Liz Kimmins
Newry and Armagh · Sinn Féin · Northern Ireland
“I do not know how it will have affected North Antrim specifically unless the Member is referring to something in particular. We all have a responsibility in climate change and what we do to try to mitigate its impacts.”
“As the Member rightly said, removal of the zero-detriment policy is for the AERA Minister, and I have engaged with the Minister on that, as well as on the removal of the statement of regulatory principles and intent. I recognise that removing that would have detrimental impact on future development.”
“In response, we recently developed and introduced new appraisal guidance, which represents a significant and deliberate shift in approach. Under the previous arrangements, schemes were largely determined by a monetised cost-benefit ratio threshold where, typically, projects that fell below a ratio of one did not progress.”
“A number of significant issues have led to that scenario. I assume that the Member is referring to waste water capacity. I have said that NI Water has suggested that it needs between £3·5 billion to £3·6 billion for the next price control period.”
“Recruitment is a key challenge faced by all Departments. In questions to the Minister of Health, my colleague from Newry and Armagh referred to the recruitment issue that recently impacted on Daisy Hill. The challenge is not unique to DFI. I want to put a focus on ensuring that we build our internal capacity and improve staffing levels.”
“The Executive and the Assembly agree that the Executive's Budget is not adequate, which is why we are in that negotiation. When it comes to the capital budget, we have to factor in a timeline for the legal challenge that we are going through. It is unlikely that we will get a decision from the court on this side of the summer recess.”
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“<BR /> <BR />The provision of free period products in healthcare settings is particularly important and will ensure that everyone who needs to access what are essential items during their time in hospital can do so. Being in a hospital as a patient or when accompanying a patient is generally a very stressful and anxious time. The provision of such products will hopefully alleviate some of the embarrassment or discomfort of being in a hospital without having adequate protection. <BR /> <BR />The Committee recognises that the provision of free period products on that scale may present logistical challenges and add financial pressures to already stretched budgets for each of the trusts.”
“It notes that that will result in the availability of period products on 1,300 premises across 507 health and social care sites. <BR /> <BR />Period products are necessary and essential items that should be readily accessible and available to those who need them, when they need them. By improving access to essential period products in our public service buildings, including in our hospitals, we will help normalise menstruation and reduce the stigma surrounding periods. Periods are a normal part of life. We often take it for granted that everyone has easy access to period products, when, unfortunately, that is not always the case. The free provision of period products in our hospitals will go some way to assisting those in our community who experience period poverty.”
“I welcome the opportunity to confirm the Health Committee's support for the motion. The Committee considered the policy proposal for the statutory rule (SR) and the statutory rule itself at four of its meetings since June 2024. It invited departmental officials to attend two of those meetings to discuss the regulations. As the Minister has set out, the regulations specify the public bodies that sit within the functions of the Department of Health that must ensure that period products are available, free of charge, to persons on their premises who need to use them. <BR /> <BR />The Committee supports the naming of the five hospital trusts as the public bodies that will provide free period products for use by patients, staff and visitors.”
“I acknowledge the huge amount of work that is being done through the social care collaborative forum. I hope to hear more about where we are at with that today, because we know that the issues will not be solved overnight, as much as we would like them to be. The recent crisis has, however, crystallised the need for us to move at pace on some of them. Doing so will undoubtedly have a huge impact across the board. <BR /> <BR />I am not here to attack the Minister or to criticise him for things that are beyond his control in the here and now. As a collective, we will all work together. My colleagues, the Committee and I are keen to work with the Minister to deliver on the issues as soon as we can.”
“Our acute care at home service — it is also known as Hospital at Home — is hugely successful in the Southern Health and Social Care Trust (SHSCT), for example. That trust has a really effective way of improving patient outcomes and taking pressure off our hospitals. I hope to hear more from the Minister about how the Department can work not only to expand that valuable service so that there is equity in accessing it across the North but to enhance it. <BR /> <BR />Some other ways in which we can look to reduce pressure are by ensuring that GPs and other senior clinicians can assist with admissions, be that through direct admission by a GP rather than people having to go through emergency departments or through helping to triage patients in hospital to keep the flow moving at pace. <BR /> <BR />Finally, social care reform is key.”
“As the previous contributor said, those services are fundamental to Professor Bengoa's vision of transformation. The longer that we are unable to progress his vision, the further away that transformation will be. We know that our budget will never tackle all the issues that we encounter here, and that is as a result of over a decade of Tory austerity. No matter how we dress it up, the Tories starved this place of the funding that we not only need but deserve in order to deliver the public services to which people right across our communities should have access. We must start to shift the dial. <BR /> <BR />Some of the solutions to the problem are things that will help keep people, particularly our older population, out of hospital.”
“The call handlers in the ambulance control centre are dealing with some of the most traumatic scenarios imaginable while trying to advise people on the other end of the phone, reassure them and keep very difficult situations calm while patients and their families wait on an ambulance. They all want us to produce realistic solutions that will ensure that patients no longer experience what can only be described as a less than adequate service. <BR /> <BR />We all agree that the budget is not there to do everything that we need to do. We recognise that and acknowledge that the Minister undoubtedly has a very difficult job. We also need to recognise, however, that the key solution is external to our hospitals: it is in our social care system and in our primary-care and community services.”
“<BR /> <BR />People do not want to hear platitudes from us today, and they do not want to hear us talking about the same issues and going round and round in circles. They want solutions. The solutions are there. <BR /> <BR />Paramedics and ambulance staff are held up in ambulances with very sick patients for hours on end instead of being able to do properly the job that they trained to do and that they love. Those very ill patients are often lying in the ambulance for two or three shift changes of ambulance staff before they get through the doors of an emergency department, let alone admitted to a hospital bed.”
“<BR /> <BR />A perfect storm of increasing demand for emergency and unscheduled care — there was a 12% increase in category 1 emergency calls between 2022-23 and 2023-24 — along with chronic staff shortages across our health and social care workforce have led to capacity deficits in our hospitals and social care. That has meant that patient flow through hospitals is often at a standstill at the front and back doors. That impacts on ambulance waiting times at emergency departments and, more importantly, on response times, which, as we have heard in the past few days from Dr Nigel Ruddell, the medical director for NIAS, will result in deaths if the situation is not addressed. Sadly, a number of years ago, I saw such delays result in the death of a young woman in my constituency.”
“In the past few weeks, we have, undoubtedly, seen some of the most harrowing scenes in our health service for many years. The impact of that has been felt across the North by way of corridor care, patients being stuck in hospital as they cannot be discharged home and the backing up of ambulances at emergency departments for hours, as others have said, and sometimes days due to the overwhelming pressure on the system. Whilst there has been a serious escalation as a result of the winter period, those pressures are felt all year round. Many of the issues that we are speaking about today are, unfortunately, not new.”
“On engagement activities concerning the draft SI, the Committee was advised of a possible forthcoming internationally harmonised framework and told that the EU has proposed reform of its pharmaceutical legislation, part of which takes a similarly decentralised manufacturing approach. <BR /> <BR />Following the evidence session on 12 December, the Committee agreed to recommend that the statutory instrument be approved by the Assembly.”
“The Committee considered the instrument, having been notified by the EU under directive 2015/1535. No comments were received from the EU. The Committee invited departmental officials to attend its meeting on 12 December 2024 to answer questions on the significance of any divergence by the EU from the new framework and to give an overview of engagement with the EU on the instrument. <BR /> <BR />Officials provided the Committee with an overview of the current communication mechanisms between the EU, the MHRA, the British Government and the Department of Health on the supply of medicines.”
“Therefore, I welcome it that, although the instrument does not have a specific review clause, the POC and MM provisions will be covered by the review clause already embedded in the Human Medicines Regulations 2012 and will be subject to regular review. Further, the Medicines and Medical Devices Act 2021 requires the Secretary of State to lay a report every two years on the operation of the regulations.”
“The control site will be the only named manufacturing site for applications for manufacturing licences, clinical trials and marketing authorisation. It will be responsible for ensuring compliance with the internationally aligned standards and for notifying the MHRA of reportable issues and will be subject to routine inspections by the MHRA. <BR /> <BR />To ensure the quality, safety and efficacy of medicines and treatments in a new era of healthcare, the MHRA must carry out its role effectively. Accountability and best practice in the healthcare system is one of the Health Committee's main priorities.”
“<BR /> <BR />The Committee was encouraged to learn that impact assessments found that the public sector is expected to benefit through savings from the faster-moving treatment of patients and that manufacturers seeking to produce POC and MM products may gain substantial annual benefits of, on average, £3·3 million. The change in the inspection protocol is expected to mean a reduction of 95% in POC and MM inspections and bring cost savings to small, medium and large firms that are at the forefront of the technology. All together, that will improve access to effective healthcare for patients. <BR /> <BR />I highlight the important role of the Medicines and Healthcare products Regulatory Agency in ensuring the success of the new framework.”
“I welcome the opportunity to confirm the Health Committee's support for the motion. The Committee welcomes this timely legislation, which will help put our healthcare system at the forefront of advanced healthcare technologies and ensure access for patients to innovative treatments and medicines. <BR /> <BR />As outlined by the Minister, the regulation provides a framework for regulatory oversight of point-of-care medicinal products and modular manufacturing systems. The Committee welcomes that the regulatory approach in the new framework, known as a "hub-and-spoke" model, is considered to be long-established from its use in the manufacture of blood-derived medicinal products.”
“I thank the Minister for his answer. Given that the road is treacherous, particularly in winter conditions, and there have been numerous incidents over the years, will the Minister consider adding the road to the gritting schedule for the time being?”
“I thank the Minister for his statement. It is certainly ambitious, but it is very welcome. There is so much in it that we have been working on in the Committee, so I am pleased to see that the Minister is listening. Thank you for that. <BR /> <BR />I turn to the piece on cancer services. We would all agree that improvements are much needed and much welcomed. It would be remiss of me not to mention the formidable Jody Gormley, who, sadly, lost his life and his battle with cancer just last night. <BR /> <BR />Minister, you alluded to the cancer strategy in the statement, so will you indicate whether that is based on full funding of the strategy? If possible, will you elaborate a bit more on the lung screening programme? We have been speaking about that recently in Committee, and we had the event in Stormont on it.”
“On the topic of public service, First Minister, one of the hardest-working public servants whom we have is currently working very hard, because there are only 16 more sleeps until Christmas Day. On behalf of all the boys and girls who are very excitedly waiting for Santa and his reindeer to arrive on 25 December, I ask whether everything is on track.”
“I thank the Minister for giving way. You mentioned illegal products and Botox products. Given that you have said that you will keep an eye on what is happening across the water in Britain, I ask that we look at what is happening in the South. The documentary that I mentioned earlier highlighted the black market between the North and South on this island. If legislation and regulation moves at a greater pace in the South, we will be more at risk of greater implications here. I ask the Minister to bear that in mind as well.”
“That further emphasises the need for us to act accordingly in the North. <BR /> <BR />This is a crucial issue that we must get to grips with urgently in the interests of public safety. Making it an obligation to be properly trained and licensed by a relevant regulatory body is about protecting not just people who access treatments but practitioners. I therefore ask the Minister to develop options for essential regulation in the industry and to ensure the introduction of the appropriate oversight and training that is required for those who administer these products. I ask Members to support the motion.”
“<BR /> <BR />In England, the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 made it an offence for a person to administer botulinum toxin or a filler by way of injection for a cosmetic purpose to a person under the age of 18 in England. In April 2022, the Health and Care Act 2022 gave the British Secretary of State for Health and Social Care the power to introduce a licensing regime for non-surgical cosmetic procedures in England. Similarly, in the South of Ireland, following an 'RTÉ Investigates' documentary that, earlier this year, provided a covert insight into the scale of illicit practices across Ireland, particularly on a cross-border basis, the former Taoiseach Leo Varadkar indicated that work was ongoing on strengthening regulation of the industry in the Twenty-six Counties.”
“<BR /> <BR />In a recent case in England, 33-year-old Alice Webb, a mother of five, passed away due to complications from a liquid Brazilian butt lift (BBL) procedure, which involves placing dermal filler in the buttock area. Among advanced medical practitioners, that is known to be an extremely unsafe procedure, and there have been many public calls, dating back to 2023, from industry leaders such as Save Face to ban the use of liquid BBL procedures. It beggars belief that there is no legislation here to determine who can administer those products and procedures. As is highlighted by the examples that I have described, regulations must be put in place urgently.”
“Complications from maladministered injectable aesthetic treatments can range from bruising and skin drooping to anaphylactic shock, permanent blindness, sepsis and, in some cases, even death. Many advanced practitioners in the aesthetics industry have professional qualifications in nurse prescribing, pharmacy, dentistry or medicine and have undergone much more advanced training in the aesthetics field. They have demonstrated from experience the importance of their clinical knowledge in ensuring that they respond effectively and efficiently to complications when needed, which many practitioners without the same level and depth of training would not be able to do.”
“That is not a criticism of those who have undertaken training in good faith. They are not doing anything wrong under the current law. However, when things go wrong — whether a reaction to the product or an error in its administration — they may not always be in a position to provide the necessary aftercare to the client, and that can have many serious implications.”
“That is a shocking fact, and even more shocking is that, at present, there is no legislation in the North to protect young people under 18 when accessing treatments, despite the very evident rise in teenagers getting lip fillers and other treatments. Anecdotally, practitioners have told us that children as young as 14 have attempted to access these treatments for purely cosmetic reasons. That is why I welcome the amendment from Diane Dodds and Alan Robinson, which further strengthens our objective to protect our young people from the potential negative side effects of these procedures. <BR /> <BR />As previously mentioned, more and more people are offering these services, many at a relatively low cost, yet there are serious concerns about the level of training and expertise obtained to enable them to do so.”
“It is also important to recognise the important use of botulinum toxin and fillers in medical treatments, including, but not exclusive to, the treatment of chronic migraines and excessive sweating, often under the direction of a medical professional. <BR /> <BR />The genesis of the motion is therefore not to place a ban on those procedures but to ensure proper regulation to mitigate the risks of complications, particularly given the lack of regulation currently in place. Despite the clinical nature of these treatments and the very serious complications that can arise for various reasons, those providing treatments are not currently under any obligation to register with the Regulation and Quality Improvement Authority (RQIA) or any similar body.”
“In the past, aesthetic treatments of that nature were generally seen to be something that celebrities and the more affluent in our society could access, particularly in the US. However, over time, the demand for those treatments has risen exponentially, giving way for more and more people to offer these services, often at a much lower cost. <BR /> <BR />From the outset, I want to say that I have no issue with aesthetic procedures, and as a woman of a certain age, I fully appreciate that they can help many people to feel good about the way that they look, which can go some way to boosting confidence and self-esteem. Many highly trained practitioners deliver an extremely safe service, using only high-quality products.”
“We tabled this motion in the hope that we can create consensus on the urgent need for greater regulation of non-surgical cosmetic products and procedures in order to improve the safeguarding of the health and well-being of our population, particularly our young people. As many Members will be aware, in the past number of years, there has been a significant rise in the number of people seeking aesthetic procedures such as, but not limited to, botulinum toxin — more commonly known as Botox — and dermal fillers. <BR /> <BR />There is no doubt that there are huge pressures in society to look good, which can largely be attributed to social media and the content that dominates our young people's social media platforms daily.”
“We cannot, however, continue to haemorrhage funds in managing the symptoms of the problems created by a lack of transformation. Spending huge sums of money on locums and agency staff, as well as the need to outsource services from the private and independent sector, is not the best use of public money. While that is unavoidable in many circumstances, we need a fundamental plan for stabilising and securing our workforce, a plan that values our extremely talented staff and ensures that they choose to stay in the North for the long term. <BR /> <BR />Finally, I acknowledge that some of the transformation work has begun, but we have so much more to do. I look forward to continuing that work with the Minister and the Health Committee in the time ahead.”
“Let us keep our eyes on the bigger picture: the children and families who need the services. <BR /> <BR />On the broader transformation piece, the recent Bengoa conference has hopefully refocused minds and reinvigorated the importance of the implementation of the transformation that our health service so desperately needs. The Health and Social Care (HSC) workforce across the board are frustrated with the lack of progress. Patients and their families need and deserve access to a more effective and efficient health service. He has been in post only a couple of months, but I acknowledge the Minister's commitment to delivering transformation. The Health Committee is keen to see that transformation happen at pace. <BR /> <BR />There is no doubt that it is not a simple task.”
“We should not lose sight of the fact that the hospital is about giving children the best start in life and ensuring that mothers can access safe, timely care throughout pregnancy and childbirth. It is about equity in healthcare by ensuring that all families, regardless of their circumstances, have access to the support that they need when they need it most. <BR /> <BR />While delays and setbacks are deeply disappointing, our focus must remain on the goal of delivering a world-class maternity and children's hospital that will serve generations to come. It is a project of hope, of vision and of immense importance to the people of the North that will enhance the huge talent and expertise that we have across all maternity services in the North. I urge us all to maintain the momentum and ensure the delivery of that vital facility.”
“The new hospital has the potential to change that by offering centralised, world-class facilities that are equipped to handle complex cases and emergencies under one roof, which will provide not only better outcomes for patients but peace of mind for parents and caregivers. <BR /> <BR />Furthermore, investing in a modern maternity and children's hospital will enable our healthcare professionals to work in an environment that supports innovation and best practice. Those staff members, who are the backbone of our health service, will benefit from the tools, technology and infrastructure required to deliver the highest standards of care. It is an investment not just in facilities but in people, patients and providers alike.”
“I support the motion. I will focus on the essential need for the hospital and on the transformative impact that it will have on the people of the North. <BR /> <BR />At its core, the hospital represents more than just bricks and mortar: it is a lifeline for families and a place where children can receive the care that they need and where mothers can give birth in a state-of-the-art environment. The people of the North deserve a health service that prioritises them, and the facility is a cornerstone of that commitment. Every day, countless families navigate the challenges of accessing specialist maternity and paediatric care, often facing long waits or travelling outside their community for treatment.”
“Will the deputy First Minister detail what further support she and the First Minister may be able to provide?”
“I thank the Minister for his answer. Red-flag referrals are one of the most concerning issues in gynaecology. Will the Minister give an update on any work that has been done on that? We had the cervical smear review in the Southern Trust, and, for many women, that is the most worrying aspect of it. If the Minister could provide information on that, I would be grateful.”
“Daisy Hill is one of the elective overnight stay centres, and it has been doing fantastic work to date. However, there is always room for more. What consideration have the Minister and his Department given to potentially expanding it to include orthopaedic surgeries? That is one of our biggest waiting lists, and many of us will have constituents who are on those waiting lists, so I would like to hear a little bit more about that.”
“I thank the Minister for his answer. I understand that representatives from EOS IT Solutions were on the Singapore trade mission last week. Will the Minister say more about that company?”
“I just want to come back on that point. First, as Miss McAllister said, there is no reference to criminal sanctions in the motion. Secondly, do you not think that this is the time to have those discussions, in order to outline what people's key concerns are, from all sides of the debate, so that we can move forward to find a suitable outcome that will benefit everyone and keep patient safety paramount?”
“That is the motion's ultimate objective, and, essentially, the amendment would ensure that all stakeholders are an integral part of the process and that the principles of co-design and co-production are fully implemented throughout. <BR /> <BR />There is no doubt that difficult conversations remain to be had, but we cannot stand still on this any longer. By working together, we can ensure that there are strong frameworks in place to protect all of our patients, uphold strong confidence and trust in our system and protect staff, going forward.”
“Any culture of cover-up must be eliminated. We need to put the best interests of patients at the forefront to ensure that no family has to wait years upon years for the truth when a loved one comes to harm. We have seen that time and again, through the hyponatraemia, neurology, urology and infected blood inquiries, to name just a few. The huge impact that that has on patients and their families must not be underestimated, and one thing has been consistently made clear: had facts been made available at the earliest possible stage, a lot of the pain and trauma could have been avoided. Families could get some level of closure and justice for their loved one, and the learning from those experiences could be used to reduce the risks of the same mistakes being made time and again.”
“In a climate in which our health service is under extreme pressure, staff are burnt out and often work in unsafe conditions and mistakes and errors are at a higher risk of occurring it is vital that that is recognised and informs any proposals. Staff must not be the collateral damage for organisational failings or poor management and planning. That must be abundantly clear when it comes to duty of candour. As a whole Executive, we must collectively strive to reduce the significant pressures on our health service. <BR /> <BR />Sinn Féin wants to ensure that patients, their families and all our staff have confidence and trust in our health service and that people feel safe to speak out when things are not done how they should be or when mistakes are made, so that steps can be taken to address that at the earliest stage.”
“<BR /> <BR />Understandably, a number of representative bodies for professions in our health service have outlined their concerns and a lack of support for the proposals, particularly for those around individual duty of candour, citing that workforce pressures have not, to date, formed part of the discussions and that staff feel very much that they are the low-hanging fruit when harm is caused and blame ensues. That is crucial in any discussion of or decision to move to an individual duty of candour. That is why we seek to amend the motion to ensure that there is full co-design and co-production with staff as well as families. Staff must be part of any process to develop legislation, to ensure that they can outline their key concerns and are listened to.”
“We cannot allow that to be the case. <BR /> <BR />It is important that the organisational statutory duty of candour requires each organisation to provide training, support and protection for staff to enable and empower them to fulfil their individual duty of candour, underpinning the open and honest culture for which we strive. An overwhelming majority of our dedicated Health and Social Care workers are committed to and strive to provide the best care for their patients. That is why the amendment seeks to ensure that there is genuine co-production and co-design that involves staff, patients and families who have experienced harm. It is crucial that those with lived experience of the serious adverse incident (SAI) process are involved in the development of legislation around duty of candour.”
“Families have a right to know the circumstances, if their loved ones experience harm. It is only right that they get that. Likewise, staff need to feel safe to be open and honest, as that protects them in the crucial work that they do and ensures that our healthcare is delivered to the highest possible standard. <BR /> <BR />Sinn Féin commends the patients and families impacted by the hyponatraemia and other scandals in Health and Social Care for their perseverance and endurance in their search for truth and justice. The outcome of their efforts must be a health and social care system that is open and transparent and inspires trust and confidence in all those who deliver and use its services. We need to make the changes, otherwise more and more scandals will continue to blight our services and our society.”
“As mentioned, we have experienced a number of scandals in the health and social care service in the past number of years that have left many patients, families and staff with a sense of distrust in the system and a feeling that many issues were missed that developed into major incidents for patient safety. As MLAs, a lot of us will have dealt with individual cases of families who have lost a loved one or faced life-altering conditions as a result of mistakes being made and have waited and continue to wait far too long for answers and for change to occur. <BR /> <BR />We believe that it is important that we have both an organisational and an individual duty of candour to ensure that the highest levels of transparency can be relied on at every level of our health service.”
“A statutory duty of candour seeks not to punish workers for mistakes but to empower them with the knowledge that, if harm is caused, they can flag it to ensure that there is learning and to help improve the processes and systems that are in place. By initiating an openness framework, we can start to make the change from a blame culture to a culture of learning. The most important piece of work is the cultural shift that is required in the health and social care system. That shift needs to ensure that staff feel supported to assist in system learning and improving outcomes for patients.”
“I, too, acknowledge all the families who have used their experience to ensure that those who come behind them do not go through the same traumatic and distressing experience that they went through. Without them, we probably would not be in this place today, although what we are discussing is a sad indictment of the system. <BR /> <BR />Openness and transparency are fundamental to underpinning trust in our health and social care system. It is what all users of those services are entitled to expect. A culture of openness benefits patients and service users, but it also benefits those who work in Health and Social Care (HSC).”
“Go raibh míle maith agat, a Phríomh-LeasCheann Comhairle. I thank Alliance for tabling this very important motion. We have had numerous discussions on the issue in the short time that the Health Committee has been in place. Without speaking for others, I think that we are all very much on the same page on the issue. Even in the short time since February, when we first came together, we have heard, time and time again, about the very difficult reality than many patients and families face. We have listened to and met numerous families and people with lived experience of the harm that has come to them as a result of mistakes, cover-ups and other factors. We felt very strongly that now is the time for change. We cannot wait any longer. We cannot continue to see such inquiries and scandals coming to the fore.”
“Over the past week, I have been in frequent contact with the Minister and his officials regarding issues in the Southern Health and Social Care Trust, particularly at Daisy Hill and Craigavon hospitals. What will that immediate stabilisation look like? Obviously, we want to see a workforce plan for long-term sustainability, and the previous Member asked about that, but what will we see in the immediate future, because that is key to stabilising services now?”