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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“It is brilliant for us to clap for health and social care workers on a Thursday night, and very well deserved, but we are hearing ongoing concerns about access to PPE and difficulties in testing, so one of the best things that the public can do at this time is to stay at home in order to protect and not overburden our health service. I look forward to the time when these measures are no longer necessary, when we have the testing and contact tracing systems in place to do as the global experts say — to test, isolate and trace — but we are not there yet. <BR /> <BR />In a recently published guidance document, the World Health Organization advises a number of steps that need to be in place to deal with the situation. The first is that transmission is controlled.”
“The WHO indicates that these measures are effective but have a cost. They also lose their benefit if they are not coordinated across the entire island. Effective implementation and coordination across the island is essential, especially as part of a future review of the regulations. <BR /> <BR />I believe it is worth noting that the measures were already largely observed in the North ahead of the Executive, with many schools effectively closed, events cancelled and families already self-isolating. We are only now starting to see the benefits of that. Essentially these measures are designed to keep the public safe, but they are also — and this is an important point for the public to remember — vital in keeping front-line workers and staff safe.”
“<BR /> <BR />There are many parts of the regulations that I could discuss at length, whether it be the make-up of the list of underlying health conditions or the provisions on public gatherings, especially the needed changes around funerals and wakes, which have a special place in our community life in Ireland, both in the towns and, perhaps especially, in rural areas like my own. However, I will focus on the key aspects of the regulations: the powers to restrict movement and travel. <BR /> <BR />The need to reduce unnecessary travel and social interaction is a key response that is backed up by international evidence from the World Health Organization, the European Centre for Disease Prevention and Control and many others. Restrictions on travel and movement are one of the most noticeable measures to reduce social contact.”
“<BR /> <BR />It is crucial that we learn and implement the lessons from the start of this outbreak. We must do that swiftly to ensure that mistakes are not repeated and to prepare for further phases or surges of this virus. The Health Committee will continue to play its part in that process. The Committee agreed that it was content with the health aspects of the regulations. <BR /> <BR />I will now add some remarks as Sinn Féin's spokesperson for health. It cannot be said enough that we live in unprecedented times. The scope of the provisions within these regulations shows the extent of the measures deemed necessary to tackle COVID-19. They say that a week is a long time in politics, but it appears to be an absolute age during this pandemic.”
“<BR /> <BR />Due to the urgency of the situation, the Committee was unable to take the views of other Committees with regard to the cross-departmental elements of the regulations, as it would normally do. The Committee therefore agreed to consider only the health aspects of the regulations. <BR /> <BR />Members acknowledged the unusual nature of the regulations and the restrictions contained therein, but broadly supported the need to implement such measures in the current circumstances. The Committee noted that the regulations provide that the Department of Health must review the need for the restrictions and requirements imposed by the regulations at least every 21 days, with the first review being carried out by 18 April 2020, and that the regulations will cease to have effect after a period of six months.”
“Members raised the important issue of communicating the regulations to ethnic minority communities, for example in the form of leaflets in other languages. The chief environmental officer undertook to feed that back into the system and to act upon it. <BR /> <BR />Finally, the question of procedures at ports and airports was raised in terms of addressing the risk of further transmission of the virus from cargo or passengers — another issue that has come to prominence recently as flights are carrying seasonal workers from eastern Europe. The Committee was advised that airports would be treated as workplaces when it comes to social-distancing requirements, but I think that questions remain over the approach to individuals arriving on flights from elsewhere.”
“Complaints may be made to the relevant body. We were also informed, however, that under the rule, only the PSNI are given relevant enforcement powers but that designation of other bodies was under active consideration. I would be grateful for an update from the junior Minister on this matter.”
“<BR /> <BR />Concerns were also raised about the safety of employees in businesses that remain open and members asked whether those businesses that fail to put in place social-distancing measures would be required to close. Members flagged concerns that some businesses are reported to be operating without social distancing or PPE. The Committee was advised that it remains the responsibility of business owners to ensure the health and safety of their staff, if their business remains open, and the need for all workplaces to strictly adhere to guidance from the Public Health Agency and the Health and Safety Executive. <BR /> <BR />Members were further advised that the Health and Safety Executive and the environmental health departments within councils each have responsibility for different aspects of this and that.”
“I welcomed, in this respect, the memorandum of understanding that has been signed by the Chief Medical Officers, North and South, which aimed, where possible, to ensure cooperation and harmonised messages, and highlighted that cooperation is important to ensure that regulations do not present barriers or blockages in dealing with the COVID-19 crisis. <BR /> <BR />Committee members also sought assurances that the regulations would not disrupt the manufacture or supply of essential products and goods, especially medical and other supplies. We were advised that, subject to advice on maintaining social distancing, the rule did not require the closure of manufacturers. We discussed enforcement powers being given to the PSNI and were assured that the police have powers to disperse gatherings.”
“The Department advised the Committee that, due to the serious and imminent threat being posed by the incidents and the spread of coronavirus, the Department was unable to submit an SL1 policy proposal, and that, to allow public health measures to be taken, the regulations were made without a draft being laid and approved. <BR /> <BR />We heard evidence from the Chief Environmental Health Officer in the Department of Health. The Department advised that the regulations cover three main areas: restrictions on businesses permitted to remain open; restrictions on the movement of people; and restrictions on social gatherings. Committee members raised a number of issues, including the importance of comparative information on similar measures in the South of Ireland and effective and ongoing North/South cooperation.”
“Ba mhaith liom cúpla focal a rá ar dtús mar Chathaoirleach an Choiste Sláinte. I would like to start my contribution by expressing my sincere condolences to those who have lost a loved one during this difficult time. I know that is shared by party colleagues and all members of the Health Committee. It is not easy to lose a loved one at any time but it is, perhaps, particularly difficult at this time of social-distancing and lockdown measures. <BR /> <BR />The Health Committee considered the Health Protection (Coronavirus, Restrictions) Regulations at its meeting on 2 April.”
“I thank the Minister for the work that he has been doing, and I appreciate the work that his Department, teachers, schools and staff have been doing at this difficult time. What are the circumstances of this outbreak that would require school closures?”
“I thank the Minister for the urgent briefing that he has given to the Assembly today on an issue that is very fluid and, at times, fast-moving. I also endorse his recognition of the work that is being done, and will be done in the time ahead, by the PHA, medical clinicians and front-line health staff. <BR /> <BR />A concern that I share with many people is that the North's public services must be given the flexibility to respond to the unique circumstances that we have here on the island. Those circumstances are of benefit in some ways but can bring additional challenges. Will the Minister outline what consideration he has given to how services may move from containment to delay and mitigation, including whether that will be done in consultation with the Southern healthcare authorities?”
“I thank the Minister for work that I know he did in conjunction with the PHA last week on schools. Will he commit to his Department, along with the Public Health Agency, assisting boards of governors and school leaders in dealing with concerns that will arise when schools run into difficulties?”
“<BR /> <BR />As Sinn Féin health spokesperson, I look forward to working on legislation that comes forward in future programmes. Certain measures would be very useful in addressing health inequalities. One is supporting and encouraging a higher uptake of breastfeeding, which produces better outcomes. That is long overdue. We also want developments on carers' rights to come from the 'Power to People' report that was commissioned by Michelle O'Neill when Minister of Health. We are acutely aware of the need for a single piece of legislation to provide clarity on safeguarding legislation, as well as providing additional protection for older members of our community.”
“I, too, welcome the publication of the legislative programme today. Although there is no legislation that directly impacts on health, some measures that are being introduced will have a significant impact on the physical and mental health outcomes of many vulnerable people. I will draw particular attention to two of those measures: sector size in housing and the binning of the bedroom tax, as is being introduced by Minister Hargey; and the domestic abuse Bill that is being introduced by the Minister of Justice. <BR /> <BR />The Committee is working on a series of forward work imperatives, and we will look at those in due course, but I do not think that anyone will be surprised to learn that we expect legislation to come our way that relates to public health and Brexit and as a consequence of ongoing inquiries.”
“I thank the Minister for addressing the House on the issue. We know that it is a very fluid situation and that it can change multiple times over the course of a day, never mind over a weekend or week. I welcome the high-level activity across and between these islands over the weekend and the efforts of you and your clinical leadership team. In keeping with your comments, I acknowledge the efforts of front-line staff. <BR /> <BR />Given that we are such a small island and that North/South interconnections, travel and interaction are part of the social and economic fabric of this island, as the First Minister acknowledged in the Chamber earlier, will the Minister agree that maximum cooperation and coordination, similar to the weekly COBRA meetings, between the health services North and South is now not only beneficial but essential?”
“Will the Minister acknowledge that the projects that are identified in New Decade, New Approach do not represent an exhaustive list of the Department's priorities, as it should also strive to progress other vital projects such as the A4 southern bypass and the upgrades to the A32 Omagh to Enniskillen road?”
“I have a follow-up question to Pat Sheehan's. Will the Minister acknowledge that working with families closely and in good time can prevent inappropriate admissions, from which many of the long-stay residents of Muckamore have come? Will he also commit to look at the trust's budgeting in terms of learning disability underspend, where moneys that have been allocated to help parents and carers to support people at home have been underspent to the tune of millions of pounds, and ensure that that will not happen in future?”
“Does the Minister recognise and agree that working carers are some of the most disadvantaged in our society and that they struggle to juggle their caring responsibilities along with accessing, retaining and protecting their progression in work? I ask the Minister to consider implementing that directive as speedily as possible.”
“We need to explore how we can generate further improvements for all our people in the time ahead. The work of the Health Minister in developing an all-Ireland paediatric pathology service is a fine example of how we can reach out to address key issues of concern in a way that meets the needs of our population most effectively. I wish the Minister well in dealing with the many and complex challenges that he faces at this time.”
“Our responsibility as public servants is to come up with ideas that allow us to fulfil our duties to constituents. Tory austerity must be challenged through sound proposals that will allow us to address the pressures on the healthcare system and other public services. Increasing our suite of fiscal powers is one avenue that must be explored so that we, the public servants sitting in this institution, have the latitude to decide how we generate revenue and how best to spend that revenue so that the daily lives of our constituents are improved. <BR /> <BR />Our healthcare system has benefited from significant North/South cooperation in numerous and important ways, with our constituents feeling the benefits that come from the effective and efficient sharing of resources and the provision of health services across the entire island.”
“Transformation of the health service is vital if it is to serve the needs of our entire population across rural and urban communities, particularly the more deprived communities that already suffer unequal health outcomes in important measures of physical and mental health and well-being. <BR /> <BR />The transformation of particular components of the healthcare system — for example, reduced waiting lists and the provision of IVF treatment according to NICE recommendations — are just some of the many promises made in the 'New Decade, New Approach' document. Not surprisingly, a Tory Government who have savaged public service funding for years may now also renege on many of the commitments they made in that agreement. We cannot be complacent when it comes to the health and well-being of our communities.”
“I will leave it to the Minister to explain to the House why that is the case. I urge him to prioritise that spending immediately. <BR /> <BR />While we have renewed our commitment to the transformation agenda proposed by Bengoa and the then Health Minister, Michelle O'Neill, it is difficult to see how we can achieve that when we cannot afford the double running required to transform our health service. Just last week, we heard that the rate of GP closures in Fermanagh and parts of Tyrone — a largely rural area — means that patients could end up being bussed to see GPs.”
“Victims and those affected by the blood contamination scandal have waited and suffered long enough.”
“Since the institutions were restored in January, progress has been made on addressing pay issues in the health sector. I welcome the resolution of pay issues for a workforce that continues to unselfishly bear the burdens in a health service that is starved through Tory austerity measures. I particularly welcome the commitment to victims of the blood contamination scandal, with an extra payment of £1 million being made available by the Minister to those affected. The money is ring-fenced and is intended to alleviate hardship for those infected with hepatitis and HIV in the contaminated blood scandal. However, we are concerned that £400,000 of that has been withheld. I urge the Minister of Health to release the entire £1 million, as allocated.”
“<BR /> <BR />The move towards a three-year Budget has been widely supported and will be crucial for Health to move towards a process that will allow the long-term planning that is essential to reform. Go ceann píosa, is dúshlán ceart dár gcóras pleanáil fhad-téarmach a dhéanamh le buiséad aon bhliana. For now, though, proper long-term planning with a one-year Budget is a real challenge for our system. <BR /> <BR />I look forward to the coming year and to the chance to engage constructively on the spending plans for the reforms that we have. Ag deireadh an lae — at the end of the day — we have no choice but to deliver. <BR /> <BR />I now want to take a couple of moments to speak in my role as health spokesperson for Sinn Féin.”
“<BR /> <BR />The new Committee is still at an early stage in its development, but we are already identifying issues that make it difficult to comment effectively on budget priorities. We cannot look at the papers supplied to the Committee thus far and identify, for example, how much, it is proposed, we spend on mental health and on cancer or the split between primary and acute care. Fantastic work may well be going on to address those balances and priorities, but previous Committees were not able to get clarity on that. We are, therefore, seeking further detail and enquiring about progress towards transparency and accessibility in our budgetary processes.”
“The Department is on record that, in the 12 months up to April 2019, the cost of temporary workers across Health and Social Care came to just over £200 million. That cost has more than trebled since 2014-15 and could clearly go some way towards achieving transformation, if workforce planning, recruitment and retention issues can be effectively addressed. <BR /> <BR />The Committee has asked questions about savings targets and the reliance on savings targets, which are acknowledged as unlikely to be achieved in some cases. Efficiency is clearly vital, but we will want to know that savings are achieved by strategic decision-making and not by opportunistic cuts where vacancies occur at random.”
“<BR /> <BR />We know that it can be done, and we know how it can be done. We have cross-party agreement on the road map, including the roll-out of multidisciplinary teams with investment in primary and community care, as advised by countless reports over the years. Moreover, we know that, if done effectively, that investment will be repaid with early intervention, health promotion and prevention, which will ease pressure on acute care. Ní mór dúinn glacadh leis an riosca gur, gan maoiniú ceart, is deacair an t-athrú a mheas. We need to acknowledge the risk that, without sufficient funding, transformation becomes much more difficult. An example of that is the current substantial reliance on locum and agency staff.”
“<BR /> <BR />In 2016, the previous Committee heard evidence that, without adequate investment in transformation, hospital waiting lists would rise and GP practices would close. Members will know that that is, indeed, what has been happening, despite a wide range of initiatives being undertaken and £100 million having been invested in transformation in each of the last two years. Last week, at the Health Committee, we heard that, without faster and further reform, patients could end up being bussed from Fermanagh and Tyrone to see GPs east of the Bann. Tá a fhios agam go rí-mhaith go bhfuil Comhaltaí ar gach taobh ag déanamh a ndíchill le cinnte a dhéanamh nach dtarlaíonn sin. I know that Members on all sides will want to do everything possible to prevent that from becoming a reality.”
“While in-year monitoring moneys helped to bridge the gap last year between the original allocation and cost pressures, those funds are mostly non-recurrent and do not, therefore, allow for long-term planning. Of course, some of the increasing costs derive in part from success such as longer life expectancy and better medicines, which are to be welcomed, but the substantial impact on existing services inevitably makes transformation more difficult. While there is cross-party acknowledgement of the need for double running to allow transformation, we have not yet seen evidence that that necessary step will be possible at the scale required, which is, of course, a serious concern.”
“I thank the Minister of Health for inviting me, on the Floor of the Chamber, to join the strategic health partnership forum. I confirm that I have accepted his invitation and look forward to working with all concerned on that important issue. I also acknowledge that the HSC budget this year will have exceeded 50% of the block grant. On the one hand, that demonstrates a welcome response to need, but it also underscores the urgent need for radical reform, as we have all agreed. <BR /> <BR />In recent weeks, the Committee heard evidence from the Department and from stakeholders of significant inflationary pressures of around 6% and inescapable pressures estimated at around £345 million, and that is before the transformation budget and New Decade commitments are added.”
“Fáiltím roimh an deis páirt a ghlacadh i ndíospóireacht an lae inniu mar Chathaoirleach an Choiste Sláinte. I welcome the opportunity to address and participate in today's debate as Chair of the Health Committee. I acknowledge, in the first instance, the positive start to consideration of the Heath and Social Care budget since the institutions were restored, in terms of early progress on addressing pay issues and a renewed commitment to the transformation agenda seen in the 'New Decade, New Approach' document. I particularly welcome the resolution of pay issues for a workforce that continues to bear an unreasonable burden as pressures increase, along with the commitment to address safe staffing issues in partnership with staff representative bodies.”
“Does the Minister acknowledge that parity with the South's testing system for cars would greatly alleviate the pressure and backlog facing MOT centres and potentially save the Department from some of the spending envisaged for a new network of test centres?”
“It was said in the Health Committee that there is a lack of data relating to children's mental health in particular. Will the Minister take account of that and see whether he can urgently move to address the lack of data, as any forward planning will be dependent on good data? There are also concerns around data transfer post-Brexit. Will the Minister also consider those issues?”
“On 30 January, the Health Committee was briefed by the permanent secretary and senior officials on health priorities arising from the 'New Decade, New Approach' document. The permanent secretary advised the Committee that, even should resources be made available immediately, the Regional Fertility Centre does not have the capacity to start delivering three cycles of IVF treatment to all eligible women immediately. Further to a question from a Committee member, we then wrote to the Department to follow up on the permanent secretary's commitment to give consideration to whether, in light of the acknowledged limited capacity, the promised three cycles of IVF could be provided outside the North for women close to the age threshold for treatment. The Committee awaits a reply to this query with interest.”
“I welcome the inclusion of "education and information" in amendment No 2. I believe that that would add positively to the motion and matches the intent and desire to improve health outcomes for all. It is important that we destigmatise and remove any notion that talking about fertility or sex education is wrong. <BR /> <BR />I also acknowledge the intent behind amendment No 1, which seeks to address a concern relating to current capacity issues and the potential for discrimination against those at the upper end of the age limit. While there may be some concern that this could effectively disadvantage younger people, I accept that it would have merit as a short-term measure. On that basis, we also support amendment No 1. <BR /> <BR />I now wish to add a few brief remarks as Chair of the Health Committee.”
“I know that many here will be eager to hear directly from the Minister today on how he plans to overcome these challenges. <BR /> <BR />The recent paper produced by the British and Irish Governments refers explicitly to the commitment that:”
“It is often a deeply stressful and challenging time for all concerned. There are daily reminders of the problems, and often no way to get away from them; we think of times like Christmas, Father's Day and Mother's Day. People who are desperate to start families do not have access to the IVF treatment that they deserve. <BR /> <BR />This has been a very long campaign. There have been debates on the matter going back as far as March 2012, when the then Health, Social Services and Public Safety Committee brought a motion to the House. Since then, there have been numerous queries on the issue from a broad range of interested MLAs. In response to a question for written answer, the Health Minister raised not having enough trained staff or the room and space to provide the services.”
“I would like to recalibrate that by saying that I am deeply proud to represent the fantastic people of Fermanagh and South Tyrone. I am proud to represent those from the engineering and economic heartlands and manufacturing bases from Dungannon to Derrylin, from historic and world-renowned Belleek to historic Benburb, and from the magnificent mountains of Cuilcagh to my own beautiful Brantry. I also acknowledge the efforts of my predecessor in the House to represent the constituency, not only because that is well-earned and deeply deserved but because, as many of you will know, I would be in serious difficulty at the home place on Sunday evening if I did not acknowledge it. <BR /> <BR />I move to the motion. The availability of IVF treatment is an emotive and sensitive matter.”
“Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I would like to state how proud I am to speak as a representative of Fermanagh and South Tyrone, a historic constituency. I have often reflected on how a parliamentarian from our neighbouring island once referred to:”
“Does the Member agree that the uncertainty surrounding Brexit has created great anxiety among farming and rural communities? In light of the negative impact that that, potentially, is having or will have on mental health, will he commit, in his role as Chair of the Agriculture Committee, to work with the Minister to address that area of concern?”
“When does the Minister expect the additional payments to commence?”
“I, too, thank the Minister for his statement. Having met last week, along with the Deputy Chair of the Health Committee, one of the groups that represents the victims of the contaminated blood scandal, I particularly welcome his ability to find an additional £1 million for that. It is fair to say that the testimonies that we heard from those people last week were truly harrowing in relation to the extent of the difficulties it has created for them, both the lifelong nature of their illness and the severity of it.”
“<BR /> <BR />I ask the Minister, recognising the vital role that staff play, which he has acknowledged, to commit to work closely with trade unions in the time ahead through the strategic health partnership forum and to reconvene the transformation advisory board.”
“Ar dtús, cuirim fáilte roimh an Aire, agus déanaim comhghairdeas leis. I congratulate the Minister on his appointment to this very important Department. I look forward to working with him and the members of the Committee to deliver on the health needs of our people here. <BR /> <BR />We all recognise that there are many challenges and huge complexity in the Department. The challenges include those around physical and mental health, but they also go across the primary, acute and social care sectors. It will require genuine partnership not only across parties, Departments and health trusts but with staff, service users and their carers. That approach will help to transform and deliver the healthcare that we need.”