening range of specialities is reporting immense pressures and worsening service provision, including trauma and orthopaedics, general surgery, urology, ears nose and throat (ENT) and pain management. Older people, young people, men, women, the rich, and especially the poor, are left living in pain and in fear about the state of their health. <BR /> <BR />I know, through my constituency office, that many of those who approach me about waiting times are also living in fear for their job prospects.”
“Of all those waiting, 86,000 — or 40% — have been doing so for more than 18 weeks, even though the target is, of course, that no one should wait for longer than 18 weeks. In the words of the Department's publication:”
“The intention of the motion is neither to make party political points nor apportion blame; it is to remind all Ministers and all parties that the longer the uncertainty about the future of the Assembly exists, and as we continue to fall deeper into our financial black hole, the longer ordinary people are left reeling from the consequences. <BR /> <BR />Let us remember the scale of the current problem. As the motion says, in June 2015, some 373,000 people were waiting for a first outpatient appointment, diagnostic test or inpatient treatment at hospitals in Northern Ireland — that is equivalent to over 20% of our entire population. Just think about that for a moment. The total number waiting for a first outpatient appointment is over 212,000, a 46% increase on the 145,500 waiting in the same period last year.”
“I welcome the opportunity to move the motion. In the midst of yet another crisis facing the institutions, we must not forget the thousands on hospital waiting lists. Many are growing increasingly frustrated, and who in the Chamber could blame them? I can only imagine how exasperating it must be for people to be told that they could wait for months, if not years, for a crucial appointment, and then turn on the television in the evening and watch the farcical scenes here. The whole thing would be funny, if it were not so deadly serious.”
“The Minister has just touched on my point about the €500 million package. It appears attractive at face value, but, as you say, once it is divided across the 28 member states, it certainly declines quickly. The UK's allocation is subdivided into the four regions: can the Minister provide an update on what discussions she and her senior officials have had with DEFRA about Northern Ireland's allocation?”
“I also thank the Minister for her statement, although there is little in it that will actually reassure farmers or deliver any meaningful support. <BR /> <BR />The Minister rightly talks about the size and importance of our local agrifood industry, but does she accept — this is a point that has been raised with all of us so many times over the summer during the protests — that her main priority must be to stabilise the industry and keep the farmers that we have in business? Many face financial ruin, as you know, Minister, and the mental anguish associated with that. We have to protect the farmers we have at the moment, as well as getting that balance of seeking to expand.”
“I thank the Minister for his answer. Can he provide an update on any indication the Department may have received from DFP — as you know, you have experience of that one — about the potential for in-year cuts to departmental budgets?”
“Minister, I wrote to you at the start of this month requesting an urgent meeting to discuss the plight of the Northern Ireland Attention Deficit and Hyperactivity Disorder charity. Four weeks later, however, I have not even received an acknowledgement. First, I ask you for an explanation. Secondly, can you give me a commitment that you will find the 30 minutes that are necessary to meet me and the charity to hear about the exceptional work that they do throughout Northern Ireland?”
“Eventually, after challenging the Committee's concerns for some time, the agency shifted ground. They have agreed to move the focus from a specific website to a more general online presence. <BR /> <BR />In addition, amendment No 22, relating to the review, at least offers some possibility for further improvement again in three years, but I warn the Department and the Food Standards Agency not to use the amendment to simply appease and defer the concerns that have been raised with them during the Committee meetings.”
“People eating in restaurants would see the rating, but many people ordering from takeaways would not. The Bill is just as important for customers of takeaways as it is for those of restaurants, so it is important that it is adopted correctly for both. <BR /> <BR />I got the sense in Committee from the Food Standards Agency that it was reluctant to broaden the scope to include online sales. They said that it would not be resource-neutral, as staff time would be required to check for compliance. While it would undoubtedly require some supervision, I do not accept the broader argument given. In the time taken by a council official to make one physical inspection of premises to ensure compliance, dozens of websites could be checked in the same period.”
“<BR /> <BR />As we know, the means by which people order their food is significantly different from what it was even a few years ago. The requirement to physically display stickers on a premises showed no cognisance of the fact that more and more people choose to order their food over the Internet. In fact, a whole new industry of websites is developing to catch the market of astute consumers who want to conveniently chose from the range of takeaways in their areas. I know that that has worked very successfully for businesses in my area. By ignoring the fact that so many people are now ordering online, the Bill would have missed on impacting the decisions of a significant number of people.”
“As has been said previously by Members, one area of the Bill that the Committee spent a lot of time on was how the ratings could be communicated online. That is what I will focus my comments on. As we have heard, amendment Nos 3, 14 and 19 all relate to that. <BR />At the moment, the Bill proposes to place a duty to display a sticker or notice on a prominent position in a premises. Many businesses operating the voluntary scheme already display those stickers on doors on the way into their premises, but that is not surprising, given that they have something to be proud of. Last year, however, only 13% of businesses that received a poor score took part in the scheme. Thankfully, they will not have the luxury of choosing after the Bill has been implemented.”
“The Food Standards Agency states that it could happen only in cases of inaccurate or defamatory content, but, nevertheless, I urge that caution needs to be exercised here.”
“I am sympathetic to that idea, but, ultimately, I realise that adopting such a scheme could take away from the purpose of the Bill — namely, self-compliance by businesses. <BR /> <BR />Amendment No 12 gives the Department the authority to restrict the number of requests for a review. That is a sensible proposal, as it should, in theory, mean that pressures on staff are kept to minimum. However, the right to request a rerating should be exercised equally across all council areas. <BR /> <BR />The right to reply, which amendment No 13 briefly touches on, was another issue that the Committee took an interest in. It makes sense to allow businesses to write in and state what they have done to improve the hygiene standards on their premises, but it will surprise some people that council officials have the ability to edit these responses.”
“I welcome the opportunity to make a few brief remarks on the first group of amendments. <BR /> <BR />I acknowledge the beneficial role that the Committee played in scrutinising the Bill, identifying issues and persuading the Department to come back with further amendments. As a result, many of the amendments before us are indicative of the will of the Committee. Amendment Nos 1 and 2 are examples of that: both make sense and show a greater degree of pragmatism. Amendment No 1 still allows councils to provide information at an early stage, and amendment No 2, along with amendment No 9, makes sure that there are no excessive delays between councils notifying the Food Standards Agency of a rating. <BR /> <BR />This group also touches on the appeals process. When Pubs of Ulster was before the Committee, it called for a period of grace.”
“I will support it at this stage only for it to go to Committee, but we will reserve our position for the latter stages.”
“I would hazard a guess that, if the wider population had been aware of the proposals, the consultation responses would have been rather more mixed. In fact, I will go further and say that most people would be shocked that their private information is held at all and, even worse, is already shared in some circumstances. Broad public unawareness of existing powers, especially those that are now being proposed, should not be mistaken for acceptance by the Minister or his Department. I have no reason to doubt the authenticity of the broader intentions of the Bill, but its broad-brush nature and wording trouble me. At this time and in the absence of still crucial information, I and the Ulster Unionist Party would not be content to see the contents of the Bill get into statute.”
“However, I reiterate that private information and data, especially on healthcare, is an issue that many people across Northern Ireland feel strongly about. The Minister has rightly indicated that safeguards will be to the fore in what the Bill proposes to do, but, rather regrettably, the detail attached to them will be decided later in future regulations and after a further consultation exercise. For the time being, we are asked to rely on little more than the word of the Minister and his officials. <BR /> <BR />In addition, while the Department and the Minister stress that the vast majority of respondents to the consultation were supportive of the proposal, they should perhaps be a little more honest about the wider picture. There were only 14 responses, and the majority of those were from the health organisations.”
“I know the Minister would probably refute the allegation that drugs or insurance companies could wangle their way under this broader public interest definition, but the Bill does not give me those reassurances. I do not need to remind the Minister of the uproar in England — I know Mr McKinney has already alluded to that — when it was revealed last year that such companies were effectively able to buy patient information. Whilst I accept that this is a different Bill that is trying to do different things, the same core principles in the use of confidential patient data apply. <BR /> <BR />I appreciate that the Department claims that the legislation would improve the planning and delivery of health and social care services and would provide information to inform the future diagnosis and treatment of illnesses.”
“Just because the Department thinks disclosure would be necessary or convenient does not automatically make it the case. The Department appears concerned about applying the test of public interest within the current legislative framework, yet, in reality, the Bill appears to do nothing to make it any clearer. It does not even make a stab at giving a high-level definition of public interest, and that is very worrying. This is only one area that needs much greater detail and explanation, and, worryingly, it sits in the very first clause. <BR /> <BR />Even the scope of where the Bill would apply is not made clear. It mentions health and social care but includes a caveat of anything else "in the public interest".”
“I am conscious that the Department should do what it can to minimise legal risk to itself and its bodies, but, equally, I am concerned that at the core of patient treatment throughout the NHS should be the promise of confidentiality. The sharing of data is not a problem when the patient has consented, but it becomes complicated when, for whatever reason, consent was not achieved. At present, in such circumstances, I believe that a blend of legislation is applied, including the Human Rights Act and the Data Protection Act, but there is a potential weakness in the application of common law. <BR /> <BR />The public interest test is a bone of contention at present, but, having read what the Bill intends, I am not satisfied that what the Department proposes to do is any better.”
“I also welcome the opportunity to speak at this stage of the Bill. As openly admitted by the Department and the Minister, the overall intent of the Bill is to minimise the risk of legal challenge that he, his Department and the health and social care sector more generally could face as a consequence of using service user information that identifies individuals for purposes other than the direct care of the individual. In other words, the Department and its trusts want to be protected from service users — "patients", in everyday terms — taking action if they later find that their details were used and released. The overall intent of the Bill, therefore, gives me some concerns.”
“<BR /> <BR />In conclusion, I thank the Committee staff, Stella and her team, for all their hard work on the Bill, for it has been a long slog for them as well. In addition, it would be remiss of me not to thank the officials, especially those from Rivers Agency who had the unenviable task of having to visit the Committee on so many countless occasions.”
“Instead of the Committee focusing on key issues such as CAP reform or alleviating some of the instability in the dairy or red meat sectors, we had to spend a huge amount of time on this Bill. <BR /> <BR />The fact that it has taken four years to get to this stage shows that the initial proposals were either ill thought out or deliberately ambiguous. Nevertheless, today represents the last step in the process. Today's Bill looks and sounds quite a bit different from the one that was first proposed. Many of the changes have already been discussed, not least additional financial support for reservoir managers. I call on the Minister to bring forward the schemes and accompanying detail without delay.”
“Getting to this Final Stage has not come a day too soon, in my opinion. The Bill has been hanging around the neck of the Committee for quite some time, and, to be quite honest, I have found that it has often been a distraction. <BR /> <BR />That is not to trivialise the issue because it is a very important matter. People need to know that large volumes of water upstream or uphill are safe and do not pose a threat to them or their families. However, I am in no doubt that the Minister and her Department were more than happy for the Committee to spend month after month scrutinising the Bill and effectively demanding significant rewrites for large aspects of it.”