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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“Some years ago, in San Diego, the need for development in that area was recognised and a £5 billion a year economy was created around that. That would help not only pancreatic cancer sufferers but the wider population of cancer patients. <BR /> <BR />I am conscious that I am almost out of time, so I conclude by saying that we must move on this because another 40 years cannot pass with the survival rate remaining at 3%.”
“Thank you very much. I was just about to refer to that. It is helpful that that drug is available to pancreatic cancer sufferers, but it does not take away from my wider point that, for all cancers, greater access to these drugs would, I think, make a difference. <BR /> <BR />I would like to underscore the point further: if we embrace the cancer drugs model, we could get them free under the Pharmaceutical Price Regulation Scheme (PPRS). That would also underscore our well-established drug development research at Queen's University. I fully believe, having travelled to San Diego in the summer, that there are real economic benefits to be had from embracing that overall model and in having a cancer centre of excellence here.”
“I thank the Minister for his helpful intervention. Will he clarify whether Abraxane is included?”
“That means that patients can receive personalised medicine, and, of course, scientists are continuing to work on developing new drugs and treatments. There obviously needs to be an integrated approach to the delivery of treatment for cancer patients through personalised medicine. <BR /> <BR />My appeal is that we fully embrace the new, innovative cancer drugs that are available. The SDLP has spent most of this year highlighting the need for greater access to these specialised cancer drugs and, indeed, many —”
“I refer to a point made earlier: if someone has not visited their doctor for 12 years, an alarm bell or red flag must welcome them on their first visit back, and their subsequent appointment should not be delayed. Mechanisms must be put in place to ensure greater dialogue between primary and secondary care providers. I echo the call for an efficient and effective care pathway to accommodate that. <BR /> <BR />Over the last number of years, significant attention has been focused on personalised medicine as a method of delivering treatment for cancer patients. There have been advances by organisations such as Cancer Research UK, which has conducted considerable research into tumours, noting in particular how individuals react differently to treatment.”
“It is without doubt that early diagnosis is paramount to increasing survival rates of patients suffering from pancreatic cancer. I will underscore Mr Buchanan and Mrs McLaughlin's point again: 48% of pancreatic cancer diagnoses are made at emergency admission, when the cancer is at an advanced stage and it is too late for treatment to effect a cure. In those cases, only 9% survive after one year. <BR /> <BR />It is evident, from what we have heard, that numerous difficulties exist in diagnosing pancreatic cancer at primary care level. The fact that 40% of patients visit a GP three or more times before a diagnosis also speaks for itself.”
“All that could be conducive to increasing overall survival rates. However, almost as deeply worrying is the international, national and regional differentiation of survival rates. According to a Eurocare study in 2009, the UK survival rate after one year is 16%, which is well behind the European average of 20·9%, with countries such as Belgium having almost double the survival rate of the UK. Most startling is that here in Northern Ireland, the survival rate after one to five years is, at 3%, the lowest of all. As I said, that has not changed. These are obvious failings, which are having a further detrimental effect on sufferers of pancreatic cancer. <BR /> <BR />The figures speak for themselves, but we must acknowledge the systemic issues and that some of it is our fault.”
“<BR /> <BR />There are obviously serious problems, which the Assembly and Government can go some way to address. What can we do? Mr Buchanan said it: greater research funding is needed, along with a campaign for more public awareness of symptoms, as was said. GPs also need to be provided with greater support in their diagnoses — for example, through access to CT scanners. As Ms McLaughlin said, GPs must have in place a proper care pathway to fast-track hospital admissions for diagnosis and specialist treatment.”
“As SDLP health spokesperson and a Health Committee member, I welcome the opportunity to speak on such an important issue, which has affected and continues to affect many people here. I thank those who tabled the motion. <BR /> <BR />As noted by Members who spoke previously, pancreatic cancer is one of the leading causes of cancer death in the UK and has the worst survival rate of all cancers, yet it receives merely 1% of research spend. That comes in at around £5·2 million, which is significantly lower than is spent on other types of cancer. The five-year survival rate for pancreatic cancer is 3%. That has not changed in the last 40 years, despite significant advances in the treatment and survival rates of those with other cancers such as breast and prostate.”
“I would like to add that the SDLP is committed to seeking greater transparency and accountability from DHSSPS on the budget. I further add that these issues are not dissociated from those that we face in the budget: on the one hand, potentially doubling spending to ease a significant pressure; on the other, cutting budgets with, it appears, no consistency with the strategy to put community provision front and centre. We need longer-term strategic thinking with transparency and accountability at its core. Otherwise, we will have an ever-pressurised health budget bouncing between an unexamined demand and a shortage of funds.”
“However, the Committee is of the view that these policy intentions lack a supportive action plan that would clearly set out how this will be achieved. The Committee, therefore, recommends that the Department produce an action plan, detailing how it will decrease spend on private sector elective care over the next two to five years by making better use of in-house, service-based solutions. The action plan should include projected costs for spend on private sector elective care for the next three to five years; proposals to develop capacity in the health service sector to better match supply against demand on a long-term basis; proposals to ensure that any private sector contracts required demonstrate value for money; and a timetable setting out the key milestones in this process.”
“It is not sustainable by any means, and we need to find quickly in-house solutions to these problems that will alleviate the ever-increasing waiting times for elective care. It is imperative that the Minister and the Department take due consideration of the issues raised and take immediate action, not in dealing with the short-term problems but rather in taking a consistent and thoroughly planned approach that is needed over the next three to five years if we are to meet increasing demand and deal with excessive waiting lists. In that sense, the Department must be innovative and proactive. <BR /> <BR />The Committee welcomed the Department's policy intention to reduce its reliance on the private sector in the future by better matching in-house supply with demand.”
“There is a further question about whether the Department is getting the best value in negotiating these deals with the private sector and whether the relevant staff have been properly trained to conduct such negotiations. In Professor Normand's evidence to the Committee, he highlighted the fact that, in the Republic of Ireland, civil servants were not properly trained in negotiating good deals with the private sector. One must ask whether that could also be the case for our health system. <BR /> <BR />The problem is that we have an excessive over-reliance on the private sector, which tells us that the baseline capacity is not aligned to meet increased demand. Using the private sector repeatedly is only a quick fix solution. It does nothing to alleviate the long-term systemic issues that we face.”
“How much of that growth is the result of cancelled hospital appointments, when an operation is then provided in the private sector? Last year, we cancelled 185,000 hospital appointments, not all of them directly related to operations. Are we effectively paying twice for the same operations? The unfortunate situation is that, over the last number of years, demand has increased, by 5% to 6% last year, and appropriate action is not being taken to alleviate that, especially in drilling down to why we are cancelling those appointments. <BR /> <BR />As demand exceeds supply, it results in heavy backlogs and excessive waiting times. The private sector is the main means to alleviate that, and it costs more.”
“The Committee has received evidence that, since 2009, the amount spent on private sector elective care is between £55 million and £65 million a year, as was mentioned, with spend in 2013-14 being £66 million. That represents a worrying 5% of the total spend on the private sector for elective care. In comparison, the Committee has received expert evidence comparing the approach adopted by other jurisdictions in the UK. <BR /> <BR />It is important to highlight the fact that England and Scotland provide private sector elective care only to accommodate additional capacity at the margins that is not required all year round. In the Scottish system, that amounts to just over 0·2% of that provision. We must, therefore, ask ourselves why we spend considerably more on the private sector for such care here.”
“As health spokesperson for the SDLP and a member of the Committee for Health, Social Services and Public Safety, I welcome the opportunity to speak on such an important issue as waiting times for elective care. I thank the Members who have spoken and endorse their remarks. I also acknowledge the great work done by the Committee in bringing the debate to the House. I will speak on one issue: recommendation 4 on the use of the private sector in providing elective care in the public sector. <BR /> <BR />The Committee's report on waiting times for elective care notes that, over the past number of years, there has been an increase in the use of the private sector to provide such care.”
“Perhaps the Minister could outline in some detail how this plan and indeed others that he has outlined here this afternoon are in any way consistent with Transforming Your Care. Does this decision and the others not represent a further series of nails in the coffin of Transforming Your Care, which is underfunded and failing?”
“— and more in the last two years, what action are you taking to audit across the Department, the board and the trusts to ensure that existing budgets are providing best value for money and best outcomes for patients?”
“Minister, is it not true that it is not just demand? Given your predecessor's acknowledged waste in the health service, the fact that the health service spent £50 million in the last two years on bank staff, a significant proportion of which did not go to front line services, tens of thousands of cancelled appointments every year, and boards' staff numbers swelled by 25% —”
“Can the Minister reflect on whether the pharmaceutical price regulation scheme (PPRS) would make a substantial difference to the actual pharmacy spend? In other words, does he accept the notion that embracing the scheme would mean a zero rise in the pharmacy bill?”
“I thank the Minister for his statement. I congratulate the international working group for the work that it has done. We welcome this, particularly the joint nature of the discussions. Minister, you made the statement, but I think it only appropriate that we from the SDLP congratulate your predecessor, Mr Poots, on his sterling work in furthering this project. <BR /> <BR />It throws up some questions, as you outlined. In your previous answer, you touched on the parents. Would it be appropriate for recommendation 1 to come ahead of the consultation to allow the immediate establishment of that working group so that parents, clinicians and all the rest of them can involve themselves in early discussion? <BR /> <BR />You talked about the economics earlier.”
“Will the Member accept that it was remiss of me not to welcome you to your new post and your first formal speech? I now welcome you.”
“If we do not do that, not only are we failing our older people now but we will fail the next generation of older people. I support the motion.”
“The Committee is aware of the Departments' plan to conduct such research. However, it was estimated that that would cost £500,000 over a two- to three-year period. The Committee questions whether, in the current financial climate, it is economical for the Department to outsource such research. It is therefore recommending that the Department should not commission researchers or consultants to evaluate and review Gnangara and Hemsworth Court but rather that that work should be carried out by officials from the Departments and/or their arm's-length bodies as part of their existing roles. <BR /> <BR />Finally, the first of the recommendations again reflects, consistent with earlier comments, a lack of strategic thinking and a failure to collect and evaluate information about projected need, especially against the projections in TYC.”
“Although there has been some dialogue between the Departments on the potential for risk sharing, DHSSPS appears reluctant about the idea. There needs to be further communication and transparency. There must be clear evidence that sufficient numbers exist to fill new developments, with a relevant timescale and an effective action plan in place. <BR /> <BR />Recommendation 5 relates to research into Gnangara and Hemsworth Court, which is a similar facility. The Committee notes with great concern that there were serious shortcomings at Gnangara and Hemsworth Court. A bespoke piece of research was being planned to analyse those shortcomings and what action could be taken to rectify them, which would provide valuable insight — so the official said — and help facilitate the overall development of supported living facilities.”
“To stimulate further development, the Committee believes that consideration must be given to risk sharing and that, if further developments fail to meet the target, the trust and the housing association should take the weight of any financial shortcomings. Although that is, of course, not the objective, risk sharing may in fact act as an added incentive for the trusts to promote their supported living facilities better. In that regard, the Committee is formally recommending that the potential of the trusts to take on an element of risk sharing with the housing associations be further explored. <BR /> <BR />The Committee also recommends that there should be more joint planning between the trusts and housing associations before decisions are made to commission new facilities.”
“There must be greater liaison between Departments, trusts and associations and the adoption of thoroughly considered action plans to minimise the potential for those voids. Under the current system, all the financial risk is taken by the housing association, and the voids have the knock-on effect on it of having to incur unbudgeted and unsustainable losses. One prominent example of that is Gnangara in Enniskillen, where losses are estimated to be around £1 million. That, in turn, acts as a disincentive to the housing association, not just in Fermanagh but all across the North.”
“<BR /> <BR />Perhaps the greatest issue holding back the further development of supported living facilities has been the issue of vacancies or "voids", as they are known, in the current facilities and their financial implications for housing associations. The Committee is aware that, although some facilities have waiting lists, there are voids in others. They are present across all five trusts to differing extents and remain of particular concern. That relates to evidence provided to the Committee by the Northern Ireland Federation of Housing Associations, which has pointed to significant voids in some supported living facilities that have serious financial implications for that housing association. The federation identified that:”
“I welcome the opportunity to speak on today's important motion, as SDLP health spokesperson and a member of the Health, Social Services and Public Safety Committee. I endorse the comments of other Members in relation to the report. I confine my comments largely to recommendations 4 and 5. <BR /> <BR />The Committee recognises the importance of implementing the Transforming Your Care plan. Part of that implementation involves the development of supported living facilities, which provide a vital service for vulnerable people and for necessary care and independence, allowing them to be part of the community and to retain relationships important in everyday life.”
“I thank the Minister of his fulsome answer. My supplementary question touches on the recession, but in another way. What implications would cuts in departmental budgets have for measures to improve road safety?”
“— where are the alternatives that can make a significant, immediate impact on our energy demands nationwide?”
“Therefore, as the search continues for the most viable alternative to coal, oil and gas, we must also ask ourselves what are the alternatives that can have an immediate impact and strengthen our national grid. We have already seen much debate and consternation surrounding fracking, as has been touched on. Sinn Féin has said no to fracking but —”
“<BR /> <BR />We must also take all steps necessary to limit the geological risk inherent in deep geothermal energy exploration. Further impact assessments are needed, and those must be continuous during exploration and the potential establishment of deep geothermal energy plants to limit any potential negative impact on the environment. In that regard, until we overcome the hurdles of deep geothermal energy, the motion remains narrow, as it will not have any significant impact on our energy demand in the near future. It is only through future planning, proper regulation, further consultation and providing proper financial incentives to investors that the scheme will become a reality and be delivered.”
“In that sense, it is unlike other sources of renewable energy that have been tried, tested and established in this region, such as harnessing wind, solar or biomass. <BR /> <BR />There remain other obstacles to overcome before we could even get going. For instance, we must be progressive in tackling high initial capital investment. It has been asked whether the renewable heating incentive is fit for purpose, so we must work closely to ensure that the proper financial provisions and incentives are in place to provide a competitive market and to attract investment for further growth. After all, it is estimated that it costs just over £3 million for every borehole drilled for exploration and that one plant — in Ballymena, for example — would cost £30 million to develop.”
“<BR /> <BR />Deep geothermal energy is not without its limitations, and it is those that we must overcome. Perhaps the greatest issue facing deep geothermal energy in providing heat and electricity for countless homes is the time that it would take to develop and establish such a system here. As the Cambridge Economic Policy Associates (CEPA) report highlights, the establishment of a system is highly unlikely to happen before 2020, and it will even take a few years for exploration to begin beforehand. Do we have a timetable to push that further and faster? <BR /> <BR />Deep geothermal energy requires a long-term approach, with further planning, study, consultation and execution required if it is to have a significant impact. A road map must be developed.”
“The approach taken must be part of an all-Ireland initiative so that consumers, North or South, can benefit from increased sustainable energy supplies at a competitive price. Deep geothermal energy certainly has the potential to be part of that initiative. <BR /> <BR />I would agree that, following the studies that have been conducted, the process has significant potential here, especially in some of the areas suggested. If the developments in Southampton, along with other models in western Europe, are anything to go by, deep geothermal energy has the potential to provide a large amount of renewable heat and electricity. It will also effectively help with reducing carbon emissions, addressing climate issues, providing employment and economic benefits to local companies and, most of all, driving down prices for the everyday consumer.”
“In an attempt to curb that, we must be innovative and strategic in utilising alternative, sustainable and renewable sources of energy that will enable us to meet the Executive's targets of achieving 40% of our electricity from renewable sources and 10% of our renewable heat by 2020. <BR /> <BR />Although we have made some progress over the past number of years, more needs to be done. In that regard, we must stand united in tackling climate change and driving the green agenda, as was suggested, to meet those targets. This is also about creating partnerships, and, in that sense, we must work closely not only in our own Departments but with our colleagues in the Republic to ensure the effective and efficient sharing of resources, with the possibility of cross-border interconnection.”
“I welcome the opportunity to contribute to today's debate. I reaffirm the SDLP's support for the development of deep geothermal energy as part of an integrated approach, with the hope that it can positively impact on our over-reliance on fossil fuels and attempt to satisfy our ever increasing energy demands. <BR /> <BR />As Members are well aware, we are too heavily reliant on imported fossil fuels for our everyday energy needs, and with demand and price ever increasing, we must act now to avoid an energy crisis in the near future. It is clear that, as the prices of fossil fuels increase, so does fuel poverty, which affects the most disadvantaged. Recent reports estimated that some 300,000 households here are experiencing fuel poverty.”
“I thank the Minister. There is a further step. Is she prepared to issue clear guidelines to farmers on ways to reach the targets that are set by Europe?”
“On the back of what Mr McGimpsey said, this was once described as the "golden mile" of Belfast. Members will probably all recognise now that it is significantly tarnished. The Minister has reflected on the demand, but can he point to a resource that would answer that demand at some point?”
“The figures are huge, and, as the Minister quite rightly points out, they affect the health budget to the tune of £900 million. In terms of priority, and given that this is a historical problem, would it not be appropriate for an Executive task force to, once and for all, begin to tackle it head-on?”
“The Scottish experience tells us that if we shout long and hard and with commitment the Government may listen. The DUP says that its negotiation was the best on the table and there could be no more movement. The Scottish experience tells us that it might be a hard negotiation, but there is room. Why is it that the DUP is not up for tough negotiations on behalf of its own people? Here, for me, is the implication of the talks. Everybody has to approach it with equal standing and, in that respect, if the Government are willing to enter into negotiations, the least that we can do is tell the British Government to take the fines off the table. We cannot negotiate with our hands up our back.”
“I will put the same point to you as I put to your colleague: it is not about individuals but about us all going to Downing Street with the same message, saying the same thing, not different things. I do not believe your negotiation. I do not know whether you did a deal with the Tory Government over some of the issues and future strength at Westminster. I do not believe, when you come back and say that you negotiated the best deal possible, that you dealt for all our people —”
“We have no consensus on what is in reality a problem shared across all the constituencies reflected in the House. Instead, we have the DUP behind closed doors at Downing Street saying one thing and Sinn Féin behind closed doors saying another. That is a failure for our people. That experience shows us that there is room for renegotiation based on the consensus that our people are worse off but deserve better. Indeed, if there is not room for negotiation, what is the point of putting welfare reform on the table in the upcoming talks?”
“Its research, which is, once again, in-depth research, shows that PIP is just not responsive to the needs of cancer patients. Macmillan's research shows that people with cancer are waiting up to six months before they receive the support to which they are entitled. That is an absolute disgrace. <BR /> <BR />We have evidence from elsewhere, concern for here and, as we have heard, a fraying among the coalition over its own plans. What can we do? We can create a strong argument based on political consensus around recognition that we have a legacy issue here: 40 years of violence, long-term mental ill health, deprivation and unemployment. Tory welfare cuts — "reform" as they describe it — were about people getting out of welfare and into jobs. What jobs? In particular, what jobs are there in our most disadvantaged areas?”
“At this stage, it should be noted that the coalition Government have come in for huge criticism for not carrying out a cumulative impact assessment of how welfare reform will affect that vulnerable group of people. <BR /> <BR />In Scotland, the organisation GPs at the Deep End, a group of over 100 GPs in the most disadvantaged areas of Scotland, has found that the welfare reform package — not elements of it but in its entirety — will be detrimental to the poorest in society. So alarmed are they that they have called on the Government to act to avoid a potential social disaster. Some of our sick and vulnerable people will fall victim to welfare reform. The Macmillan cancer charity has done a specific piece of work that demonstrates the effect that the personal independence payment will have on people with cancer.”
“At least we are now getting into the space that I will arrive at in my contribution, which is about agreeing in a consensus form what it is that we are saying to the Treasury. At the moment, we are not. <BR /> <BR />The moneys are huge and will have major implications for all. We have already heard how three of the worst-off districts most affected by the reforms are in the North, not in the Tory heartlands. Although the impact has not fully been felt here yet, it has been in the rest of the UK. For example, in Wales, another in-depth study — this time by Citizens Advice — found that many have been left struggling to maintain a minimum standard of living and are now forced to make a choice between eating and heating. The study also found that those with mental health problems were most adversely affected.”
“Even the DUP, in its amendment, admits that there would be a "negative impact". At least, we have got agreement on something. <BR /> <BR />I will spell some of that out from a financial and health perspective. We are being asked to deliver over £750 million of cuts as part of our contribution to over £19 billion that the UK Government want to save. We are 3% of the population being asked to deliver 4% of the cuts. It is unfair. If we had a direct read-across of population to cuts, we would be £200 million a year better off. Surely that is worth arguing for.”
“I welcome the opportunity to participate in the debate today. I support the motion and oppose the amendment. <BR /> <BR />Saying a fundamental no to Tory cuts has to be the starting point for negotiation. Ultimately, whether the DUP likes it or not, further movement on some of these issues could emerge from talks, and I will touch on those later. <BR /> <BR />It is worthwhile pointing out that the motion talks about the disastrous impacts that welfare reform would bestow.”
“I think that we all understand that there are pressures. Can the Minister reassure the House that he is taking all measures possible to deal with admitted waste in the health service?”