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.”
The complete record
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“The Committee has raised issues about the speed at which regulations are being made, and it has requested further information on the analysis of the expected impact that regulations will have to ensure that there is sound evidence for extending or easing restrictions. <BR /> <BR />The Committee was briefed by the Department on these rules at its meeting on 18 February. I note that members were disappointed by the lack of detail provided by the Department, especially on the discussions on changes to the click-and-collect rules. The Committee raised issues with the Department on click-and-collect rules in relation to regulations considered by the Assembly on 8 February. The Committee did not receive any further clarity on that issue from the Department at its meeting last week.”
“<BR /> <BR />The regulations in front of us today are about some very practical purposes, such as allowing driving instruction on behalf of the emergency services and allowing customers to collect Motability vehicles. However, even now, some of these regulations are out of date following Executive announcements last week on the extension of the lockdown period and changes to click-and-collect rules, and we know that we will get additional amendment rules to scrutinise in the coming weeks. <BR /> <BR />This serves to highlight the difficulty in scrutinising and debating regulations that we know will be out of date.”
“First, I place on record the thanks of the Health Committee to all those health and social care workers out there who continue to work in such difficult and trying circumstances, and whose dedication to helping those most in need and the vulnerable over the past year has been inspirational. <BR /> <BR />I, too, welcome Mr Poots back to health and back to the Chamber. He reminds us that many people out there are struggling with many other conditions and that the health service is trying to cope with those along with COVID and all the problems that predated it. Minister, we also appreciate everything that you are doing to get us through this very difficult time.”
“You touched on the issue in a previous answer, Minister, but will you expand on it? As a representative of a rural community, I am aware that this is a time of year financially when spare cash is often directed towards improving roads. I am sure that we all continue to see roads in poor condition, as I have today. Would you be open to a further bid for road maintenance, Minister?”
“That has been acknowledged several times, Minister, but there is still an absence of any sort of east-west passenger locator form. As well as a robust all-island approach, we also see to see a robust both-islands approach. In the run-up to Christmas, you indicated that you were looking at passenger health locator forms as a way of improving our tracking and management of east-west travel. Is there an update on that?”
“It is clear that COVID-19 does not recognise borders, which speaks very much to the need for enhanced collaboration and working together. Will the First Minister outline the practical benefits of all-island cooperation in managing our response to the public health emergency?”
“<BR /> <BR />The developments with vaccines are hugely welcome and provide scope for hope that the worst days of this can be behind us. However, we all recognise that, given the current situation with new variants across the world, there is no certainty with vaccines. We need to maintain the other public health measures, reinforce and increase the strategy of find, test, trace, isolate and support, and that needs to be kept in parallel with positive developments around the vaccines.”
“<BR /> <BR />As previously discussed, members have concerns about the limitations of post hoc scrutiny and the continuing approach of legislating without formal consultation and impact assessment. It is acknowledged, however, that this opportunity for debate allows Members to place their views on record and, we trust, inform subsequent regulations. <BR /> <BR />I will now make a couple of brief remarks as Sinn Féin's spokesperson for health. First, we recognise that these restrictions are necessary and are designed to stop chains of transmission. We also understand that these powers would not be necessary if there was not a pandemic. However, there is a growing understanding that a cycle of lockdowns and easements is not sustainable and has negative consequences.”
“That will provide assurance that lessons have been learned and that restrictions are being eased or put in place appropriately. <BR /> <BR />At the briefing by officials on 28 January, the Committee sought clarity on a number of issues, including the rules for indoor gatherings under regulations 5 and 5(5)(a). A number of members also sought clarity on the rules for click and collect and highlighted concerns about an uneven playing field between small independent retailers and multinationals. The Committee was advised that the Executive were further considering the issue, and I would be grateful if the Minister could outline progress on that matter.”
“The Committee received very late notice of the briefing and the rule, and accompanying papers had to be tabled at the meeting, giving members minimum opportunity to consider the rule. <BR /> <BR />I have previously outlined on prior regulations the urgency with which the regulations are being made and the resulting lack of prior engagement. The Committee has enquired about efforts to analyse the impact to ensure that future regulations are informed by such learning. Indeed, that issue was raised directly with officials at the briefing on 28 January. I ask the Minister to ensure that the Committee receives the rules in a more timely manner, alongside an analysis of the expected impact that the easing or putting in place of restrictions would have.”
“It is with great difficulty that the Committee has considered the statutory rules that place restrictions not only on what we can do but on our interactions with family and friends. However, we understand that we need to do all that we can to reduce the pressure on our health service and its staff, who are working under extreme pressure. We are also thankful for the continued roll-out of the vaccine programme, which provides us with hope that there will be an end to the restrictions. <BR /> <BR />This specific rule came into operation on 7 January and makes a number of provisions, including restricting gatherings, introducing restrictions on movement from home, and introducing a power to direct people to return home. The Committee was briefed by the Department on the rule on 28 January.”
“The Health Committee understands all too well the impact that the pandemic has had not only on our health service and its staff, as referred to at the outset of the Minister's remarks, but on all our people right across the North and, indeed, right across the island. <BR /> <BR />I am conscious, as we discuss the regulations this afternoon that, taking the combined figures from NISRA and the figures from the Twenty-six Counties, 6,134 people have lost their life to COVID. Every one of them is an individual, family and community tragedy, and I send sympathy and condolences to everyone affected. <BR /> <BR />The past 11 months have been difficult for everyone, and I thank the vast majority of people who have followed the restrictions that have been put in place.”
“I offer again my condolences to everyone who has been a victim of the pandemic in any way and for those who have sadly lost their lives. <BR /> <BR />The report is on the impact that COVID-19 has had on care homes, especially during the first surge, but many of its warnings and lessons would have been suitable for consideration before the COVID pandemic and will remain suitable afterwards. Care home residents are not just patients but have wider family and friends. COVID-19 has a considerable impact on their relationships and visiting, and there is stress about loved ones catching it. I recommend the report to the Assembly.”
“<BR /> <BR />I will make a few short remarks in my role as Sinn Féin's health spokesperson. I thank every one of the stakeholders who participated in this, including independent care home providers, family members, the unions and many other groups and organisations who assisted us with the report. I also acknowledge the strong cross-party work by all members during the inquiry. It was clear that identifying the flaws and areas of concern was done constructively and in a bid to offer workable solutions and recommendations. I hope that the Department and Minister will consider each in that spirit and commit to their implementation. <BR /> <BR />As a personal reflection, I say that the impact that this devastating pandemic has had on our people continues to weigh heavily on us all.”
“That said, there is so much work to do, and recommendations in the report have potential read-across to other sectors in the case of future pandemics. The good news is that we know what needs doing: adult social care reform and wider transformation of the health service have never been more urgent. The mental health toll of the pandemic will require a long-term investment. <BR /> <BR />The recommendations in the report were developed in a collaborative manner and agreed unanimously and are offered in a spirit of constructive engagement as a contribution to future pandemic planning. We look forward to engaging further with the Minister on the implementation of the recommendations and trust that the Executive will give positive consideration to the financial support required to do so.”
“On behalf of the Committee, I also thank the Clerk and Committee staff, who put so much work and effort into the completion of the report. <BR /> <BR />Members will, no doubt, join me in thanking and acknowledging once again not just our precious care home staff but the wider health and social care family, who continue to struggle to get us through the emergency after what have been eleven exhausting months. I wish to convey the Committee’s appreciation to the Minister and his senior officials for their positive engagement with the Committee throughout the period, and I acknowledge the number of positive initiatives that were implemented in a short few months. <BR /> <BR />Case numbers and pressures remain worryingly high, but the vaccination programme is already offering protection in our care homes and some hope for the wider community.”
“<BR /> <BR />Having heard impressive evidence of the success of other countries in learning from SARS and containing the current pandemic, we recommend that renewed efforts be made to gather and learn from the breadth of international experience of pandemic planning and management. <BR /> <BR />Human rights concerns were raised in respect of visiting, testing and end-of-life planning. The Committee recommends that guidance be developed on the consideration of human rights issues during a pandemic. <BR /> <BR />In conclusion to my remarks as Chair, the Committee wishes to put on record its gratitude to the 691 individuals who took time to respond to our survey, the families who engaged with us virtually and the stakeholders who appeared before us and informed our recommendations with their experiences, concerns and ideas.”
“<BR /> <BR />While the Committee recognises the enormous pressure under which Health and Social Care (HSC) and departmental staff were working at all levels and the considerable volume of guidance developed and advice put in place, communication and engagement issues were central to criticisms raised with us. The Committee was concerned to hear on several occasions that initiatives had been introduced without prior engagement with providers or unions. Co-design, co-production and robust communication plans remain essential, even in a pandemic, and could have averted some of the problems raised with us.”
“<BR /> <BR />Moving to pandemic planning, the Committee believes that a key lesson for the future is ensuring that care homes are at the very centre of pandemic planning from the outset. There should be centralised procurement and supply of PPE to care homes without charge and ring-fenced funding that can be accessed quickly via a streamlined and transparent mechanism. The Committee endorses the call in the rapid learning initiative for accredited regional training on infection control. The Committee recommends that each home be required to designate an appropriately trained staff member, other than the manager, to lead on infection control.”
“Members were concerned to hear of the adverse impact on residents' overall well-being of reduced access to podiatry, occupational health and other care. There is a need for consistent implementation of the policy regarding in-person access to care homes as is deemed necessary by the health and social care professionals concerned and subject to testing and PPE requirements. <BR /> <BR />Advance care planning (ACP) issues were also raised with the Committee. That conversation needs to happen with each care home resident on an individual basis, ideally well ahead of any crisis. It should be led by the clinician who knows the individual best, with the input of other relevant professionals, and should be reviewed periodically as required.”
“The Committee welcomes the ongoing work being led by the Chief Nursing Officer on an enhanced clinical care framework for care homes.”
“The Committee endorses the Minister’s desire to ensure that providers can be inspected corporately, rather than the RQIA being confined to looking at each home individually. <BR /> <BR />The Committee also welcomes the Minister’s review of regulation and believes that there must be consequences for failures of care. We recommend consideration of models by which quality and delivery of care can be linked to funding and reviewed in future contracting arrangements. There should also be the capacity to recoup public funds where poor service has been evidenced. <BR /> <BR />With regard to access to health and social care, while we heard impressive reports of innovation and the use of technology to provide safe and effective care during the pandemic, there are clearly limits to approaches such as virtual ward rounds.”
“<BR /> <BR />Turning to regulation of the sector, stakeholders expressed appreciation for the advice and support role provided by the Regulation and Quality Improvement Authority (RQIA) during the first surge of the pandemic. Others expressed concern at the consequent reduction in inspections at a time when oversight from families and other professionals going into homes was almost non-existent. The Committee concluded that inspections and dedicated advice and support need to be resourced to continue in a pandemic. <BR /> <BR />The RQIA briefed the Committee on its move to a risk-based assurance framework and on its research to identify a number of key characteristics associated with homes most at risk of an outbreak. Those included larger homes and larger providers, as well as those with recent or frequent management changes.”
“Caring for dying residents and grieving relatives has undoubtedly taken its toll on their mental health. Access to the Health and Social Care psychology helpline was appreciated in that regard. <BR /> <BR />Staff support was also offered by trusts and brought in via agency workers. Each solution created other difficulties, adding to pressures in the health service generally, as well as increasing risk of infection through staff movement. Efforts must continue to ensure that, where possible, agency staff work in one home only. Recognising the workload, the Committee also wants to see staff ratios for care homes agreed in discussion with stakeholders.”
“For many, it is a vocation rather than a job, but we must look at recognition, reward and retention in what is a hugely challenging work environment. While the Committee welcomed the Minister’s commitment guaranteeing sick pay, we are calling for urgent reform to address low pay, poor terms and conditions, and additional measures to make social care a more attractive career in the time ahead. <BR /> <BR />Moving on to issues with staff levels, understaffed homes had to manage sickness absence and staff self-isolating as a result of COVID-19. Others were unable to come to work due to caring responsibilities, with schools and day centres closed. Care workers’ responsibilities increased, with symptom monitoring, increased infection-control measures, and providing additional care to large numbers of unwell residents.”
“A number of very welcome additional funding allocations were made available: some £6·5 million in April; £11 million in June; and a further £27 million in October, as well as staff support and PPE. Questions remain, however, about underspends arising from administrative constraints, leading to the Committee’s recommendation that streamlined processes are required, subject to audit and verification, but they need to be flexible to allow care homes to meet their needs at any given time. <BR /> <BR />Throughout the past year of the pandemic, we have asked some of our lowest-paid workers to shoulder an enormous burden on our behalf. The skill and value of that work is long overdue proper acknowledgement.”
“Having heard very worrying evidence of PPE shortages in the spring, aggravated by a global shortage and spiralling prices, it came as a great relief to hear by May that supplies to care homes had stabilised and were being provided free of charge, which we understand remains the case for the moment. There remains a longer-term question around procurement, and the Committee recommends that charges should not be imposed on care homes without a review of the tariff. <BR /> <BR />The pre-existing strain on the sector regarding funding, staff levels and staff terms and conditions was exacerbated by COVID, which generated additional costs from staffing to cleaning and support for visiting.”
“<BR /> <BR />From an early stage, the Committee expressed concerns about patients being discharged from hospitals to care homes without a negative test. That was reinforced by evidence on the challenges of isolating older and vulnerable individuals, particularly those with cognitive decline. The Committee recommends that no one be discharged from hospital to a care home in which they are a resident without having tested negative for COVID-19 unless the care home confirms that it has the staffing and facilities to ensure isolation for the required period. That should be subject to monitoring and review. We continue to believe that step-down isolation facilities should be explored as a way of further reducing risk.”
“<BR /> <BR />Our report endorses their calls for safe and meaningful contact to be facilitated through identification and implementation of innovative measures, rapid roll-out of the care partner initiative and better communication and consistent implementation of guidance. <BR /> <BR />Significant progress has been made on testing since this time last year. It is certainly one of the key elements to addressing this and any future pandemic. The Committee recommends that, subject to rapid testing becoming available, there should be daily testing of all those who enter a care home, including residents who have attended an external appointment. Capacity issues remain. The Committee recommends further consideration of pooled testing in order to make better use of existing capacity and an increase in local capacity to test and analyse results.”
“One of the sessions that really hit home for me and, I think, other members was an informal Zoom call that we had with families of residents, who described the traumatic impact of visiting restrictions on the physical and mental well-being of their loved ones, the importance of ensuring meaningful contact and the limits of technology for those with sensory or cognitive impairment. They recognised the sterling work that was being done by staff to provide care in the most difficult circumstances and the risks that were involved in visiting. However, they were clear that the risk had to be managed in communication with families and that it must also be balanced against the harm that would be caused by isolation as their loved ones approach the end of their life.”
“There was virtual consensus on a number of significant points on pandemic planning from the acknowledgement of pre-existing workforce shortages to initial problems with PPE supply and testing capacity. <BR /> <BR />Mr Speaker, you will be glad to hear that I do not intend to go through all 54 recommendations. However, I want to give the House a sense of the areas that we looked at in the report. <BR /> <BR />With regard to visiting, whereas the Government's speed of response was challenged, I do not believe that anyone could have said the same of care homes; most had restricted visiting or closed their doors before they were actually told to do so.”
“As of 1 January 2021, 775 of our care home residents had died with COVID-19, which is some 40% of all registered COVID-related deaths. It was clear from the early stages of the pandemic that there would be significant impacts on older people, particularly care home residents. Much of the Committee's work in the spring was focused on that area, prompting our decision in July to conduct an inquiry. <BR /> <BR />In setting its objectives, the Committee agreed that it wished to be forward-looking and to put its energy into learning from recent experience in order to provide constructive suggestions for the future. Many of the issues, from staff terms and conditions to workforce shortages, and funding and regulation, brought the wider question of adult social care reform into sharp focus.”
“Minister, we need you absolutely to be a Minister in every sense of the word.”
“We need to see all those things happening. Too often, we have waited for others to lead and we have then followed that lead. First of all, we should be leading for ourselves — with the devolved powers that we have, there is no reason why we cannot do that. However, to follow England, which has one of the worst track records in the world, is a crucial mistake. We need to tailor our solutions to the situation that we are facing. <BR /> <BR />To finish, Minister, in the Irish language, the word for Minister is Aire, as you may or may not know; you will hear it occasionally here in the Chamber. The word is Aire. Aire has two other meanings in the Irish language, and they are relevant here. The second meaning is to take care of someone or to protect them. The third meaning of Aire is to listen to, to pay heed to or to pay attention to advice.”
“So, we need to see better space within schools. We need access to remote or blended learning to be made available to all to ensure that we do not increase inequalities in education, as we have seen increasingly in health. Ventilation issues need to be addressed in schools. As I mentioned earlier, the test and trace system needs to be put in place in schools to let them get on with education and to allow the public health authorities to deal with find, test and trace.”
“We need to see more appropriate steps being taken and taken faster in what we are doing here. If we are delaying the reopening of schools, that delay needs to be for a purpose. We need to be doing things with the time that we are putting in place.”
“We have been too slow at times — and still are — to put in place a proper find, test, trace, isolate and support system that is effective across the community and that supports the continuing educational needs and does not put teachers and children in vulnerable situations. We have been slow to see a blended learning approach being used, which schools are ready and welcome to embrace, in order to prevent further increases in the transmission of COVID-19. <BR /> <BR />Minister, this is in the context where we have fully devolved education and health systems. We have the opportunity to move quickly, to be agile and to take measures which are appropriate to what is happening here and to the needs of our community. We have, at times, squandered that ability.”
“<BR /> <BR />We need to know, Minister, what the health and scientific advice is beyond 11 January and when you received the advice about when to open schools. While we all want to see schools open, it must be absolutely safe for them to do so and they must operate in a way that is safe. <BR /> <BR />At the start of the pandemic, the World Health Organisation issued guidance. Mike Ryan, in particular, said that the enemy in dealing with a virus in a pandemic is delay and that you have to act fast. That advice applies to education just as it does to health. <BR /> <BR />Too often, we have responded slowly here. We have seen where, at times, we have been too slow to close schools when it was necessary and to deal with the exam situation.”
“I thank the Minister for that intervention. <BR /> <BR />We are dealing with a situation where yesterday, in the past 24 hours, we have had 2,143 cases. That is 40% of all tests that are coming back as positive. We are looking at two significant mutations: one that emerged in the south of England and one in South Africa, both of which, potentially, have a considerable impact on younger people in terms of transmissibility and the effect and impact on them, and that is very worrying. While we all value education and want to see our children in schools, no more so than teachers themselves, we must recognise that schools are part of our community. They are vulnerable to and part of the transmission of the virus, and we need to take all of the steps that we are taking to recognise that.”
“I welcome the decision that the Minister has made, although it is very late in the day. Surely, the same information was available 10 days ago which would have allowed schools to plan better. However, we are operating in the overall context of significant and growing health concerns. In that context —.”
“Mr Allister is no longer in his place, but I want to comment, in light of what you said as well, that we heard reference — rather insulting, in my opinion — to "useful idiots". We are discussing this politically today in the context of politics. This has been a debate and a discussion right across our society. People who are involved in farming, agriculture, business and community development are entitled and were entitled to take part in that debate, and they have expressed their significant concern. That is why the protocol is necessary. The protocol is a result of Brexit.”
“Make no mistake about it: on a small island those things matter. We need to ensure that we are working effectively and cooperatively with each other. At present, we can see that the world has moved on and Britain has moved backwards. We cannot be dragged along in their wake; our society deserves better.”
“<BR /> <BR />As my colleague mentioned earlier, the issue of medical research and cooperation has been evident in the past number of months. However, we do not know about the future. Again, the Irish Government has said that it will guarantee the ERASMUS scheme, but those connections and relationships matter. We are about to throw a massive hurdle in the way of all of that, and it will impact on our system. <BR /> <BR />At present, we are all quite aware of the high-level cooperation with the North West Cancer Centre and paediatric cardiology services. However, there are over 150 other cross-border service level agreements. Some or all of those may survive this trauma. However, the ongoing development of those linkages for the benefit our population will now be under severe threat.”
“The new immigration system will very negatively impact on many future EU citizens: citizens who we need, value and who contribute in a range of ways across our business and health and social care sectors. Surely, if we have learnt one thing from COVID, it is that the skilled workers are those who provide care, supply equipment and work on the front line. We are now going to place additional barriers to their entry to our job market. We are going to put them through language tests and place salary levels at a point that will discriminate against them. Again, there is a notion of a skilled economy, but we need workers who have a range of skills and many of them will be discriminated against as a result of the regime that has been brought in.”
“We depend on an integrated supply chain for medicines. At the very last minute — a number of weeks ago — an arrangement had to be arrived at whereby an additional 12-months supply was bought. That was not a solution to the problem, but breathing space to try to find a solution. However, those are the types of problems that Brexit is piling up for us. There is no good Brexit; we did not vote for it, but we are being dragged out along with the English Government. The Member opposite talked about Brit-bashing. There has not been much need for that because they are doing quite a good job of that themselves through the self-inflicted exit from their current trade deal. <BR /> <BR />There is also a significant problem that has been discovered in recent weeks.”
“Doctors, nurses and other regulated professionals will now have to wade through a maze of red tape to have their qualifications recognised, whereas at present there is a seamless system in place. I believe that that will have significant impacts on cross-border health workers who cross the border in both directions. <BR /> <BR />I have been discussing the issue of medicines and essential supplies with the Department of Health since 2019. We had been assured all along that the issue had been dealt with: supply chains would deal with the issue, and everything was in place. At the time, I made the point to officials that it does not matter what plans are made if lorries cannot get out of Kent to bring the medicines here; that is going to create a problem. We have seen that writ large over the past couple of weeks.”
“<BR /> <BR />As part of my research for this debate, I serendipitously came across the fact that the collective noun for turkeys is a rafter. At present in Westminster, we are seeing a rafter of Tory turkeys voting for Christmas at Christmas time and cheered to the rafters by the DUP all the way. <BR /> <BR />Unfortunately, we all have to live with the damaging and lasting impacts that that is likely to bring, and that includes the health sector. We are seeing the loss of the European health card. While the Irish Government have stepped in to ensure that the card continues, there are no guarantees and we need to see how that scheme rolls out in practice.”
“Absolutely. In my role as Sinn Féin's health spokesperson, I agree that that is a critical point. <BR /> <BR />I also heard Members on the opposite Benches quoting Winston Churchill extolling taking opportunity from difficulty. He could hardly have meant that you would create the difficulty in order to find the opportunity, so I do not think that that is overly relevant either. <BR /> <BR />The Member opposite talked about looking at the negative and at the doom and gloom. Surely he read the British Government's own analysis right at the start when they identified that, given that this was the first time that a nation had entered trade negotiations to take themselves out of a trading arrangement, there would inevitably be additional costs, including non-trade, non-tariff costs.”
“It is ironic that the First Minister and the previous contributor mentioned the vaccine. Yesterday, I welcomed the fact that over 33,000 people here have received the Pfizer vaccine. It was developed by a Turkish immigrant who was working with a German company in conjunction with a Belgian manufacturing plant. The world has moved on, while Britain has moved backwards. There is no question that narrow English exceptionalism and interests have taken over here.”
“Thank you for that answer, Minister. It is important that the Irish Government honour their commitment to co-fund the project. Will you comment on how much of the Shared Island Fund the A5 is expected to receive and whether you are considering multiple simultaneous phases of the project?”