Danny Donnelly
East Antrim · Alliance Party · Northern Ireland
“I thank the Minister for that answer. It will not satisfy the people of the area. The completion of the 3 km distributor road was planned to be a key part of the development, linking hundreds of houses to the wider road network, but, due to a planning issue by her Department in the 1990s, it never happened.”
“I thank the Minister for his statement. Minister, as you mentioned in your statement, the inquiry was highly critical of what it describes as "an adversarial and oppositional approach" by the Belfast Trust to the inquiry.”
“The Minister mentioned the need to reform the health service. In light of the recent startling figures that show that half a billion pounds was spent on locums over the past three years, does he agree that investment in attracting permanent doctors may be a more prudent use of Department of Health resource?”
“<BR /> <BR />As a nurse, I condemn the attacks in the strongest possible terms and highlight the specific impact that they have had on people who care for us when we are at our most vulnerable.”
“Every day, they treat patients with skill, compassion and professionalism. Let us be absolutely clear: when a nurse is intimidated on her way to work and chased by masked men into the Ulster Hospital, that is an attack on our health service.”
“I will speak today about the attacks on our international healthcare staff. I begin by saying that my thoughts are with the victim of the brutal attack in north Belfast and his family. I hope that he recovers well. <BR /> <BR />Violence has no place in our society.”
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“I thank the Minister for his answer. Where does 'Going for Growth' fit into his new vision for agriculture?”
“Thank you. Does the Minister agree that the mental health strategy cannot help to combat the mental health crisis that we are in when it is not being funded adequately?”
“as an urgent priority, but it should also encompass transformation more widely. We also need to invest —.”
“The proposer of the motion spoke about the fact that we have been talking about transformation for years, so it will be telling for us all to see whether Members from certain parties in the Assembly join protests at healthcare facilities that are earmarked for transformation. <BR /> <BR />Northern Ireland is not a large place, and we need a more efficient health service. That will not be possible if all parties do not commit to the Bengoa principles from nearly a decade ago. I support the motion and cannot disagree with it in principle, but it is disappointing that the party that tabled it has a history of calling for Executive parties to make difficult decisions at Assembly level while opposing such difficult decisions at a local level. <BR /> <BR />Finally, we welcome the call in the amendment for a "health service rescue plan".”
“To date, my party and I have been disappointed by the Department of Health's slow progress on addressing the urgent need for transformation. We have to acknowledge, however, that several parties in the Chamber are failing to support the need for transformation in their constituencies. They often do so for short-term, narrow purposes when they should be looking at what might be successful in the long term. I will give one example. In November last year, Lisburn and Castlereagh City Council members debated the closure of the out-of-hours GP service at the Knockbreda Wellbeing and Treatment Centre, which is set to move to the Mater Hospital. The current model leads to significant overspending, and that transformation is in line with the Department's No More Silos policy. Transformation will never be delivered, if it is not allowed to start.”
“I respect and acknowledge the difficult position that Minister Nesbitt, like all Ministers, is in. He is dealing with not only an extremely challenging financial settlement but the loss of time that could have been spent developing vital strategies and legislation. We have had a Health Minister in place for only three of the past eight years, two of which were occupied by the COVID pandemic. That left our health service without the necessary leadership and accountability and led to the development of a two-tier health service, with many people in Northern Ireland now paying huge amounts of money for healthcare from their savings, from borrowing or from their family. <BR /> <BR />I agree with the SDLP motion that a key problem is:”
“I thank the Opposition for tabling a motion on the most critical issue that we face: the crisis in our health service. We have just discussed how important devolution is for Northern Ireland, and the repetitive cycle of institutional collapse has had a devastating impact on our democracy and on the public's trust in our political institutions. <BR /> <BR />Let us look at the practical impact of having no Assembly and no Executive in place. No Health Minister meant no progress on many of the issues raised in the motion; no action on tackling some of the worst waiting times in Europe; no capacity to address the growing mental health crisis; and, as the amendment states, no further progress on the potential for "digital capability, innovation and research". <BR /> <BR />The motion rightly states:”
“I have had a similar experience since becoming part of the APG. My timelines are now flooded with tweets and things about free spins. Does the Member agree that free spins seem to be an incredibly harmful thing to offer online? If we were handing out free shots of alcohol to alcoholics or free cigarettes to smokers in public, nobody would consider that to be acceptable.”
“It is our view that the UK Government have a duty of care to individuals and communities here, who are exposed to marketing by online gambling operators licensed by the Gambling Commission in Britain. We need treatment centres for gambling harms here in Northern Ireland.”
“Such a model is already being introduced in GB, where a statutory levy is to be introduced from April 2025, with 50% of the resulting funds being specifically directed to the purpose of commissioning treatment and support services. I commend the Health Minister for the recent representations that he made, alongside the Minister for Communities and the Minister of Education, to the Secretary of State for Culture, Media and Sport, asking that Northern Ireland receive a share of that statutory levy. The levy is expected to raise £100 million for research and the prevention and treatment of gambling harms. Currently, it will cover England, Scotland and Wales but not Northern Ireland.”
“An immediate step that could be taken to fund the specific services for gambling disorders, as well as the much-needed research and prevention measures, is the introduction of a levy on gambling operators.”
“Furthermore, screening programmes should be introduced across all Health and Social Care services in Northern Ireland to help to identify and assist problem gamblers who are reluctant to seek support. Members may be aware that the National Institute for Health and Care Excellence (NICE) guidelines now recommend that GPs and healthcare professionals in England look for gambling-related harms, including to health, finances and people around the patient, such as their family and local community, so that that patient can be identified and offered treatment. <BR /> <BR />Given the financial pressures on the healthcare system here, lack of funding remains a significant obstacle to providing treatment.”
“<BR /> <BR />Several sources, including the voluntary and community sector, have told the APG that, due to insufficient training, questions related to gambling are not being asked of people who present to addiction services in the healthcare system or the voluntary sector. That means that people with gambling disorders are not being diagnosed correctly and not receiving the support that they need. The Minister should prioritise making training available to GPs, emergency services, social care services and other Health and Social Care (HSC) professionals on issues pertaining to gambling, allowing them to more effectively diagnose, signpost and treat patients presenting with a gambling disorder.”
“In the absence of capacity here, the Minister should investigate the possibility of our health service commissioning NHS England to treat people with problem gambling here. NHS England now regularly uses remote treatment. Recent academic research has found that, while it is not as effective as face-to-face treatment, remote treatment for gambling disorders works and may help to circumvent the practical and psychological barriers associated with face-to-face intervention, such as monetary costs, distance, the lack of flexibility, a desire for secrecy, embarrassment and the fear of stigma.”
“That means that people suffering from gambling disorders here have no access to specialised treatment. Furthermore, capacity in psychiatry and psychology services in general is extremely limited. The Royal College of Psychiatrists told the APG that we were in the midst of a psychiatry workforce crisis. There has been no increase in psychiatry training places in Northern Ireland since 2007, and there are currently only two addiction psychologists across all five healthcare trusts. By contrast, since 2008, NHS England has established 15 specialised gambling clinics, with seven new clinics having opened in the past year as the demand for their services continues to grow. <BR /> <BR />The Minister must address the current unmet need in the healthcare system in Northern Ireland.”
“As friends and colleagues can attest, I have little interest in sport, and I had little experience of gambling until I attended the all-party group on reducing harm related to gambling, which was an eye-opening experience. We have seen evidence of the damage done to people's finances, relationships and health by gambling, and we have heard from families who have lost loved ones to suicide as a result of gambling. It has been heartbreaking at times. Gambling is causing a high level of harm in our communities. As Philip said, 2·3% of the population is at risk, which is 40,000 people. That is a staggering figure. It is clear that we need to act. <BR /> <BR />There are no commissioned treatment services for gambling addiction in our healthcare service.”
“I thank the Minister for his answer. I certainly agree with that. Given that community pharmacies were a key pillar of his winter preparedness plan of last year and likely to be so again this year, what engagements has the Minister had with the UK Health Secretary on this topic and what he is doing to support this key sector?”
“The projects are associated with spiralling costs and ever-increasing delivery timelines. What is the Minister doing to ensure that future projects are delivered on budget and on time?”
“I know that one of the Minister's priorities is to focus on health inequalities, and I would like to hear him expand on that in his response. <BR /> <BR />There is no shame in mental ill health or illness. It is like any other sickness. No one would feel ashamed of having asthma or a physical injury, so no one should ever feel ashamed because of their mental health.”
“I appreciate that, on previous occasions, the Minister has indicated that the pressures facing his Department impact on his ability to carry out such public awareness campaigns, so I again encourage him to engage with mental health organisations in our communities, as they do invaluable work, including on public awareness. <BR /> <BR />It is important to emphasise that mental health is not solely a Department of Health issue. Although Health is the primary responsible Department, mental health should be a cross-departmental priority. The Programme for Government (PFG) acknowledges the role of the Department for Communities, for example, in noting the importance of sports in supporting mental and physical health. Ministers have also highlighted the overlap of poor mental health and economic deprivation.”
“The first action in the mental health strategy outlines what we must do in that respect: increase awareness of the different kinds of mental well-being, mental ill health and mental illness; encourage understanding and acceptance of their impacts; and recognise the signs of mental ill health. We should use public mental ill health education and effective awareness raising as methods of improving public knowledge of the key measures that we all can and should take to look after our well-being and that of others and, most importantly, to reduce stigma through encouraging discourse and dialogue.”
“<BR /> <BR />Funding is not everything, of course, and one step that the Minister could take is to engage with our experienced community and voluntary organisations on what they can assist with to fully realise that vital strategy. That is a key requirement of the strategy, specifically action 17. As the motion states, we need a work plan, and I look forward to hearing the Minister's suggestions on that and on how the Health Committee can work with him to help deliver it. <BR /> <BR />Another vital issue is the need for anti-stigma and anti-discrimination public awareness and education campaigns.”
“During the previous, reduced mandate, Minister Swann introduced the mental health strategy 2021-2031. I commend Minister Nesbitt for his efforts to ensure the continued implementation of the strategy. Progress has been made, but more needs to be done. I remain convinced that, on the road that we are taking, we will not see its completion by 2031. At a Health Committee meeting in November, we received an update from the Department of Health on the funding plan for the mental health strategy. It is worrying that the funding allocated in the years since 2021 has increased only slightly compared with the huge increase that is required each year as the strategy develops.”
“That includes the absence of multi-year budgets, which are essential for long-term planning in our health service.”
“We have not seen adequate investment in mental health through departmental resources. Last year, around 7% of the departmental budget was allocated to mental health. That is well behind England at 11·4%, Scotland at 9·4% and Wales at 13·3%. We also have to be aware of the long-standing mental health issues that relate to the Troubles. The trans-generational trauma in our society is a legacy of decades of violent conflict and is likely to persist for decades. <BR /> <BR />Mental health services in Northern Ireland have faced a difficult period over the past few years. In particular, that is a consequence of the political instability that prevented any decisions being taken in this place in five out of the past eight years.”
“What we say about mental health matters. That applies particularly to those of us who are in a public role: for example, in the Assembly. Therefore, I encourage all Members to be cautious in their language, especially given the unfortunate history of debates in the Chamber at times. Just yesterday, we heard an MLA recite lyrics from a musical to joke about a marginalised group that experiences higher levels of mental health problems. <BR /> <BR />The levels of mental ill health are higher in Northern Ireland than in the rest of the UK, as Mr Robinson highlighted. We have seen the impact of that in the increase in waiting lists for CAMHS referrals. As other Members have mentioned, it is extremely concerning that more people in Northern Ireland have died through suicide since 1998 than died during the Troubles.”
“I thank the Sinn Féin members for tabling the motion. Alliance is happy to support it. <BR /> <BR />Unfortunately, stigma persists across our society in respect of mental health challenges, including in our political system and sometimes even in the Assembly. All parties in the Assembly should improve their efforts to support friends and colleagues who are experiencing mental ill health. We often hear the phrase "It's OK not to be OK", but many people living with long-term conditions sometimes feel judged, isolated or discriminated against. In 2024, evidence from Inspire, which is launching phase 2 of its If It's Okay campaign in March, highlighted the difficulties that people who experience mental ill health face. For example, 64% of respondents said that they felt shame because of their mental ill health.”
“Thank you very much, Mr Deputy Speaker. I hope that the House will support our motion.”
“Sorry: £50 million. I was glad to hear about the £50 million to increase the real living wage for domiciliary care workers this year; that 50 paramedics are being trained every year in Northern Ireland; the announcement of the 10-year workforce plan for the Northern Ireland Ambulance Service; and about the success of the integrated care hubs — again, the Health Committee saw that on its visit to headquarters — which has resulted in a 40% reduction in mental health calls.”
“He is absolutely right about that and about how all areas of healthcare are interdependent. It is about the flow, and we need to address the problems in social care in order to widen the bottleneck. I was glad to hear the Minister mention the £500 million investment to increase the real living wage for domiciliary care workers —.”
“It is important that those issues are raised in this place at this time. <BR /> <BR />Colin McGrath highlighted the fact that, at the end of their shift, paramedics are handing patients over to the next paramedic in the back of an ambulance, which, again, must be unbearable for them and for the patient in the ambulance. He said that there had been closures of units that could have provided beds for recuperation and eased a bit of the pressure. <BR /> <BR />I will go on to the Minister's speech. The Minister said that he had visited six A&E departments since Christmas, which is laudable. I welcome that, because I know that he has talked to front-line staff about what they see as solutions. He said:”
“She also suggested that direct admissions to hospital from GPs could also help people to avoid our A&E departments. <BR /> <BR />Diane Dodds noted that the pressures are not new and that we are just chugging along, that the number of staffed ambulances has not risen along with the increasing pressure on our staff and that workforce planning is needed to improve patient flow and address issues in social care. <BR /> <BR />Alan Chambers said that this is not just a Northern Ireland problem and pointed to critical incidents across the UK. He queried whether the debate is the best use of everyone's time. I say that it is and that this is a very important debate. People need us to talk about the matter and to highlight solutions and raise the urgent issues that patients have faced over the past couple of weeks.”
“My colleague Stewart Dickson opened the debate and gave examples from his constituency of the long stays in ambulances and A&E that people had come to him about. He suggested that GPs should have better access so that they can refer people more quickly for diagnostic tests, and he emphasised the need for transformation towards the Bengoa reforms. <BR /> <BR />The Chair of the Health Committee, Liz Kimmins, highlighted the fact that the pressures are not new but are the result of a perfect storm of increased need. We have certainly seen that with the increased flu numbers over the past couple of weeks. Liz highlighted the Hospital at Home service that is active in the Southern Trust and suggested that its expansion across Northern Ireland could help to divert people from A&E.”
“<BR /> <BR />We have all heard over the past couple of weeks from constituents who, sadly, have needed A&E or the Ambulance Service for medical emergencies. We have heard their experience, and it is very real for anyone who has been in those circumstances and for their family. One case that particularly struck me was that of a 98-year-old lady who required an ambulance. She was in the back of the ambulance for 11 hours and then on a trolley in A&E for five days. That is absolutely unacceptable. It must have been incredibly traumatic for her and her family, who were hoping to see her get better as soon as possible. <BR /> <BR />I will address a few of the comments that people have made.”
“Community staff are working as hard as possible to deliver those essential services. We also need further progress on and support for care homes and domiciliary care, recognising that those services can provide an alternative to hospital visits. However, the Department is not providing adequate support in those areas. The Minister's statement in November on winter preparedness mentioned the possibility of people accepting a temporary community placement in a care home or a nursing home after being discharged from hospital. That would be a positive step for those who can avail themselves of it, but what further support can the Minister and the Department provide not only to care and nursing homes but to organisations such as our community pharmacies, which also face pressures?”
“<BR /> <BR />It should be noted that overcrowding in A&E departments is associated with longer hospital stays and even increased mortality. Dr Russell McLaughlin from the Royal College of Emergency Medicine did a study last year that looked at 2022. The evidence that he presented suggested that 1,400 people died in that year in Northern Ireland — excess deaths — because of overcrowding in our A&E departments. I can only imagine what the figure will be for this winter. <BR /> <BR />While it is understandable that the Minister has called on people to consider, when appropriate, alternatives to hospital such as visiting pharmacies or general practice first, that needs to be accompanied by more decisive decisions by the Department to support people who are in vulnerable positions.”
“Long waits outside hospitals have become increasingly common. Again, we heard that when we met paramedic and ambulance staff at the headquarters. While it is an all-year problem, it is exacerbated by winter pressures. <BR /> <BR />The key problem here is the flow of patients throughout hospitals, particularly the bottleneck at the back door: the failure to discharge patients when appropriate, leading to a lack of available beds for those who need to be admitted. I saw that for myself while working over the holidays in a busy hospital ward. It is clear that little has changed since the publication of the Department of Health's winter preparedness plan in early November. That did not adequately address the issues, which led to overcrowding in hospital wards and delay in people being safely discharged.”
“No one should ever have to face that while they are at work, especially not those who are working under severe pressure to save lives, as our hard-working and resilient Ambulance Service staff do every day. <BR /> <BR />Another problem that faces the Ambulance Service is the difficulty in admitting patients into hospital. We have talked again and again today about the issues with flow. One example of that was reported by the BBC news during the Christmas holidays, when a patient was waiting in an ambulance outside a hospital for 19 hours. Nineteen hours covers a series of paramedics' shifts. I think that it was Mr McGrath who said that paramedics were handing patients over to each other in the back of an ambulance. No patient should have to wait that long. However, the most concerning aspect of that is that it is not an isolated incident.”
“The Minister has indicated that more staff have been recruited in the past year. Certainly, members of the Health Committee visited ambulance HQ and met some of our new trainee paramedics. That is fantastic to see. That recruitment is always welcome, and we should encourage people to consider a career as a paramedic or ambulance staff, but we have not heard the corresponding number of people who are retiring or leaving the service. <BR /> <BR />There is also the threat of abuse, harassment and even violence towards ambulance staff. Last week, it was reported that around 55 members of ambulance staff are abused or attacked every day across the UK. That is absolutely unacceptable abuse that can have a lasting impact on the well-being of staff and has led to many people leaving the Ambulance Service. There is no excuse for such violence.”
“The number of people who have died while waiting for an ambulance has also trebled in the past five years. From 2020 to 2024, sadly, 149 people have lost their lives while waiting at home for emergency response help; specifically, 50 in the year 2023-24. Of course, it cannot be said that a delayed ambulance response is a contributory factor, and we must remember that every death is a tragedy for the individual, their family and friends and the wider community. The Department of Health must do what it can to assist the Northern Ireland Ambulance Service to release ambulances to respond to those calls. <BR /> <BR />The motion raises some of the issues facing the Ambulance Service that, to date, the Department of Health has failed to address adequately. One such issue relates to the lack of workforce capacity.”
“The need for institutional reform cannot be ignored or forgotten. <BR /> <BR />The statistics that indicate the pressures on the Ambulance Service are truly shocking. As the motion states:”
“I was pleased that, last week, we discussed that with the Minister in the Health Committee. The pressures were simply too urgent to wait until we returned today. <BR /> <BR />To his credit, the Minister provided a written statement to the Assembly on his plans for winter preparedness on 6 November, but, while welcome, it did not provide the details or the planning needed to fully tackle the yearly crisis that we faced this winter. That will require a long-term approach, including multi-year budgets, political support for reform and greater efforts to protect the welfare of hard-working HSC staff, who go above and beyond all year round to deliver the best possible service. As has been said many times, we cannot deliver in the long term until we have proper political stability in this place.”
“Thank you, Mr Deputy Speaker. I will begin by thanking all Members for their contributions. It is an important debate. I welcome the fact that this is the first Assembly motion of 2025. I encourage all Members to vote in favour of it. <BR /> <BR />As the final Member to speak in the debate, I want to discuss some of the points that were raised by other Members, particularly the Minister, but I want to make a few specific points first. As I mentioned, this is the first opportunity for debate in this new year, and it is absolutely appropriate that we begin with such an important issue: the pressures facing the Northern Ireland Ambulance Service and the implications of those pressures across the wider Health and Social Care service. As we all know, the pressures on health services are significantly worse in the winter months.”
“The transformation process is clear: a school, once it is granted integrated status, transforms over time and will not be the finished article when making the case for change. Why has the Minister not given those schools the opportunity to transform, including on reasonable numbers, over time?”
“<BR /> <BR />We discussed the issue at the Health Committee last month, and the Committee was content to support both the draft SR and the intent of its policy objectives. It is important, however, that the regulations provide the highest standards of quality of manufacturing and other aspects, such as clinical trials and marketing. I therefore encourage the Minister to continue working with the relevant authorities to achieve that. The point-of-care innovations have the potential to have a huge benefit for patient health, so it is very welcome that Northern Ireland will be prepared to adopt them into treatments when they become available.”
“I will speak briefly on the statutory rule (SR), which we in the Alliance Party are content to support. I thank the Minister for bringing it to the House today and for his contribution. As has already been outlined, the SR will provide an updated regulatory framework for point-of-care and modular manufacture medicines, which reflects modern technological innovations beyond previous factory-based methods of manufacturing such medicines. <BR /> <BR />Many of the medicines have a short shelf life and therefore need to be manufactured close to hospital or to where patients are situated. The regulations will therefore be useful to providing that flexibility in order to accommodate patients and providers.”
“<BR /> <BR />The overwhelming scientific consensus is that vaccines are a very safe and effective way in which to combat infectious diseases. No vaccine or medicine is perfect, but there is no safer way of staying protected this winter. All Members and the Department of Health should therefore encourage everyone who can avail themselves of vaccinations to take them. In doing so, they will better protect themselves and support the health service. I also encourage everyone in the Chamber to call out vaccine misinformation, which is sadly becoming more prevalent in our politics, and on social media sites in particular. Social media companies must play a greater role in challenging misinformation and false statements, as we are seeing a backward step being taken on many such sites.”
“<BR /> <BR />Although there have been a small number of deaths and serious injuries following the introduction of the COVID vaccines in 2021, those same vaccines have saved millions of lives. Their development within a short time frame, while following all the required trials and taking precautions, remains one of the great scientific achievements of this century. <BR /> <BR />More broadly speaking, vaccinations are the most effective method of preventing infectious diseases. Vaccines have been the primary cause of the worldwide eradication of smallpox and the restriction of diseases such as polio, measles and tetanus in much of the world. Vaccines are available for 26 preventable infections, and the HPV vaccine, which protects against cervical, head and neck, anal and genital cancers, is now available to our children and young people.”
“Every available vaccine has been rigorously tested across many stages of trials before being introduced and is regularly reassessed after its introduction. Any potential health risks are constantly monitored by scientists. As with any medication, there is a small chance of side effects from getting a vaccine, but most are minor, such as a sore arm following an injection or a mild fever for several days. Serious injuries are extremely rare, while tragic incidents, where lives have been lost owing to the side effects of vaccination, are even rarer. In the vast majority of cases, however, vaccines are safe, and it is important to remember that people are far more likely to be seriously injured or killed by a vaccine-preventable disease than by a vaccine.”
“I will talk about the importance of vaccination and the need to tackle misinformation about vaccines. The situation is especially concerning over the winter period, as we have seen a rise in infectious diseases such as COVID-19 and the flu, in addition to the usual pressures that our already overstretched and under-resourced health service faces. <BR /> <BR />We will be discussing those pressures in more detail later through our Alliance Party motion on ambulance services. At the Health Committee last week, we heard about the low rates of vaccine uptake, and the Minister and the Public Health Agency (PHA) have attributed some of that to vaccine hesitancy. <BR /> <BR />I emphasise to everyone that vaccines are safe.”