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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“It has even taken the breath away of health experts in other parts of the British Isles. <BR /> <BR />Whilst I am not asking the new Minister to comment on this — it would not be fair to do so as it was before her time — it is worth remembering the words of Nigel Edwards, the chief executive of the Nuffield Trust, towards the end of last year. He said that heads would roll in England if hospital waiting list figures were on the same scale as those in Northern Ireland. This is not a blip, and it is not a minor issue; it is the single biggest issue that the Assembly is facing. <BR /> <BR />So I was pleased yesterday morning to learn that the Minister decided to make a last-minute statement on the issue — whether that was related to the timing of today's motion is immaterial — but I was disappointed by the tame tone of it.”
“That is over 20% — over one in five — of our population. Whilst I welcome the slight decrease in the sheer numbers of people waiting over the maximum permitted times over recent months, the improvements were made only following last-minute funding allocations not through any degree of political leadership or anyone taking control of the wider causes. <BR /> <BR />On that point, I ask the Minister again specifically about the status of the £30 million announced by Simon Hamilton on 6 March. Whilst the Executive had agreed to allocate £40 million, virtually no record exists of the subsequent allocation. Can the Minister confirm that that money was received and that it is being spent? Nevertheless, the overall crisis is unprecedented; it is far worse than any since the restoration of devolution over 15 years ago.”
“Whilst I am glad we are debating health matters so early in the new Assembly mandate, I take no comfort from the subject matter. Given its seriousness, this is the second time within nine months that I have brought forward a motion on this issue. Just like the debate my party led last September, the overall intention of today's is not to make party political points nor is it to apportion blame. Instead, it is to reiterate to the new Minister, who I wish well with what is undoubtedly the hardest job in the Executive, the sheer scale of the crisis affecting our local patients. <BR /> <BR />No one in the Assembly will disagree that there is a crisis engulfing our local health service. The most obvious sign of that is, as the motion states, the fact that over 376,000 people were waiting, as of the last official publication of waiting times.”
“— and do what is right for Northern Ireland.”
“The paper has been positively welcomed by experts, and I will send a copy to the new Health Minister for consideration with this indicator in the PFG. <BR /> <BR />In conclusion, I encourage the Executive parties, when they eventually consider the targets they will set for themselves, to challenge and not merely agree with the Civil Service and to set reasonable, tangible targets. I encourage them to not just accept the low hurdles but to seek to drive forward real, lasting and important changes for our people. That is not an easy task with a Civil Service that, two decades on, is still struggling with the post-devolution era. I trust that the Executive will do what is right for Northern Ireland. We on the opposition Benches will constructively criticise where necessary —”
“<BR /> <BR />Finally, turning to indicator six, "Improve mental health", there is an ever-increasing body of evidence proving that our poor rates of mental health are directly related to our previous levels of violence. It is a legacy issue, with not only victims being affected but the children and grandchildren of victims. We cannot ignore the staggering fact that more people have lost their life through suicide since the Belfast Agreement than died during the entire Troubles. This is a core issue for the Ulster Unionist Party, and it is why, in February, we published a detailed policy paper dedicated to the issue containing 15 specific points, including ideas like a mental health champion, greater focus on prevention and tackling signals earlier and tackling the stigma sometimes associated with poor mental health.”
“There could be little surprise that following the success of the cancer patient experience survey in England and Wales, the PHA and McMillan Cancer Support here funded a similar survey for Northern Ireland. The 2015 Northern Ireland Cancer Patient Experience Survey covered around 5,000 adult cancer patients in Northern Ireland with the primary diagnosis of cancer who had been inpatients or day-care patients and were receiving active treatment between 1 December 2013 and 31 May 2014. This is just one example of why indicator five, "Improve the quality of the healthcare experience", is crucial. However, it is essential that the trusts, when listening to patients, are open and responsive to the concerns that will inevitably be aired.”
“<BR /> <BR />We delivered the creation of the Public Health Agency despite opposition from the DUP at the time, and we will firmly oppose any measure to dissolve it, especially now after the deeply flawed and poorly handled announcement on the abolition of the Health and Social Care Board. I would certainly like to see a commitment from the First Minister and deputy First Minister for the PHA to continue for the next six years. <BR /> <BR />When we look at indicator four, "Reduce preventable deaths", we see that there needs to be a commitment to target each of the five big causes of early death: cancer, stroke and heart, respiratory and liver disease. We also need to look at our ratio of intensive care beds.”
“Why is there no indicator on committing to continually review services to ensure that they are able to adapt to an ageing population? When it comes to reducing health inequality, we cannot forget that people who come from socially disadvantaged backgrounds are much more likely to die from heart disease and respiratory disease. Far too many of those deaths occur before the age of 65, and most are entirely preventable with only a few lifestyle changes. Smoking, an unhealthy diet, excessive alcohol consumption and little physical activity all greatly contribute to this inequality.”
“Overall, in 2015-16, 99% were seen on time in the Western Health Trust, yet only 66% were seen in the South Eastern Trust and an appalling 43% in the Belfast Trust. In addition, rather than including bland indicators, such as increasing respect for each other, maybe the Executive should place a duty on its Ministers to respect their staff. Maybe then, scenes such as the Royal College of Nursing and the Royal College of Midwives threatening to take industrial action, partially as a result of sheer anger at the attitude of the then Health Minister, Simon Hamilton, could have been avoided.”
“<BR /> <BR />Our second key priority would be to remove the abhorrent variances in the quality of care provided across the five health trusts. Take the target that 100% of patients with suspected breast cancer be seen within 14 days.”
“Targets, despite what some officials in the Department and trusts might say, remain important as a means of monitoring and judging health performance. From the outset, I urge the Executive to avoid being taken down the path of believing that somehow health targets are a burden or are in any way unnecessary. <BR /> <BR />There are 42 indicators in the current draft PFG framework document, and only six relate to health. I want to make some brief comments on some of them shortly. Whilst no one could disagree with any of the six, what is more noticeable is what is not included. At a time when 376,382 people are waiting for a first outpatient appointment, diagnostic test or inpatient treatment, surely the most pressing target for the Department and the Executive collectively is to deliver timely and safe treatments for patients.”
“I welcome the opportunity to speak on the Executive's draft Programme for Government framework. I do so from a health perspective. Is it a draft framework or a vague wish list to buy some time for officials to draft yet another document that will probably only be ignored anyway? It makes me wonder what all the meetings in the six months leading up to the election were really all about. The fact that the last Assembly existed without a Programme for Government for 2015-16 demonstrated exactly how little regard the document is actually given. <BR /> <BR />The amateurish and unprofessional measures accompanying the health indicators will give people very little confidence. It would have been better to leave them out, rather than rush them in before it went to the printers.”
“I thank the Health Minister for her statement. We have called for this issue to be the Executive's number one priority and I am pleased that you are addressing it in your first statement. It is also timely, given our party motion tomorrow on this issue. I note the Minister's wish, on the bottom of page two of her statement, to attain stable finances and sustainable services. Does she agree that funding the health service through short-term monitoring rounds must become a thing of the past, and will she provide an update on the additional £30 million announced by her predecessor on 6 March? I note that that is not mentioned in the statement.”
“Even today. You have been a true friend to me, and I thank you for that.”
“I thank the Member for his continued support and loyalty. I, for one, will miss him greatly. When I joined the Health Committee, Kieran, you were an inspiration and a support, and you remained steadfast and committed throughout. I also had the honour of working with you on the Agriculture Committee and on mental capacity. I will never look at Kircubbin again without thinking of you and all those references you made.”
“I hope that the future Health Minister, whoever he or she may be, will ensure a consistent focus on increasing life-saving transplants and, indeed, will listen to the organ donation family, those who are closest to one of the most emotional issues that we can debate in the Chamber. <BR /> <BR />It gives me great pleasure to welcome the Bill and its passage today. The important outworkings for us all will come when the ink is dry.”
“I again urge that their involvement be central to any public awareness campaign to ensure that their considerable expertise and knowledge is utilised to the full. <BR /> <BR />Organ donation and transplantation affects so many families across Northern Ireland. Those of us in that organ donation family remain firmly committed to ensuring the promotion of and increase in life-saving transplants. The House is more than aware of the considerable public support for change that has been consistently identified. I again say that I do not wish this can to be kicked down the road, and, like my esteemed colleague Mr McCarthy, I, too, will be watching.”
“Whilst e-cigarettes are leading to people coming off the traditional tobacco cigarette, insufficient research exists on their long-term health effects. The Assembly may need to revisit that in the next mandate. <BR /> <BR />The ban on smoking in cars carrying young people is another positive aspect of the Bill. Smoking causes harm not only to the individual but to those around them, particularly children, whose lungs are still developing. The toxic cocktail of chemicals that quickly builds up in cars should hopefully now occur even less. <BR /> <BR />I am hopeful that the human transplantation and organ donation aspect of the Bill will ensure that the passionate volunteers and charities who have promoted organ donation across Northern Ireland for many decades will no longer do so alone.”
“I am pleased that the Bill has reached this stage. The Assembly has a relatively good record in adopting policies designed to assist people to give up smoking and to stop others taking up the habit in the first place. We need to remember just how damaging it is to a person's health. Every time a smoker has a cigarette, they inhale over 4,000 chemicals. For as long as it remains the greatest cause of preventable death and disease in Northern Ireland, the Assembly must continue to take a hands-on attitude to tackling smoking. Crucially, that includes preventing young people becoming addicted in the first place, and, therefore, I am pleased that today's Bill prohibits the sale of nicotine products to under-18s and from vending machines.”
“I am also very happy that this Bill has reached its conclusion. It is a practical piece of legislation, and I am very pleased that the Social Care Council will now have greater powers to recognise the achievements of its workers. The only further point that I will make today is one I have made several times before: I urge the Department, and the NISCC in particular, to work very closely and carefully with the sector to ensure that undue pressure is not placed on employees.”
“The outcome of that engagement was very clear to see through the significant number of amendments that were made to the Bill over recent weeks. For once, Northern Ireland is taking the lead not only locally but, in the case of this Bill, internationally. So many years after it was first proposed under Bamford, we can be rightly proud of it.”
“That is why I am so grateful to all the mental health organisations that so generously fed into the scrutiny of the Bill. I know that all members of the Committee are grateful for that important feedback and contribution.”
“Over recent weeks, amongst the rush of legislation being steamrolled through the Assembly, it could have been possible to overlook just how important and groundbreaking this Bill is. It will introduce a single statutory framework governing all situations where a decision needs to be made in relation to care, treatment or personal welfare. The Bill represents the biggest reform of law about decision-making in many years, and, certainly, it is the first time that the Assembly has so fundamentally reformed such a complex area of law. <BR /> <BR />When we, as legislators, set new mechanisms to assist people who lack capacity to make decisions for themselves, we obviously need to show great caution. Throughout my time on the Ad Hoc Committee, I was very conscious of that.”
“<BR /> <BR />Let us not fool ourselves: if Europe was not likely to come in and slap a major infraction penalty on us, even that single issue would not be before us in the Chamber today. Of course, as I have said before, that would not have been the first time that DARD's ineptitude has brought infraction fines to the door of the Executive. The fact that the Department belatedly realised the importance of the clause is some comfort at least, and it may, at long last, have started to learn from its mistakes.”
“How do you follow that? I imagine that most Ministers would be slightly embarrassed to have presided over a Bill like this. Having gone from what was, only weeks ago, a 19-clause Bill about ensuring protection for our marine and inland aquatic environments, in the end, we have been left with today's sorry state of affairs. Given all the time and energy that went into consulting on the original proposals in the Bill, it was only through sheer incompetence that the Department waited until the very last moment to introduce a Bill. Even then, the majority of proposals in it came far too late. Therefore, we have been left with just a single clause that deals with the enforcement of EU rules.”
“I thank the Minister for his answer. He will be aware that I have raised the issue with him on a number of occasions, yet those affected are still waiting. I appreciate that the issue affects staff in other Departments. Can he outline, however, what actions he has taken on behalf of those staff in his Department who still contact all of us on the issue?”
“Despite the fact that, bizarrely, the DUP and Sinn Féin worked together to block many of our practical amendments, it is better to have a weak Bill than no Bill at all. I hope that the next Minister will revisit that issue.”
“I am pleased to speak on the Final Stage of this Bill. As I have repeatedly said throughout its passage, the rural White Paper action plan that preceded it left much to be desired. Whilst I am glad that there will be a statutory duty on public authorities to take rural needs into account when developing and implementing government policies and delivering public services, I am still somewhat disappointed with the limited scope of the Bill. In a way, this Bill represents yet another missed opportunity. We only have to look at other parts of the United Kingdom, where there are significantly more protections in place for rural communities. For instance, I tried to place in the Bill a presumption against rural school closures, as exists in Scotland and England, but, given the limited scope of the Bill, it was not possible.”
“It is an international first; therefore, it is essential that we use the amending stages to ensure we get it right.”
“The Minister referred at the last stage to an investigation by DFP and to how the more prudent course of action would be to let that work conclude before the Chamber took a vote on such a matter of importance. Clearly, the Minister believes that the ensuing two to three weeks has been a sufficient time. <BR /> <BR />Nevertheless, I am glad that the Assembly was able to handle the Bill in the manner than it did. It has been a long time in the making, and I know from my time on the Ad Hoc Committee that there is no doubt that what we have before us is a hugely complex piece of legislation. It was, therefore, predictable that the Department would table a significant number of amendments to it. <BR /> <BR />The Assembly should be proud of the Bill and of the new framework it will introduce.”
“I support the amendments in the group, although I was surprised to see amendment No 4, which will lower the age of lasting power of attorney to 16, not least because of the previous tabling of a petition of concern and what the Minister said about the equivalent amendment that was tabled at Consideration Stage. I will quote, if I may:”
“I, for one, would find that to be a betrayal of the considerable public will for change clearly identified by the Public Health Agency's surveys. <BR /> <BR />Once again, I challenge the Health Minister to ensure that organ donation is given prominent billing in the next Programme for Government discussions. I am content to support the amendments proposed by the Minister and Department, but I am mindful that we should all remember the brutal reality: that despite many years of trying, and public support for organ donation standing at around 90%, the number of local people signing up to the organ donor register has not risen above around 35%.”
“<BR /> <BR />In relation to public awareness, I would welcome the Health Minister's assurances that the local charities in the transplant forum, which have done the heavy lifting in promoting organ donation for decades, will be involved in the awareness campaigns to ensure that their considerable expertise and knowledge is utilised to the full. I do not, however, wish the Health Department to kick the can down the road by stating that, once the Bill is passed, we must wait for the legislative outworkings to become clear before we can ever look at adopting a soft opt-out system in the future; in other words, Members, that we should adopt a wait-and-see approach — only to find that the Welsh system is delivering results and saving lives — and then decide for ourselves that it would be a good idea to explore a similar system in the future.”
“I welcome the opportunity to speak on the third group of amendments on human transplantation and organ donation. The amendments proposed, Nos 8 through to 14, are largely technical, and I am content to support them. It will come as little surprise to Members that I am prepared to accept my own wording in relation to organ donation, which is a direct lift from my private Member's Bill, the Human Transplantation Bill. <BR />As I said during Consideration Stage last month, I support the amendments in this Bill, but I reiterate that public awareness is just one part of a soft opt-out system.”
“In addition, I hope that the study will report on any findings from other countries where the levy is operating. That will be very important, because much of the global debate is now concentrating not only on the possible health benefits but on what some people see as a disproportionate or unfair impact on poorer families. Under the two years proposed in amendment No 5, the Department will have no excuse not to give this issue the full depth of consideration that it deserves.”
“The Minister and his officials have quite clearly decided that a public consultation on sugar-sweetened drinks is not necessary. I think that that is quite disappointing. However, given how little value many Departments, not least Health, now give to consultations, the outcome will be little changed. At this stage, rather than only having a consultation for consultation's sake, I will give the Department the benefit of the doubt with this study exercise. It is my hope that this report, aside from being expert-led and ambitious in its thinking, will still very much test public opinion on the introduction of a levy. In addition, I hope that the study, not least because of clause 8(2)(f) in the Bill, will produce a researched set of recommendations on how it is envisaged that any revenue raised be spent.”
“As Ulster Unionist Party health spokesperson, I am happy to support the amendments in this group. The fact, however, that the Department has had to bring the amendments forward today is further proof of why a ban on smoking in cars carrying passengers under 18 should have been in the Bill at its introduction. Instead, it was left up to Members to bring the issue forward through amendments, despite cross-party support and general support in the Department. I am still not really sure why such an approach was adopted; nevertheless, we are where we are, and today's amendments should further strengthen the prohibition.”
“Does the Minister recognise the frustration in the community when announcements about new capital projects are made, but years pass with nothing happening on the ground? What does he believe is the root cause of that?”
“If those implications are that they need to ensure that they have met their statutory requirements under the Bill in a timely manner, I do not see why that is a negative thing. We need to remember that the public authorities in the Bill are not insignificant in size or scale. Bodies such as the Education Authority and the PSNI have bigger budgets and far greater staffing levels than DARD, so they should be in a position to adapt to it in a timely manner. It is up to the Minister, in her winding-up remarks, to make the case for an extension; if she does not, it is up to the parties to decide whether they are content for DARD to avoidably drag its feet for yet a further year.”
“Some people will look at today's Bill and think that it was a missed opportunity for the Department to really enshrine protections for our rural communities. It remains unhelpful that, for whatever reason, the DUP and Sinn Féin thought it necessary to block many of our previous amendments, which would have strengthened the Bill, including requiring mandatory training for key DARD staff and placing a legal duty on the Department to make sure that public bodies cooperated. That has dumbfounded most impartial observers and, I know from reading emails that I have received, many people working in rural support bodies. Nevertheless, I still have not heard any good reason today why the Department thinks that it is unable to implement the Bill within 15 months. <BR /> <BR />I quote directly from the Minister at the previous stage:”
“I welcome the opportunity to speak at this stage of the Rural Needs Bill. We support amendment Nos 1 to 6; however, we will oppose amendment No 7. <BR /> <BR />We must remember the Bill's origins. The rural White Paper action plan was approved by the Executive in May 2012 and formally launched by the Minister of Agriculture and Rural Development in June 2012. That is over four years ago. It is five years from the date of commencement currently in the Bill and six years if today's amendment is made. Six years? That should be enough for people to judge the sheer inefficiency of the entire process. <BR /> <BR />That plan, which was long awaited, was notable not just for what it included but for how much it lacked any strategic vision and measurable outcomes.”
“When will the Minister provide the detail of the list of eligible items that farmers can apply for under the farm business improvement scheme so that they can begin to prepare for expenditure for later this year?”
“I thank the Minister for his answer. I have many elderly constituents who continue to struggle with letter after letter from the Housing Executive, which, despite recent changes, continue to be complex and confusing. That often leads elderly tenants into arrears through absolutely no fault of their own. What assurances can the Minister give that those letters will eventually be provided in plain English to help those who simply wish to live in their home and pay the correct amount each month?”
“I, therefore, support the removal of all the other clauses, if only to ensure that the taxpayer is not left footing the bill of further incompetence from the heart of this Executive.”
“Of course, this is not the first time that DARD's inaction, incompetence or mismanagement — whatever the reality may be — has brought infraction fines to the door of the Executive. Indeed, the Department is still to tell us what recent communication it has had with Europe on that issue. <BR /> <BR />I am aware that the Commission was made aware in January 2015 that DARD was in the process of bringing forward legislation. However, I wonder whether the subsequent 12-month delay was noticed and whether that is why the Bill, or even just clause 6, could not wait until the start of the next Assembly mandate. Nevertheless, we are where we are, and the Department and Minister clearly think that this clause cannot wait.”
“<BR /> <BR />I know that the industry expressed a certain degree of concern about the gap between the consultation and the later progress of the Bill, so perhaps the Minister could explain DARD's reason for that gap. It is regrettable that the Department, with all its personnel and expertise, was unable to bring it forward any sooner. Instead, it waited until the very last opportunity, and that resulted in today's raft of joint opposition to clauses from the Minister and the Committee, which is effectively gutting the original Bill. <BR /> <BR />Whilst the legislation also sought to ensure adequate protection for our marine and inland aquatic environments, its main priority was, in fact, an apparent last-minute panic to ensure that we meet our European Union obligations and, therefore, avoid the risk of further major infractions.”
“I welcome this stage of the Fisheries Bill. After this morning, the Bill will be significantly smaller than that which was first proposed. Whilst I understand the reasons, I am disappointed that the Minister and her officials effectively forced the Committee into adopting this position by giving us so little time for proper scrutiny. It was not the case that the Department was hamstrung by delays with the consultation. Indeed, there was a full year between the end of the consultation in 2014 and the Bill's eventual introduction in the Assembly. In fact, I have still not really heard an explanation for that delay from the Department.”
“I thank the Minister for giving way. Just for clarity, as you know, Minister, I met your senior officials on three occasions about departmental amendments. Why, despite repeated requests from the Committee Chair and me, did you not bring forward those amendments?”
“<BR /> <BR />Whilst I accept that good work is being done and that the amendments may go some way to help, the brutal reality is that, despite many years of trying and public support for organ donation standing consistently at around 90%, the number of local people signing up to the organ donor register has not risen beyond around 35%.”