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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“We need to be able to identify how much is being spent to address waiting lists rather than having to write to the Department to request that information. <BR /> <BR />Recently, we received a briefing from NISRA on health inequalities in the North. The information provided was hugely concerning. We see an increase in health inequalities in key areas such as mental health and drug misuse and a life expectancy gap in males of over seven years between the most and the least deprived areas. Today, where you live has an impact on your life expectancy. If you live in the most deprived area, you will live, on average, seven years less than someone who might live just a couple of miles from you.”
“That has to be a priority in the coming years. <BR /> <BR />On scrutiny of spending plans and priorities, it can be difficult first to identify spending priorities and then to track that spending over the financial year, particularly in the complex area of health. The Department has such a large budget that we tend to get the headline figures with no real detail on total spend to tackle waiting lists, total spend to tackle health inequalities or spend in relation to mental health. Further work needs to be done in the Department and at Executive level to provide more information to enable the Committee to fully scrutinise spending plans and priorities and track how effective those plans and programmes are in delivering the outcomes that we are looking for.”
“That can be done by funding the implementation of the transformation programme and by listening to the experts: the health and social care professionals who are working in the system. A good example is the recent '10 Steps Not 10 Years' action plan from the Royal College of Surgeons. We also need to work with the unions and those who receive the services to come up with the solutions that are so badly needed. <BR /> <BR />I mentioned yesterday that only 0·7% of the Health budget has been allocated to transformation. That allocation is to keep already implemented programmes resourced. We know that investing money in the system now will provide savings further down the line. We know that investment in waiting lists, early interventions and prevention provides significant savings and better outcomes for patients.”
“OECD figures provide data that shows that the longest average wait for cataract surgery in 17 OECD countries is in Poland, at 250 days, with the average wait in England, Scotland and Wales being approximately 60 days. The Committee, however, received correspondence from an individual just this week who had been advised that the waiting time for their father's cataract surgery here is four years. <BR /> <BR />The length of waiting lists is having a significant impact on our constituents' and families' quality of life and a massive effect on health outcomes for patients. We need to do more. We need to help people, such as the person who is waiting for cataract surgery, to have a better quality of life.”
“I will speak on behalf of the Health Committee and then make some brief comments in my role as my party's spokesperson on health. <BR /> <BR />As the Minister of Finance outlined yesterday, the Department of Health has been allocated almost half of the entire resource budget, with a resource allocation of almost £6,451·9 million. There is no doubt that that is a significant amount of resource funding for the Department. It has indicated, however, that, despite that large allocation, this is a standstill Budget and there is no space or funding available to tackle backlogs and waiting lists. <BR /> <BR />We have to be honest and admit that our waiting lists are among the worst in developed nations across the world. An example is cataract operations.”
“Does this year's Budget provide the Health Department with funding that will allow it to progress a much needed transformation?”
“Will the Member outline any alternative suggestions that were put forward by his Minister to the Executive on the Budget?”
“Given your acknowledgement of the complex issues that educational welfare officers are equipped to deal with, Minister, have you given any consideration to investing in more educational welfare officers in order to help us emerge from the pandemic?”
“Has such a bid or proposal been brought to the Executive? Can the Minister provide any detail on that?”
“A recent report issued by Carers NI states that 79% of carers in the North have not had a break from caring during the past 15 months. That is unsustainable and is driving those carers to breaking point. We need to take that into account urgently. Carers cannot be left behind and ignored. They need to be supported and recognised. That needs to be done through restoring day-care and respite services; dealing with the restoration of those services; progressing the COVID-19 recognition grant for carers, which appears to be no further forward; and ensuring that the future reform of social care places carers at the centre of any changes. I thank all carers and health and social care workers. <BR /> <BR />Finally, the Minister for Infrastructure has indicated that she is prepared to allow money to be reallocated back towards Health.”
“We need to have the same level of commitment, creativity and urgency in dealing with waiting lists as we have had in dealing with COVID-19. <BR /> <BR />Many services for mental ill health face not only an increase in referrals but a noticeable increase in the severity and complexity of the care that is required. For example, between March 2019 and September 2020, referrals to eating disorder services jumped by 43% and those needing a review by 64%. Recently, there has been consultation on two considerable new strategies: a substance use strategy and 10-year mental health strategy. A lot of focus will be given to the content of those strategies, but also to the funding that is allocated to them; indeed, rightly so. <BR /> <BR />I also want to touch on the fact that this week is Carers' Week.”
“Yes, I agree. We need to utilise and mobilise every single piece of testing and to follow that up with tracing and supported isolation. I absolutely agree, and I thank the Member for raising that point. <BR /> <BR />I want Members to welcome the additional £495 million from the Department of Finance, though the Minister and I recognise that that is merely a drop in the ocean in relation to what is needed to tackle the problems across the health and social care sector. At its very core, the budget for Health is problematic, as it is non-recurrent and denies us the ability to plan and develop a first-class healthcare system that workers and patients are entitled to. However, we need to do everything that we can in the short term and not be paralysed by the lack of longer-term funding.”
“One of the practical measures that the Department of Health and the Public Health Agency (PHA) can undertake is a better communication strategy that informs our community of the full availability of testing and allows members of the community to take that up. <BR /> <BR />If we are to go into the autumn and winter better equipped to deal with the pandemic, the Department of Health must ensure that a comprehensive testing, tracing and isolating programme is at our fingertips and that it can be mobilised instantly when and where the need arrives. In light of that, I welcome the additional testing put in at Kilkeel over the weekend. To defend the community against the delta variant and COVID itself, we need to apply that type of localised support, based on find, test, trace and isolate.”
“<BR /> <BR />I now will make a few remarks as Sinn Féin health spokesperson. It is fair to say that the COVID-19 pandemic has upended our entire economy; nowhere is that more evident than in the health and social care sector. However, our problems of waiting lists and workforce pressures started long before the pandemic. We are not out of the woods yet, Members, in relation to the COVID crisis, as evidenced by the numbers of delta cases discovered in the North. I have heard recently from healthcare professionals and others working in testing centres of the low uptake of available PCR testing, with the suggestion that people are not aware of that programme.”
“<BR /> <BR />The Committee had has some difficulty in identifying spending on specific priority areas in the Department of Health's budget. For example, how much is it proposed that we spend on mental health and on cancer? What is the split between primary and acute care? How much is proposed to be spent on inequalities and even on addressing the waiting lists? When officials briefed us on the budget, significant time was taken on identifying the detail of proposals and allocations. Therefore, the Committee welcomes further work on providing more detail and granularity in the financial briefings to allow members to identify spending priorities and associated funding. The Committee will continue to monitor the budget and to seek to engage constructively over the coming months.”
“However, there is an allocation of only £22 million for MDTs in the budget. That does not allow for the expansion of MDTs; it merely provides continuing support for those that are in place. <BR /> <BR />We all share concerns about the length of waiting lists. The Minister outlined that it would take £1 billion over 10 years to address the waiting lists. I think that we can all agree that that needs to be a priority over the coming financial years and that there is a clear need for recurrent funding to make inroads into those waiting lists. Indeed, the Committee has written to the Executive to outline its view that there is a need for an Executive meeting solely on the issue of waiting lists. As we understand it, if that is to be addressed, it will require the whole Executive to commit to it.”
“The Committee welcomes the additional amount. However, the Department outlined that, with the lack of recurrent funding, it is essentially a standstill budget that will make it difficult for the Department to make any inroads into the waiting lists. <BR /> <BR />Over the coming years, we need to focus on the transformation programme. However, the 2021-22 Budget provides only £49 million for the transformation agreed under the NDNA agreement. That is 0·7% of the overall Health budget. While allocations for additional nursing staff and mental health are welcome, it does not go far enough. Over the past months, we have heard significant evidence of the very real benefits of multidisciplinary teams (MDTs) in primary healthcare. GPs have told us how beneficial they are.”
“I will speak first on behalf of the Health Committee, and then I will make some brief remarks as my party's spokesperson on health. <BR /> <BR />There is no doubt that the past 15 months have been an extremely challenging period for everyone, with the pandemic, lockdowns, disruptions and the loss of many loved ones in very difficult circumstances. It has been especially challenging for our health and social care system and its workers. I pay tribute to those staff who have sacrificed so much over the past 15 months. They have worked beyond what was expected of them, and we thank them all for their service. <BR /> <BR />The Committee was briefed by officials on the 2021-22 Budget and was advised that, as things stand, the Department anticipates additional funding of £495 million as compared with its opening baseline last year.”
“The Minister will be aware of the welcomed additional value that such an inclusion would have in the value of our beef output — up to 20%, some evidence indicates — and of the fact that the carbon footprint of our grass-fed cattle is much lower than the global average. Does the Minister agree that an all-Ireland PGI status would play a key role in recognising the fact that we have the world's most climate-friendly beef here on the island of Ireland?”
“Our health and social care system is in crisis. There is a huge challenge in the coming years to deliver the health services and care that our constituents need, deserve and are entitled to.”
“The Royal College of Surgeons advised today that, as of December 2020, over 323,000 people were waiting to see a consultant and 105,000 people were waiting for admission for surgery. That equates to one in four of our constituents waiting for the healthcare that they need, with some of them experiencing unbearable pain and stress. That simply cannot continue. We cannot address waiting lists without addressing chronic staffing shortages, and we need to see multi-year budgeting for that to take effect.”
“The health and social care sector is being challenged in ways that we have rarely seen. The state of our healthcare system has undoubtedly been worsened by the COVID-19 pandemic, but our problems started long before that. The Tory Government and their austere economic policies have failed, and nowhere is that failure clearer than in the emergency departments and the GP waiting rooms across the North that every one of us is dealing with. It is undeniable that austerity causes suffering. It causes workforce shortages, bed shortages and equipment shortages, and, most importantly, it denies our constituents the right to enjoy good health standards. <BR /> <BR />The waiting lists that we are talking about today are not a new story.”
“Although in-year allocations are, no doubt, hugely welcome in a very difficult system, Members will appreciate that they are not conducive to long-term planning, and the Committee underlines the need for a multi-year budget that provides the recurrent funding and certainty that we need to see. <BR /> <BR />In concluding my remarks as the Health Committee Chair, I say that there is concerning evidence of increasing financial strain in the health and social care system and little opportunity to make the type of progress that is needed to address those strains due to COVID-19 as well financial pressures. The Committee will continue to monitor the situation and seek to engage constructively as that progresses. <BR /> <BR />I will now make some remarks as Sinn Féin's health spokesperson.”
“While we appreciate the fact that many other factors result in health inequalities, such as housing and education, there is simply no doubt that health is a key component and that we need to see active planning rather than a restatement of the problems. We must ensure that our population all have equal access to services and equality of outcomes.”
“There is a clear need for recurrent funding in the coming years to make inroads into those waiting lists and, ultimately, see better health outcomes for patients. That needs to be taken on board by the British Treasury. <BR /> <BR />The Committee considered the issue of health inequalities. We raised concerns with officials and the Minister about what are increasing health inequality gaps, especially in relation to mental health and substance use. We continue to see large inequalities in health outcomes for large parts of the population. We need to see more work from the Department and the Executive in tackling health.”
“It was disappointing to hear that the funding set aside for transformation projects is largely to fund programmes that had previously been implemented, and that there is little scope to expand or introduce new transformation projects within the current budget settlement. <BR /> <BR />The Committee has significant concerns in relation to the length of waiting lists, which have been referenced by nearly every Member who has spoken. The COVID-19 pandemic has, no doubt, exacerbated waiting lists and left patients in very difficult circumstances, resulting in them needing more complex treatment by the time that they get around to their appointments. The Minister recently outlined that it would take £1 billion over 10 years to address the waiting lists. I think that we all agree that this needs to be a priority over the coming financial years.”
“That is a priority agreed across the Executive and reiterated in 'New Decade, New Approach'. The 2021-22 Budget provides £49 million for NDNA transformation. That is 0·75% of the overall health budget. While allocations for additional nursing staff and mental health are indeed welcome, it just does not go far enough. <BR /> <BR />Over the past number of months, we have heard significant evidence of the very real benefits of multidisciplinary teams (MDTs) in primary healthcare. GPs have told us how beneficial they are, and we see the reality of that where they exist. However, in this Budget, there is an allocation of £22 million for MDTs. That is not to allow the expansion of a very successful transformation programme but merely to continue to service the MDTs that exist.”
“<BR /> <BR />The Department outlined that it would be very difficult to achieve the effective delivery of strategies, such as those for elective care, cancer, emergency care and mental health, without recurrent funding and reliance on in-year monitoring. That is deeply worrying and should strike us all with fear as those are strategies that, if not resourced and implemented effectively, will result in poorer health outcomes for patients. I think that we all agree on the need for a health and social care system that is resourced in a way that produces better health outcomes for all our constituents. <BR /> <BR />The Committee raised a number of concerns with officials in relation to the budget. Everyone is agreed that transformation is essential to deal with rising costs.”
“At that briefing, the Health Committee was advised that, as things stand, the Department anticipates additional funding of £495 million compared with its opening baseline last year. While that additional amount is welcome, the Department did outline that, with the lack of recurrent funding, this is, essentially, a standstill budget that will make it difficult for the Department to make any inroads into the waiting lists that the Minister has called "dire" and "appalling". The Department's director of finance outlined that she is even more concerned about the 2022-23 position as the temporary COVID funds are, essentially, masking the scale of the underlying financial pressures within the system.”
“I rise to provide the House with details of the Health Committee's scrutiny of the 2021-22 budget. <BR /> <BR />First, I acknowledge the enormous pressure under which the health and social care system is working. I have said many times that the system has been stretched beyond breaking point. We are grateful to all our health and social care workers, who have sacrificed so much over the past year. It is true that our health and social care staff have been, and are, the greatest asset that we have. We need to do everything that we can to support them in their roles as we move out of fighting COVID-19 and into recovery, and addressing the very lengthy waiting lists and increasing health inequality gaps that we see right across the North. <BR /> <BR />The Committee was briefed by officials on the 2021-22 budget on 29 April.”
“Minister, there has been no progress on oral health outcomes. We have some of the worst in these islands. Given the profound health inequalities that exist and the underspends in the Department, will you commit to allocating resources to address that inequality?”
“I welcome all of the strategies and all of the plans and recognise that they are genuinely put together, but, if we do not have the workforce, we will not be able to deliver it. Sin a bhfuil uaim.”
“We cannot go further without mentioning the mental health and well-being of carers, who, even before this pandemic, were placing their own health and self-care and mental and physical health before those who they are caring for. This year has been unbelievably tough, and they cannot be left behind any longer. We need support for our carers. <BR /> <BR />The Take 5 Steps to Wellbeing campaign is a truly and ingeniously simple but effective campaign that promotes positive mental health. I also think that it is important that people think about their mental health and well-being where they work or in their place of study and that employers play a role there too. Securing a good work-life balance is important to mental health and well-being. Finally, and very briefly, we need the workforce.”
“We need increased access to counselling GPs, and we need resource targeted to CAMHS to provide children and young people with access to services that they need, when they need them and where they need them. We need to effectively listen and to put in place the effective responses. <BR /> <BR />I now want to make a few remarks as Sinn Féin spokesperson for health. I declare an interest in that I previously worked as a social worker. It is widely recognised in the sector that, if we could do more earlier, we would see the benefit not only for health and well-being but even down the line with cost savings and in supporting people better before the crisis has become a bigger issue.”
“It is important to highlight the fact that behind every one of these statistics are individuals, families and communities that we need to support through the most difficult of circumstances. <BR /> <BR />Over the past week, we have heard many good examples of work being done in the community and voluntary sector to promote mental health and well-being across our entire population. We have also heard on many occasions about the very positive impact that multidisciplinary teams are having in primary healthcare settings and the real benefits of GP surgeries having access to counselling and talking therapies. What we need now is the financial support and resource to respond.”
“<BR /> <BR />One of the worrying lines that was repeated a number of times over the week was that there will be a tsunami of additional mental health issues coming out of COVID-19 and that we need to prepare, resource and fund additional access to counselling services in GP surgeries and through the community sector to deal with that oncoming tsunami. <BR /> <BR />We also received a briefing from the Department on health inequalities. The statistics on mental health inequalities across the North are stark. They are ingrained, and, worryingly, there appears little evidence that the funding of services is sufficiently impacting on those health inequalities.”
“I welcome the fact that there was an indication that there will be more spend to come, although it is marginal, going from 8% up to 10%. However, some of the things there are a step in the right direction. There is a recognition that the waiting list fluctuates at times as a result of vacancies, and I hope to come back to that later. <BR /> <BR />It was also stark to hear of the level of service provided by the community and voluntary sector because the trusts do not provide it and to hear that that sector is picking up the slack on all of that. For example, the only counselling service that the Belfast Trust, the North's largest trust, provides is as part of its Lifeline suicide prevention service, and that is at the very top end of the scale.”
“<BR /> <BR />Many of the organisations that we met last week emphasised the size, complexity and sheer scale of the task at hand. We have seen in the media recently the extent of the waiting lists for children and young people to access the child and adolescent mental health services (CAMHS). Recent information from the Department states that there are over 900 children and young people on the waiting list for CAMHS, with over 380 waiting more than nine weeks for access to services. That is clearly not good enough for our children and young people. I want to acknowledge, however, that we received a letter from the Minister yesterday, I think, with further information on CAMHS, and I look forward to looking at that in more detail.”
“<BR /> <BR />The young people highlighted the good work being undertaken in the voluntary and community sector, which we in the Chamber recognise, because we have all experienced that. They outlined the work happening in youth clubs, sporting organisations and others to encourage them to discuss their mental health and well-being. They also argued, effectively in my opinion, that sometimes it is easier to talk in a sport setting or at a youth club than it is in school or more formal settings, where they told us that it can, at times, feel like a box-ticking exercise to discuss mental health. That is not to take away from the massive amount of very good work that is being done in education settings. Again, however, we need to listen to and heed what we are hearing and to respond where we can.”
“I have to say that the Deputy Chair also said not to rule her out in that respect, so I suppose that we will just have to watch that space. <BR /> <BR />It is very clear that positive mental health is about more than just health services. It is about social interaction, being connected, being active, feeling involved and being heard, which is an important element. It is, therefore, understandable that COVID-19 and the lockdowns have had a significant impact on not only the well-being of our children and young people but everyone who was starved of that social interaction for long periods and is now slowly being allowed to interact more normally. We need to ensure that we support our children and young people through that process. We need to listen to and heed them and to respond effectively.”
“Some of the comments from the young people included them saying, "Give us the right help at the right time", and, "We need help and support services outside Monday to Friday 9 to 5". We need to listen to that and to respond effectively to what they are saying. <BR /> <BR />During the meeting, they all emphasised how much they missed social interaction with their friends. They said that they missed going to school, participating in sport and going to the local youth club. They also mentioned not being able to go to discos and socialising there, which was effectively put on our agenda during an earlier debate this morning. Many of us here will not be rushing back out to discos any time soon, apart from maybe Justin.”
“Hopefully, we can give a voice to those young people this afternoon. <BR /> <BR />One of the young people outlined how difficult it was to know what services were available to them, and that is coming from young people who are generally tech-savvy and fairly well informed. They outlined that just knowing that support is there and where they can find and access it was, sometimes, all the reassurance that they needed. <BR /> <BR />One of the other key issues that they highlighted was that they need support at the time of a crisis and that support down the line is often not appropriate. We heard about the long waiting lists and the fact that they cannot access services at the point of need, which, at times, puts them off seeking support. That is a worry.”
“In today's debate, it is important to reflect on what our young people are telling us about mental health and well-being. They very articulately outlined that they fear not being heard and that we are not listening to their worries, concerns and fears. They said that, too often, we get stuck talking about — what we all recognise as buzzwords — strategies, implementation and monitoring and that we do not listen to their views, opinions or real-life experience of the very different and difficult pressures they face today. That is the true essence of co-design, whereby people can take ownership and feel that they have been heard and responded to. We need to harness the creativity and energy that young people bring to the debate, not dismiss it. Those young people were very clear that they know what they need and when and where they need it.”
“We deeply appreciate you all taking the time to share your experience. We all agree that some very good points were raised during the meeting, and, throughout the debate, you will hear from Committee members about some of the comments and suggestions made.”
“I especially thank Kirsty and Julie, who shared their lived experience of the help that counselling has provided to them in very difficult circumstances. <BR /> <BR />I also thank, deeply and sincerely, all the young people who met Committee members last Wednesday night to share with us the impact that lockdown has had on them. A very special thanks goes to Lee, Deirdre, Destinee, Ciara, Orlagh, Jamie, Darragh, Troy and Niall.”
“Last week was Mental Health Awareness Week. During the week, the Committee for Health met a number of organisations and individuals in order to help us better understand the real impact that COVID-19 has had on our mental health and well-being. <BR /> <BR />First, I thank all those organisations and individuals that met the Committee over the course of the week. We very much appreciate the expertise and experience of every one of them. I thank the Royal College of Psychiatrists (RCPsych), Inspire Wellbeing, Action Mental Health (AMH), the Psychological Society of Ireland (PSI), Voice of Young People in Care (VOYPIC), YouthAction, the Children's Commissioner, the interim mental health champion and the #123GP campaign.”
“However, the Committee's role is to scrutinise legislation, and the process leaves the Committee unable to undertake that role effectively. If the junior Minister could indicate any ideas that are being discussed that might improve our consideration, it would be greatly appreciated. However, the Committee agreed to recommend that the Assembly approve the regulations.”
“Members raised a number of other issues, including engagement with the hospitality sector, plans to pilot non-socially distanced events in the North and cross-border travel. <BR /> <BR />There is continued frustration among members of the Committee at the limited opportunity that the Committee has to consider COVID-related rules. I acknowledge the Chair of the Executive Office Committee's remarks on the hard work involved, but the Committee would like to be able to scrutinise the regulations more effectively, not only the pace of easing but how we deal with cases where easing might create further problems. I raise the issue every time that I speak about the regulations, and the Committee continues to raise the matter with the Department. We understand that there are tight time frames.”
“It is important that we follow the rules and guidance as they are eased, because, ultimately, this will allow us to move more quickly to the point where COVID has less impact on our lives. <BR /> <BR />The Committee was briefed on the regulations at its meeting on 6 May. The Department's briefing gave Committee members the opportunity to discuss the regulations in more detail, and a number of issues were raised. Members continued to raise the issue of the change of messaging from "Stay at home" to "Stay local". There were concerns about the definition of "Stay local" and how that would be enforced by the PSNI. We were advised that the issue is under consideration by the Executive.”
“<BR /> <BR />Last week, during Mental Health Awareness Week, the Committee met a number of groups and many young people to discuss the impact of COVID-19 on them. A number of young people highlighted the fact that they missed school, sport and social interaction with their friends. One mentioned that they missed discos. That highlights the important role that relationships play in improving our well-being, and the fact that these rules will allow more access to our friends and family is welcome. It is absolutely brilliant — I think that we all agree — to see children and young people out and participating in sport again. Long may that continue. <BR /> <BR />Again, I need to state that this is a process. I urge everyone to continue to follow the guidance and regulations that are in place and not to push or bend the rules.”