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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“What we need is a fully integrated and collaborative approach to economic policy that is truly joined-up and which transverses all levels of government, and, even as the report reflects, transverses mandates and fully involves business and the community. <BR /> <BR />May I add one point that the Chair did not have the opportunity to make? It reflects a point in the report that further work will need to be undertaken to further consider the requirements for a society and community strategy. <BR /> <BR />Ministers will big up their own strategies, for example, the joint 'Enabling Success' for 2030 and its focus on economic inactivity, and that is welcome. However, in the meantime, STEM subjects are being cut, most recently, maths and English language courses at the University of Ulster. Where is the economic focus there?”
“Thank you, Mr Principal Deputy Speaker. I thank the Member for his intervention; he makes the point very well. As I was saying, there is little point in one Department attempting to attract FDI to areas where there are skills deficits in the workforce, where there is limited connectivity, transport links and electricity supply. The Chair of the Committee made that point very well indeed. That should have been the job of government. It should be a top priority during the end of this mandate and throughout the next. We cannot continue to have a shared-out government — one for me and one for you — but genuine, joined-up and delivering. In what way is it joined up, and in what other Government, would it be acceptable for one Minister to instigate a judicial review against another?”
“They are not aligned to a long-term strategic vision; that is not dependent on welfare reform. There is no evidence of a joined-up approach between Departments, local councils, business and the community in developing new policies; that is not dependent on welfare reform. Joined-up government should be a fundamental principle of any economic policy, as there is little value in one Department attempting to attract FDI to areas where there are skills deficits.”
“It is clear, as has been reflected here, that our economy is not performing as well as it could be, and we only have to point at the key indicators that compare us with the rest of the UK and the Republic of Ireland to emphasise the point. <BR /> <BR />I am glad that we now have the ability to debate the report and its key recommendation of implementing a 20-year rolling plan for Northern Ireland. That is what it is calling for, but I repeat what it says we do not have — a view shared by those at the heart of business here — we do not have a long-term economic plan for the North. There is no overall strategic integrated approach to economic development and there is no recognition that a problem exists. Is anybody embarrassed? They should be. Departments developing policy in isolation is not dependent on welfare reform.”
“It is a comprehensive and wide-ranging report that took a holistic approach in analysing how Executive decisions directly influence the economy and how we can best facilitate long-term infrastructural development, economic growth and, most importantly, job creation. <BR /> <BR />I would like to take this opportunity to commend all those involved in bringing forward this report, including the Committee Chair and members, Clerks, departmental officials and the many stakeholders who gave evidence. It has been an arduous task, by any measure. <BR /> <BR />Today's report is a timely reminder of the major economic problems that we face.”
“I rise as a member of the Committee for Enterprise, Trade and Investment and on behalf of the SDLP to support the recommendations put forward in the report. Over the last year, corporation tax has divided opinion among economists, academics and businesses etc, but we have consistently heard that it will bring 40,000 jobs and have also been told that, on its own, it will not be a silver bullet. The report today serves as an illustration of that point.”
“I thank the Minister. Considering that the main plank of the 2011 Transforming Your Care (TYC) plan was an ageing population with greater need, what formal assessment has been made of that need, and what plans have developed as a result?”
“I will be brief, as I only want to say that I concur. Amendment No 19 did exercise the Committee, and, after substantial toing and froing and a reasonable amount of tension between all involved, we eventually arrived at the amendment. We welcome the provision from the Department and the assurance from the Minister that it will not be delayed. <BR /> <BR />To add to the comments that were made by Pam Cameron, you only have to watch your television at night to see the extent to which advertisers recognise that there is an online market for food. It is a sensible provision, and we welcome it.”
“<BR /> <BR />The Committee Stage of the Bill was largely non-contentious and has the broad support of the Health Committee and stakeholders from the private sector. Against that backdrop, I welcome the Minister bringing forward today's amendments. As was described, most are technical and are of a procedural nature, but they do not distort the original purpose of the Bill.”
“The consideration of this legislation by the Health Committee has been a valuable experience, with each clause and schedule undergoing extensive scrutiny to ensure the legislation is best placed to fulfil its policy objective. In that context, it is important to take this opportunity to commend all those involved in bringing forward today's Bill, including the Minister and the Department for accepting the Committee's concerns about online purchasing and the timescale for review changes; the Food Standards Agency — I see that two of its officials are in the Chamber — for its diligent work and advice to the Committee; councils; and all the stakeholders who engaged with the Committee during the scrutiny process.”
“It builds on the voluntary scheme that was outlined and removes the weakness associated with the scheme, whereby a number of businesses with a lower rating failed to display their rating stickers publicly.”
“As was highlighted, that was a voluntary scheme, and it played a very valuable role as a pilot by establishing an overall authority. The Bill adds further architecture to that. <BR /> <BR />We can agree that Botanic Avenue, the Lisburn Road and the Ormeau Road, along with many other areas in my constituency, are bustling and vibrant areas that are populated with diverse food and drink opportunities. That needs to be celebrated, and there is no doubt that the food hygiene rating scheme has added to public confidence across Northern Ireland by providing eateries with the best possible incentives to provide the service that we expect. <BR /> <BR />Against that backdrop, the Bill can only be welcomed as a step in the right direction.”
“I welcome the Food Hygiene Rating Bill, which, as was described, is designed to build on the voluntary food hygiene scheme and prescribe in law a mandatory obligation for restaurants and some shops that sell food to display food hygiene rating stickers. We have heard how it will give customers valuable information to make informed decisions and provide a strong incentive for businesses to comply with existing hygiene law. <BR /> <BR />We have come to learn the value of the food hygiene rating scheme in promoting public confidence in many establishments. If, for example, you were to take a walk down Botanic Avenue in south Belfast, as I did last night, you would see a multitude of dining establishments, all proudly displaying their five-star rating.”
“I thank the Minister for giving way. He will not want to get into a protracted debate at this stage because a lot of this will be debated in Committee. Part of the evidence that we heard was about academic research. What safeguards and guarantees will be put in place to ensure that such information will not be forwarded to the very organisations that, he says, should not receive it?”
“<BR /> <BR />Although I see merits in the Bill — I should re-emphasise that — in information sharing between appropriate health and social care agencies, we must ensure that any information shared is not mishandled or used purely for commercial purposes without the consent of the patient. Until the House is satisfied that those concerns have been fully addressed by the safeguards in the Bill, the SDLP cannot support it in its current format. However, we look forward to the Health Committee rigorously examining the Bill and making its recommendations.”
“Will organisations have to pay a fee for the data to be extracted, and, if so, how much? The principles and associated actions in the Bill will no doubt place greater financial burden on the Department. At this stage, we do not know how much, but can we infer from the work carried out in England that there will be an additional cost? We have already seen from the reduction in the 2011 Budget and onwards and in the current financial context that, quite often, plausible initiatives fall by the wayside as a result of the need for additional fiscal resources in a climate of cuts. A good example of that has been Transforming Your Care.”
“It is important to note in the debate that our Bill's remit is even wider than the English Act. The English Act makes consideration only for medical care, whereas this Bill makes consideration for medical and social care. We have already reflected on the questions that attaches to that wider gate, if you like. That provokes more questions about the disclosure of patient data and what safeguards should be in place to ensure that their data is protected from exploitation. <BR /> <BR />Will the Minister provide clarity on what organisations can apply for access to data? Will the data be available only to organisations in or through Northern Ireland? We have already heard questions about the status of the committee that was suggested and whether it "may" be set up as opposed to whether it "should" be set up.”
“I refer to an article in 'The Guardian' on 6 June, which reported that 700,000 patients have had their information shared despite making attempts to opt out of the process, as was in the legislation. There are 700,000 people out there who sought not to have their information shared yet have had it shared. Will the Minister give us some assurances that the Bill will contain robust provision for making sure that that could not happen here? <BR /> <BR />To compound the issue further, a recent review of the data care programme in England, which, I remind the House, will operate under very similar — almost copycat — legislation, found major issues with:”
“I am not confident that the Bill tells us. That raises the question of whether the Minister can give assurances that patients' data will not be disclosed to third parties; for example, merely for commercial purposes. The House has to ask itself whether that would be an acceptable position to be in. <BR /> <BR />The Health and Social Care Information Centre in England is charged with the processing and disclosure of medical information under section 251 of the Health and Social Care Act 2012. That organisation is now rolling out its data care programme, which allows information to be sold to insurance companies and big pharma companies. Only this month, it came in for considerable criticism.”
“Clause 1(1)(b) to refers to "the public interest". What exactly do those terms mean, and who decides in that context? Further questions arise in the use of the terms "care or treatment" and "social well-being of an individual". As I highlighted, most concerning is the fact that the Department has yet to define those terms and provide robust definitions of the circumstances in which patient data can be disclosed without consent. What is "the public interest"? What is the "social well-being of an individual"? In what exact circumstances can patients' data be disclosed?”
“What does that mean? <BR /> <BR />Clause 1(1)(a) refers to:”
“We see that as part of this process of finding out how robust the safeguards in the Bill actually are. For the record, I will give a few examples. Clause 1(1) states:”
“<BR /> <BR />It is important in the context of today's debate that we look at ways to build systems and devise ways of working that meet the standards and services that we and the public expect. I am trying to suggest a positive approach, but, of course, as has been highlighted, there are issues to be addressed. England and Wales have moved to legislate on the issue. I am glad that we have reached Second Stage today, but a number of important issues require closer scrutiny. <BR /> <BR />There are significant concerns about the intent and wording of the Bill. As was reflected, the Committee heard evidence that the legislative process outlined includes a catalogue of inconsistencies and areas of potential confusion, and that further information should be sought.”
“It involves the public interest test as part of the duty of confidentiality, and consideration has to be given to data protection and human rights laws. However, it is now clear that that alone is not enough, and we heard that reflected. <BR /> <BR />Through engaging with many clinicians and considering the invaluable work undertaken by the Cancer Registry at Queen's, it has become explicitly clear that there is a need for change in this area of health reform, and that is accepted. They told us that the law governing their work in profiling diseases, which aims to improve diagnosis rates and treatment outcomes, is confusing. There exists a real possibility that legal proceedings could be taken against them.”
“I, too, welcome the opportunity to contribute to this very important debate, and to do so as SDLP health spokesperson and member of the Health Committee, which, as you heard, recently received briefings from the Department on the principles and objectives of the legislation. <BR /> <BR />It is clear that we support all measures and actions that are undertaken to ensure that the provision of health and social care services are the best that they possibly can be. Disclosing patient data that will improve diagnosis and treatment outcomes has to be welcomed, but effective checks and balances must be provided when a patient's consent is not expressly given. <BR /> <BR />Just by way of background, disclosure without the patient's consent is governed largely by common law.”
“— it is up to the universities to make a decision. Given the importance of science degrees and the potential expansion of the cancer centre in south Belfast, which could bring very well paid jobs, will the Minister indicate that he will put further pressure on the universities to look more favourably on the type of degree that could lead to those better-paid jobs?”
“The Minister's answer reflects part of my concern, which is about making sure that degree courses that are relevant to the future economy will go ahead. However, in reply to a question for written answer and in this reply, the Minister indicates that, fundamentally, despite his advice or encouragement —”
“I thank the Minister. The SDLP sees the apprenticeship model as being a strong tool for freeing up the issues around long-term unemployment, but what steps can be taken to ensure that any such apprenticeships will lead to longer-term employment for students and not to a situation where we have a conveyor belt of reduced-cost labour, for example?”
“We believe that it is a step in the right direction in giving autonomy to and protecting some of the most vulnerable in society. However, as we have reflected, some improvements can be made, and we look to further analysis, if you like, by the Ad Hoc Committee and scrutiny of the Bill and the Consideration Stage next in this Chamber.”
“I would like the respective Ministers to give an indication of what plans exist for facilitating such training and give assurances around funding. <BR /> <BR />There is an obvious need to ensure at the outset that the various bodies and individuals operating under the Bill are adequately funded and resourced. The Chair of the Ad Hoc Committee referred to finance and the extra cost, and I am sure that it would be beneficial to have some sort of an economic audit carried out on that because, while some people see everything as cost, could there be savings to be had as well? Budgets will be cut, and that has been reflected. We need assurances that the principles of this Bill will be deliverable once the scheme of practice is implemented. <BR /> <BR />To finish, the SDLP is supporting the general principles of this Bill.”
“The review concluded that existing cultural and organisational practice amongst all professionals involved in the care of vulnerable adults must change, because they were failing to implement the ethos of the Act. This concern must also be reflected here today, and the issues of ageism and existing perceptions about learning disabilities must change. The process of implementing this legislation needs thorough consideration, as it requires a significant amount of education and training across levels of care, including health and social care staff; capacity assessors, as outlined in the Bill; and specialist professionals such as social workers, doctors, hospital staff and all those involved in the criminal justice system.”
“I welcome that approach, but, in fleshing out the guidance, we have to ensure that there is a clear measure of support available, whether that is through minimum standards or otherwise. We need to ensure that when older people are making important decisions about their future, which often happens in urgent or time-critical situations, they are given the best opportunity to make their own choices. <BR /> <BR />At this stage, I will focus on the practicalities of the Bill. Last year, there were serious concerns highlighted by the House of Lords over the implementation of the Mental Capacity Act 2005 in England and Wales, which the Health Minister referred to.”
“There are issues involving parental responsibility and its interaction with existing legislation. That will need to be clarified. <BR /> <BR />Also, we must ask whether the provisions of the Bill reflect the particular needs of certain groups in society. Considering the prevalence of dementia in our society, the scale of which I have outlined, and other age-related mental conditions, coupled with the fact that we have an ageing population, we must ensure that action is taken that protects and provides safeguarding and proofing for older people. In that regard, the Bill calls for suitable and adequate support to be given to individuals when all decisions relating to capacity are taken.”
“The Bill has been described as representing a paradigm shift in the approach to the care and treatment of individuals with mental disorders. No longer will they be treated or seen as a separate class of individual. Capacity will no longer be defined differently among people, which has to be recognised as a positive move. <BR /> <BR />Some of these issues have been addressed, but it is important to reinforce them. There are issues that need to be resolved in this Bill, even at the outset. As has been reflected, there needs to be clearer provision for people who are aged under 16. That group will not have rights under the Bill's provisions, and there needs to be clarity over what action will be taken to ensure that young people benefit from having effective safeguards and protection in place on issues relating to capacity.”
“<BR /> <BR />I welcome the general principles of the Bill, as I have said, and its aim of empowering vulnerable adults with impaired mental capacity to make as many of their own decisions as possible. I welcome the fact that adequate legislative measures and safeguards are in place to ensure the individual is protected when decisions have to be made on their behalf. As I have already reflected, it is also positive to see David Ford and the Health Minister embracing the Bamford report to this point and its recommendations by bringing forward the single piece of legislation. <BR /> <BR />With this Bill, we have an opportunity to be world leaders in setting the best standards achievable for vulnerable adults who may lack, even intermittently, the capacity to make important decisions for themselves.”
“It was finalised in 2007 and recommended a single piece of legislation that would provide a framework for reform of mental health legislation. <BR /> <BR />It is appropriate at this point to mention that the SDLP previously noted its concerns over the Bamford action plans and the appropriate funding being made available to implement them. To stress that point: they have not been successfully funded by successive Health Ministers, and there is a broad spectrum of individuals who do not receive the appropriate level of care or support that they need. It is important that the Assembly reflects on that today. However, it is positive, in the context of today's debate, to see some outcome from the Bamford action plans.”
“That has proved problematic in developing the quality of services that we want, and it has not helped to promote public confidence around a very sensitive issue. <BR /> <BR />It is important to take this opportunity to commend all those involved in bringing forward today's Bill. It has been an arduous task by any measure, and I am sure the scrutiny by the Committee — it has had five meetings — reflects that. We should praise all those stakeholders who have engaged with politicians and the consultation exercises and the Ad Hoc Committee deserves recognition, as I have said. <BR /> <BR />As we all know, the development of the Bill has been a long process, starting back in 2002 with the Bamford review, which was commissioned to examine the best possible way to provide services to people with mental health issues or a learning disability.”
“It is in that context that we see how important today's Bill will be for those with mental illness and their families and extended families. <BR /> <BR />For decades, Northern Ireland has lagged behind the rest of the UK in not having a fully tailored legislative framework for mental capacity. Instead, we have relied on the antiquated Mental Health (Northern Ireland) Order, which wraps mental capacity around mental health disorder in the common law, relying on the outdated principle of necessity. The concerns of those with mental illness have historically been separated from the treatment of capacity in general. That remains the case in England, Wales and Scotland, which have proceeded with developing legislation that has been enacted for a number of years. We have been lagging behind due to the absence of an exhaustive framework.”
“As SDLP health spokesperson and a member of the Health Committee, I support the general principles of the Bill. The wide scope of the Bill is to be welcomed. It will directly impact on everyday and more serious decision-making for many vulnerable groups, such as those linked to health, welfare and finance. <BR /> <BR />Just to give some statistics, in Northern Ireland, we have almost 20,000 people suffering with dementia, 1% of the population suffering from schizophrenia, some 13% suffering from depression and almost 214,000 carers here for people who may lack capacity. All those people and many others may need important decisions to be made on their behalf, or they may need to make decisions for other people.”
“In the context of what I have been saying, we want money spent properly; we want a proper Budget. We said from the outset in 2011 that there were insufficient funds. We need to see proper funding for government here.”
“We have also heard Simon Hamilton say that he has established a regional leadership group to drive transformational change, but he had all that in the plan: he had a consensus ahead of the plan, which developed into the targets that were never implemented. He had a plan, but he is rapidly turning into a man with no plan. In light of that, the Minister must re-evaluate the Transforming Your Care model so that the system does not further deteriorate and staff are not placed under further pressure. I will accept an intervention at this point.”
“I am deeply worried that what we are hearing now is an attempt to throw a smokescreen around a failed plan. We have heard the Minister talk a lot about reform since taking his post. He says that he wants a world-class health service and that he wants health staff to embrace reform to tackle resistance to change. I am sorry that that is where the Minister finds himself: appealing to staff for change. <BR /> <BR />The TYC document made one very important point at its core. It said that failing to plan for the future would lead to unplanned and haphazard change that would not be in the best interests of patients. That is exactly what we have been seeing.”
“I am going to take the Speaker's advice, Mr Wilson, because there is no extra minute for giving way. <BR /> <BR />Now, the plan is not so much a plan: according to some departmental officials, it is a "philosophy"; according to the Health Minister, it is about the "principles" of TYC; according to the new Health Board chief, TYC was in the "context" of 2011. The context of 2011 has increased in 2015. You can see where they are going here. Is the plan still a plan? In that context we should all be worried that the concept of measurable change has been diluted and that millions of pounds have already been spent with questionable noticeable change. <BR /> <BR />I have already, in the midst of the headlines around that issue, approached the Audit Office to investigate TYC.”
“We have had two years of obfuscation, and now we are hearing something different. Now, the plan is not so much about a plan —”
“However, these cuts will be further compounded in this financial year, especially if the leaked commissioning plans published by the 'Irish News' are anything to go by. <BR /> <BR />Financial crisis or not, these cuts are completely counter-strategic to the TYC plan and do nothing but increase pressure on the system and negatively impact on the care that patients receive. It is the SDLP that has been saying that, and it has become increasingly clear that more people are beginning to accept the narrative, none more so than the recent Liam Donaldson review, the Audit Office's general report and the Northern Ireland Human Rights Commission's report into health and social care. Remember, we have asked some very basic questions over the last two years. Where was the plan? What were the targets? How were they being implemented?”
“<BR /> <BR />In light of the recent monumental healthcare failures and financial crises, we have to ask ourselves whether the health service is reforming for the better and whether the plan is still valid. As I said, that was four years ago. We would have had reasonable expectation of progress; but the SDLP has been asking questions about the plan, its budget, implementation, measurement and targets. In the end, we have a patchwork of targets, with trusts making decisions in silos, cutting community services, creating health inequalities, and with no central strategic plan. <BR /> <BR />As you know, during the tail end of last year, the five health and social care (HSC) trusts made a number of supposedly temporary service cuts as a result of financial crisis. We would like to know whether those are still temporary or not.”
“The SDLP has had suspicions about a privatisation agenda, but few have disagreed with the concept of taking care closer to the home and that that was the way to go. The plan was to shift healthcare provision from centralised institutions and into the community. If it was about anything, it was about the future strategic direction of health provision here. It was meant to be a three-year to five-year plan. It was anticipated that it would cost over £70 million and that we would see a stabilisation of health spend by now because, remember, that was in 2011, and we would see savings of £50 million per annum. If we had implemented it, we would not be in the state we are in today. That was the TYC business case endorsed by the Executive.”
“<BR /> <BR />The service here employs almost 55,000 people, who are dedicated professional staff working to the highest standards; but it is concerning to see the ongoing pressures suffered by staff on the front line and the numerous escalation measures in crisis management protocols that have been instigated. These are clear symptoms of the problem; they are not the cause. I think that the cause lies in policy and strategic direction. <BR /> <BR />We all know about the major change agenda in the system called Transforming Your Care (TYC). That represents, in essence, a number of things: first, a consensus about what is wrong with the system, and, secondly, a plan about how to deal with it.”
“<BR /> <BR />The SDLP has indicated these failures in the health service time and again, and it is clearly very much in the public mind; but, remember, our current health financial situation has not yet been impacted on by welfare reform. It is brought into the argument all the time, but an important point to remember is that Health was protected in this year's Budget and was given an additional £204 million to protect front-line health services; but that has not stopped our series of Health Ministers seeking to hide behind the welfare issue.”
“<BR /> <BR />We all know that the narrative we are facing at the moment is that we are facing ever-increasing waiting times; issues with hospital deaths and non-reporting A&E crises; incomprehensible breaches in 12-hour and four-hour targets; we are paying twice because of operations brought in through another system; our health staff are increasingly under significant stress and pressure; cancer drugs are being denied to our most vulnerable; and the service is witnessing massive wastage with bank and agency staff spend, among others. The public rightly have a genuine concern for how the system is being run.”