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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“Its report contained deeply troubling testimony from clinicians, describing the harsh reality inside Northern Ireland's emergency departments. It was very clear that corridor care is undignified, causes harm and must be eradicated. <BR /> <BR />Somewhere between acknowledging burnout and dismissing the impact of delay, the Minister's position changed. Unfortunately, the lived experience of the staff did not. Just before Christmas, the Chair of the Health Committee, Philip McGuigan, and I carried out a visit to an emergency department, unannounced, to understand the reality on the ground directly from the patients and the staff. I place on record my sincere thanks to the healthcare workers who took time in the middle of their exceptionally busy shifts to speak with us so openly and honestly.”
“recognising the significant level of burnout across the health service. Yet, by October, the tone had shifted. At Question Time in the Chamber, the Minister said that he was not sure that he agreed that delays had any impact on staff morale and claimed that we were way ahead of the previous year. With respect, a rushed plan, published only three weeks earlier than the year before, is not way ahead. It is marginally less late. Ten days after that statement, a Health Committee briefing that was, bizarrely, mainly pictures acknowledged that moral injury to staff was one of the red lines that had already been crossed. Then, on 17 December, the Royal College of Emergency Medicine published its report, stating that morale was at "an all-time low".”
“To me, as a healthcare worker and as a politician engaging with stakeholders, it seems that those blank pages and big discussions were more of a big distraction from accountability. It is something that looks comprehensive on paper and something to say when asked that fails to translate into improved outcomes or reduced winter pressures. <BR /> <BR />At the urgent Health Committee meeting in January last year, the Minister acknowledged that they would not crack winter pressures outright, but he said that they had to deliver:”
“We were then told by the Minister that the 2025 winter plan would be even more expansive, involving even more stakeholders and a blank-page approach that would begin in late February or early March at the latest. However, that is exactly when planning began the year before, and we already knew where that approach led. Publication was in November, when services were already under strain. Why repeat a process that demonstrably failed, particularly when starting from a blank page and promising even more consultation? <BR /> <BR />I want to be very clear. I support co-design. I advocate for the involvement of healthcare professionals and experts at every level of health policy, but doing so in a way that slows delivery to the point of ineffectiveness is not meaningful co-design.”
“When the Minister and departmental officials were called to an urgent meeting of the Health Committee in January last year, amid a spike in winter pressures, I took the opportunity to raise the winter preparedness plan. I was told by officials that planning for 2024 began in March, yet the plan was not published until November. At the time, the Royal College of Emergency Medicine (RCEM) described it as "too little, too late". That was a stark warning from front-line clinicians on the dangers of winter planning delay. The explanation offered for the delay was that the document had to pass through multiple layers of review with numerous stakeholders.”
“We tabled the motion on behalf of the patients who are waiting hours for an ambulance; those who are waiting outside a full A&E in the back of an ambulance, unable to get in; and for the patients who are in overcrowded emergency departments on trolleys, chairs and, appallingly, as we have seen, even on the floor. The motion is for the patients who are in corridor beds and wards and who are pushed into any available space, and for the staff — my colleagues — who have dealt with those pressures for long periods and who I have seen impacted on from working under those conditions. <BR /> <BR />It has been a long road of continued warnings and repeated failures that have resulted in yet another year of crisis-point pressures on staff and patients in our healthcare system.”
“I urge the Minister to seriously consider the consequences of looking only at cutting the numbers, without considering the human cost. I urge him to at least make a start now.”
“I know that the Minister has no issue in looking at all-Ireland services, especially with regard to such a sensitive issue. <BR /> <BR />I often fear that the narrative that "change cannot happen overnight" is a way of avoiding responsibility for implementing any actions. Why not start now, so that we are not in the same position in another seven years, hearing the same excuses, while families face the same burdens in the midst of their unimaginable suffering? Calling for a comprehensive implementation plan is easier said than done, but we cannot continue with the cycle of bottom-line budgets without considering efficiencies. If we do that, not only will we still be here in another seven years but we will likely be worse off.”
“Long-standing vacancies already sit at around 40%, which leaves the service fragile and families exposed to the consequences. <BR /> <BR />No one denies the challenges that the services face. The reality makes the absence of a local service more understandable, but it does not justify endemic delay. Although there has been some action from the Department through ongoing discussions to explore the options for an all-Ireland network model to provide the service, discussions alone are not enough to give timely answers to bereaved families, and discussions alone will not urgently stabilise or strengthen paediatric or perinatal pathology services. The HSC website refers to the feasibility of an all-Ireland approach and to the fact that it is deliverable only in the long term: but how long is "long term"?”
“<BR /> <BR />Dr Bernie Croal, president of the Royal College of Pathologists, has emphasised the fact that paediatric pathology services are absent in entire regions, with no consultants in post in Northern Ireland, the south-west of England or the Midlands. The outlook is further complicated by the age profile of the existing workforce, which was mentioned by the previous Member to speak. More than one fifth of consultant paediatric and perinatal pathologists are expected to retire in the next five years, and that pressure is not being offset by new entrants. Training numbers remain too low, which means that there will not be enough doctors to replace those who retire, let alone to fill the posts that have been vacant for years.”
“When reading a news report, from just two days before Christmas, stating that active recruitment for a paediatric pathologist in the Belfast Trust did not begin until two years after the post became vacant and that senior staff believed that advertising started a year and a half earlier than it did, it is hard to believe that the efforts have been significant enough. That leaves a profound and unsettling sense of hopelessness about the state of our health service and the systems that are meant to govern it. I can only imagine that a parent who has lost a child needs every accommodation and comfort that they can possibly get. They need support from the system and do not need the additional burden of having to navigate the logistical complexities of the situation as it stands.”
“At what point does it stop being an interim measure? Can we really describe seven years of practice as an interim measure? The HSC website also states:”
“Since early 2019, paediatric pathology services in Northern Ireland have effectively ceased. Instead of those essential examinations being carried out locally, hundreds of families have had to send their babies to Liverpool for post-mortem examinations, with the figure being, I think, 1,105 infants and children since 2019. That arrangement was put in place as a temporary measure. The HSC website states:”
“As an East Antrim MLA, I very much welcome the MDT roll-out. It will benefit GP practices and patients. The Minister mentioned the professions that will be involved. He will also be aware of the high vacancy rates in social work across Northern Ireland; they are as high as 50% in some areas. What is the Minister doing to bring those vacancy rates down so that the MDT roll-out can include social work?”
“I certainly welcome the investment in the health service. I note the £495 million for reducing our scandalous waiting lists, which is a Programme for Government commitment, and the funding for the mother and children's hospital at the Royal Victoria Hospital site. Does the Minister agree that significant overspends in the Department of Health and Department of Education have contributed to the difficult position in which the Executive find themselves? Given that a way forward appears to have been negotiated with the Health Minister, what is the status of the discussions with the Education Minister?”
“Thanks to the Minister for that answer. He has indicated that the DUP is blocking changes to the early payment discount and the maximum capital value. As mentioned, those changes would raise money to support small businesses here. What rationale, if any, has been offered for that position?”
“Just so that I understand you clearly, Minister, you said that, due to financial pressures, you were unable to progress any of the recommendations: is that your current position?”
“We have pay uplifts that leave out vital parts of the healthcare workforce, and we have a neurology service that has roughly one consultant for every 1,600 patients and one specialist nurse for every 700 patients. We cannot continue to address recognised failures only with words and unactioned reviews. A funded delivery plan with clear timelines, accountability structures and the patient voice embedded throughout is clearly needed. How can we call for those things when the embedded culture is clearly set on keeping the system inequitable and reactive? The review will just be another waste of resources if actionable delivery does not follow, along with the culture change and reform that are needed.”
“<BR /> <BR />I have spoken previously about the constant recommendations in basically every report across our health service that recognise the need to develop additional workforce capacity. The Minister told me in the Assembly that a delayed winter plan would have no impact on staff morale, yet, two weeks later, it has appeared as a red-line concern in the departmental report. I can say from personal experience and from speaking to healthcare staff that it has had a serious impact on morale in the service. <BR /> <BR />It has been consistently reported that mental health problems are one of the biggest causes of staff sickness in the public sector, including the trusts, yet we have a mental health strategy that is effectively shelved and completely underfunded.”
“Consider the Department's approach to some of the priorities set out in the review. At the Health Committee last week, when discussing the Department's budget, my colleague Nuala McAllister asked the departmental finance officer about projected savings and whether they were simply cost savings or efficiencies. She was informed that they were mostly just savings, which raises serious concerns that there is a culture of bottom-line budgets on paper as opposed to efficient spending with best outcomes and patient-centred care in mind. How will we ever have a person-centred service if that is the Department's approach? It feeds into the need to use current resources more effectively, but how can it be a more efficient service when the Department admits that it is more focused on saving money than being efficient?”
“I do not doubt that the Minister has genuine empathy for the people in those circumstances, and I do not doubt that he would like to deliver real and meaningful change in neurology services, but empathy and kind words will not fix the health service.”
“<BR /> <BR />The report of the neurology review sets out four main priorities: a person-centred service; developing additional workforce capacity within neurology; addressing gaps in current services; and using current resources more effectively. In responding to the consultation, we strongly supported the vision but urged that the focus needs to be on delivery. Person-centred, evidence-based care cannot be achieved without investment, across all trusts, in workforce, infrastructure and support services. Services need to be designed with and for people with neurological conditions, particularly through condition-specific pathways that reflect lived experience. Is that going to happen? Well, the Minister attended the launch of the FightForNeuro campaign, and the Northern Ireland Neurological Charities Alliance (NINCA) stated that he:”
“As Diane highlighted, those people feel abandoned. We have heard about the shockingly long waiting lists for routine appointments, on which patients wait for years, while their conditions deteriorate. That impacts on their health, quality of life and finances. It also results in additional pressures on the health service. <BR /> <BR />In August, Alliance responded to the consultation on the neurology review, which accurately outlined the serious and systemic challenges within neurological services. Waiting times are unacceptably long. Workforce shortages across consultants, nurses, AHPs and psychology staff create an unacceptable variation in access and outcomes across the trusts. The absence of local neurology teams and condition-specific pathways further undermines service consistency and quality.”
“Thank you, Madam Principal Deputy Speaker. I endorse the FightForNeuro campaign, which was launched in Stormont in November of this year. That campaign is testament to the powerful stories of those with lived experience, and it highlights the urgent need to address the gaps identified in neurological care following the publication of the final report of the regional review of neurology services. Some of the quotes from the campaign are shocking. One patient said:”
“We have just heard from the Minister that he has not met any of the language commissioners yet. Does he have any dates or plans to meet them?”
“Without wishing to extend the seasonal metaphors, that is Christmas fudge. The Economy Minister is in China. Does the deputy First Minister accept that such overseas engagements are happening without an Executive-agreed framework and that the lack of strategy is potentially damaging to Northern Ireland at a time when clarity and agreement are urgently needed on the approach to handling issues such as human rights?”
“I thank the deputy First Minister for that answer. Earlier this year, the Equality Commission published a research paper entitled 'Funding for Equality Groups in NI: The impact of the transition from EU funding to UK Shared Prosperity Fund'. Which recommendations from that research has the Department considered, and which, if any, is it taking forward?”
“<BR /> <BR />People in the last year of life deserve security and dignity, not financial crisis. The evidence that Marie Curie has presented demands a serious and coordinated response, and I urge the Executive and all parties to give the recommendations the consideration that they deserve.”
“A more coherent approach, grounded in early intervention, predictable financial assistance and reliable data-sharing, would reduce hardship and strengthen public confidence that government is willing to meet its responsibilities to those who are least able to navigate complex systems at a time of profound vulnerability. <BR /> <BR />Marie Curie has set out recommendations, such as better identification and information-sharing to ensure that people with a terminal illness are reached quickly with support; a minimum income guarantee that includes early access to the state pension for those of working age and reforms to income support; and measures to address energy costs and to support the most vulnerable in our society in their final days. The report makes it clear that it is an issue for all levels of government, including the Assembly.”
“Council areas in Northern Ireland such as Derry City and Strabane; Belfast; Newry, Mourne and Down; and Causeway Coast and Glens are in the top 20 in the UK for the highest fuel poverty rates during the last year of life. We need to recognise that rising levels of poverty at the end of life do not occur in isolation; they mirror structural inequalities that have gone unaddressed for too long, including gaps in income support, limited access to specialist palliative care services and the absence of coordinated planning across Departments. People receive support only when they reach crisis point or, in some cases, not at all.”
“Extremely sick people have been forced to choose between heat and food, using credit cards to keep the lights on while undergoing chemotherapy. Individuals too unwell to work have been forced to because they lack the income that they need to survive. Those stories highlight a deeply inhumane crisis affecting people when they are at their most vulnerable. <BR /> <BR />The report states that being in the last year of life is a significant risk factor for falling into poverty, and the rates are getting worse: 20% of people in their last year of life are estimated to be in poverty, rising to 27% if we look at fuel poverty specifically.”
“I draw attention today to the findings of Marie Curie's report entitled 'Dying in Poverty in Northern Ireland 2025'. I recently attended and took part in a discussion on the report launch with the Marie Curie team. It was an incredibly powerful event that highlighted the desperate and inhumane situations that those in their final days face at a time when they need the most support. No one deserves to die in poverty. <BR /> <BR />The report sets out a stark and deeply troubling reality for people in Northern Ireland and discusses the rise in poverty, specifically fuel poverty, for those at the end of life. Dying in poverty is not inevitable, but, for too many people, it has become their expected reality. The testimonies in the report make for harrowing reading.”
“We are happy to work with Minister and the Department on taking forward the recommendations to achieve real progress for patients and families and to build a sustainable sector that is able to meet the needs of our communities. I commend the report to the House.”
“While I appreciate that patients should be treated in the best place for their care, I do not see how we cannot plan better to provide services in the community and prevent those emergency admissions. It is proven that, when we provide better services in the community, emergency admissions are greatly reduced. Palliative care should be one of the pillars of the Minister's shift-left agenda. Not only does it provide better services and support for patients and families but it is a prime example of providing funding in the community to reduce pressures on our hospitals. <BR /> <BR />The important part is what we do now, and I make it clear to the sector and the Minister that access to palliative care services will remain a priority for the Committee.”
“The Department should use the scoping work that it is undertaking and the work of the inquiry to bring forward a cohesive strategy and implementation plan that takes into account the growing need for palliative care. My real concern is that, if we do not build sustainable community services now, in 10 years, we will not have improved access to palliative care services. We spend too much money on unplanned care in Northern Ireland. <BR /> <BR />The Marie Curie report showed that, in 2022, in the last year of life, approximately £350 million is spent on palliative care. Of that £350 million, approximately £195 million is spent on emergency admissions.”
“The Committee had been told that the bulk of the work on advance care planning has been completed, and I ask the Minister to implement that as soon as possible. <BR /> <BR />We heard of the need for a clinical lead for palliative care in the system. The Committee believes that the Minister, the Department and the sector would benefit from the expertise of a clinical lead. That could increase the visibility of palliative care in the system and provide the necessary priority for the issue. The Minister can and should appoint an interim clinical lead as soon as possible. <BR /> <BR />There has been no strategy for adult palliative care since the last strategy ended in 2015.”
“Again, he noted the discrepancy in access to palliative care in rural areas. Finally, the Minister highlighted his visit to the Children's Hospice, stating that he observed joy with the families and the patients in there at that time. <BR /> <BR />I will highlight a couple of issues that could be introduced immediately with little resource. We have heard of the importance of having discussions with our family about our wishes when a terminal diagnosis is given, and we have heard from those with lived experience about the importance of advance care planning and how, at present, there is not enough communication of patients' wishes across the system. We have heard stories of patients having to share their wishes a number of times across different service providers.”
“Thank you, Linda. I agree with the Minister and with Linda. We had many visits to hospices, and we did see that. That is palliative care being done at its very best. <BR /> <BR />The Minister also referred to the Department's ongoing scoping exercise and how that would work in parallel with the report. He highlighted the fact that some of the recommendations have not been costed and pointed out recent improvements in palliative care and end-of-life care. He highlighted the need to look to the future in order to plan for palliative care needs in years to come and reassured us that any concerns that we have about the pace of progress are not due to a lack of focus. The Minister said that a review at a workshop is planned for next month, which was very reassuring to hear.”
“<BR /> <BR />The Minister responded to the debate and thanked the Committee for undertaking the inquiry and, in particular, for the personal testimonies, highlighting that all healthcare is personal and that it will affect many of us and many of the families that we are aware of. He thanked the palliative care workforce and committed to responding in detail in the new year. The Committee will look forward to that.”
“<BR /> <BR />Linda Dillon talked to the evidence that was heard, stating that it was powerful and emotional. I agree with Linda. At times, it was very emotional in the Committee. She said that not receiving palliative care is a trauma in itself and that palliative care is not about dying; it is about living with dignity. I agree completely with Linda there. <BR /> <BR />Alan Robinson highlighted a key line in the report and said that palliative care provides a support system for patients to live as fully and as actively as possible until the end of life. He highlighted the need for a clinical lead for palliative care and, in particular, highlighted recommendation 27, which is the need for a new palliative and end-of-life care strategy. He called the inquiry report "a landmark moment", which I agree with.”
“He also highlighted the fact that too many people still associate palliative care with the end of life and miss the fact that it improves the quality of life. <BR /> <BR />Colin McGrath said that palliative care is sustained by extraordinary people but is constrained, and that there are communication issues, particularly due to the lack of support after 5.00 pm. Again, out-of-hours issues came up, as did the fact that the current system unfortunately provides trauma to people long after their loved ones have passed away. Colin highlighted the stark inequalities of support being different across Northern Ireland because of where you live. He highlighted the experience of Anne Sheppard and her husband, which was reported by the BBC today, and I do not think that any of us who heard that would not be moved.”
“<BR /> <BR />My colleague Nuala McAllister noted that the Committee heard from services about how they could be improved, and she highlighted recommendation 9, which is the need for a 24/7 central point of contact, be that a telephone or online service, which would be crucial for families and would make a meaningful difference. She also highlighted the need for swift access to palliative care medications — again, something that was very common across a lot of the evidence. She mentioned speaking to patients and families with experience of palliative care. <BR /> <BR />Alan Chambers spoke about the political unanimity on high-quality care at the end of life and highlighted the uneven access to palliative care, particularly in rural areas, which again was something that we heard about quite a few times.”
“The report has taken over a year to produce, and it outlines the priority that the Committee gives to the issue. <BR /> <BR />Many issues have been covered in the debate, and I will comment on some of the contributions. The Committee Chair, Philip McGuigan, opened the debate. Diane Dodds noted the assisted dying Bill that is passing through Westminster and thanked the contributors with lived experience and the sector. She noted the inconsistencies in provision across Northern Ireland — something that we heard about time and again. Also, she noted the lack of out-of-hours support, which was also a constant theme in the evidence. She highlighted the fact that hospices are not fully funded to provide specialist services. She highlighted the importance of the recommendations, especially recommendations 1 to 5.”
“Last week, when the Committee visited the South West Acute Hospital, we called into the Cancer Focus hub in Enniskillen and heard about the great work that it is doing, including providing support for families. <BR /> <BR />I also pay tribute to the businesses and the public who support our hospices through their donations. Without that support, some of those services would not exist. <BR /> <BR />I also thank the patients and families who have shared with us throughout the process when we have visited hospices, in written submissions and through the lived experience event that we held. Your experiences have shaped the recommendations in the report. <BR /> <BR />I also thank my fellow Committee members and the Committee staff for their work on the inquiry.”
“Thank you, Mr Deputy Speaker. It is a privilege to make a winding-up speech on this debate as Deputy Chairperson of the Committee for Health. I thank Members for their contributions on this important issue and the Minister for responding to the motion. <BR /> <BR />I place on record my thanks to the sector and the healthcare professionals who so ably care for the most vulnerable in our communities and provide support to patients and their families in the most difficult of circumstances. We have heard many stories about the impact that your care has had on families for a long time after their loved ones have passed away. Over the past year, we have seen many projects providing much-needed support to patients and families.”
“I thank the Minister for that response. How are the new standards an improvement in cross-compliance in environmental protection and animal welfare, and fairer for farmers?”
“Will the Minister outline his plans for horticulture under the sustainable agriculture programme?”
“I do not have that figure in front of me, but I am aware of the mental health professionals who are able to work and talk to people in mental health crisis and who are able to de-escalate the situation and assist the people who are in crisis. <BR /> <BR />Mike Nesbitt responded to the debate. He said that it is critical that the right person responds to a person in a mental health crisis. He also said that he does not agree that the health service is broken. He said that the people receive treatment once they get into it, but that the pathways may be broken. He advised that the Health Committee should advise and assist the Minister. I do not believe that the Health Committee has received a full list of priorities —.”
“There are mental health professionals who are highly skilled in communicating with people in distress. We have seen that with the NIAS staff working with the South Eastern Trust. They are able to talk to people in distress, and they are able to de-escalate the situation.”
“Thank you, Linda. I agree with that. I was struck by how many Members have served on the Health Committee and the Policing Board, and for how long. I think that the Minister has done both. I absolutely agree that there is a lot of experience here. <BR /> <BR />Jon Burrows said that the concern for safety calls are a whole-society issue and that the PSNI is often sent to mental health patients because, at times, they can be violent. He also highlighted the fact that the PSNI is currently needed to force entry into houses and suggested that PSNI officers are negotiators who can talk someone off a bridge, sometimes by talking to them for up to eight hours. He said that the PSNI has those skills. I disagree slightly with that. It does not need to be a police officer.”