Michael McGimpsey
South Belfast · Ulster Unionist Party · Northern Ireland
“Bearing in mind that the election will be fought on issues around health, spiralling waiting lists, employment, and investment in education, does the First Minister believe that, in the event of a Brexit, 25% of our exports will continue to go to the Irish Republic, or does she believe there is a threat there?”
“I established the Health and Social Care Board and, when I left, there were 335 people working there. That figure is now somewhere over 600. It has been allowed to bloat by, roughly, a factor of two. The Minister needs to clarify whether most of those bodies are going to be moved into the Department.”
“I am disappointed with that answer. I would be surprised if, when my name appeared to ask a topical question, the Minister's officials did not come forward with a suggested list of topics that I was liable to ask about. That is the whole point of topical questions. I remind the Minister that Breda is a school designed for 850 pupils.”
“I will give way in a moment. <BR /> <BR />It is just as clear that response times are key for the Fire Service. The faster the response time, the more likely a successful outcome in dealing with the incident. <BR /> <BR />There is another issue here that I want to deal with.”
“<BR /> <BR />It is quite clear that the funding has been going down. It was £81·6 million in 2011 and £69·7 million in 2015, we are now down to around £65 million. The funding is going down, and it is preposterous to try to say that that will not compromise the service, a crew or the public.”
“There are a number of reasons why you underspend: it may be that it was not allowed to spend, or it may be that there are vacancy controls in place that prevent it from spending money on recruitment to replace personnel. Of course, 80% of its budget goes on personnel.”
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“I think that no one really understands the situation that Simon Hamilton has allowed himself to drift into, a position where he has such a life-and-death situation to deal with and is not at his desk and is not here today. He can talk to the 'Belfast Telegraph', but he cannot come here and talk to us. It illustrates the situation perfectly. <BR /> <BR />The health service has been underfunded for the last four years. We know that from the 2011 Budget. I take no firmer evidence than the example of Edwin Poots, who went into the health service in spring 2011 and said that he did not need another penny and had all the money he needed. There would be no more money, but he would do it because, as he said, productivity in our hospitals was low and he would fix it through productivity and efficiency.”
“I thank Mr McKinney for that intervention. I read Simon Hamilton's article in today's 'Belfast Telegraph'. It illustrates perfectly the point that he makes: the Minister does not understand the role that he has in addressing such a crisis. He should, because, on Thursday night, he was on 'The View' and Janice Smyth of the RCN told him clearly what he was there to do: to give leadership and strategic direction. That is what we are asking for now. Without that strategic direction and leadership, the situation will continue to drift. I have no doubt that it is liable to get worse. That is a matter of life and death. That is absolutely irresponsible.”
“We could be talking about all of those areas, because they are all areas in which waiting times far exceed anything we have seen in the recent past. Indeed, we are now estimated to be at the worst waiting times in the health service for 15 years. Our health service is in crisis. We need an emergency response; we need a crisis response; and we need immediate action because our patients are in extremis. How do we get that? We get that by the Minister taking an emergency action plan to the Executive and getting that support. Sammy Wilson promised at the last Budget in 2011 that, if there were any financial shortfall, he would go to the Executive and simply top-slice all Departments to get that money — a promise, of course, that has not been kept. That is the situation that we are in. That is why we need the Minister to be at his desk.”
“If there is any delay in the diagnosis of a serious or life-threatening condition such as cancer, there is a reduced likelihood of a successful outcome. That is a fact. We are talking about a life-and-death situation. We have an absolute responsibility and duty to deal with this. That is the problem, and it has to be addressed. It has to be fixed, and it can be fixed. This is not the way that it has always been. Normally, in the past, our cancer services were on target because they got the support and resource from the House and the Executive that they required. This has not been the case for a number of years, and I will go into that in a few moments. <BR /> <BR />The reality is, of course, that we could equally be talking about cardiology, neurology, trauma and orthopaedics, ophthalmology, general surgery, ENT or gynaecology.”
“It is not fair on them, any more than it is on the patients, that they are under such stress and pressure and are not provided with the resource and support that they need to deliver for the patients in the manner they want to. I will not go through all the statistics that we have heard today from successive Members — statistics on waiting time targets not being met, whether they are for breast cancer, urgent GP referrals or moves to inpatient or outpatient treatment Throughout cancer services, we are slipping. <BR /> <BR />It is clear that we all understand that, if you are waiting for cancer services, the likelihood is that you can come to harm. Early diagnosis and early intervention are, of course, the key.”
“I rise to make a winding-up speech on this important debate. I thank all Members who have taken part in it and have added valuable contributions to this debate on cancer services, particularly Oliver McMullan and Seán Rogers for their personal contributions, indicating and illustrating exactly the situation for patients of our cancer services. <BR /> <BR />First, let me say that our cancer services have very good staff. We have very good doctors, oncologists, health professionals and nurses dealing with cancer in Northern Ireland. We must pay tribute to them for the tremendous work they do and for the huge number of successes they are responsible for. They literally give people back their life in countless situations.”
“Last year, 50 of them went off to Australia and Canada, and that is an issue.”
“<BR /> <BR />If we are prepared to address that problem, it can be fixed. This is not something that cannot be done: we did it before. I took over from Paul Goggins in 2007. He had begun a process, and, in the three years that I was Health Minister — I am by no means saying that it was all down to me — we put a system in place to fix this problem, but we have to provide the wherewithal and the means for that. <BR /> <BR />Let me give you another example. You talked about shortages. I found the money to train an extra 70 doctors a year in the Queen's medical school. I had to take the money off the wards, because, of course, the money for training doctors does not come from DEL or the Department of Education but directly from the Department of Health.”
“<BR /> <BR />We have a major problem. There were clever remarks about DRD: our Minister resigned to go into opposition, and the fact that nobody has been nominated to replace him is not down to us. That is not our fault, and you should think about that. We have this huge problem, and we are talking about it and saying that we will fix it with TYC or Donaldson's recommendations. We are getting esoteric and philosophical, and we are saying that we should not have any more private money and all the rest of it. We must have a plan of action right now — I called for this in the Health Committee many months ago, and I am still calling for it — to address the issue. We are not seeing a plan, and, as long as that is the case, we are looking at patients coming to harm and being in trouble.”
“I still do not understand the logic of your saying that our proposal will lead to cuts. You can only pay for the service that you fund, and we are not funding the service that is required. The Member is right that, under the last Minister, Bangor Community Hospital shut. One of the key elements of TYC is step-down beds, GP beds and intermediate beds. So the idea should have been to take folks out of the Ulster Hospital, where they were receiving acute care, and, if they were not fit to go home or into a nursing home, they are provided with good nursing care that is overseen by GPs. However, Bangor Community Hospital has been shut, despite promises to the contrary. I agree that that type of convoluted approach is wholly contradictory. I have an issue with domiciliary care charging and the statutory residential care home closures.”
“Ms McLaughlin talked about the private sector, but I make no apologies for buying operations wherever I could get them to make sure that those 300 patients were properly dealt with. If I had not done that, a number of them would have come to harm. <BR /> <BR />We are in an extreme situation, and we are not prepared to face up to it. As I said, I support TYC, with the two caveats that I outlined, but it will not fix the problem. I support much of what Donaldson said — perhaps not all of it — but his recommendations will not fix the problem now. This is an emergency.”
“The fact is that we have an urgent problem. Fully implementing TYC and Donaldson's recommendations will not fix this; we now need emergency measures to fix the problem. The Belfast Trust, for example, abandoned elective spinal care at the end of last year. Imagine the number of patients who are sitting in extreme pain and distress. Although 100% of urgent breast cancer referrals should be seen within 14 days, we are down to 80% being seen within that time, so a number of women who are in trouble are not being seen in a timely manner. <BR /> <BR />It is the same with cardiac surgery. When I was there, there was a demand for 1,300 open-heart surgery operations in Northern Ireland, but we had the capacity for 1,000.”
“Of course, the DUP voted against it, but that is neither here nor there.”
“The DUP did not believe me; Sinn Féin did not believe me; the Alliance Party did not believe me. Those three parties streamed through the lobby and voted for a Budget that was inadequate. I actually predicted these consequences if we did not properly fund the health service. We all share the blame. All the parties that voted for that Budget share the blame. They need not stand and wag their fingers now, because they are the architects of this situation. <BR /> <BR />There are certain things that you have to do for the health service. You have to invest in your buildings, your equipment and your people; you have to be efficient — in my time we produced £700 million of efficiencies over three years; and you have to engage with the public about their health, and I set up the Public Health Agency to do exactly that.”
“I agree: 95% within four hours is the target. Recently, we were there or thereabouts throughout our A&Es. All waiting times have slipped, and if you are not being seen in a timely manner, you are liable to come to harm. That is the issue. Cradle-to-grave healthcare, free at the point of delivery, is what we are here to provide. If we are not prepared to face up to that, we need to be honest with our constituents. <BR /> <BR />At the last Budget I dealt with, in 2011, this House was not prepared to face up to the bill to run the health service. I said that, based on the money that was offered, I needed an extra £200 million a year for three years and another £150 million in year 4 — £750 million — just to keep the health service stable, and where we were then was an awful lot better than where we are now. This House voted against that.”
“We brought surgical teams in from England to work nights and weekends to address the needs of patients, because patients who are not seen in a timely manner are in pain and distress, and many come to harm. The waiting times for cardiology and for cancer mean that our patients are coming to harm.”
“<BR /> <BR />The other key element as we look forward is the Donaldson plan to rationalise the acute sector. Many Members have some difficulties with that, not least Dominic Bradley, who is bringing forward a debate about the A&E at Daisy Hill. That is an example of where change is inevitable, and the attitude shown in that debate can help the Minister for Health, whoever it is, make the decisions he has to make. I remember that when I took decisions on the health service, general hysteria broke out in this Chamber among all parties. <BR /> <BR />The waiting times now are as bad as they have been at any time in the last 15 years. When I took over in 2007, something like 200,000 people were on the waiting lists, and we got that down. To do that, certain steps have to be taken.”
“I thank my party colleague Mrs Dobson and all those who have taken part in this debate. We recognise this for the important issue it is. It is a part, although by no means all, of the problem that the health service is facing. The solution proposed by Mr McKinney — the full implementation of TYC — is a part, but not all, of the solution. I say that because full implementation of TYC would include charging for domiciliary care and closing statutory residential homes, which I have an issue with, and, as Minister, I resisted those types of measures. Much of TYC — I called it "shift left" in my day — is a good idea. It is about taking care into the community and supporting the community; but it needs major investment, and that major investment is not available, which is why we do not have it.”
“On a point of order, Mr Deputy Speaker. Earlier, you ruled that Mr Allister was off the mark when he talked on this subject. Is Mr McCrea not also off the mark with his totally inaccurate remarks on a separate issue?”
“I thank the Minister for that answer. Could she indicate, while she is still in the planning process, what notional budget she plans to allocate to the programme? Can she confirm the number of grounds she anticipates will benefit, and when does she expect moneys reaching the clubs and organisations to be spent on the ground?”
“In view of the fact that this matter is a key part of the Stormont House Agreement — I welcome the Minister's comments about the full implementation of the agreement — will he confirm that he is not currently considering a partial implementation of the Stormont House Agreement and is in fact working towards its full implementation?”
“I agree with the Minister that we provide good public housing. The problem, of course, is that there is simply not enough of it. What effect will the projected 2,000 properties for this year being reduced to 1,500 — a 25% reduction — have on the waiting list, particularly for the provision of vital family-sized housing?”
“I will draw my remarks to a close by making a plea to the Minister to intervene. Here is another reason that this should be provided: to give our children the best start that we can in the communities that, by any definition, are seriously socially deprived.”
“In the society that we are trying to build, in which we are all together, the key thing for us is that we live together, work together and are educated together. This is an absolutely perfect example of how we address the issue. It is about the provision of that new school, which has been so long in the planning. We have hit hurdle after hurdle. We have communities on board. It seems that that is the best way in which to address this.”
“<BR /> <BR />A second point concerns the provision of primary schools. In inner south Belfast, we have the issue of the consolidated primary school. That issue has been running for about 15 years. I have been involved in it with various communities, and it just seems to go from one hurdle to another. The latest hurdle is the director of the Council for Ethnic Minorities appearing to say that newcomer children will not go to the new school and that they want to stay in Fane Street Primary School. That would jeopardise the provision of a new school. I will speak to Patrick in due course, and I am quite sure that he did not intend to get the reaction that he did, but that type of situation is most unhelpful.”
“Without rehearsing all of that, let me point out the situation in inner south Belfast. At Arellian Nursery School on Sandy Row, there were 104 applications for, I think, 54 places. I had meetings with the Belfast Education and Library Board (BELB) and the chief executive of the new board. They have found 40 extra part-time places, which has done an awful lot to address the issue this year. I am grateful to them for their support, and the parents clearly are as well. That has gone a long way to addressing the gap, but it is a gap that we knew was coming. It is not rocket science to work out the birth rate and what the needs and demands will be and match those to provision. If we had demand and provision matched, it would avoid an awful lot of angst in schools and, not least, families. That is very important.”
“There are certain conflicts. One of the conflicts, as has been pointed out, is that working parents appear to be disadvantaged in provision compared with parents who are defined as "socially deprived", which appears to be based on the criterion of certain benefits. Working parents who do not derive those benefits are not designated as socially deprived, and their children may lose out. That is not good enough. It is wrong. All children have the right to be treated equally, no matter who their parents are. Those who are socially deprived must, of course, have our support, but no parent should be coming to me and saying, "Because we're not on benefits and not meeting that criterion, our children lose out". <BR /> <BR />The issue in inner south Belfast has been well pointed out. Máirtín Ó Muilleoir pointed it out, as did Fearghal.”
“It was put to me that that is the time when children's brains are effectively hardwired. It is very difficult for them to catch up if they miss out on the opportunity at that time.”
“I thank Mrs Cochrane for securing this debate on a very important subject. Like her, my office has had a huge amount of interest from constituents who have expressed concerns about preschool and primary provision. <BR /> <BR />We should start with a first principle: we are here to provide an education system that is free and specially tailored for the mixed talents and abilities of all our children — not some of them or most of them but all of them. A key part of that education system is, of course, preschool and primary provision. It is clear that some of our children lose out on preschool and nursery provision. I will talk about primary provision in a minute. One of the things that was impressed on me very much when I was Health Minister was how important those early years were for children.”
“— about exactly where this is going. Thank you.”
“This is in reference to Antrim A&E. I also had a part to play in delivering that. I remind the Minister that the four-hour waits, which should be at 95%, are down at around 60%, so clearly we need reform. I bring him to Transforming Your Care (TYC). It is a process that we used to call "shift left", before Edwin Poots changed it to Transforming Your Care. Will we get a published timeline, with money, which is properly benchmarked? There is a lot of confusion in the Health Committee about exactly where we are with the process. It is essential to keep the patient at the centre of care, and, frankly, the Committee, as well as many of the officials, appear to be in the dark —”
“I did my best, thank you, yes. Absolutely.”
“It is much needed. It would bring together all the local communities, which strongly support it, and integrate newcomer communities with the local community so that we live together, work together and are educated together, rather than continue with a form of segregation, which we appear to be developing.”
“Will the deputy First Minister agree with me that one of the best ways forward for community relations is to provide the new primary school, which has been in planning for somewhere around 15 years?”
“I thank the Minister for quoting those figures. Can I quote him two other figures that he omitted? The figure for the economically inactive is the highest in the UK and is up 4,000 from this time last year. Most crucially, our rate of youth unemployment is also the highest in the UK, up 3,000 from last year. Will the Minister undertake to give the same deal to our young people as young people get in Scotland? In Scotland, when young people leave school, they are offered a place in education, training or employment. That way, we will not have an indictment on this House that young people in their hundreds and thousands leave school to go on the dole.”
“Mr Principal Deputy Speaker, I join you in welcoming the Minister.”
“I refer also to the danger of Departments underspending. There is also the danger in the current financial climate that we may be forced to send money back to the Treasury. Will she give us some comfort and assurance on those points?”
“I, too, welcome Mrs Foster to her new post.”
“I thank the Minister for her answer. The BBC 'Spotlight' programme clearly illustrates that whatever legislative regime we have, it is imperfect. It is not properly working, given the level of greed, exploitation and downright cruelty that we saw. Will the Minister explain what steps she will now take to put an immediate stop to that type of trade; to prevent it happening now and in future; and to allow dog breeders who rely solely on good practices to continue without unjustified stigma?”
“Bearing in mind the important role that the Internet and Internet chat rooms have had in promoting suicide, how effective have the Byron report and the Byron task force been in bringing providers into some sort of social responsibility to help us press down on what is one of the scourges of our society?”
“I thank the Minister for his answers. This is a very important scheme for Belfast because of the tremendous traffic congestion that we get in that area. All things being equal, as we go forward, can he indicate what steps he will be able to take to minimise disruption during the actual construction process, bearing in mind the disruption to traffic in the area at the moment?”
“I agree with the Minister that staff have performed wonderfully for us in Belfast in the A&Es. However, I point out to him that, even though we have highly professional, dedicated staff, we still have, in terms of four-hour waits, the worst A&E waiting times in the UK. We look forward to seeing the new figures coming out in a week's time. Is it not an indictment of the board of the Belfast Trust that the Chief Medical Officer has had to be drafted in as chief executive of the Belfast Trust? The board had one year to appoint a replacement to Colm Donaghy and has failed to do that. Is that not an example of that board dropping the ball?”
“The evidence suggests that abuse has virtually doubled — and that is in the institutional setting, so we can imagine that in the private home setting the problem is probably much greater. I therefore look forward to hearing what the Minister has to say.”
“Domiciliary care packages have been squeezed over the past number of months and longer, but they provide much more than simple physical support for our elderly: they are also a means of protection. <BR /> <BR />I have no problem in supporting this. I look forward to hearing what the Minister has to say and what the thinking of the Department is now. It was very much in favour of guidance when I was in his shoes. I assume that he will come forward with ideas for legislation, but legislation on its own will not do it. Legislation has to be backed up. We need to hear what sort of support the Department is proposing to put in place to deal with the situation.”
“<BR /> <BR />The elderly population is growing: the demographics are quite clear. Most older people will be supported in their own homes for most of the last third of their lives, and our responsibility lies there. I am concerned that domiciliary care packages will be cut back, because it is about more than the simple physical provision of various personal services. It is also about staff going into people's homes and having time to spend with the individuals to talk to them and to ensure that they are in good heart and are not being subjected to any form of abuse as far as they can possibly determine. I have always seen that type of inspection by our domiciliary care providers as a key part of the protections for our elderly population. One visit a day is certainly inadequate.”
“It is probably easier to oversee that setting and ensure that the vulnerable elderly population in it are properly protected. In investigations of abuse, around 50% of cases are in care home settings. <BR /> <BR />Most of our elderly population are not in care homes but in their own homes. Indeed, the whole thrust of health provision is to keep individuals in their own homes for as long as possible. It is much more difficult to provide protection for vulnerable adults and frail elderly people in that type of setting. Very often, the abuse comes from family members in the form of physical, financial and emotional abuse and neglect. It is most difficult to provide protection. That is where we need legislation, penalties, as Mr Poots said, and proper investigations to ensure that we provide the best protections we can.”
“I thank the proposers for tabling the motion, which, of course, in common with others, I support. It is important to reflect on the fact that we are talking about older people in care homes and institutional settings. Allegations of abuse have risen quite dramatically over the past three years, and that is a disgrace. We are in a position to do something about it. Guidance has been in place since 2010. The Commissioner for Older People is now saying that it is time for legislation, which I also support. It is important to bring forward that legislation. <BR /> <BR />In an institutional setting, whether a care home or a nursing home, we have the capacity to deal with the issue, not least because staff there can be registered, trained and properly inspected.”
“It is crucial that the drainage project includes Balmoral Golf Club land to provide protection for Sicily Park and Greystown Avenue. How long does the Minister envisage contractors being on site in Balmoral? In other words, for how long will golfers face inconvenience?”
“— that this is, in effect, a plan to reduce the service to match the budget that is available and that it is, in fact, a closure plan? When are we going to see the actual closures and the list?”
“Yes, you have. I am just doing it. Do you accept —”