Colm Gildernew
Fermanagh and South Tyrone · Sinn Féin · Northern Ireland
“I thank the Minister for his statement. I have been working with Dungannon Chamber of Commerce and Industry. It will welcome this work, particularly in light of its concerns about vacancy and protecting the retail heart of towns such as Dungannon.”
“I thank the Minister for his answer. Minister, you said that there has been an improvement. However, recently, there were reports of over 1,400 patients waiting more than 28 days. How will you ensure that trusts consistently meet the targets for suspected cancer appointments in particular?”
“However, the Committee will want to examine carefully how any new or amended powers would operate in practice. Powers relating to information sharing, official warnings, directions, removal from office and disqualification can have significant, long-standing consequences for charities, trustees, staff, volunteers and, indeed, public confi…”
“<BR /> <BR />The regulations are consequential to the uprating order and provide the supporting technical changes needed to ensure that the revised benefit rates operate correctly. The regulations increase the earning limit for carer's allowance from £196 a week to £204 a week.”
“In response to those findings, Minister Hargey introduced the Charities Bill, which was enacted in 2022. The legislation put in place many of the review's priority recommendations in the limited time remaining in that mandate. The Charities (Amendment) Bill represents the next stage of that reform programme.”
“The Committee will wish to explore the implications of those changes, including for organisations operating across jurisdictions or delivering charitable activity in or from the North. Our charity sector includes a diverse range of bodies.”
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“Minister, you have largely answered my question on the expungement of records. Clearly, you are aware that it is taking place in the Twenty-six Counties. Are you indicating a firm commitment that the records of those who have been victims of trafficking and who have been convicted of prostitution or offences of that nature will be expunged?”
“My intervention was not about that; it was about capacity. The suggestion was that charging might be used to manage capacity rather than developing the necessary capacity.”
“I recognise the point that the Member is making around capacity. However, does he agree that it is not up to the sponsor of this Bill, necessarily, to deal with the capacity issues, and that, by and large, no one is parked at a hospital unless they need to be there, either by reason of visiting a loved one, receiving treatment or working, so the capacity issue is one for the Department to address? Does he agree that the unfair taxation on workers and those people who have to access the car parks by car is more for the Department?”
“Will the Member accept that the Bill sponsor has indicated that, in Scotland, number plate recognition is being used to address that issue.”
“For those people to then be faced with a barrier going in and having to pay for parking is an additional pressure that we should address. <BR /> <BR />The other thing I want to say clearly is that the abolition of hospital car parking charges must be a stand-alone measure. It can have no impact on negotiations for a pay settlement for the health and social care sector. It is entirely separate from that, and it is important that we send a message from the House that we genuinely value Health and Social Care workers, we will demonstrate that value and we will tackle the inequalities that flow from hospital car parking charges.”
“Asking those families to then pay exorbitant rates to park their car at a hospital is often a matter of asking them to make hard choices in their family budgeting. <BR /> <BR />Hospital car parking charges are an unfair tax on our already burdened Health and Social Care workers. At a time when we are working to retain and recruit key front-line healthcare staff, passing the Bill would be a practical indication to them that we support them and will ensure they are not being unfairly taxed. It also needs to be set in the context of the number of weekends over the past month or two that staff have been asked to come in from their leave, to leave their families, to abandon their break and to come in to pull the health service out from pressure.”
“A large part of my constituency is rural, and I know that there are constituents who are in poor health and can ill afford charges, with the impact of reduced income, additional travel and all that flows from that. By way of example, in Brantry, County Tyrone, which is in my district, if you do not get on the blue bus at 8.15 am, you are not getting the bus, and there is one bus home in the evening. That highlights the real inequality for those rural dwellers in certain areas who have a lack of access to public transport. Patients and their families in rural areas of Fermanagh and Tyrone who have to access treatment in Belfast, Derry or Enniskillen have significant additional travel costs in fuel and wear and tear to their cars.”
“There were also questions about current concessions for free parking in hospitals and whether or, indeed, how they could be expanded to include other patients and visitors. <BR /> <BR />Providing that it passes Second Stage, the Committee looks forward to engaging with stakeholders and scrutinising the Bill in further detail. <BR /> <BR />I would now like to make some remarks as Sinn Féin health spokesperson. First, I thank my colleague Aisling Reilly for bringing forward this very important Bill. Car parking charges create inequalities for patients and their families who access hospital facilities. In particular, car parking charges cause inequalities for those from rural communities, who have poor infrastructure and cannot easily access buses or trains.”
“Finally, she highlighted that charges have already been abolished in Scotland and Wales. <BR /> <BR />Members asked questions during the briefing, including on the financial impact of the Bill. The Member outlined that the annual cost to trusts would be approximately £8·8 million per year. Members asked how trusts could ensure that free parking would not be abused and become an option for commuters. Members outlined that they wanted to ensure that parking was available to those who needed it most. There was a discussion on the use of technology to ensure that parking is not abused. The Member explained that number plate recognition was used in Scotland, which is something that the Department and trusts could consider.”
“She also outlined that a significant number of health workers have to pay an additional charge of approximately £60 a week to safely park at their place of work. She indicated that the cost can vary between trusts and even within trusts. For example, to park for the day at the City Hospital costs £11, whereas, at the Royal, it costs £5. That is a significant amount for some of our lowest-paid health workers to pay and has resulted in many staff having to park off-site, which has its own health and safety implications. The Member outlined that parking costs for patients and visitors were adding to already difficult situations when the focus should be on getting better. Aisling also outlined the significant impact that parking charges have on rural dwellers who cannot rely on public transport to attend hospital.”
“I welcome the opportunity to make some initial remarks on behalf of the Health Committee, outlining our consideration of the Bill, before speaking as my party's health spokesperson. <BR /> <BR />As the Bill sponsor has outlined, this is a relatively short Bill of three clauses that essentially inserts a new article 3A into the Health and Medicines (NI) Order 1988, preventing the Department, trusts and other health service bodies from imposing charges for parking for staff, patients and visitors to hospitals. The Committee was briefed by the Bill sponsor on the principles of the Bill at our meeting last Tuesday. The Member provided the Committee with an overview of the need for the Bill and the consultation that had been undertaken.”
“Will the Minister clarify whether those 84% were contacted personally or via a text message?”
“Minister, over recent weeks, there have been significant and worrying increases in pressure on a range of emergency departments, including the Royal Victoria Hospital, Craigavon Area Hospital, Antrim Area Hospital, Altnagelvin Area Hospital, Enniskillen hospital and the Ulster Hospital. Will you confirm whether minor injury units at hospitals have experienced similar pressures?”
“That requires clear messaging, clear communication and clear leadership by the Department of Health, in the first instance, and by the Executive. I hope that we see that clear leadership emerging as we enter a difficult winter period.”
“Those people need to reflect on the impact of what they are saying and causing, but I also think that there should be a more structured response around tackling and challenging that misinformation. <BR /> <BR />My experience is that the vast majority of sensible people understand that this is a global pandemic that continues to rage around the world; continues to affect our people here; continues to cause people to become seriously ill; continues to cause people, particularly young people, to develop long COVID; and continues to take the lives of members of our community. In that circumstance, I believe that people understand that we have an obligation and a duty to act and to do something about that.”
“We need to send a very clear message to the public about why we are asking them to continue to abide by that guidance. <BR /> <BR />That is a considerable impact that is related to just one measure, but, of course, we know and understand that it takes many layered, interwoven and interdependent measures to create a credible public health response. That is why an updated strategy is needed. It was needed before the winter of 2020, and it is still needed today, before the winter of 2021. <BR /> <BR />I will also very briefly touch on the issue of the misinformation that is circulating in the community. Disgraceful and shameless lies are being told at gatherings by people who claim to have scientific knowledge.”
“As restrictions are being lifted, what is the goal and strategy of the Minister's Department? How does that match up with the pressures that are facing health services today and in the months ahead? <BR /> <BR />I asked the Minister in September how the Department monitors face-covering compliance and enforcement. It was disappointing to hear that there are no formal measures in place. Does the Minister believe that compliance can be reliably monitored and, if so, how might that be done? <BR /> <BR />I draw attention to a recent study that received considerable attention, and I want specifically to make the House aware of it today. It was in the 'British Medical Journal', and it found that mask-wearing cuts COVID-19 incidence by 53%.”
“Last year, almost to the day — 23 November — the Assembly passed a Health Committee motion in relation to an updated strategy, but we have not really seen an updated strategy to date. That motion called on the Minister to:”
“We, as a Committee, often see the rules only after they have been made. That has caused some issues; members have had questions that officials have not been able to answer. I encourage the Minister to bring back the SL1 stage to allow the Committee sufficient time to consider any changes. I am thinking especially of rules related to possible COVID certification. The Committee agreed to recommend that these health protection regulations be approved by the Assembly. <BR /> <BR />I will now make some remarks in my role as Sinn Féin spokesperson for health. It is important that the regulations are considered in the context in which they are made, and with the desired outcome understood.”
“We would like further information to be provided to the Committee when we are considering these rules in order to allow us to apply full scrutiny to decisions that have been taken. <BR /> <BR />The Committee also highlighted some concerns in relation to the enforcement and monitoring of the adherence to rules and guidance. Members of the Committee highlighted the need for a more robust process of gathering information on enforcement and adherence. We are concerned that enforcement is largely left to individual businesses to take forward, which can put business owners in a difficult position. I would appreciate it if the Minister outlined his views in relation to how we can enforce rules at this time. <BR /> <BR />The Committee also states its concern about the legislative process.”
“By following them, we will save lives. <BR /> <BR />It is of the utmost important that we see the successful roll-out of the booster programme over the coming weeks, as that will help cut the risk for some of the most vulnerable of contracting COVID-19. I encourage anyone who is eligible to get the booster vaccine to get it as soon as they can. <BR /> <BR />In relation to these regulations, it would be good to hear from the Minister today about what the impact has been since the relaxation of the restrictions. Has there been any impact on the number of cases or, indeed, the numbers in our hospitals? The Committee remains concerned about how information and modelling is used to make decisions in the Executive.”
“The pandemic has had a major impact on many people in our communities. Many have lost loved ones, and our thoughts are very much with each and every one of them and their families. <BR /> <BR />We have seen the impact of the pandemic on our health and social care staff. They have done an amazing job in very difficult circumstances. I thank those staff for their hard work and continued dedication throughout the past 21 months. <BR /> <BR />We have seen the impact that the pandemic has had on our already creaking health system, and there remain a consistently high number of people with COVID in our hospitals. Indeed, we now see increasing pressure on our hospitals as we once again move into the winter period. That is why it is important that people continue to follow the rules and the guidance in place.”
“Once again, I am regrettably in the position of having to condemn threats made against the Minister and threats and abuse that have been directed towards other Members of the House in the course of doing their duty. I particularly underline the fact that disgraceful graffiti that appeared in my constituency is in no way reflective of people in that constituency's views. I express my solidarity and support for the Minister in his work and condemn the disgraceful, faceless attacks that continue to circulate. <BR /> <BR />I will make some very brief remarks as Chair of the Committee and then some comments as my party's health spokesperson. This is the twenty-sixth occasion on which I have spoken on behalf of the Committee about health protection regulations related to the pandemic over the past 21 months.”
“<BR /> <BR />The Committee seeks the extension owing to the extremely heavy workload in front of it and the large number of Bills that it has to scrutinise before the end of the mandate. The heavy workload means that the Committee has to meet twice a week to be able to consider all the evidence for the Bills and to get them through Committee Stage before the end of January. The Committee therefore requests an extension to 28 January 2022. The proposed extension will allow as much time as possible for detailed consideration while balancing consideration of other Bills. <BR /> <BR />I commend the motion to the House.”
“The Abortion Services (Safe Access Zones) Bill passed Second Stage on 12 October 2021 and was referred to Committee Stage the following working day. The Bill requires the Department of Health to establish safe access zones around buildings that offer sexual and reproductive health services and makes it a criminal offence to harass people in any safe access zone. <BR /> <BR />The issue of protests outside healthcare clinics came up during the Committee's evidence gathering on the Severe Fetal Impairment Abortion (Amendment) Bill, and there has been a significant response to the Committee's call for evidence. It is planned that oral evidence on the Bill will commence in December.”
“That, a chairde, is another important step on one of the most fundamental challenges facing the Assembly, our community and the island. The Bill, with the proposed amendments, can act as a real catalyst towards that shared ambition and goal. I support the amendments and the Bill.”
“It must provide secure, properly staffed, fairly paid work and career opportunities for our invaluable front-line health and social care workers, who we must now surely recognise as the real backbone of our community. <BR /> <BR />Transparency and accountability must be an integral part of the transformation going forward, and so I am also a strong proponent of amendment No 2. That amendment places a duty on the Department of Health to bring forward its regulations on the AIPBs, subject to the draft affirmative procedure, meaning that the proposal must come before the Assembly and the Committee for scrutiny. That will ensure that there is Assembly and Committee representative input and sign-off on the new model when those plans are complete.”
“It must recognise the unique demographics and geography of this place and serve everyone in our community in a way that effectively and fairly meets our growing health and social care needs, whether urban or rural, east or west and, indeed, North and South. It must fundamentally and effectively bear down on the unsustainable inequalities that exist throughout our physical, mental and social care systems at present. We cannot continue to tolerate postcode lotteries, mental health underspending or the lack of social care to support our loved ones to live out their lives in a place of their choosing with the support and dignity that they so richly deserve.”
“Transformation of the health and social care sector has to be designed and delivered collaboratively between the people who commission the service, those who use it, those who deliver it and those who can provide their unique perspectives as experts with experience.”
“One of the principles of the Bengoa expert panel was that the system should be collaborative, not competitive, and should work in partnership across government and with industry, academia, the community and voluntary sector, staff and patients to deliver new models of care, and, further, that the remodelling of the system should be a transparent and collaborative process. <BR /> <BR />It is with that in mind that I am a staunch proponent of the amendment relating to the continuation of local commissioning groups, allowing them to remain in place until the Department finalises its proposals for the replacement area integrated partnership boards. The transformation of any system can succeed only when the local voice of knowledge, expertise, connection and commitment is part of the decision-making process.”
“I place on record the thanks of myself and the Committee to the Minister and his officials for their ongoing engagement with us throughout the Committee Stage. <BR /> <BR />I will make some remarks now as a Sinn Féin MLA and the party's spokesperson for health. The Bill is a first step in the important and vital project of transforming the health and social care system. The move to close the Health and Social Care Board has been widely agreed upon by past Ministers, including my party colleague joint First Minister Michelle O'Neill when she was Minister of Health. As we know, our entire health and social care sector is under unprecedented pressures, and while those pressures have been worsened by the ongoing COVID pandemic, they are hardly new. The need for a major overall and complete transformation has never been more evident.”
“The regulations will be subject to the draft affirmative procedure, giving the Committee and the Assembly the highest level of approval. The Committee looks forward to considering the regulations when they are brought forward. The rest of the amendments make the necessary changes to allow the provisions of the first two amendments. <BR /> <BR />As I mentioned, members agreed to support the Department's amendments and wish to thank the Minister and his officials for taking the Committee's concerns into account and addressing them. The Committee looks forward to continuing engagement on the new structures. I also place on record my thanks to the Committee team and the Bill Clerks for supporting members through scrutiny of the Bill in such a challenging time when workloads are extremely heavy.”
“The Committee also requested that any reports should outline how the new ICS addresses health inequalities in our communities. <BR /> <BR />The Committee welcomes the amendments proposed by the Minister. The Committee was briefed on the amendments on 21 October and agreed at its meeting on 4 November that it was content to support the amendments and therefore would not table its own amendments. Amendment No 1 provides for the continuation of the local commissioning groups beyond the closure of the board and will make LCGs statutory bodies. The LCGs will remain in place until the Department makes regulations in respect of the area integrated partnership boards. <BR /> <BR />Amendment No 2 places a statutory duty on the Department of Health to bring forward regulations on the AIPBs.”
“<BR /> <BR />Before speaking on the amendments, I will address one of the other key concerns for the Committee: openness and transparency in decision-making. Significant resource is allocated when decisions are made on the commissioning of services, and the Committee believes that there should be a robust accountability framework that provides not only the Assembly but the general public with the necessary reassurances that decisions on the commissioning of services are evidence-based and meet the needs of the local community. The Committee sees the reporting framework as key to ensuring accountability, transparency and public confidence in decision-making. The Committee is content that any accountability framework and reporting regime will now come back to the Assembly through the amendments proposed today.”
“It was the Committee's view that an amendment of that type would allow the retention of the LCGs until regulations were drafted and ensure that there was no vacuum in local engagement and input. The Committee further agreed that the LCGs should cease to exist once the regulations on the new model were approved. That should prevent the Department from having to double-run the two systems. <BR /> <BR />The Committee considered options for amendments provided by the Bill Clerks and agreed amendments to clauses that would provide the Committee with the necessary assurances that it sought. The Committee was also advised that the Department was considering proposing amendments, and the Committee agreed that it would not table its amendments until it had considered any amendments proposed by the Department.”
“<BR /> <BR />At that point, the Committee agreed that it wished to see an amendment made to the Bill to include provision for legislative powers that placed a statutory duty on the Department to bring forward regulations on the new ICS model and framework to be laid in the Assembly, and for such regulations to be approved by the affirmative resolution procedure. It was the Committee's view that such an amendment would ensure that the Committee and the Assembly would have oversight of the new model and that a higher level of scrutiny would be afforded to the Assembly in that instance. In addition, the Committee outlined its concerns about the possible loss of local input during the transitional arrangements. The Committee agreed that any amendment should reflect an additional requirement that LCGs be retained.”
“<BR /> <BR />At a briefing on 9 September, the Department advised that the new AIPBs would not be in place when the board and LCGs were dissolved, as the new system needed to develop and mature, and that any legislative process could be restrictive to the development of the new framework. The Department advised that it would not be tabling any amendments to address the Committee's concerns. At its meeting on 16 September, the Committee considered the Department's response and remained of the opinion that it would be difficult for it to support the clause if unamended. The Committee maintained its concerns that the Bill, as currently drafted, did not include any statutory underpinning for the new health and social care system that would be in place upon the closure of the board.”
“The Committee looks forward to seeing the Department undertake further and ongoing engagement work. <BR /> <BR />The Committee values the important contribution that HSC stakeholders can make to the future planning arrangements and encourages the Department to continue to adopt a collaborative approach to that work going forward. At that point, however, the Committee remained unsatisfied about the lack of certainty and detail on future arrangements, and, at the start of July, it asked the Department to consider tabling amendments that would allow LCGs to continue until the new framework was in place. The Committee also agreed that it wanted to see an amendment that would provide the Assembly with a role in the scrutiny of the transitional arrangements.”
“The draft framework document provided information on what the ICS model would look like. It will include provision for a regional group, five area integrated partnership boards, as the Minister outlined, and locality- and community-level structures. The framework document also sets out the Department's views on the development of governance, accountability, finance and budgetary arrangements. <BR /> <BR />The Department undertook a targeted consultation on the future planning model draft framework document between 19 July and 17 September 2021. The Committee welcomed the consultation on the draft framework and, additionally, the consultation on the development of a new independent appeals process for family practitioner services contractors as being important first steps in garnering key stakeholders' views.”
“It further advised the Committee that the expertise and experience of the LCGs, particularly their role in gathering local intelligence and informing the planning and delivery of services based on identified need, would be built on in the design of those groups. <BR /> <BR />The Committee remained concerned, however, that it did not have enough information on the future planning model and on what would replace the work of the LCGs. Following the briefing session with the chairperson and the chief executive of the HSCB on 29 April, we asked the Department to provide further detail and briefing on the new commissioning structures. The Department provided the Committee with an advance copy of the draft framework and advised of its intentions to engage with key stakeholders.”
“The Committee was concerned that removing the local commissioning groups would remove a significant amount of accountability and transparency from the decision-making process. The Department advised during Committee Stage that significant work was under way to develop a new integrated care system model, whereby local providers and communities would be empowered to come together to plan, manage and deliver care for their local population, based on a population health approach managed and delivered at a local level. <BR /> <BR />The Department advised that the new model reflected the importance of ensuring that local input and intelligence remained key to the shaping of HSC services that would meet the needs of the population.”
“I will now outline the Committee's views on those issues. Its primary concern was the lack of clarity on the future commissioning framework. The Committee had significant concerns about how local engagement and input into decision-making would continue when the Health and Social Care Board and the local commissioning groups were dissolved. During oral evidence, the Committee heard that there was a lack of engagement on the future planning model. We were concerned about that lack of engagement. <BR /> <BR />The Committee sees local engagement and input into the commissioning of services as being one of the key pathways to addressing health inequalities and ensuring that services meet local communities' needs.”
“They included a lack of clarity and detail about the new arrangements and, in particular, what would replace local commissioning groups; the Department's lack of engagement with stakeholders on future arrangements; a desire on the part of stakeholders to have input to the development of the future planning arrangements; diminished local input to commissioning; reporting arrangements; and whether the transfer of functions would deliver increased transparency and accountability and reduce bureaucracy.”
“<BR /> <BR />All the organisations that provided evidence to the Committee acknowledged the need for reform of our health and social care (HSC) structures, and a number of them welcomed the Bill as part of the ongoing transformation process. Members of the Committee shared stakeholders' views on the need for reform and acknowledged the Department's assertion that the closure of the board was an important first step on a wider transformation journey. The Committee also acknowledged that the closure of the board has been the policy position of the Department since 2015 and endorsed by three Health Ministers in turn, including Minister Swann. <BR /> <BR />During consideration of the Bill, the Committee highlighted a number of its concerns to the Department.”
“I welcome the opportunity to outline the Committee's scrutiny of the Health and Social Care Bill before commenting on the Department's amendments. The purpose of the Bill is, as referred to by the Minister, to give effect to the decision to close the Health and Social Care Board. Following agreement of Second Stage on 16 March 2021, the Committee issued a call for evidence. Nine written responses were received, and the Committee took evidence from the Department and nine other organisations. I thank those who responded to the call for evidence and subsequently gave oral evidence that highlighted their concerns about the Bill.”
“<BR /> <BR />During the briefing, the Committee sought assurances about the use of these powers by the Secretary of State on regulators in the North. The Committee was assured that any use of the power that would affect local regulators such as the Pharmaceutical Society would require that a new legislative consent motion be agreed by the Assembly. I welcome your addressing that issue directly in your remarks today, Minister. <BR /> <BR />The Committee sought further information on the power to extend section 60 to include senior NHS managers. I thank the Committee for the work that was carried out in relation to these LCMs and the Department and the officials for working with the Committee on them. The Committee was content with the LCM.”
“In relation to the final LCM about the regulation of healthcare and associated professions, the power sought in the Bill seeks to implement a wider reform programme, creating a more flexible regulatory framework for healthcare professionals. The Department outlined that it is essential that the provisions extend to the North of Ireland, as divergence may disrupt the movement of regulated healthcare professionals in and out of the North. <BR /> <BR />The provisions widen the scope of section 60 of the Health Act 1999 and allow the British Secretary of State to make changes, including the closure of a regulator, taking professions out of regulation where it is no longer required for the purpose of the protection of the public and providing for the future expansion of the use of section 60 to include senior NHS managers and leaders.”
“<BR /> <BR />The Committee also sought clarity on the use of the European health insurance card (EHIC), now that we are out of European arrangements. We were advised that travellers could make use of the global health insurance card (GHIC), which would cover healthcare provision in the Trade and Cooperation Agreement and in countries where there are reciprocal healthcare arrangements. The Committee recommends that there be a communication programme to inform travellers of that change. <BR /> <BR />Again, I flag up the need for better local engagement and input to the legislative consent process. We need to ensure that legislative consent does not have an unforeseen impact here. Local engagement and input is key to ensuring that. The Committee agreed that it was content with the LCM.”
“I will not go through the Committee's consideration of the LCM process, as I covered that in the previous debate; rather, I will outline the issues that the Committee raised about this LCM. <BR /> <BR />The Minister has outlined what the LCM on the international healthcare arrangements in the Health and Care Bill does in relation to the management of reciprocal healthcare with a number of countries. Essentially, it enables the British Secretary of State to implement bilateral healthcare arrangements with the rest of the world. During the briefing by officials on 14 October, the Committee sought clarity on any impact that the LCM would have on North/South cooperation on healthcare. It also sought an assurance that the Minister of Health would not be prevented from making healthcare arrangements with other regions across the world.”
“That is why I welcome the fact that the Department stated that the registry would be set up by the MHRA only when alternative approaches to capturing data were not feasible and there was sufficient public health need. There are criteria for when a registry could be initiated. It is important that the criteria are robust and adhered to meticulously. <BR /> <BR />I commend the LCM to the House and welcome the collaborative approach to the issue on a pan-UK basis.”