Fearghal McKinney
South Belfast · Social Democratic and Labour Party · Northern Ireland
“We need to do everything we can to bring investment and job opportunities. A prosperity strategy should also include a massive programme of workforce training and skills enhancement.”
“In particular, we want the Programme for Government to adopt a much more joined-up style of government that delivers much greater accountability and transparency and will itself say that it wants Northern Ireland to work.”
“<BR /> <BR />We can point to collective achievements — local government reform among them — but just months ago the echoes of our past threatened our political future, reinforcing the challenges to our delicate political system that the Good Friday Agreement could never have foreseen.”
“Creating much better social cohesion and integration must be another Programme for Government requirement. <BR /> <BR />Health reform, job creation, better infrastructure, creating world-class education and tackling social deprivation are issues on which the SDLP is not prepared to compromise.”
“There are many big challenges facing Northern Ireland, perhaps the biggest of which is to get people into work. It is our job to create the infrastructural and educational opportunities and to maximise those opportunities.”
“It is our job to ensure that our people can and should dare to dream that life can be better; that our children will not be forced to leave these shores for the promise of work in Australia or America because of a failing economy — I referenced the Joseph Rowntree Foundation's latest research; that our health service provides a service th…”
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“He goes on to say, and I think it is worth reading these issues into the record, that commissioning is underpowered and, effectively, not working. We will vote for money for the health service today, but unless there is some sort of radical change in the system, we will not be spending money wisely; we will not be spending money well; and we will not be spending money consistent with patient need. I want to conclude on Mr Donaldson's report on the issue. I think the health system here should be embarrassed that this point could ever be asked or raised as an issue in a report by someone as eminent as Sir Liam Donaldson. The report asks, "Who runs the health and social care system in Northern Ireland?"”
“He also said that the review team heard TYC referred to as "Transferring Your Care", "Postponing Your Care" and even "Taking Your Chances". His report states:”
“<BR /> <BR />I reiterate, once again, that the invest-to-save plan of reform at the heart of the health-care system, Transforming Your Care, has not, by any stretch of the imagination, been properly funded. There has been a lack of shift left in expenditure into the community. That has resulted in very little meaningful outcome. I have been saying that, the SDLP has been saying that and it is becoming increasingly clear that more people are beginning to accept that narrative, none more so than Liam Donaldson, who conducted his most recent review into the health and social care system here. He said that the work of TYC is not properly planned or funded and that it has led GPs to take matters into their own hands by way of GP federations.”
“I will deal with some of the patient flow issues later. <BR /> <BR />In the past few months, we have also seen further evidence of consistent breaches of performance targets in A&E with regard to four and 12-hour waiting times. We have the worst record in all of the UK for meeting four-hour targets. We have seen the direct consequences of that with the curtailment of elective care provision, which still has to play itself out, which has caused delays in surgery and treatment and, in turn, left many patients needlessly suffering. We cannot continue to ignore the issues involving our accident and emergency provision that have surfaced during the past number of years. They are all too commonplace in a health and social care system that is buckling at its knees.”
“I welcome the opportunity to contribute to today's debate. I will focus on health, social services and public safety. As the Minister and all of us are aware, there are genuine and many pressures on the health service. Throughout the past number of months, I have expressed the SDLP's concern about the financial allocation given to the health service. Emanating from those fiscal shortfalls is the fact that severe and intolerable pressures are being witnessed in the provision of health and social care here. Once again, we only have to look at the recent cases, less reported, but still existing, of pressure in our emergency departments. That reflects the fact that they are not sufficient to maintain a high quality of patient care in order to deal with patient flow and provide that high-quality care.”
“We should all feel the utmost sympathy for those who have found themselves not able to have the operation that they were promised and also angry that we find ourselves debating these issues once again on the Floor. Will the Minister agree with me that, just like last year's A&E crisis, this situation is simply another symptom, not a cause, and that the real cause is a failed plan with no funding?”
“Older people should not be seen as a cost that society needs to bear. They are an integral part of our lives and community. We should value them.”
“It should be seen as a platform in the ongoing journey of providing key mechanisms and safeguarding individuals from abuse and neglect. It must also act as the impetus to raising much-needed awareness. We must begin to value older people truly and to invest in their lives and care.”
“The current legal framework here is obviously disjointed and convoluted. It consists of a range of statutes, policies and guidance. We have seen at first hand that, when these rules are slack and we lose sight of the person, when monitoring and care standards are relaxed, the presence of abuse is witnessed. The adult safeguarding Bill is an attempt to bridge the gaps in our current approach by providing a more robust framework in reporting and responding to allegations of abuse and promoting greater collaborative partnerships between the various statutory bodies, voluntary organisations and the independent sector. <BR /> <BR />As I said, we must see this as an ambition, if you like, not gesture legislation.”
“<BR /> <BR />It is important to acknowledge the work that our Commissioner for Older People, Claire Keatinge, has undertaken in promoting the needs of our older generation, in raising much-needed awareness and, importantly, in advocating a change to our legal framework to protect older people. In that regard, the events that took place at Cherry Tree House and Ralph's Close are damning indictments of our current approach to protecting the vulnerable and marginalised groups in our society. It is evident that our current approach is not fit for purpose. As I highlighted, it is the same as was experienced in Winterbourne View in Bristol and in unit 3 of the bungalow in the Republic: different jurisdictions with different safeguarding mechanisms but the same abuse.”
“For example, the recent report, 'Appreciating Age', identifies that our older population will contribute something in the order of £25 billion to the Northern Ireland economy in the next 50 years. It is in part due to Northern Ireland having an increasing age population. NISRA has projected that, by 2062, there will be an additional 318,000 people over 60 compared with today, but, with a shift in our demographics, we must look at the wider picture. In reality, that increase means that we will be more heavily reliant on nursing homes and residential care homes and the provision, as I articulated, of care in our communities. If Transforming Your Care and its ambition were to be realised, that would increase care in the community and in homes, with home being the hub.”
“Finally, we must ask whether the system has the potential to abuse, not just in care settings but in the home, and whether the financial pressure that leads to pressure on staff, 15-minute domiciliary care packages and people receiving meals but no contact has the potential to create neglect and whether that is ultimately abuse. I refer to the Age NI report, 'Would You Eat Sandwiches for Your Tea Every Night?', which highlighted the need to focus on the needs of the person and not the finance, and I welcomed the comment, which reflected that in its entirety, in Sir Liam Donaldson's report, which was published today. <BR /> <BR />Our older population is living longer, has more active lives and is engaging in and contributing significantly to society as a whole.”
“Absolutely. Ultimately, that will become an issue for the judicial service, post a definition of abuse. We have seen footage taken, not just here but elsewhere, of the types of abuse, and anybody who perpetrates that type of abuse should be subjected to a zero-tolerance approach. I welcome the intervention. <BR /> <BR />We must question whether existing legislation, such as that on autism, is delivering to the extent to which it should and whether the outcomes of reports such as Bamford, which made important recommendations, have been delivered. Remember that we are still waiting on the goods, facilities and services legislation that will address inequalities, not just for elderly people but for the younger population.”
“Of course, institutional abuse involves not just the elderly but those with other care needs, such as people with learning disabilities, and it is our contention that any proposed legislation that calls for a definition, as the motion does, would ultimately lead to embracing those two at least.”
“I welcome the opportunity to participate in today's debate about abuse in care home settings, which is a topic that is very important to all of us. Without doubt, every person has the right to safety, free from abuse and neglect, and everyone is entitled to receive care delivered by well-trained, properly managed, committed and compassionate staff. We must be determined to make that reality. I therefore commend the rationale that underpins the motion and the fact that it focuses on abuse, but we need to be aware that abuse comes in many forms and is perpetrated by individuals and organisations that might like to forget that or even have us forget about it. <BR /> <BR />The SDLP supports the motion, but it also recognises that it is distinctly limited, given that it only concentrates on abuse of the elderly in care homes.”
“The Minister has already highlighted the issue of Balmoral Golf Club. Will he confirm that officials at the club have indeed engaged in positive and meaningful discussions with Northern Ireland Water in order to achieve a positive outcome for flood alleviation? That positive outcome will not be achieved if, ultimately, it is detrimental to the golf club business.”
“Can the Minister confirm that dealing with backlog issues belies the reality that there have been substantial reductions and a downward trend in legal aid cases of up to around £20 million in criminal defence?”
“I am reluctant to say, "I told you so", but does this report not represent a vindication of those who have been rightly critical of a service that has not been delivering, up to and including criticism of who runs the system. I remind the House that this Minister and his predecessor have robustly and at all costs defended that system. In that light, is it not now time, not for another debate, but for decisions, finance and action?”
“I thank the Minister, but maybe we can hone this a little. My understanding was that money was set aside in the Executive. Were it not to go ahead, would there be flexibility for the money to be spent elsewhere?”
“The implications for EU funding were it not to go ahead.”
“I thank the Minister for his full answer. Could he explain to the House why he thinks it is so important to legislate on climate change?”
“I welcome the statement and concur with colleagues in their acknowledgement of the good work thus far. I want to highlight the point that, while it is worthwhile updating the structures, the real prize here is the brand, as the Minister said. Should that not include a politically tolerant community at peace with itself, reflecting common ambition? Is it the price of failure to arrive at that that those who come may leave?”
“We need ring-fencing and a definition of "core public services", and we need to agree what those core public services are. Otherwise, it is sticking plaster not strategy.”
“This amounts to an appeal for real, joined-up government, where training, job creation, education — specifically early-years programmes — are prioritised in those areas at most need to effect the greatest change and help to reduce the demand on health and welfare.”
“What this Budget does not do is strategically tackle those issues head on, and if it does not, it will only put further pressure on the expensive side of the system. What we need is a strategy, not a sticking plaster. There is a need to develop and maintain a long-term focus on helping those communities facing or threatened with poverty, even when we have witnessed the savage nature of consequential austerity measures and the further squeezing of our block grant. We need to tackle deprivation on all fronts, and the way to do that is through proper joined-up government. If there is one truism about the health service as delivered here, it is that it can only attempt to deal with the demand as it comes and can do little to alter it.”
“It is clear, they say, that the social care value is being ignored and that people with lower-level needs are not receiving support to remain nourished, healthy and independent in their own homes. This is despite the fact that it is the ambition of the underfunded change plan at the heart of the health service. Running alongside this is a domiciliary care approach that favours 15-minute visits to homes, burning carers out with the maximum visits/minimal time approach to care delivery. <BR /> <BR />Missing from this Budget is a comprehensive strategy that fundamentally recognises, as did the Stormont House Agreement, that we have legacy issues that need to be resolved, the crux of which are social deprivation and long-term unemployment.”
“We have a TYC plan that wants older people at home and to reduce the need for hospital, and a trust whose actions may put them into hospital and in a weakened state. The meals service is a vital core public service that should be receiving funding but is not. <BR /> <BR />Moreover, those who provide the daily meal service — this is the point made by my colleague — act, as American researchers have found, and, indeed, we have found anecdotally and I found when I recently accompanied a meals on wheels service provider to a number of homes in Belfast, as eyes and ears, or a safety check, if you like, reporting on the changing health or needs of housebound older adults. That is the view of many who provide the services.”
“I thank the Member for his helpful intervention; I will get to that very point in just a moment. <BR /> <BR />I point to a study done in recent years that shows that, out of nearly 10,000 people screened on admission to hospital, 34% were found to be at risk malnutrition and 21% were found to be at high risk. Seventy-one percent were admitted to hospital from their own homes — in other words, the malnutrition originated in the community. The community, which should be receiving funding and provision, is not. It has been put at risk and may ultimately cost us at the expense of the hospital side. The focus of TYC was on provision in the community and keeping people out of hospital.”
“However, because of cutbacks, the South Eastern Trust, in its wisdom, will deliver this service, not once a day, not once a week, but once a fortnight in the form of 14 frozen meals. This from a trust whose job it is, as part of an integrated care system, to deliver health and social care.”
“Let us remember that the health service believes that the growing numbers of elderly people are an increasing demand on the expensive hospital side of provision. Let us look at how the system is treating those older people and how it is thinking about keeping them out of hospital. I will illustrate this with one example that demonstrates just how flawed the thinking on these issues is and which highlights the need for a different approach to how we define and order core public services. The South Eastern Trust is, I understand, tendering for a meals service. At the moment, most of those services focus on the daily delivery of a chilled meal that is later heated and eaten.”
“The change plan at the heart of the health service has been talked about time and again in the Chamber. It recognises that there needs to be a greater provision for the community side, home being the hub, to help to alleviate the pressure on the expensive hospital side of our health service. Do the Budget and the motion address that? I suggest that they do not. <BR /> <BR />TYC will continue to be funded out of a monitoring round system that itself will have little money, and it will also mean that, because there is a growing financial pressure, other elements of health service spend will take priority over the change plan. I noticed this morning that, in the January monitoring round, TYC got no money at all.”
“However, in our view, it is much broader than that and may well impact on every Department. Where health is concerned, we all recognise that there are a number of demands on the system. They include a growing older population, but huge demand arises from the health issues emerging from the long-term unemployment and deprivation that I just referred to. It is a no-brainer, and until we start to tackle the pressure that that puts on our system, we will continue to administer sticking plasters and not strategy. <BR /> <BR />What has the Budget done and what does the motion in front of you encourage? They merely recognise the issues at the crisis end and do not focus on the demand side. For us, a core public service must focus on addressing that demand and get to the heart of dealing with long-term unemployment and deprivation.”
“<BR /> <BR />A recent study compiled by the poverty and social exclusion project revealed that more than a quarter of adults here are living in multiple deprivation — that is, living without basic necessities. We have the highest rate of benefit claimants in the UK, the highest rate of youth unemployment at 20%, and economic growth is still lagging behind that of the rest of the UK. We should have been dealing with those issues. The facts speak for themselves, and it is in that context that I would like to address what is a core public service. My worry is that the approach that we are taking is really a sticking plaster and not a strategy. There is a vague sense that core public services are the front line — doctors and nurses, for example. Certainly, they represent a constituent part of it.”
“We have to consider the impact that that will have on our public and private sector, but we also have to make sure that every pound that we spend is spent well. Unfortunately, simply referring to core public services in that regard does not cut it without robustly defining what is a core public service and how funding it will help towards government targets. <BR /> <BR />At the start of the Troubles, we were top of the league table in deprivation in a number of key areas like west Belfast, north Belfast, Derry and Strabane and other rural areas in Northern Ireland. Forty years later, that picture remains largely the same for some of those areas, and the intervening years have piled on intergenerational unemployment, mental health issues, poor health and a host of associated health and other issues that it will take years yet to resolve.”
“<BR /> <BR />The essence of our amendment is the definition of public services. It is crucial that we actually arrive at a definition before we commit to how we spend vital public funds. I welcomed the Finance Minister's comments about the need for a better definition so that we can ensure that we set strategic objectives that will help with the definition of core public services, meaning that we can fund those accordingly. We also need to ensure that that happens not solely but largely for health, welfare and education. <BR /> <BR />The Stormont agreement as embraced by Sinn Féin and the DUP is a pivotal moment in the politics of Northern Ireland. The days of the big cheques that are sufficient for our needs may well be over.”
“I welcome the opportunity to participate in today's debate. At the outset, it is worth pointing out that the unified approach taken towards the end of the year was not adopted earlier by some of the parties that are now praising that approach. I think that we should all regret that. You will recall the DUP going in one door at Downing Street and Sinn Féin going in the other ahead of the summer, giving the Treasury the classic opportunity to divide and conquer. That happened not at its expense but at the expense of the public. Meanwhile, we were reminding people that that was no way to negotiate and that only a unified approach would have the best chance of success for our people. Even then, there has been only partial success, but I am glad to see that the joint approach was finally adopted.”
“Does the Minister accept that that remains very ill defined? There is no better illustration than the arm's-length body the NIFRS. The Northern Ireland Fire and Rescue Service is excluded, when it clearly performs a critical front-line role.”
“I welcome the broad focus on protecting key public services. When it comes to health, the Minister said that there was an Executive:”
“In that context, can the Minister address how her Department is addressing inequality of arts provision for children who are deaf or have severe hearing difficulties?”
“I thank the Minister for her answers, and I look forward to seeing the completion of the project. Will she clarify the circumstances around stadia money and whether any of it gets handed back for distribution in the monitoring rounds?”
“Thank you, Mr Speaker. I congratulate you on your election. <BR /> <BR />I warmly welcome the Minister's positive comments in relation to the working relationship with the Minister in the Republic, Leo Varadkar, which I hope continues. The SDLP has always taken the view that North/South makes sense, so, as you can imagine, we are doubly excited when we hear talk of joint projects and considerable EU funding. Perhaps the Minister will take the opportunity to expand on the range of those projects available and the extent to which further funding might become available.”
“— just as the Stormont House Agreement did, that we have legacy issues that need to be resolved. We need a joined-up government approach to deal with those matters, because Health cannot deal with those issues that are, ultimately, creating the demand in the system.”
“Missing from all this is a comprehensive strategy that fundamentally recognises —”
“I will reiterate the examples once again: £50 million was spent on bank and agency staff, 30% of which went to private administrators, not the front line; £50 million was spent on sickness; £40 million was spent on fraud; and, between them, patients and hospitals cancelled 360,000 appointments last year. That is a failure in the system. As I have repeated here on numerous occasions, we have to pay for some of those situations twice because we have to buy in the private sector to shorten the queues.”
“Of course, we have Dalriada, among others. <BR /> <BR />Frankly, I am bewildered when it comes to health service strategic decision-making. Before Christmas, the board told us that individual cuts were the trusts' responsibility. After Christmas, it was clear that the trusts had been told that the approach was to cut elective care procedures. Who is running the system? Added to the contradictions around strategy is a plan to protect the front line and a plan to cut funding to arm's-length bodies, of which the Fire Service is one. How mad is that? If the Fire Service is not front-line, nobody is. <BR /> <BR />One of the biggest issues for me is the need to ensure that all appropriate options for savings are considered. Significant waste has been identified in the health service.”
“In recent comments to the Committee, the Health Minister talked about it no longer being a five-year plan but a 10-year plan. Our Programme for Government target — a shift left of £83 million from the hospital-based community — has not been met. <BR /> <BR />If one thing sums up the lack of strategy, it is the way that the trusts set about the savings plans towards the end of the year. There is a complete lack of strategic focus, but there is, of course, a focus on the bottom line. Remember what TYC said on investing in community and compare that with some of the decisions that individual trusts made to meet their bottom line. They have been referred to before. Even when the decisions were made, some, such as that about Bangor's minor injuries unit, were quickly reversed. That underscores the fact that there was not a strategic focus.”
“I have said before that the crisis witnessed in our A&E departments is the symptom, not the cause, of a failed approach to the health system and health finances. <BR /> <BR />Although we welcome the £200 million of additional funding to protect our front-line services, we will not see the delivery of the core strategic plan. In its current form, it is destined for failure. We have to ask at what cost. Remember that it is still being funded, but it is not delivering. So, at what point does the plan become the drain on resources rather than the solution to the problem? This is evident from the fact that the £70 million required for its implementation over a supposedly three- to five-year period has not been delivered: £38 million has, and £15 million to £17 million has been set aside in this Budget.”
“There are personal stories about the impacts that this failure of strategic thinking has on our ill and vulnerable citizens. <BR /> <BR />I will make a point that I feel compelled to make during all these health debates: there is a need to differentiate between those who work in the system and those who set up the system and created the failures in it. I would like to praise our doctors, nurses and ancillary staff for the tremendous effort that they put into ensuring that we are looked after no matter what — be it a minor ailment or major surgery. Our health personnel are among the best, and they want to deliver the best. It is the system that is broken and puts them, the patients and the public under such strain.”
“If I read the headlines in the papers correctly, even yesterday, it seems that the health authorities have learned absolutely nothing and are calling this a unique spike. It is not a spike; it is a result of a failure of strategic thinking. <BR /> <BR />When we look at the statistics, we sometimes miss out on the personal impact — the stories behind the headlines. May I quote one line from an email sent to my office this week? It is from somebody who had their operation cancelled at the last minute, with very short notice. The person said:”
“<BR /> <BR />The health service continues to provide a service, but it does not have at its core a properly funded and managed strategy to deal with the growing strains in the system, and this Budget does not do anything about that. We do not have to look too far to see where those strains are. In the past few days, we have seen the headlines; we have witnessed extensive waiting times at A&E departments across the North; and we have seen a curtailment of elective care provision, with the cancellation of nearly 180 appointments across all trusts in the past few weeks. Those are just the most recent headlines. The year has been dominated by them. In fact, 2014 started with a crisis that the Department desperately tried to convince us was a one-off.”