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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“Given the often overbearing nature of the Northern Ireland Environment Agency (NIEA) and its unwarranted treatment of farmers, what assurances can the Minister give that the strategy will not result in further hounding of the farming community?”
“I thank the First Minister for her answer. Given that the now-in-post Executive press secretary is undertaking cross-departmental engagement with the media, especially on behalf of the Department of Health, can the First Minister give an indication of the financial savings that Departments will realise as a result of the new appointment?”
“I thank the Minister for her statement and for the eventual publication of the two reports. She talked about "a period of double running" and said that she will be clear about the finance when that begins. Does she recognise that Transforming Your Care (TYC) failed because of the lack of budget? What assurances can she provide to the public, patients and health professionals that this report will not fail? Was the Minister surprised by the apparently limited detail in the 'Systems, not Structures' report?”
“Therefore, the Minister may shortly be required to take the unprecedented step of intervening to ensure that the patients and residents do not find those homes facing closure with all that entails for them personally and for their families. We do not want to see repeats of the scenes from last year. I am thinking particularly of Donaghcloney in my constituency. <BR /> <BR />Nursing staff deserve fair pay for the vital work they do. I support the royal college and all it is doing to ensure fairness. When we look at newly qualified nurses, we see that they must see a progression ahead of them, a clear stairway to career enhancement in their job. I support the motion and the amendment and urge the Minister to take action to support all our nursing staff.”
“I urge the Minister to instigate an investigation to assess the challenges facing our private nursing homes. Let me give you an example. Last week, my party was contacted by a local private nursing home owner. Her sheer frustration and distress were obvious. Recently, she lost her deputy home manager and four staff who were working 36 hours a week each. She lost a further staff member on 48 hours' notice, and several more all with significant contracted hours have handed in their notice. So many nursing staff leaving was no reflection on her ability as an employer; it is simply because staff are being enticed away from our local homes to work for agencies. <BR /> <BR />Our private nursing homes are spiralling towards a crisis. They are haemorrhaging staff, particularly to agencies.”
“The challenges facing our local nursing workforce are nothing new. Whilst we have heard much about piecemeal investments in local nursing services, the Minister and her officials know, as do the nurses on the ground, that a 6% increase over five years is insignificant in comparison with the far faster rate at which demand and indeed the scope of their role is growing. <BR /> <BR />As was mentioned by my colleague, the Department appears reluctant to tell us the number of nursing posts that are vacant. What we know is that, earlier this year, there were 850 vacancies across Northern Ireland. The number in my trust — the Southern Trust — increased from 19 to 226 in just two years. <BR /> <BR />While nurses are, of course, the public face of local hospitals, they have an equally important role in caring for people in private nursing homes.”
“I struggle to think of a health setting where nurses are not the first, middle and last point of contact for patients on their journey. It is absolutely essential, therefore, that they, as a workforce, are supported and properly planned for. In its document, 'A New Vision of Nursing and Midwifery', the Royal College of Nursing highlights that:”
“I apologise to my Upper Bann colleague for missing the earlier part of the debate. <BR /> <BR />As has been said, our nurses are the lifeline of the local health and social care service. Over the years, we have seen a sea change in what it is to be a nurse. Their role, input, scope and responsibilities have all changed dramatically. That change is saving lives. I say that as a mother who has relied on nurses to help care for my son. Like so many other families, I can name the nurses who cared for our loved ones. I want to use the opportunity to publicly thank Hazel, Rozzi, Kathryn and Alison, all of whom still play a part in my son Mark's life. They became an extension of our family, and I cannot speak highly enough about how they all went above and beyond the call of duty. <BR /> <BR />Nurses are by far the largest group of health staff.”
“I thank the Minister for his answer. I appreciate the circumstances, and I think that he is saying that the main sticking area seems to be with the utility providers. Will this delay mean any additional costs being associated with the eventual completion of the project?”
“As we know, there have long been calls for parity of esteem between physical and mental health services. That is something that I have fully supported, and the report simply adds to the appeals. What are the legal barriers to parity currently?”
“<BR /> <BR />I will leave my final word for the staff who are emotionally drained and demoralised. They are in no way to blame for the crisis. They are the very people who hold the system together. Collectively, they form the final line of defence against total collapse. <BR /> <BR />I take no pleasure whatsoever in speaking on this topic in the House. I commend the motion to the House in the hope that action will be taken to resolve this crisis.”
“I know that I am. Each case tugs at the heartstrings. <BR /> <BR />I have only skimmed over one of the problems facing the local health service. If I had much longer, I would not be able to cover the sheer scale of this unprecedented crisis. I am sure that many Members wish to speak. They will understandably each raise situations that affect their constituents. It is not the intent of the motion that the Minister takes any concerns that are raised as personal criticism; rather I ask her to acknowledge that in addition to those who, every day, receive the earth-shattering news that their fight against cancer has begun, the 225,000 outpatients, the 70,000 inpatients and the 100,000 people who are waiting for a diagnostic test deserve better than they are getting now.”
“We are dealing with matters of life and death, but the most frustrating thing is that we and the public across Northern Ireland are simply being asked to accept failed targets; accept that another 12 months have passed without improvements; and accept the regret of the current Minister of Health and the disappointment of the last. Words become hollow when actions do not follow. In the House today, we should be primarily focused not on lists, percentages and spreadsheets but on the humans behind the statistics; the young woman who faces delay with her breast cancer treatment or the grandmother who watches her children knowing that she may not be around to see them grow up. I am sure that every MLA in the House will come down with case after case of constituents who are all desperate and have been told that they must wait a lengthy time.”
“The fact that, as we stand here today, people are having their health compromised should be enough to shame the Department of Health and the Health and Social Care Board into action. The fact that these words were spoken in the Chamber 12 months ago and that the most recent figures show waiting targets being failed by the trusts is a matter of shame hanging over the Executive. <BR /> <BR />People who are living with cancer cannot afford to wait. Indeed, the Health and Social Care Board is on record stating that:”
“When are these actions going to turn back the tide of lengthening waiting times and reduce the pressure on key front-line staff who, along with patients, bear the brunt of ministerial and departmental dithering? <BR /> <BR />In her response, the Minister will no doubt explain that, next week in this House, she will publish the Executive's plan to reform the local health service, but when will we see the longer-term stable budgets that will allow health managers to effectively plan for future service delivery; longer-term budgets that will allow cancer consultants and specialists to know that support will be there for them and that short-term funding solutions, which lessen the problems only for them to return again, will become a thing of the past?”
“We heard the words "disappointed" from Minister Wells in 2015, "silence" from Minister Hamilton in last October's debate, and, last week, "shock" and "regret" from Minister O'Neill. When, after all those condemnations of the service that they lead, will they turn from words to action?”
“— try to use that increase in demand as some form of twisted justification for a subsequent reduction in performance. I appreciate that the trusts will take part in a workshop next week to look at longer-term solutions. However, workforce planning, led by the Department, is absolutely critical here. The right cancer specialist, in the right place, is what is needed to banish, or at least to lessen, the worry and concern that all families with a loved one waiting on a cancer result or treatment experience. More importantly, there needs to be a reduction in the period between initial discovery, diagnosis and treatment to improve outcomes. <BR /> <BR />Time and time again, the issue of cancer waiting times has been raised in the Chamber.”
“There certainly does not appear to be a balance. We know that in October there is an increase of around 40% in the number of women coming forward for a breast cancer check-up. That is to be welcomed. We cannot then feign surprise when there is a dramatic spike in diagnostic demand following those major awareness campaigns. Better patient safety and better cancer outcomes are exactly why money is targeted at the campaigns. However, what really galls me is when bodies, such as the Health and Social Care Board, sordidly —”
“<BR /> <BR />It is fitting that we are having this debate in Breast Cancer Awareness Month, when our fantastic charities, including Cancer Focus, Macmillan and Action Cancer, put their shoulder to the wheel across Northern Ireland to fundraise and to raise awareness of early diagnosis. There are far too many charities and charity heroes to name here today, but you all know who you are and the life-saving work that you are doing in October and throughout the year. <BR /> <BR />However, their efforts are not being matched by Government when it comes to diagnosis and treatment. For instance, I ask the Minister whether she is content that an integrated plan is in place to balance expectations raised by the public health campaigns and the need for people to be seen by the right person at the right time.”
“We all know that cancer tears the heart out of families and shows no mercy whatsoever. While I can speak from the perspective of losing my grandmother at the age of 41 and my best friend in January, who was only 48, I know that some Members can speak from personal experience. Cancer touches too many lives — far too many lives. <BR /> <BR />I want to put on record my appreciation for the work of Professor Mark Lawler and others in pioneering research. I had the privilege of viewing their work first-hand over the summer. Whilst we have expert nurses, consultants and cancer specialists, they are being placed under mounting pressure.”
“<BR /> <BR />I remember well, as I stood in the Chamber to move my private Member's Bill, the Human Transplantation Bill, being told not to bring emotion into the Chamber. I remember well the cries that went up, "We cannot bring legislation based on emotion". That is what is wrong with the Assembly: there is not enough emotion; there is not enough care for those whom we are elected to represent. Given the very real pain being forced on our constituents because of decisions taken or, perhaps, most importantly, not taken by Ministers, from whatever party, it is right that we, as elected representatives of the people, bring their emotion into the Chamber. I make no apologies for standing up for the mother who waits week on week, month on month, for scan results or for the grandmother spending months waiting on surgery.”
“A single vacancy or absence due to sickness quickly snowballs into intolerable situations, such as that experienced in the Southern Trust, where only 15 of the 224 people were seen within the red-flag period in June. Of course, when one trust recruits a new key staff member, the problem often transfers to the trust that he or she has just come from. The issue of displacement is one that I feel has not been properly investigated by the trusts and the board. I urge the Minister to look into that point. <BR /> <BR />Something as simple as ensuring that each trust has an effective succession plan for key posts could prevent many of these delays developing in the first place. Until such fundamental measures are taken, the system will remain crippled and broken due to its lack of resilience.”
“In comparison, 22% of patients were diagnosed at stage 1 and had a much higher one-year survival rate of 95%. For breast cancer specifically, Cancer Research UK states that around 99% of women will survive for five or more years after diagnosis if diagnosed at stage 1, compared to just 15% at stage 4. It is all fine and well to talk about statistics, but, as I have indicated, delays mean the difference between life and death. <BR /> <BR />Yes, the delays for breast cancer patients in June in the Southern Trust were particularly awful, but they were by no means the only problem. The Northern and Belfast Trusts have also experienced frankly appalling cancer performances. The problem there, like the problem in the Southern Trust, primarily came down to personnel rather than capacity.”
“We know that that number is 121 in the Belfast Trust for last year, but the Minister has so far refused to answer as to the situation in the Southern Trust. <BR /> <BR />Of course, as the motion suggests, the reason that targets exist is because any delay can lead to a reduced outcome. Failure to diagnose cancers at an early stage can mean much harsher treatment is needed. It can make the consequences of treatment that much more difficult, and it can severely impact the chances of someone recovering and living well when their treatment ends. That is especially the case for cancer, a truly wicked disease that thrives in a vacuum of delay. <BR /> <BR />The recent Northern Ireland statistics show that, between 2010 and 2014, 18% of cancer patients were diagnosed at stage 4 and had a one-year survival rate of just 33%.”
“<BR /> <BR />One year on from our motion that called on the Health Minister to ensure that cancer services are adequately organised, funded and resourced, we received the most recent figures from the Minister, which show regression rather than progression. That performance in relation to breast cancer waiting times has been described by the Minister herself as "shocking", and she has expressed her regret at those figures. That was two weeks ago in the House, when a question for urgent oral answer highlighted that, in June of this year, only 6·7% of breast cancer patients in the Southern Health and Social Care Trust were seen within 14 days. Later today, in Question Time, we will likely hear the number of women who were not seen within the target of 14 days and who then were tragically given a breast cancer diagnosis.”
“The people with suspected or diagnosed cancer, whose lives are entirely in the hands of our health service, are often genuinely terrified about what the future holds for them. They simply will not care about what MLA from which party said what. These are men and women, young and old, who are going to be given a diagnosis that will rock them and their loved ones to their very core. They will experience a sense of fear that they never knew they could. This debate should be held in a manner that we would be comfortable with any one of those people sitting in the Public Gallery above us watching and observing.”
“My party warned at the time that the trusts were not given enough time to use the money on waiting lists and, sadly, that appears to have come true. That is an absolute disgrace, and all those responsible for raising patients' expectations only for them to be later dashed should be ashamed of how they played politics with our health service.”
“<BR /> <BR />Last November, much was made of the additional £40 million that was secured in the monitoring rounds to specifically tackle waiting times; indeed, the then Minister, Simon Hamilton, claimed that it would allow an extra 10,000 to 15,000 operations and treatments to be progressed. It is with absolute exasperation, however, that the Ulster Unionist Party has now learned that £18·5 million of that £40 million was not spent on waiting lists and instead was redirected to plug the gap on other pressures in the health service.”
“I welcome the opportunity to move the motion in the Chamber today. I also welcome the fact that the Minister is here to respond. When I moved a motion on cancer waiting times last October, no Minister was available to respond. It was at the time of the in/out Ministers. Now that the Executive have found a newly forged unity and we, alongside the SDLP, have formed the official Opposition, it is wholly right that we raise in the House the issue of cancer waiting times, their impact on all our people and the actions taken to address the waiting times crisis.”
“Minister, I really hope that you listen to today's debate. You have said that domestic violence is your key priority. I hope that you will detail the exact steps that you will take to deliver improvements for the victims of this appalling crime.”
“Unfortunately, however, as we have heard time and time again in this debate, the current rudimentary response is not working, and too many cases simply end up without punishment. One of the first places to begin to try to lessen the chances that a report could be withdrawn the next day is the immediate response after that report. I doubt that many things are more gut-wrenching than a victim leaving a violent partner, often breaking up the family unit, only to see the accused get off scot-free. It must be absolutely terrifying for them.”
“So, I ask the Minister if she is satisfied that all the required support mechanisms are in place to support these young people. <BR /> <BR />Domestic violence is not some sort of faceless crime where someone unknown can come and go. It is often a warped battle between feelings of love and absolute betrayal, but that does not mean that the justice system should not respond; it must, and it must plan a response for each individual case.”
“I thank the Member for his intervention. Having spoken to constituents, I know that keeping their children safe is key and is a priority. Even in spite of the violence, as we know, many may still be bound to their partners by strong feelings of loyalty and even love. So, even more challenging are the circumstances where the abuser is the parent of their children. <BR /> <BR />Victims are torn as to what to do about the abuse or, understandably, may be keen to maintain the family unit and may see that as a more important consideration than their own welfare or even their own safety. The effects of growing up in the midst of domestic violence can be devastating for children. The feeling of fear and confusion that those poor children experience when they see abuse must be awful, never mind when the abuse comes from their parents.”
“It is a question that, I know, Members in this House have pondered, but I believe that it is too simplistic a question for what is often an incredibly complicated situation. We need to remember that tackling this form of abuse, whether it is physical or mental, is incredibly difficult because the aggressor is in or has been in a long-term relationship or marriage with their victim.”
“The nature of the abuse means that it often recurs, sometimes for many years. So, it has a particularly cruel effect on victims. <BR /> <BR />I remember chairing a session of the Commonwealth Women Parliamentarians on domestic violence. An older lady presented to us with her personal domestic abuse experience, and she told us in graphic detail how her induction to married life was at the end of her husband's fist and how it took her 20 years to escape his grasp. The sad message of her presentation was that, from either gender, this is an all too common experience. <BR /> <BR />I am sure that there are people, particularly those with no experience of abuse, who ask the question, "Why would anyone stay?".”
“Before I start my contribution, I ask Members to keep the two young girls who were knocked down in Banbridge this afternoon in their thoughts and prayers. <BR /> <BR />It is a tragedy that domestic violence and sexual crime is one of the most common yet least reported crimes in Northern Ireland. Of course, we are not unique in that respect, but, nonetheless, the fact that there are women and men today suffering violence at such endemic rates is absolutely heart-rending. I know from talking to PSNI officers how the initial bravery of the all too rare reporting of an incident can often dissolve, with many reports withdrawn soon after, compounding the misery and pain. <BR /> <BR />Domestic violence can manifest itself in many ways, but, most often, it is in the form of verbal or emotional abuse, with direct or implied threat of violence.”
“Will the Minister acknowledge that the true extent of the damage caused by last year's flawed re-rating process may never be known? Given the extent of the errors made, as evidenced through the number of appeals, what guarantees will the Minister give small businesses that a situation like that will be avoided in the future?”
“I thank the Minister for his comprehensive answer. Given that, without those courses, many, as he said, would be unlikely to enrol on campus-based education courses, does the Minister appreciate the stepping-stone effect that community education can give to further study? What help is he providing colleges with to measure the impact of community courses and better target provision for rural areas?”
“Minister, you will be aware that I wrote to you in August on behalf of the Banbridge employees, many with over 20 years' service to the company, who were concerned about their future and that of their families. Does the Minister share my condemnation of a company from the Republic of Ireland purchasing the creamery to great fanfare in May only to close it in September? What steps will he take to avoid future piracy in the dairy industry?”
“Skills learned in childhood last a lifetime, and the pace of life seems to increase year on year, with quick-fix solutions often meaning that healthy lifestyle choices are given less thought than they should be. The choices made have a long-term consequence for families and, indeed, for the health service. Health choices have less prominence in the child's life and therefore less impact on them physically and mentally. On the flip side, promoting healthier living will have long-term positive benefits for families. <BR /> <BR />I thank the Members who tabled the motion and encourage the Finance Minister to support the concept of an approach to promoting healthier lifestyles amongst our children. That approach should include government, the private sector and the voluntary sector.”
“Promoting healthier lifestyles amongst our children is not a stand-alone job for the Education Minister or the Health Minister. If we are to achieve the best results, there must be a combined effort across government with input from the private and voluntary sectors.”
“It is an inspirational new book and online tool that connects children of all ages with the concepts of food growing, food heritage, the importance of buying local produce and how to cook it from scratch. It is precisely the sort of initiative that we should encourage for our children and young people. I thank the MLAs who attended and supported Jilly at her launch. The breadth of attendance at that event gives a flavour of the organisations whose input is crucial when it comes to encouraging healthier choices amongst children: the Public Health Agency, the Food Standards Agency, the Belfast Food Network, Northern Ireland Environment Link, the Department of Justice, Eco-Schools, the Education for Sustainable Development Forum, the Health and Social Care Board and the Ulster Farmers' Union were there, to name but a few.”
“I thank the Member for his intervention. Early intervention is key right across, as you state. <BR /> <BR />If the Executive get it right on the health of our young people, that will deliver countless benefits and reduce the pressure, as I said. I pay tribute to the excellent staff who work in our health service every day. <BR /> <BR />I have heard it said many times that your health is your wealth, but I would extend that description: our people's health is Northern Ireland's wealth. There is a clear and direct link between healthy eating, healthy living and a healthy economy. <BR /> <BR />Last week, I had the honour of hosting writer, cook and friend, Jilly Dougan, as she launched her new initiative, 'Sow, Grow, Munch', in the Long Gallery.”
“Not only does a healthy lifestyle bring short-term benefits to the health of our young people, but it delivers skills, knowledge and practice that will live on through generations of our people. If the Executive get it right when it comes to the health of our young people, that will deliver not only countless benefits to families and public health but financial savings by reducing pressure on an already over-pressurised health service and the excellent staff —”
“Setting aside his concerns during the Final Stage of the Health (Miscellaneous Provisions) Bill that it is a regressive tax, he is right that the revenue made available as a result of the tax should be utilised to increase public health, and where better to start than with our children? <BR /> <BR />I agree entirely that funding should be set aside for this purpose, because instilling healthy lifestyle choices in our young people will result in short- and long-term health benefits. We know that eating a balanced diet, taking regular exercise and maintaining a healthy weight can add years to your life and reduce the risk of certain diseases, including cancer, diabetes, cardiovascular disease, obesity — the list goes on and on.”
“I welcome the opportunity to speak on the motion and commend its signatories for bringing it to the House. In March, the then Health Minister, Simon Hamilton, expressed this concern:”
“Does the Minister agree with me that a key tool to ending scenes of people sleeping rough on the streets of Northern Ireland would be to place a statutory duty to prevent homelessness on public services such as the NHS? Will she consider that?”
“These waiting times are symptomatic of the human tragedy engulfing the entire Northern Ireland health service. Such shocking performances would see heads roll in other regions, yet again we have a Minister who refuses to take any responsibility. I pay tribute to the amazing staff — the doctors and nurses who are working day in, day out. Will the Minister detail how many of the 215 out of 224 suspected breast cancer patients in the Southern Trust who were not seen within the target of 14 days were subsequently given a breast cancer diagnosis?”
“We have had the debate, the conclusions and the working groups, so I look forward to the Minister's contribution and, I hope, assurances that action will follow. I once again commend those who tabled the motion for raising the issue in the House, and I truly hope that a patient-led approach will follow.”
“One trust suggested that this would require ground structures, people and information to allow management of chronic epilepsy in the community, with timely and relevant support from specialist staff in hospitals. It also focuses on the need for a clear pathway of referral from primary to secondary care and, crucially, a Northern Ireland-wide database to maintain records for people with epilepsy. However, a database cannot stand alone; it should be the start of measuring what is currently not being managed as efficiently and effectively as it could be. <BR /> <BR />In conclusion, we had a debate in the Chamber in 2013 and an important report by the all-party group in 2014. Action must therefore follow.”