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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“I do agree. And I have to say that I am quoting in response to Mr Lyttle, who made a comment referring to other professional bodies. I am referring to the leader of a professional body who has arrived at a considered opinion on this matter. I am not going to reject that, in this context, given the nature of his most recent comments. <BR /> <BR />I just want to make a couple of comments in relation to this particular issue in amendment No 61:”
“It would border on eugenics. That was the view of the Chair of the Royal College of Obstetricians —”
“Now that is extremely important. We are not advocating it, and it should not be advocated that this is a choice item. It is not a choice item. It is dependent on the effect of the abnormal pregnancy on the health of the mother. If we were to consider that fatal foetal abnormality in itself would be a reason for termination of pregnancy, then that is not a satisfactory situation. He was then asked why not. He added:”
“Perhaps I will address it by referring to Mr Robin Ashe, Chair of the Royal College of Obstetricians and Gynaecologists (RCOG) in Northern Ireland, who, only as recently as this morning, reflected on these very issues when he said:”
“I would like to make one comment about your intervention, which is reflective of earlier comments. Had there been proper consultation, we would not have had from my colleague here such an early proposed amendment, consistent with what he believes is the existing law.”
“I accept that you have put your view, but I do not accept it.”
“I welcome the intervention but, at the outset, we need to understand what the context of the consultation was, and where you, Minister, said that you were going to. You sought to consult on the issues of fatal abnormality and to consult, originally, on the issues of rape and incest. All I am following is the facts; there are and were no Justice Department proposals on those latter issues. Mr Agnew has, if I am getting him right, criticised me for making a point when he has put forward an amendment on matters to which there was sufficient opposition for the Justice Minister not to come forward with them. I will take Mr Dickson's intervention.”
“Perhaps the Member has read a different consultation from the one that I read. I understood that there was considerable opposition on the issue of fatal abnormality; in fact, resounding opposition. As I recall, so much was the opposition to it that the Minister dropped the issue around the rape and abuse — the issues that you have brought to the Chamber tonight.”
“I would argue that tonight's amendment is also a major change:”
“I apologise to you, Mr Speaker, and the House, but I think that it is important to repeat these matters. It is a different quote from 2013:”
“I want to quote it. I want to repeat it, and, if you do not hear it and understand it, I will repeat it again.”
“I would just like to get into the debate. <BR /> <BR />I saw Mr Dickson nodding at some of Mr Kennedy's remarks. I refer Mr Dickson to his own comments in 2013, during the Further Consideration Stage of the Justice Bill. I have to quote it to you:”
“I share the hope that this debate continues in the way described by Mr Kennedy. My colleague Mr Maginness, in preparing us for this Justice Bill, prepared a piece of paper that talked about what, in fact, the ambition of this Bill was in the first instance. It dealt with things like fines and defaulting, the Prison Ombudsman and DARD proposals. If you like, it was a gathering up of issues — something to be concluded towards the end of a mandate. A catch-all, if you like. So how have we ended up here tonight? With that backdrop and context, how have we ended up with these amendments, which touch on the issues that Ms Pengelly, Ms Kelly and others so eloquently reflected on?”
“Yes, and that against the backdrop of the incident being able to happen in the first place. There are questions to be asked about not just penalties in the event of a crime but what we as a society are doing to protect those workers in the first place. <BR /> <BR />I promised the House that I would be brief, so I will conclude my remarks. We should allow amendment No 57 to go forward. I accept that Mr Frew believes that his amendment should be further refined. I encourage him to think beyond just blue-light workers and about extending it to healthcare workers. There has to be zero tolerance.”
“It mentions auxiliary nurses being attacked, social workers, a female worker having her hair ripped out etc. The narrative of how people are finding themselves attacked in their place of work is horrendous. We should say that it is totally unacceptable. Of course, it does not happen just in hospitals or to ambulance staff; it affects fire brigades as well. It is hugely important to remember that time is of the essence in relation to any intervention by staff. Of course, that is also the case with fire.”
“While it is right to provide for tougher sentencing for attacks on front-line staff who are out in blue-light mode, we should remember the extent to which all healthcare staff are affected. In that sense, it is important to remind the House that, last year, there were over 6,200 attacks on healthcare workers in Northern Ireland. Unions and staff say that the figure, in fact, could be much higher. My colleague reminds me that she has found evidence of that in the trust area that she represents too. Staff feel that they cannot come forward, for an array of reasons. We need to find a way to extend beyond the nature of the blue-light narrative that has been reflected in amendment No 57. <BR /> <BR />A recent 'Belfast Telegraph' article outlined a lot of the issues and showed that an array of people were affected.”
“I welcome the Minister's approach of not opposing the amendment. I understand that some of the issues are being finessed much more, but I will speak on some of the context and the need for this with regard to how front-line staff are affected. Their contribution is around improving outcomes for people and finding themselves attacked, in any sense, only adds further stress and undermines the job that they seek to do on our behalf. Very often — we have to remember this — when attacked, they can find themselves out of work for a long time. That costs by way of their unavailability and the need to replace them. <BR /> <BR />The amendment does not go far enough.”
“At the outset, I commend the passionate and often personal contribution by Paul Frew in relation to the issues that he raises in amendment No 56. We were all moved not just by the personal story but by the fact that the issues raised were to do with definition, sensitivity, the person and people's interaction with each other. I also commend his leadership at this stage in offering to withdraw his amendment in favour of a consultation about the wider issues that he raised, at length, in his contribution. Even at this late stage, I appeal to the Alliance Party, who have listened to that approach, to take that approach in relation to further amendments coming up in the other group. <BR /> <BR />I will be brief, as I am conscious of time. I will restrict my remarks to amendment No 57.”
“I will leave it there. I have made my point.”
“It all comes back to the point that the DUP failed fundamentally to invest in a Transforming Your Care plan that wanted money shifted left so that there would be investment in the community and we would not have what Transforming your Care predicted, which was haphazard change. Unfortunately, the failure to plan has led to that haphazard change, which is why we are experiencing the huge queues in elective care, with 400,000 people waiting for operations and appointments.”
“I thank the Minister for his indulgence. I go back to the point I made earlier. This is not just about the maximum amount of money or the percentage of the money that is allocated to Health. It is about how that money is spent, and we know that there is massive wastage in the system. There is £50 million spent on bank and agency staff, and there is £40 million spent on sickness. Major percentages can be saved out of overprescription. Those are the issues that are at the heart of this system. <BR /> <BR />I appreciate that the Minister has made the point that I am not being glib, because I have drilled down into this issue for two-and-a-half years.”
“I thank the Minister for giving way. Will he accept that, yes, we did have a consensus and that, yes, we did have an opportunity to maximise the political will that existed around the House over the future of health but that that was in 2011 when the DUP took over Health and also had Finance and was also in OFMDFM but failed singularly to put sufficient funds behind the Transforming Your Care plan, which would have made a huge difference to our overall health service if fundamentally implemented? You had the consensus and you failed.”
“I thank the Minister for giving way. Clearly, there is not one of us who would not welcome the prospect of 30,000 new jobs, but the quality of those new jobs is important. That goes to the very point that he makes about sustainability. In that context and with this Budget, surely it is a contradiction that we are not funding the education places that would provide us with more highly skilled people to attract higher-paid jobs to fulfil the corporation tax ambition as he outlined.”
“The Member is critical of others who have not come up with ideas yet, and he pointed to a £9·2 billion black hole in our finances. Can the Member outline his plans for reducing that and for making Northern Ireland more sustainable?”
“Their presenting at A&E is causing the crisis. The logical conclusion is not just about moving money around; the logical conclusion is that it is a systems failure and that the system needs to be fixed. <BR /> <BR />I could go through much more of the detail, but I am glad that we have had the debate and that it has widened out to some of the issues that I referred to. We need to make a health and social care system that is fit for the 21st century. We have an opportunity to do that. I reiterate: we can allocate money from now until the cows come home, but we need to do it with a plan that delivers for the people of Northern Ireland.”
“We also need a direct answer on this. The Minister released £1·6 million for the independent sector, and if the homework has been done and if that sector has been in touch with the Department, the Department will know that, in fact, that sector is saying that it needs £36 million between now and April and another £9 million annually thereafter. Recipients of those care packages are some of the most vulnerable and frail people in society, and the Chamber owes it to them to ensure that their care needs are adequately met. I will make the point again that it is as a result of the failure of delivery of those care packages or the weakness of the care packages that, very often, our old people are presenting in accident and emergency because they cannot get the proper service or are not getting the GP service that they need.”
“In other words, the homework has not been done.”
“Proposal 9 dealt with domiciliary care and the home being the hub of care, which is a key provision. What do we end up with? The report states:”
“It may form part of Professor Bengoa's deliberations or analysis — I am not sure what to call it — but I look forward to his proposals. We have had reports — I have referred to the Transforming Your Care report — and we have had reports on reports. Donaldson came in and said, "Get on with implementing Transforming Your Care, and that might get you off the starting blocks". My worry is that we will simply, through these other processes, have activity disguised as movement. As I have been arguing, now is the time for action, not analysis. We had consensus on reform, as we have said, and very little in outcome through implementation. <BR /> <BR />I touched on the TYC plan momentarily, but maybe I will flesh it out because it was the plan. Even the Department's analysis has shown that it has barely moved on its update.”
“Is it merely going into that black hole? For us, that is deeply worrying. <BR /> <BR />I take issue with the repeated concept that we are sniping. Neither I nor the SDLP is sniping. We see an opportunity going into the election and beyond, starting in this mandate and potentially going across mandates, to begin to deal fundamentally with some of the big issues that affect this society. These are societal issues, and that is what we are here for — at least, that is what I understood we were here for, not merely adding up numbers and claiming to be proud of that as an active act in itself. <BR /> <BR />The Health Minister pointed to a transformation fund aimed at encouraging reform and innovation. Given the earlier comments, I cannot see anywhere where that has been fleshed out in the Budget.”
“I am sorry, Mr Speaker, the one thing that I was not doing and have not done during the debate is snipe from the sidelines. I am trying to come up with constructive answers to some of the bigger long-term problems that this constituency has. The Minister did not refer to the chronology of when he heard whatever, but, if he is suggesting that Sinn Féin is looking for our ideas on the one hand and the UUP has stolen our ideas on the other, I will be entirely happy with his intervention. <BR /> <BR />I want to ask the Minister a question directly. I have referred to it, but I want an answer if possible. It also refers to the nature of that. The budget rise is £128 million, but the trusts' deficit is £131 million. We need to know where that money is going. Is it going to future provision? Could it go to transformation or current pressures?”
“You have made it clear that Sinn Féin is bereft of ideas and is reaching out to ask the SDLP. I am explaining the prosperity process, and he is not listening. It is about making Northern Ireland work, once and for all. We have had 40 years of people destroying this place and imposing the very deprivation and long-term unemployment that led, for example, to the long-term mental health issues that my colleague continues to refer to. We, across the Chamber, know that only too well, and we know how much it costs the Health Department. We have to wake up. We have an election in three months' time. The Programme for Government negotiations have to include those elements at its core, or we will have forgotten what we are about.”
“If we were to begin to tackle those issues strategically, we would have a different approach, but Máirtín is stuck on the figures. He is just adding up figures and saying that he cannot think beyond that. He says that we are asking to move money on the abacus from here to there and back again: that is not what I am talking about, and that is not what the SDLP is talking about. The SDLP is talking about beginning to make Northern Ireland work, be self-sufficient —”
“<BR /> <BR />I talked about the prospect of investing to save, but I said that in the context of making that we make health the top priority in the Executive. If we do that, it will involve Departments other than the Health Department seeing health outcomes as a priority for them. In other words, let us begin to deal with the core issues and get to the root of the debate: the real issues that cause problems in our health service — not just the flows through it but the issues that cause the logjams. They emerge from long-term unemployment and long-term deprivation in communities such as west Belfast, and you know all about that. Statistics show that west Belfast, north Belfast, my colleague's West Tyrone constituency and Derry and places like it still top the UK league tables for deprivation and long-term unemployment.”
“Thank you, Mr Principal Deputy Speaker. I will get to addressing some of the issues. The Member said that Sinn Féin would interrogate the issues: where was the interrogation of the failure to implement Transforming Your Care? There were 99 targets, but little was done. The Department produced a report, but I did not see much interrogation of that. I have to laugh: Sinn Féin's economic plan includes paying off everybody's credit card debt, and he wants to hear from me about my plan. Maybe you should come and join the SDLP, Máirtín. That would be the answer. We will give you plenty to talk about and chew over. You do not have any plans. All that you have is a plan to say that you are proud of adding up figures on one side and not on the other.”
“I get that. I have also had experience, and I refer to it in every contribution. If we were properly dealing with the community side, we would not have had 791 patients in hospital over Christmas who could not get domiciliary care packages. Somebody needs to do the maths. There were 124 of those people who stayed in hospital for more than two months. Those were people who did not need to be in hospital but stayed there. Depending on the part of the system they were in, it might be more or less expensive than domiciliary care, but my guess is that, when we do the maths, we will find that it was significantly more expensive than the adequate provision of a home-care package in the first place.”
“We need to take the pressure off the expensive accident and emergency side and the elective care side so that we are dealing with people and giving them a service in their own areas — not necessarily a hospital service, because we could shift the context —”
“They did not have to reach out to everybody else, because there was a consensus in 2011 that we needed to deal with the issue in terms of flow. <BR /> <BR />Like a business, what flows through the system is what is important. It would have taken some money, and if the Minister is saying to me what I think he is, he too will back our proposal to put health at the very top of the Executive's priorities so that we can begin to sort this problem out once and for all. That will entail investing some money at the start to alleviate the problems at the Causeway Hospital and in Ballymena on the community side.”
“The Minister asked me a question in a particular way, and I hope this answers it: this was foreseen in 'Transforming Your Care'. There was a sentence in 'Transforming Your Care' that was very good and summed it all up; it said that a failure to plan would lead to "haphazard change". We have got haphazard change now by any measure, and it is wasting good public money. The wastage in the system is the issue. <BR /> <BR />If the then Minister of Finance and Personnel, the then Minister of Health, Social Services and Public Safety, the then First Minister and the then Minister for Social Development — I am pointing to four DUP Ministers — had even sat round their own kitchen tables, they might have got some consensus on this.”
“Of course, the PAC report was published some time back — somebody can tell me when it was — so it could be £160 million now. In other words, we are pushing money at problems and we are not solving them, which gets me to my core point.”
“I will give a very short answer: no. That is not what I am proposing at all. In fact, as I go through my speech, I will point out areas in which we could save money in the system, because there is enormous waste in the health system. <BR /> <BR />I will deal with this now, given that the Member elaborated on it extensively and asked me directly about it. The reality is that it is not just about money. I have not so far said anything about wanting more. The one point on which I intervened concerned the trust money — the £128 million — that you pointed out. My worry is that, because this is a one-year Budget, that is going into a black hole. At the time of the conclusion of the PAC report, the trusts were sitting with £131 million of debt.”
“First, some of the £40 million that was allocated to elective care operations could not be spent, because the administration was too bloated and the photocopiers could not deal with the system. Secondly, we heard that a number of cancer operations were cancelled, so it is not just elective care but emergency care.”
“Patients are being put at risk, with hospitals continuously breaching targets that were put in place to ensure speedier diagnosis and treatment. Are we to be proud or critical of that? When I say "critical of that", I mean not just negative criticism. I think that the Minister understands that. If I interpret him rightly, he comes from a background that likes to see a sufficient allocation, outcomes for people, and money spent well and properly so that we get the maximum return from it. I do not think that we will disagree on that issue. That is a very important aspect of what we are arguing about. <BR /> <BR />We have seen a massive crisis in elective care. Once again, we shifted money away from one area to A&E and created a new crisis. As I said, it now extends to 400,000 people. That is worrying on two fronts.”
“What continues to shock the public and others is that the Minister and the Department have continually failed to implement a robust and coherent long-term strategy to deal with increased demand on the system. <BR /> <BR />Another fact is that Northern Ireland now has the worst record in the UK on the 12- and four-hour waiting targets for emergency care. That is reflected in emergency departments across the North of Ireland.”
“We need to hear in the Chamber that we are delivering for people, particularly vulnerable people. However, given that we are reaching figures of 400,000 people, this is extending beyond what we would normally think of as vulnerable people living in poverty. This is extending into a much wider circle that has grown over five years. <BR /> <BR />The system could be said to be at breaking point. Patients and staff are suffering on the front line. It is our responsibility, in the Chamber, to point that out. That is not just being negative; it is what a good Budget is about. It is about allocating the right amount of money to achieve the right outcome. Against that backdrop, the latest winter hospital statistics are not surprising. We have been pointing that out for months.”
“<BR /> <BR />As we entered 2016, the Northern Ireland public again felt the cold face of the health service crisis, with seemingly insurmountable pressures on A&E and colossal queues for elective care. There are 400,000 people on waiting lists in the health system in Northern Ireland. Can we honestly stand in the Chamber today and say that we are proud of that? Over 20% of Northern Ireland's population is on a health waiting list. We have to start to think differently about how we deal with this. We have home closures followed by the stripping of home domiciliary care services. Maybe we should be proud of that. This is not about arriving at a figure and saying that we should be proud of allocating that over there, a little bit of that over there, or a big bit of that over there. It is about the delivery from what we spend.”
“<BR /> <BR />I am glad that the Minister has moved to introduce a well-deserved pay rise for staff, although the scale is criticised by unions. Nevertheless, nurses are still not getting what they deserve, and I do not think that that is something to be proud of. It remains worrying that the Minister is still embroiled in a dispute over junior doctors' contracts, while the same issue is to arise over consultants' contracts. We have to be aware of the implications of that, not just for the delivery or ultimately, if they move away, lack of delivery and the overall effect that it could have on the system. Those workers are an integral part of it. It is vital that any changes do not put patients' lives at risk and do not deter health staff from working here.”
“<BR /> <BR />As the Finance Minister and all of us are aware, there are many genuine pressures on the health service, which eats into nearly 50% of our overall Budget. The SDLP has expressed concern over the last number of years, and I think that colleagues agree that questions need to be asked. A lot of it emerges from fiscal shortfall, and the result is intolerable pressures on the Health and Social Care service. I do this in all my contributions because I think that it is important to reflect on it, but those pressures are felt by nearly 65,000 dedicated, professional staff who work to the highest standards, often in difficult circumstances. Their commitment, energy and compassion must receive the highest praise. I think that we should acknowledge that.”
“<BR /> <BR />Her colleague was also right in his point, although he did not go into the details of it — and I will give him some of them — that some waiting lists for autism assessments are two years long. The children are nearly grown up before they get a diagnosis. <BR /> <BR />Yet, Mr Principal Deputy Speaker, we have to be proud of all that. We are hearing two voices from Sinn Féin today, one that is deeply proud; and I am trying to work out what the pride is here. Are we deeply proud that we took a whole load of numbers, however many billions, added them up, shared them out, and they added up on the bottom line? The underlying stories are what we really should ask questions about. Those are questions that my colleague from Derry rightly asks and which I will now continue to focus on.”
“I have to say that I am deeply worried — I would not say aghast — by some of the contributions. It is not the contributions themselves but the contradictions in those contributions that I am hearing. The last speaker was absolutely right in just about everything she said. She was right to be critical of the commissioning plan. She was right to be disappointed at not seeing targets in the overall Transforming Your Care plan. She was right to point out that waiting times are in disarray and that we are getting quick savings and quick fixes. She was right to say that there are key unanswered questions in the overall healthcare system. She was right to point to the fact that nurses are not getting a 1% pay rise.”