Nuala McAllister
North Belfast · Alliance Party · Northern Ireland
“I have submitted quite a number of questions for written answer on autism services, and the answers, sometimes on the same day from the Department, contradict themselves. The Minister often refers to the emotional health and well-being framework as the idea that will frame all of the uniform services.”
“Absolutely. Everyone is taking my speech; I was going to say that. Of course, it is complex and subjective to the individual person. If we are truly talking about keeping an individual safe and other prisoners safe, we would not do what the amendment proposes; we would carry on in the way that the system already operates, using a risk-bas…”
“I thank the Member for his question. The Assembly Commission is progressing a programme of remedial works to address defects identified in the roof of Parliament Buildings and to protect the long-term integrity of this grade A listed building. The works have been structured in two phases.”
“More often than not, we have conversations in the Chamber or in public about trans women, but that would place a trans man who has been convicted of a violent crime against a woman in a prison with women. It does not make sense, and it is not coming from the perspective of safety; it is coming from ideology.”
“In providing catering services throughout Parliament Buildings, the Assembly Commission strives to meet the differing demands of the special dietary needs of our wide customer base.”
“I support amendment No 96 and oppose amendment No 97. I do not plan to speak to amendment No 96, as there were a number of interventions last night, and I will leave many of the remarks to my party colleague the Minister of Justice. <BR /> <BR />We oppose Timothy Gaston's amendment.”
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“They have been in touch with John Blair, a previous member of the Policing Board; Eóin Tennyson; our new Policing Board member, Peter McReynolds; and me. I, too, have been in touch with Amnesty International, the CAJ and others on the appropriate steps that political representatives and members of the Policing Board need to take. <BR /> <BR />It was and remains an outright disgrace that two journalists were arrested, and how that action came about in the first instance is even more questionable. Over the past few weeks, we have become aware that the Chief Constable might initiate a review. As a member of the Policing Board, I sought advice and guidance from the organisations that might be involved in the terms of reference of that review.”
“I declare an interest as a political Member of the Policing Board. <BR /> <BR />As everyone has said, freedom of press is paramount to an accountable and democratic society. Alliance has consistently called for that freedom — it has stood by journalists when they have been attacked in the past, overtly, and in the present day — for journalists to carry out their duty without fear of prosecution. It is that element of prosecution, in which Barry and Trevor learned that they were subject to surveillance by the PSNI, that brings us here today. <BR /> <BR />I will highlight the work that Alliance has been doing over the past few years since the issue first came to light. Since their arrests, Barry and Trevor have been in touch with my Alliance Party colleagues through Stephen Farry and Sorcha Eastwood.”
“However, instead of running away and refusing to lead, we will support the Budget, whilst continuing to engage with what will, hopefully, be the next UK Government to get a better fiscal package for Northern Ireland for good.”
“We have had so many more work streams created within the Department to look at what can be done — after we have already had inquiries and reviews saying what needs to be done That is wasting time, wasting money and impacting on people's lives daily. <BR /> <BR />Deputy Speaker, I know the Minister does not need to be a health practitioner, but he needs to listen to health practitioners and take on board their advice. When questioned, he would not even commit to meeting relevant bodies with regard to reconfiguration and transformation. Those bodies have the experience and advice on how it can be done more efficiently. <BR /> <BR />In closing, Deputy Speaker, to reiterate what many have said today, this is not the situation we want to be in.”
“<BR /> <BR />I want to focus for a bit on the number of reviews, inquiries etc that we have had: the hyponatraemia inquiry; the independent neurology inquiry; the urology inquiry; the Muckamore inquiry; the funding of services that are not in existence or even being offered — I have raised some of this directly with the Minister and in Committee — the fighting of judicial reviews where the Department knows that it has statutory obligations that it is not meeting; and the children's services review, which sets out what needs to be done. There is one thing in common across all those things: we do not have action. We have delay. We have patients, or families of deceased patients, waiting constantly.”
“It is utter nonsense to think that a party, without access to the same data and information that the Department has, can provide that up front. Nobody in any other party is buying it, and nobody in the sector is buying it. I must also emphasise that, when it comes to the workforce, "The computer says no" attitude from the Minister and the Department is not the way to prioritise or negotiate anything. The workforce has to be the starting point.”
“There is no doubt that fully implementing all the strategies currently in the Health portfolio will take a long time and require a great deal of investment. However, that does not mean that we have to take an all-or-nothing approach. That is where we have a problem. No priorities have been outlined by the Minister or the Department. <BR /> <BR />I concur with the Chair of the Health Committee that, in each of the past few sessions of the Health Committee, we have simply not had enough information and, at times, conflicting information. When you get conflicting information from the Department itself, that makes for a rather difficult starting point on costing. Even when questioned last week, officials admitted that they have not even calculated workforce costs for consultants, specialised doctors and assistant specialised doctors.”
“I do not think that anyone claims that Bengoa is a fig leaf for anything, but we recognise that a holistic approach should be taken to reform. We cannot simply do it piecemeal. That is one of the issues that we have here. I hope that others will recognise that and that they will take responsibility when it is on their doorstep. Reform cannot be undertaken day by day; it has to be done holistically. <BR /> <BR />Ultimately, and understandably, if we want to stabilise our health service for the long term, we need to invest to save. Many Members across the Chamber have spoken about domiciliary care. We all recognise that we need to invest in domiciliary care, because not doing so means more spending, more time in hospitals and more money being spent on the system.”
“Alliance is not afraid to take difficult decisions that will, ultimately, lead to a more efficient and sustainable health service. I hope that other colleagues —.”
“The message from the Minister, his Department and his party is that the budget is not enough, but they are not catching up with the rest of us. It is not just about budget; it is about how you manage your spend. <BR /> <BR />I understand — all of us do — that there are inescapable pressures and that many require significant funding. However, that does not mean that there is not room to prioritise measures that will provide efficiencies and transformation of the service. We have been talking about transformation for too long. The Bengoa report has sat on a shelf since 2016. Despite all parties having signed up to the principle of transformation, we too often see members of those parties, including the Minister's colleagues, standing on picket lines, protesting against those values in practice.”
“Throughout the past number of months, the Minister of Health has voiced his dismay at the financial situation while simultaneously failing to outline any plans to address the lack of efficient spending in the Department. That approach has culminated in his party's choosing to loudly voice its opposition to the current Budget while failing to propose any meaningful alternatives. <BR /> <BR />That inability to problem-solve or prioritise has been duly noted by many of the organisations that I have met since joining the Committee. The key issue at play should be clear to all, when you consider that our health service has the highest spend per head in the UK yet consistently has the poorest outcomes. The problem is not the lack of resource; it is the lack of reform. The feedback from the sector is clear in that regard.”
“I will speak, as health spokesperson for the Alliance Party, primarily about the health issues in the Budget. Like many others, I recognise — it is not a secret — that the current financial situation is dire and that budgets are being squeezed across Departments. Health is no exception. Like many others, I have engaged extensively with organisations from across the health and social care sector that continue to relay the same message: we cannot go on with the status quo. However, I have no clear indication of how the Minister is planning to use his budget allocation. Although I am disappointed about that, the entire Committee is not overly surprised.”
“Regarding those harsh figures, does the Member also agree that, because of burnout, gaps in the system and vacancies, the cost of locum junior doctors is astronomical? It is a vicious circle. You are not saving or investing; instead, you are spending more.”
“Does the Member agree that the junior doctors are wise to that issue? They understand the budget constraints, which is why they have not asked for 30% immediately but have said that it is the negotiation in good faith that is key.”
“Does the Member agree that the Minister would need to put a business case to the Department of Finance but that that has not been the case? There has not been a proposal, an option or anything else put forward for more finance for junior doctors' pay.”
“I commend this motion to the House and ask the Minister to get on board in a serious and —”
“<BR /> <BR />Before I finish, I thank the junior doctor committee, notably Fiona and Edwina, and previous committee member Noel, who have been engaging with me over the past few days, despite their heavy work schedules and trying to achieve an appropriate work-life balance. One of the junior doctors highlighted how they recently put their house up for sale. They will be relocating their family to England because they want to move to a location that respects them and their work.”
“Earlier today, we passed the LCM on the Tobacco and Vapes Bill. I recognise that that is a long-term approach, but it does represent an efficiency that can be made in the health system. The Fiscal Council commissioned the Nuffield Trust report, which found that patients in Northern Ireland stay for longer in hospital compared with patients in England and Wales. That is another example of why making efficiencies and investing in domiciliary care saves money in the long term as does the advancement of day procedure hubs and elective surgery hubs. The efficiency of hospital services are also brought to the attention of me and my colleagues when we meet doctors, nurses or anyone who engages in the hospital system. However, the immediate priority must be for the Minister to regain the confidence of the junior doctor workforce.”
“The Minister outlined earlier, at Question Time, that he had met the BMA, and we have had further contact from it. However, we need to be honest, open and genuine, and we need to be willing to discuss pay for junior doctors. <BR /> <BR />I do not want to pre-empt the Minister's response, but I know what he will probably say. I understand that the Executive face an extremely difficult financial year ahead and that the difficulty is not limited to the Department of Health. However, I reiterate that we will, obviously, need a business case — a proposal — to go forward to the Department of Finance. Why not engage with that first? We need strong leadership. There are plenty of efficiencies to be found in the Department of Health.”
“You can understand the frustration of junior doctors when they do not feel that they are being listened to in good faith. Furthermore, the Department is sticking to the position that any discussions around pay restoration for junior doctors is a national issue, so we must wait until agreement is found in England and Wales. That is despite the BMA being told by the Secretary of State prior to the restoration of the institutions that he could not engage, because it was a devolved issue. Where exactly do we stand? Both of those statements cannot be true. <BR /> <BR />That sequence of events left us with no choice but to bring this directly to the Floor. I understand that, in the time between the motion being tabled and today, a number of things have happened.”
“Back then, junior doctors were told that it would be implemented immediately, but, unfortunately, they learned, as we heard during their visit to the Committee, that it would be implemented in June. I would like to hear from the Minister on that. <BR /> <BR />I also want to speak about working conditions, although the motion focuses on pay. Two weeks ago, at the Health Committee, we heard from the BMA and junior doctors, who were represented by Fiona Griffin. She highlighted the issues facing junior doctors. That day, you could sense the frustration. In answers to questioning from many members, we learned of further disappointing engagements, such as the engagements with officials around working conditions in which verbal agreements were made, only to be watered down when sent back in writing.”
“With respect, how can anyone believe that the door was open in the first instance when the Minister neglected to meet the BMA face to face one day before the first strike? For the Department to state a belief, just last week, that it did not accept that the talks have collapsed was, at best, disingenuous and, I can honestly say, at worst, an exercise in gaslighting. <BR /> <BR />Unfortunately, that is not the only cause of the erosion of trust between the Minister and the Department and the junior doctor workforce. In February, there were issues around implementing the Review Body on Doctors' and Dentists' Remuneration (DDRB) uplift for 2023-24.”
“<BR /> <BR />I want to talk about why we felt the need to bring the matter to the Chamber. Before today, unlike the Minister, I, along with my Alliance colleagues and many colleagues across the Health Committee, have personally engaged extensively with the BMA to understand its reasons for taking strike action. I have touched on the pay issue, but the glaring issue in the process has been the lack of personal engagement with the Minister before today. I appreciate that the Minister is busy and that he has sent officials to meet the BMA and its junior doctors committee on a number of occasions, but the Department of Health has responded to Assembly questions, statements, press and comments in the Committee by stating that the Minister's door always remains open for negotiations.”
“I agree with the Member, and I note that she has personal experience, with her husband being under the care of many junior doctors. It is vital that their professional livelihood and work-life balance be taken seriously, given that they deal with the most vulnerable in the healthcare system. <BR /> <BR />I have outlined what it takes to earn that supplemental income. Does the Minister accept that the wages that junior doctors earn are a result of much longer working hours, antisocial hours and unsafe hours? Will the Minister please confirm how many junior doctors currently work on band 3 rotas? Does he accept that the number of junior doctors working on unsafe and unsocial band 3 rotas skews the average wages that he could quote for junior doctors in Northern Ireland? I hope that the Minister will address those issues.”
“We then had a visit from another junior doctor, who had a phone consultation with the junior doctor from the earlier shift to discuss my child's results, because continuity of care is key in diagnosing and seeing the overall picture for any patient or anybody's child. No junior doctor turns down those phone calls, because they understand the importance of that care. On admission, we had another junior doctor come to see us. That doctor had not even had time to take a break to eat that day. Even if they have time to take a break, often there is no facility in which to take it. How do we expect medical professionals to take care of us when they are running on empty?”
“For a junior doctor to receive a 50% supplementary payment on top of their basic pay, they must do at least 40 to 48 hours per week, including two 12-hour shifts, one set of night shifts and one weekend shift per month. Some junior doctors are on a band 3 wage, and, while they earn a significantly higher pay supplement on top of their basic pay, it comes as a result of working at least 56 hours per week and at the expense of rest periods. That is only if the junior doctors work those noted hours, taking breaks and lunches, which, we know, is not the case. Why? Because they simply cannot leave their patients. <BR /> <BR />Recently, I visited the children's A&E, where we were seen at 1.00 pm by a junior doctor who had already been on a long shift. The same junior doctor had to transfer shifts and work long past 7.00 pm.”
“Despite having a "junior" title, their clinical role is anything but. The reality is that, if you have to go to hospital, whether as an inpatient or on a visit to A&E, aside from nurses, you are most likely to be seen by a junior doctor at some stage. Despite playing a vital role in sustaining our health service, our junior doctors are struggling due to the unrealistic expectations put on them. <BR /> <BR />I now want to talk about pay. The Department of Health confirmed in a statement last week that the vast majority of junior doctors work on rotas that attract an additional almost 50% of their basic pay. Before commenting further on that press statement, I will say that I accept that that 50% in addition to their pay is likely to be the case. However, I will highlight what that means.”
“Junior doctors work in understaffed and under-resourced health systems that face record demands. They work through enormous backlogs of care that were made worse by the pandemic. However, those are not the only pressures that junior doctors face. There are pressures both in the workplace and at home as they try to manage the work-life balance. Many junior doctors have brought that to the conversation about this week's strike and the strike planned for June. <BR /> <BR />Before I talk about pay and the role of a junior doctor, I will highlight what "junior doctor" actually means, because the title can often mislead. Junior doctors are qualified doctors who are in clinical training. They have completed a medical degree and can have up to nine years of experience working as a hospital doctor.”
“Thank you, Madam Principal Deputy Speaker. I urge the Health Minister to urgently engage personally with the British Medical Association (BMA) junior doctors committee in good faith and with an open mind, not as a box-ticking exercise. While it may be too late to avoid the strike action planned for this week, there is still time to act ahead of the action planned for the start of June. <BR /> <BR />Secondary care in Northern Ireland is in crisis. The huge waiting lists, growing vacancies in the system and greater remuneration available in other countries are creating an untenable situation for our patients, constituents and health and social care system. Underlying all of that are our healthcare workers: our nurses, our consultants, our auxiliary care workers and our junior doctors, on whom the motion focuses.”
“Elaine, in my constituency, has a son with severe learning difficulties and autism. Recently, she posted photographs on Twitter showing the consequences of one of her son's violent outbursts that illustrate how he and she have been failed. What does the Minister say to Elaine and others like her who desperately need emergency respite provision?”
“I thank the Minister for focusing on the issue of the onus being on the retailer. Does he accept that there are retailers — often small retailers — who willingly and knowingly sell tobacco products to children, including those in school uniform, and that enforcement is key to making sure that that does not happen?”
“I look forward to working again with young people from across Northern Ireland and to hearing their voices when it comes to the regulations taking effect. I also thank Cancer Research UK for its engagement with the Committee and individual MLAs on the matter.”
“We need to ensure that we have appropriate advertising and appropriate engagement with the retail sector. Hopefully, the Minister can touch on that in his response. <BR /> <BR />I will also focus a little on the role of councils. We are all aware of the many constituents who come to us about the sale of vapes or cigarettes to under-18s. It takes councils a number of weeks to ensure that enforcement action is taken against those who sell vapes or cigarettes to under-18s. With the legislation coming into effect, we will need to ensure that there is greater support for councils to take action. <BR /> <BR />I look forward to hearing from the Minister about the issues that I have raised. The legislation to ensure that we have a smoke-free generation is a positive step for Northern Ireland towards being a world leader.”
“<BR /> <BR />For the legislation under discussion today to be successful, there also needs to be robust enforcement by relevant agencies. I thank the Minister for his interaction with the UK Government to ensure that the fixed penalty notice is set at £250. We are yet to see whether that will be enough, however. It will take time, and enforcement is important. <BR /> <BR />I will touch on the issue of vapes. The evidence is not clear as to the harmful effects of vaping, but let us be honest: there is no evidence to suggest that it is medically, ethically or socially acceptable for children to buy or use vapes, especially children dressed in a school uniform. There is no excuse for any shop or retail worker accepting or allowing the selling of vapes to children. I respect the fact that the onus will be on the seller.”
“As other Members have highlighted, the NI Audit Office (NIAO) has stated that the rate of deaths per 100,000 as a result of smoking-related illnesses is 98% higher in the most deprived areas of Northern Ireland. As a representative for North Belfast, one of the most economically deprived constituencies in the country, I am particularly keen to ensure that my constituents are protected from the harm that cigarettes cause. <BR /> <BR />I am glad to see the cross-departmental approach that is being taken to tackling the harms of smoking and tobacco. I thank my colleague Andrew Muir, the Minister of Agriculture, Environment and Rural Affairs, for taking decisive action by announcing a ban on disposable vapes.”
“They both highlight the fact that tobacco is the biggest cause of cancer and death in Northern Ireland, with one person dying every three hours as a result of tobacco use and around 1,500 tobacco-related cancer deaths each year in NI. <BR /> <BR />Beyond the undeniable human impact, there is an economic impact on the health sector. I agree with the Minister and other Members that spending over £200 million a year to treat smoking-related conditions is not acceptable. On a day when we will discuss the impact of financial pressures on the Department of Health, that cannot be overlooked. It is also important to note the socio-economic aspect.”
“I am happy to support the LCM to create a smoke-free generation by ensuring that no one born on or after 1 January 2009 will be able to buy tobacco in their lifetime. It will bring Northern Ireland into line with the rest of the UK, and Northern Ireland will become a world leader on the issue. The fact that the Health Minister engaged with the UK Government to ensure that Northern Ireland was included in the legislation must be welcomed. Ultimately, it is a public health measure designed to protect the population from the harmful effects of smoking. Like many MLAs, I have engaged with Cancer Research UK and Cancer Focus NI.”
“With regard to recommendations that are contained in the strategy, do you anticipate doing an overarching piece of legislation or can we make headway on a number of recommendations before the strategy is outlined because they are already there and that can be done?”
“Can the Minister clarify how many of the PSNI's pressures were included in her Department's bid to the Department of Finance for additional resources as part of the Budget-setting process?”
“I am happy to support the amendment and the motion. I hope that the Minister will answer the questions about primary dental care.”
“Dental care is crucial for oral health and can play a significant role in the detection of some cancers. Health visitors and social workers provide important support for vulnerable members of our community. As the roll-out of multidisciplinary teams continues across Northern Ireland, we will see even more benefits to the overall primary care sector in identifying any early health interventions that are required. <BR /> <BR />A multidisciplinary team will soon come to north Belfast, and I welcome that, but I want to raise the issue of capacity in general practice for those MDTs. Capacity in space and location is another issue that the Minister must consider.”
“The £5 million to cover indemnity costs for one year must be welcomed; indeed, we have all lobbied the Minister in our Committee capacity and as party representatives. As the BMA stated, however, the progress that has been made needs to continue past the first year. We need a long-term indemnity solution. It is crucial that we get that right and that support is forthcoming. <BR /> <BR />Primary care often represents a person's first point of contact with the health service. It is no secret that the Health Minister has many competing requests for funding. However, funding for primary care is an investment in the health service as a whole. GPs can and do provide more relief for A&E services, They can help to enable early intervention, which will inevitably ease pressures on waiting lists and lead to better outcomes for patients.”
“<BR /> <BR />It is not just limited to general practice: I am sure that other Members will agree that they hear from constituents that NHS dentistry is also a problem. I note that there was an announcement of support for general dental services (GDS) at the beginning of the month. While the asks of the motion are about general practice, I ask the Minister whether he considers that announcement premature, given that some business cases are not approved and may not be approved until as late as August. Hopefully, the Minister will address that, but I recognise that the motion focuses on general practice. <BR /> <BR />The contract agreement announced last week was undoubtedly a positive step. The BMA committee achieved a significant win, and I congratulate it on all the work that it has done over the past few years.”
“The Royal College of General Practitioners has highlighted that primary care represents 95% of the care provided to the population across a lifetime, but, despite that, primary care received only 5·4% of the Health budget in 2022-23. <BR /> <BR />We have all met numerous representatives from across the primary care sector, and they all report that the current level of funding is unsustainable. Unfortunately, the consequences of that are clear. Since March 2022, as many Members have mentioned, 25 practices have handed their contracts back to the Department. Ninety-eight practices have sought crisis support in the last four years, which is one in three practices in Northern Ireland. With existing issues around recruitment, training, conditions and pay, it is no surprise that the general practice workforce is choosing to practise elsewhere.”
“Primary care encompasses general practice, community care, mental health and dental care and a large number of other services that represent people's first point of contact with the health service. I understand that the motion focuses on GP services, but I want to touch on the others a little, and my colleague will focus on the workforce challenges. <BR /> <BR />I want to focus specifically on the funding issues that cause the instability, because we hear about that every day in our capacity as health spokespeople for our parties. There is a significant disparity between the level of service provided by primary care and general practice and the funding that they receive from the Department of Health.”
“I thank the proposer of the motion for tabling it. We are happy to support the motion and the SDLP amendment. Like many Members in the Chamber, my constituency office is inundated with requests from constituents about access to their GP. That is no surprise, because the Royal College of General Practitioners has said that, in the last month, at least 128,000 patients have been impacted by practices handing contracts back or closing. <BR /> <BR />We all know that access to GP services is the number-one issue that our constituents raise with us, but we also know that there are many reasons why they struggle to get access. I want to explore a couple of those reasons.”
“Has the Minister given any consideration to funding? I understand that it is within the remit of the Department for Communities' public realm works. Given the impact that the station will have on connectivity to Sailortown, is regeneration of the tunnel link for pedestrians under consideration? It is important that both Departments work hand in hand when the projects are completed.”
“It is crucial that the support that the parents can get for all of their family is maintained at every level, no matter the school.”
“I thank the Minister for his statement. It is welcome news. I am sure that many parents will be awaiting the long-term process, because we understand that the capital investments will not happen tomorrow. It is something to look forward to. I especially welcome the comments about Hill Croft School in Newtownabbey. I have a family member who attends the school, and we see all too well the magnificent impact that it has not just on our niece, as a little girl, but the entire family. The Minister will be aware that, when parents choose a special needs school for their kid to attend, they become part of a community and rely on that support. On parental choice, what provision will be available at the school that is chosen, be that a SPiMS unit or a special school?”
“Can the Minister clarify what actions are being taken and say whether they include action on the number of training places for social workers? While I welcome a lot of what has been said, specifics would go a long way towards saying to the workforce that more help is coming.”