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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“The Minister will be aware that, last week, Professor Ray Jones briefed the Health Committee on his review. He expressed concern and frustration about the pace of the implementation of the review's recommendations. Will the Minister assure us that he will take the decisions needed to move this on as quickly as possible before more children end up in care when that could have been avoided?”
“At that briefing, officials advised the Committee that the proposed SR would create a requirement for medicines containing valproate to always be dispensed in their original manufacturer's packaging. The purpose of that is to ensure that women and girls receive warnings regarding the risks of taking such medicines when pregnant. The officials also advised the Committee that the proposed SR would introduce flexibilities for pharmacists in the dispensing of medicines to ensure that original packaging safety information was provided to patients. The Committee fully endorsed the policy merits of the proposed SR, which aims to improve patient safety, and confirmed that again on 30 May, when we considered the SR and agreed to recommend that it be approved by the Assembly.”
“Before I speak on the motion, I, again, congratulate the Minister on his recent appointment. I do not underestimate the challenging portfolio of work that he is responsible for. I want to reassure him that the Committee will work with him and his officials in a positive and collaborative way in their efforts in the time ahead, as we said in the previous discussion. <BR /> <BR />I now turn to the SR. I welcome the opportunity to confirm the Health Committee's support for the motion that the Minister of Health moved in the House today. As the Minister outlined, the statutory rule amends the Human Medicines Regulations 2012 that govern the arrangements for the licensing, manufacture, wholesale dealing and sale or supply of medicines for human use. <BR /> <BR />The Committee was briefed by departmental officials on the proposed SR on 2 May.”
“I thank the Minister for his answer. I am delighted to see him back in his place after his absence. <BR /> <BR />We have heard of the delays in councils getting some of the funding out. To date, how much funding has the Department released to councils to fund the flood grant scheme?”
“I welcome the Minister to his role and congratulate him. I look forward to working with you, Minister. I welcome the statement. Despite the difficult picture, there is a lot in the statement that is definitely encouraging, and I am keen to work with you on that in the time ahead. <BR /> <BR />Everyone is affected by this — our families, friends, neighbours and constituents — so it is in all our interests to get the best outcome. Your key priorities are positive, Minister. They are certainly what we would like to see done, but everything is underpinned by workforce. Can the Minister advise when we can expect to see a plan around workforce to bring those priorities forward?”
“Does the First Minister agree that the COVID inquiry is an important platform for the bereaved families, who lost loved ones during the pandemic, and that lessons must now be learned across all Departments?”
“In my role as Chairperson, I give a commitment to continue to work with the Minister and support him in his endeavours to tackle the huge crisis that faces our health service.”
“<BR /> <BR />I have heard voices across the Chamber continually reverting to the need for the Executive to allocate more money to the Health Department, but I have not heard what their alternative is. From which Department will they take the money? The outgoing Health Minister indicated that he needs at least £800 million out of just over £900 million in order to stand still. That is almost 90% of the funding that is available. How do we square that circle? <BR /> <BR />I commend my colleague the Finance Minister for her work in delivering this difficult Budget in the most challenging of circumstances. I encourage the incoming Health Minister to continue to work with all Executive colleagues to support the Finance Minister to secure additional funding to enable us to deliver high-quality public services for the people we represent.”
“I will not. <BR /> <BR />As I said, I am conscious that, by this time tomorrow, we are likely to have a new Health Minister. I am at a loss as to what that incoming Minister intends to do. As I said, we are still without a plan. We have heard about all the things that the Minister cannot do, but, sadly, information on what will be done has been lacking. We need to give people strong leadership and hope, especially in relation to health. Those who are still on picket lines and waiting lists need to see leadership that not only takes on the huge challenges that our health service faces but gives them hope that we will fight for further funding to fix our health service.”
“The stance that the current Health Minister has taken is extremely disappointing. Despite some of the points made about allocations and what has or has not been provided to date, that Department has been allocated £1·6 billion over the past three years.”
“The people of the North pay their taxes to the British Government, just as the people of England, Scotland and Wales do, but we do not get the bang for our buck. We do not see a fair and equitable return for our contribution. That undoubtedly has and will continue to have a detrimental impact on our public services, particularly our health service. Even with a significant proportion of the Budget being allocated to the Department of Health, there is a major shortfall. We must get behind the Finance Minister and lobby for the funds that we need and deserve to get from the British Government.”
“We must understand that there is little scope for transfer of funding from other Departments, and we must make the case to the British Government to support our health service workers before it is too late. <BR /> <BR />I will now speak in my role as health spokesperson for Sinn Féin. The Budget is yet another example of the harsh Tory Government austerity, the consequences of which we have borne for over a decade.”
“The Committee has not therefore had an opportunity to scrutinise the Department's spending plans and is unable to come to a position on the Department's plans for 2024-25. <BR /> <BR />The Committee remains committed to working with the Minister and the Department to ensure that additional funding is provided to the Department of Health throughout the year. It is important that the Department has detailed plans for how it will spend any additional allocations that it might receive during the year. As Chairperson, I am happy to support the Minister in discussions with the British Government about the additional funding for our health service.”
“So far, the Committee has not been advised about which of those services will be cut by the Minister. <BR /> <BR />The Committee was briefed on the Main Estimates by officials at its meeting last Thursday. Members were advised, however, that the detailed plans were still not ready, as the trusts had only just provided their plans to the Department the previous Tuesday. Committee members received correspondence from the Minister yesterday afternoon, providing an assessment of the 2024-25 Budget. Again, the paper does not provide information on prioritisation, just a number of options of what might be cut. There should be clarity on the shortfall that the Department says that there is. In a number of different letters received by the Committee, there has been some conflicting information on savings made and their impact on the shortfall.”
“It is disappointing that the Committee has not had sight of the detailed spending plans and the Minister's priorities for the incoming year. The Committee has been disappointed with the lack of detail provided to it by the Minister and the Department. <BR /> <BR />When the Budget allocations were announced, the Committee received a letter from the Minister that outlined his disappointment at the allocation that his Department received. In that letter, he advised of the possible consequences of his budget, including a halt to waiting list initiatives; no pay settlements; restrictions on the use of new drugs; suspending some vaccination programmes; and a reduction of 1·1 million hours of domiciliary care, 500 independent-sector care home beds and 140 acute hospital beds.”
“<BR /> <BR />The Health budget makes up just over 50% of the total block grant and has significant implications for the health and well-being of the people here. It is crucial that we understand its impact and significance. We must acknowledge the importance of healthcare in our society. It is the cornerstone of a thriving and prosperous community. The allocation of funds in the Department directly affects the quality and accessibility of the healthcare services available to the citizens in our constituencies. We must therefore ensure that those funds are allocated wisely and efficiently. That is why it is important that we, as a Health Committee, undertake detailed scrutiny of the Department's spending plans and priorities for this year.”
“I welcome the opportunity to outline the Committee's consideration of the 2024-25 Budget. At the outset, I say that the Committee recognises the budgetary constraints and pressures that the Health Department is under in this financial year. Indeed, that goes across the wider Executive, with all Departments being under significant pressure. Over the past number of months, the Committee heard from a number of representative bodies and departmental officials about the pressures and stress that the health system is under. We heard from a number of medical professionals, including GPs, nurses, doctors, consultants and surgeons, that if improvements to the system are not made, it faces a catastrophic impact.”
“The SI introduces amendments that enable qualified registered dental therapists and hygienists and registered pharmacy technicians to sell, supply and administer certain medicines relevant to their professional practice. <BR /> <BR />The Committee was briefed by departmental officials on the proposed SI on 2 May 2024. At the briefing, the Committee sought further information about the consultation that was undertaken by the British Government, the type of medications that dental hygienists and pharmacy technicians would be allowed to prescribe and how training would be provided. At the meeting, the Committee agreed that it was content with the merits of the policy. The Committee then considered the statutory instrument at its meeting on 16 May and agreed to recommend that it be approved by the Assembly.”
“I welcome the opportunity to confirm the Health Committee's support for the motion. As the Minister said, the statutory instrument amends the Human Medicines Regulations 2012, which govern the arrangements across the UK:”
“Will the Minister give way? On the back of that, it is important that I correct the previous Member who spoke. It is not up to the Finance Minister to decide how the Department of Education spends its budget or how the Department of Health spends its budget. She makes the allocations on a very limited Budget. However, the Minister noted the developments on the fiscal framework, and that is welcome. I congratulate my colleague Caoimhe Archibald for going over to the British Treasury and fulfilling the commitment to ask for more money. That is what is needed, and it is why we are in this situation.”
“I urge the Minister to continue engagement with representatives of the striking doctors to reach an agreement urgently, as his colleagues across the water have been able to do. If the matter is not resolved, patients and healthcare staff will suffer as a result, and that will have huge consequences for our health service for a long time.”
“We see colossal waiting lists and a lack of bed capacity. Staff vacancies, including among our junior doctors, are putting patient and staff safety at dire risk. I do not underestimate the challenges faced by the Health Minister, so I do not want to come across as being too critical, but this will only get worse if we do not address the issues that force valuable staff out of the job that they have trained to do, a job that they love and, in many cases, want to stay in but for their feeling, sadly, that they have no option. <BR /> <BR />Striking is a last resort for all the doctors who are going back to the picket lines tomorrow. They should not be in that position.”
“I thank the Member for her intervention. It leads on to my next point and is exactly the point that we need to hear loud and clear. They are realistic in their expectations. They know that full pay restoration of over 30% cannot be delivered right now, but they want a commitment to work towards it, and, until they have that, they cannot move forward in good faith on any of the other non-pay issues. That is not unreasonable, given that they are still waiting for their 2023-24 uplift. I think that they said in Committee that they had been told that they would get it in June but did not know whether that meant June of this year, next year or another year. <BR /> <BR />Our health service is, no doubt, running on empty. Primary care is in crisis. Secondary care is in crisis. Social care is in crisis.”
“I do not know what the alternative is to voting for a Budget when we have absolutely no control over how much we have. <BR /> <BR />We have talked this to death. We want to make progress with full pay restoration, but, in reality, that is not achievable in the here and now. That does not negate our responsibility to progress the issue, find a way forward and give a commitment that we will work towards that.”
“When the Health Committee was told that the suggestion of an increase in pay above the DDRB recommendation as a starting point was given a flat "no", even before the Budget was agreed by the Executive, we were all, it is fair to say, fairly disappointed to hear that. That, ultimately, appears to have closed down any prospect of further negotiations. I am aware that the Minister met the BMA this morning but am not aware of any further progress on that. <BR /> <BR />There is no doubt that we are all realistic about the financial picture. The Finance Minister continues to challenge the British Treasury on the significant underfunding of public services here. The comments of the Member who spoke previously about the Executive's and our being disingenuous are pretty rich.”
“It does not take a lot of imagination to see why we are losing junior doctors in their droves when they can earn more doing the same job in the South of Ireland, in Britain or overseas. If we are really serious about tackling the crisis in our health service, that cannot be ignored. A survey by the BMA in 2022 showed that just 7% of medical students here intended to stay and work in the North. After two years with little to no change, I doubt that those figures have got any better. <BR /> <BR />Like others, I have met the junior doctors committee on a number of occasions. They outlined to the Health Committee their engagements to date with the Minister and his Department. The lack of progress has been disappointing, particularly on moving the pay issue forward.”
“Those were the stark words of the representatives of the BMA at the Health Committee on 9 May, detailing the serious situation facing our hospital doctors and GP trainees as the result of years of pay erosion and the growth in staff vacancies. As we have heard today, for the first time, junior doctors voted overwhelmingly in March of this year to take strike action, emphasising just how dire the situation on pay and conditions is. That was in March, and we are here again, two months later, with no progress on the issue. Junior doctors are once again taking to the picket lines — this time for 48 hours — demanding action on pay. <BR /> <BR />Junior doctors work in the most challenging conditions, looking after sick patients and with huge responsibilities, for as little as £12·50 an hour.”
“I share the sentiments of others and send out our solidarity to all the families who have been impacted. One of the people affected is Nigel Hamilton, chair of Haemophilia NI. We met him recently with the Health Committee. He lost his brother Simon in December. The inquiry report will be healing, but we have a long road to go. <BR /> <BR />The Minister may or may not be able to answer my question today, given what he has just said. The British Government have said that they expect payments to be made in the next 90 days. Is there any indication of how that will look for people here in the North who are affected as much as anyone in Britain? Will it affect anyone who is already engaging with the compensation scheme?”
“<BR /> <BR />I look forward to seeing the LCM progress — hopefully, we will get answers to the queries raised — to ensure that the legislation will deliver for the people here and make a significant impact on improving health in our communities for future generations.”
“However, we acknowledge that that will take time and that we must do more in the interim to support smokers to quit and raise greater awareness of the serious implications for our health from smoking. That will undoubtedly be impacted by the challenges facing public health campaigns as a result of funding difficulties. However, we must acknowledge the long-term impact of not providing education and support to smokers and those who may take up smoking. <BR /> <BR />I also want to hear more about what progress has been made with the Minister's counterparts in the South of Ireland in an effort to align policies around tobacco use and vaping. Coming from a border area, I know that it is important that the LCM does not open up opportunities for a black market for these products, which would inevitably have a counterproductive effect.”
“The Committee agrees with the Minister that the measures in the Bill offer a huge public health opportunity that cannot be missed and that will go a considerable way towards the ambition of creating a smoke-free generation. That is an ambition that the Health Committee fully endorses and supports. <BR /> <BR />I will now make a few remarks in my capacity as Sinn Féin's health spokesperson. My party also fully supports the LCM, having recently met various organisations, including Cancer Research, Asthma + Lung UK, Cancer Focus, Chest, Heart and Stroke and the British Heart Foundation, all of which endorse this very important legislation and the role that it can play in improving the health of our communities, particularly in reducing the prevalence of preventable cancers and other medical conditions.”
“I and other Committee members were impressed by their ability to convey their opinions and give their real-life experiences of smoking and vaping. I look forward to engaging with them more over the next number of years. I thank the Institute of Public Health for its engagement with the Committee on research in the area and for providing further briefing papers in advance of the debate. I also thank the departmental officials for their briefings and responses throughout the Committee's consideration of the LCM. <BR /> <BR />I confirm the Committee's support for the Minister's motion, which asks the Assembly to support the extension of the Tobacco and Vapes Bill.”
“The Committee requested, in recognition of the particular concerns that the Youth Assembly raised in relation to vaping, that the Minister and his officials make meaningful efforts to engage with our young people and, in particular, the Youth Assembly on the future regulation of vapes and vaping products. The Health Committee shares the concerns articulated by the Youth Assembly on the potential harms caused by vaping products and recognises the lack of available research on the subject. We request that the Department supports research into developing an evidence base to widen our understanding of the impacts of vaping products on health. <BR /> <BR />I thank the members of the Youth Assembly who met the Committee on the LCM.”
“The Committee therefore requests that the Minister and his officials engage with the Health Committee at the earliest opportunity on the development of the local regulations for which the Minister of Health has responsibility and the broader regulations for which the Secretary of State has responsibility. <BR /> <BR />I welcome the confirmation from the Department that the £100 fixed penalty notice for the underage sale of tobacco and vaping products outlined in the legislation will not apply here and that the fixed penalty notice here will be £250.”
“The review also found evidence to support the association between vaping and physical and mental ill health and other substance use. <BR /> <BR />The Committee shares the concerns expressed by the Youth Assembly and the Institute of Public Health about vaping. We are particularly concerned about the obvious targeting of the youth market with flavouring and packaging that is appealing to young people. The Committee notes that the Bill contains regulation-making powers that will make provisions in respect of point-of-sale displays, restriction of product flavours and packaging and age-of-sale requirements for non-nicotine vapes.”
“When we consulted Youth Assembly Members on the Bill, they told us that they were also concerned about the increasing rates of vaping amongst their peers. They told us that they were particularly concerned about the unknown impacts of vaping on health and the evident impact that disposable vapes have on our environment. <BR /> <BR />The concerns that the Youth Assembly expressed were supported by the Institute of Public Health, which also provided evidence on the Bill to the Health Committee. The institute advised the Committee that it had carried out an evidence review to support the Department of Health in responding to concerns about youth vaping. That review found strong, high-quality evidence of an association between vaping and subsequent cigarette use, supporting the idea of those products having a gateway effect.”
“However, the Committee acknowledges that the legislation is not a silver bullet. Whilst it contains provisions that will protect future generations, it does not contain measures that target the current generation of smokers. The Health Committee therefore looks forward to engaging with the Department of Health in its development of a new tobacco strategy, which must contain specific measures that will support existing smokers to quit. In particular, it must contain measures that target the groups in which smoking rates are highest. <BR /> <BR />As the Minister outlined, the Tobacco and Vapes Bill will also introduce measures aimed at tackling increased rates of youth vaping, including measures to reduce the appeal and availability of vapes to children.”
“The Department's 2023 review of the most recent tobacco control strategy reported that inequalities in smoking prevalence also persisted among other groups, particularly those with mental ill health. <BR /> <BR />The Committee welcomes the extension of the Tobacco and Vapes Bill, as the measures in it will unquestionably provide significant health benefits here, particularly for our young people. As the Minister outlined, by prohibiting the sale of tobacco products to people born on or after 1 January 2009, the Tobacco and Vapes Bill will introduce measures to stop people ever starting smoking and becoming addicted to tobacco products. The Committee wholeheartedly endorses the measure. It will surely go a considerable way towards realising the ambition of achieving a smoke-free generation in the future.”
“I welcome the opportunity to confirm the Health Committee's support for the motion that the Minister of Health has brought to the House. The harmful impact of smoking on health is well known and cannot be overstated. As the Health Minister outlined, around 2,200 people die from smoke-related illnesses each year in the North. Many more people live with the debilitating effects of smoke-related illnesses, such as heart disease, stroke and diabetes, as well as many other life-limiting conditions. The avoidable illnesses, diseases and deaths that smoking causes are unacceptable in this day and age. We also know that tobacco use is a leading cause of health inequalities, with smoking prevalence rates higher among people who live in areas of social and economic deprivation.”
“I thank the Minister for giving way. Mullaghbawn surgery is an example of where the Department and the trust have stepped in, which is welcome, but he will know from our recent correspondence about some of the challenges that are faced there because we do not have a retained workforce but are operating the service with locums. Does the Minister agree that tackling that workforce issue and ensuring that we can retain GPs who consistently provide the continuity of care that is needed for patients is more important?”
“We need to see a plan for the Budget and a workforce plan, because that will support primary care and it will support staff in the jobs that they have set out to do — they are vocations — but it will also meet the growing needs of patients and the people we represent.”
“Across the North, we have a skilled, experienced and agile community and voluntary sector that already provides invaluable support and services to some of the most vulnerable people in our communities who, without that sector, would have none of the services or facilities that are critical for their needs. It is absolutely essential that the community and voluntary sector is an integral part of any future roll-out of MDTs. <BR /> <BR />To conclude, it is fair to say that there is no doubt that the financial picture for the incoming Budget is challenging, but we cannot afford to stand still or do nothing.”
“A GP practice with a full complement MDT, working with nurses, social workers, Community Pharmacy and mental health practitioners, can bring care back into the community and, crucially, will be able to treat a variety of health, mental health and social issues, which will improve patients' health outcomes while alleviating the pressures on the health system overall and utilising the broad range of skills, knowledge and expertise that we have in spades across our statutory services and, equally importantly, in the community and voluntary sector.”
“There is a real difficulty in attracting new doctors to choose general practice as a career that they want to come to, with much more attractive opportunities in the South, in Britain and overseas with much better pay and conditions. Without a GP workforce, we simply do not have a fit-for-purpose GP service. The impact of that on patients, staff and the health and social care system as a whole is far-reaching. General practice is often referred to as the "front door" of the health service, and every person in our communities will rely on their care at some stage in their life. That is why it is vital that they are supported. <BR /> <BR />The rolling-out of multidisciplinary teams and addressing indemnity are two of the most important issues, and a permanent solution to both would take enormous strain off the entire healthcare system.”
“At the Health Committee, we heard just how stark that picture is from the royal college and the British Medical Association (BMA). GPs are experiencing unprecedented pressures as demand for their services grows but the capacity to meet that demand declines because many GPs are leaving the profession prematurely.”
“Just last week, another GP practice in my constituency announced that it will not renew its contract, owing to the huge pressure that it faces to deliver that important service. That is a very difficult decision for any GP to have to make. We heard very clearly at the recent Royal College of General Practitioners event that that is not a decision that any GP wants to take.”
“<BR /> <BR />We are in crisis management mode, trying to put money into our health service at the latter stages of a patient's journey — in some cases, when it is already far too late — when more care is needed, which costs more and adds to the already colossal pressure that is on our health service. To turn the ship around, we need to focus our efforts upstream on the first point of contact for patients, which is primary care. A properly resourced primary care service is critical if we want to transform our health service and improve the health of our communities. There is not one Member in the Chamber who has not had constituents come to them for help because they have been unable to get an appointment with their GP. That situation is worsening by the day.”
“I thank the proposer and his colleague for tabling the motion. It is fair, and not an exaggeration, to say that our health service is on its knees. Every corner of the system is under severe pressure, and staff are working in the most challenging and, too often, unsafe circumstances. Every day that that situation continues, patients get sicker and need more care, and there is less capacity to provide what is required. Something has to give. <BR /> <BR />We hail the benefits of early intervention and prevention in healthcare, as they undoubtedly promote better patient outcomes and ensure that people live well for longer. Although we know that people across the North are living longer, many live with a range of health conditions and languish, with a very poor quality of life, on waiting lists. Sadly, many even die while on waiting lists.”
“I thank the Minister for his answer. Just to be clear, there was no criticism in my question, but I thank him for the update. The Minister will be aware that the bovine TB rate is almost double that in the South of Ireland, which is obviously an issue for many of our constituents. He mentioned that he hopes to do some work, so will he give us a wee update on what that package of measures might be and how he expects to see it being brought forward?”
“<BR /> <BR />We are at a turning point for dementia treatment and research, and, therefore, we must act urgently to capitalise on that. For the first time, there is hope of detecting and treating dementia by diagnosing people with a simple blood test. Dementia's devastating impact is colossal on the lives on those it affects, the healthcare system and the economy. Now is the time to prioritise dementia, and that starts with getting more people diagnosed.”