Official Report: Monday 16 November 2015
The Assembly met at 12:00 pm (Mr Speaker in the Chair).
Members observed two minutes' silence.
Mr Speaker: Mr Mike Nesbitt has given notice and been given leave to make a statement on the attacks in Paris, which fulfils the criteria set out in Standing Order 24. If other Members wish to be called, they should indicate by rising in their place and continuing to do so. All Members who are called will have up to three minutes to speak on the subject. I remind Members that I will not take any points of order on this or any other matter until the item of business is finished.
Mr Nesbitt: I rise because, not for the first time, Paris, its natives and its tourists have been subjected to a most vicious and vile terrorist attack by religious extremists. To date, 132 are dead. Hundreds more are injured, many fighting for their life. Why? Because they ended the traditional working week in a bar or a restaurant or by attending a concert. It is hard to accept that, in 2015, such a simple act as shopping or socialising should represent an existential threat to life, but that is the grim reality of terrorism.
The House must take a firm stand against those terrorists, who, of course, are not just attacking Paris or France but represent a threat to the Western World and beyond. We must also demand a robust response. The Prime Minister has told us that, here in the United Kingdom, the threat is severe, and he revealed today that the security forces have prevented no fewer than seven planned attacks in the United Kingdom this year.
We must also remember who the enemy are. We must not paint everybody with the same brush. No Member of this Assembly should be held responsible if a high school in the United States is shot up by a white Christian just because we share the same colour of skin and the same religious affiliation. The enemy are the extremists, and any security policy must make that very firm distinction.
Today, we should focus on the human cost of the inhumanity of the perpetrators. On behalf of the Ulster Unionist Party, I extend my deepest sympathies to the families of the deceased and the injured, to President François Hollande and to the people of France. We stand together with them in defiance of those who have attacked our way of life.
In concentrating on the human cost, I finish with a quote from a restaurant worker in the wake of the attack. He said:
"One woman had been shot with several Kalashnikov bullets in her side, and she had a huge hole there, an open wound. There was nothing anybody could do. She was only about 20 years old. I knelt down and talked to her. I told her not to move and to take deep breaths. She didn't complain at all, or even say anything. She was just looking up at me and her eyes faded away. I will remember her face and her eyes all my life."
Mr P Robinson: Mr Speaker, thank you for the opportunity to join in expressing our revulsion and horror at the evil bloodbath in Paris on Friday evening, and for organising the minute's act of remembrance in the Great Hall this morning. We, in equal measure, send out our sympathy and support to the people of France. We, from our experiences, can truly empathise with them.
This was not an attack against a military or government target. The gunmen were not engaging their enemies in open warfare, nor were they locked in conflict with an army that they opposed. This was an attack upon innocent, defenceless and harmless citizens. It comprised coordinated assaults upon a concert hall, a football stadium, bars and restaurants. These were attacks on people who were out relaxing and were enjoying an evening socialising or at sporting or entertainment events. It is hard to think of less threatening or less hostile targets.
Those of my vintage will vividly remember from our country's dark past all the emotions felt last Friday by the population of Paris: the desolation, the anxiety for friends and relatives who were in the area of the attacks, the grieving for victims and the apprehension for the future. They will know for sure that life will never be the same. The scale and the merciless savagery of the carnage will make these killings stand out, but, for all the victims and survivors of terror, every act over the decades leaves a life-changing impact.
On behalf of the people of Northern Ireland, we mourn with the families of the Paris victims and pray for the recovery of the many who are critically injured and scarred. From this Chamber, we extend our condolences to the citizens of Paris and the people of France. As they mourn, we stand with them in solidarity.
Mr Ó Muilleoir: Go raibh maith agat, a Cheann Comhairle. On Friday night, like other Members, I followed the terrible events in Paris by social media, radio and TV, but I also had a running commentary because my daughter was down the street from Le Petit Cambodge, which was the first restaurant that was attacked.
I thank those who gave her and her group shelter that night close to the restaurant. In the hours since then, she has told me about the atmosphere in Paris; about how frightened people are, but also how resolute they are. In her boyfriend's circle, one young man was killed in the Bataclan concert hall, and, in her place of work, one friend has a close friend still missing. That is the horror that brings us here today in solidarity with Paris.
I will start en français: nous sommes solidaires du peuple parisien en ce moment terribles. Nous exprimons notre plus grande compassion à tous les citoyens de cette ville blessée. Geallaimid comhghuaillíocht le muintir Pháras ag an am chorrach seo, agus déanaimid comhbhrón ó chroí le muintir na cathrach cráite sin. We pledge our solidarity to the people of Paris at this terrible time. We extend deepest sympathy from across our community to the victims and survivors of Friday night's horror. We send our love and respect to the people of the wounded city of Paris, with which we enjoy close ties of history, heritage, commerce and community. Our thoughts this morning are with all victims of the global wars that engulf us today. Of course, the civilian populations suffer the most in those wars and are the most frightened, as we saw clearly in not only Paris but Beirut at the weekend. We stand, therefore, with the people of Paris in their message to the assailants who carried out Friday night's horrific attacks. We use the words of the famous civil rights song: Nous n'avons pas peur. Níl eagla orainn. We are not afraid.
Mr Eastwood: On behalf of the SDLP, I express our sincere sympathy and solidarity with the people of Paris following the devastating scenes that unfolded on the streets of the city over the weekend. As our party members gathered in Armagh, we were acutely aware of the tragedy that was taking place in the French capital. It cast a shadow over our proceedings.
I also express our profound sadness following the suspected ISIS bombing of a busy Beirut marketplace that killed over 40 innocent people. These attacks, no matter where they happen, the scale of the destruction or the culprit, are an attack on all of us who value the primacy and power of peace. As a people and as an island, we acutely understand the suffering of the people of France and Lebanon. We know what it is like to face the threat of terror and violence, and to face down those who seek to murder and maim their way to political goals. Today, we stand in solidarity with the founding principles of the French republic: the liberty to live our lives free from the threat of violence; the equality of all peoples, regardless of colour or creed; and a fraternal bond between all peoples and all parties committed to the power of peace as a tool for change. We are all united in the Chamber, across these islands and across Europe against those who seek to shake the foundations of our peace. Let that spirit of unity be the message that we send to them. It says more than anything else we could do.
Mr Ford: On behalf of my colleagues, I associate ourselves with remarks already made in the Chamber. I thank you, Mr Speaker, for your initiative earlier today in arranging the opportunity for not just Members but staff and visitors to show their solidarity to the people of Paris and France in the wake of the multiple atrocities that happened last Friday evening. Of course, as has just been said, we should not forget the similar atrocity that happened in Beirut, the ongoing challenge posed by the atrocities being perpetrated daily in Iraq and Syria by ISIS, and similar actions that happened in relatively recent times across the Middle East and north Africa, particularly in Kenya and Nigeria.
France is one of our closest neighbours geographically. It is a partner and has been an ally. It is a business partner, a partner in times of difficulty and a partner in terms of where many of us first had our opportunities to experience life in a different culture. So it is felt particularly sensitively by people throughout these islands when they see the atrocities that happened in Paris — somewhere that people can associate with holidays and times of great pleasure for themselves.
It is one of the ironies of this weekend that, in 1940, and, indeed, again in 1944, Paris was declared an open city, so that not only the architecture but the people were left undisturbed in the opening and closing phases of the Second World War. It is a further irony that a friendly football match was being played in the Stade de France between France and Germany. That is an indication of where we in Europe have moved on in recent years, but where there clearly are challenges from those who do not accept the fundamental principles of human life and welfare that we do. Friday was a direct attack, not on any perceived justifiable target, not even in the twisted sense that would have justified the attack on 'Charlie Hebdo' earlier this year, but on ordinary people — Parisians, others from throughout France, visitors — engaging in what people throughout Europe engage in on a Friday night, the opportunity to go out with friends and enjoy themselves with whatever entertainment they wish. That is why it has so devastated so many people; that is why it has affected people so strongly in what that meant. That is the reason why we must ensure that we do not have just words but that we stand together in practical solidarity with our French neighbours, whatever language we speak and whatever way we express it. Whether it is in French, German, English or Irish, the message has to be of solidarity in the face of those who would carry out such terror, and a unity of purpose that we will protect human life and human dignity, wherever the threat comes from.
Mr Allister: I join in the sentiments of shock, dismay, empathy and deep sympathy with the people of Paris and France at this time. We in this Province, of all places, know the horrors of terrorism. The scale of the slaughter in Paris, I think, causes us to struggle with the question of how any human being could do such things. It is a question that had to be asked in this Province as well, because the uncomfortable truth is that the unmitigated evil that manifested itself in a theatre in Paris was the same unmitigated evil that lined innocent workmen up against their van in Kingsmills and riddled them to death; the unmitigated evil that launched an attack on a restaurant in Paris was the same unmitigated evil that attacked a pub in Greysteel or in Loughinisland; and the unmitigated evil that launched bombs to kill was the same unmitigated evil that we experienced in La Mon and, yes, even in the most sacred of places, a remembrance service in Enniskillen. Terrorists — all terrorists — are evil and remain evil. There are no good terrorists, even in retrospect. I trust that the people of France will have the resolve and determination to ensure that they will not pander to terrorists or fete them in any way, such as happened in this country.
Another uncomfortable truth is that the open borders of Europe, sadly, have the appearance of supplying a supply line to the fifth column in Europe that would destroy our civilisation. Europe needs to assert itself and assert control over its borders before more of this horror is visited upon us. I trust that that will be a lesson learned from this horrendous episode.
Mr Agnew: On behalf of the Green Party in Northern Ireland, I would like to express my condolences to the people of France, particularly those families who have suffered directly as a result of these attacks. It is hard to understand the mindset of people who are so determined to cause misery, suffering and death and to think that, whilst we all join here in sympathy and sorrow, somewhere, there are those who celebrate those actions. That is very difficult to fathom. What is important is how we respond. I look back to the response of the Norwegian Prime Minister after the horrendous atrocity that was committed by Anders Breivik. His answer to the violence was that we need more democracy and more openness, but not naivety. That is easy to say and difficult to achieve, but it has to be our starting point. We must protect our way of life, but we must not do so by destroying it.
I have only questions, not answers. My fear is that the simple answer to the complex questions and situations that we face is usually the wrong one. We have to question how we respond. My party stands on a platform of non-violence. That is not to say that there should be no violence ever: violence can be acceptable only if and when it prevents greater violence. Again, I think that it is another principle with which we should underpin any response to these attacks. I do not believe that fighting fire with fire is the way forward. The way to mourn victims is not to create more innocent victims.
I wish the absolute best to those who are injured and in recovery and to the families who have been directly impacted by these attacks. I stand in solidarity with that wider community. This attack has had ripple effects throughout Europe. I stand in solidarity with all those who absolutely abhor terrorism.
Mr McNarry: It is not that long ago that we in this House said, "Je suis Charlie" after those murders by ISIS. We in UKIP offer our sincere condolences and sympathy to all those who have been bereaved and saddened by the carnage in Paris. We think that we are right in speaking up for many people to demand that the evil perpetrators be brought to justice and that the horror of Paris is not repeated.
I note that COBRA has been meeting to mobilise national security. That includes us. I trust that our cities, towns and villages can be assured that they, too, are protected from attacks by ISIS just as people across the rest of the United Kingdom have that assurance.
Our best wishes to Paris. Let us hope that we can all visit it for better times in the future.
Mr B McCrea: Of course, we must send our condolences to those who have suffered and show our solidarity in standing with France at this tragic time. One of the key questions that we might all consider, however, which has not yet been discussed in this Chamber, is why it is that France has become the focal point of the ISIS campaign. Why is it that France is identified as the crusader whilst others are not?
I know that President Hollande will have been disappointed in the support that he had from some people when he wanted to take air strike initiatives. There was a vote in the House of Commons, and there was a reference to the United States Congress, but Hollande and France were left standing alone. That is why they are the ones who are identified as being at the point of this war. We, therefore, all have decisions to make about whether we are going to stand four-square with them and whether we are going to do more than just issue words and platitudes. We will have to consider what the right way forward is.
Mr Allister said that there are no good terrorists. I suppose that the rejoinder to that is that there are no good wars. What is the appropriate response that we all must make to this challenge to our democracy? There is a danger that there will be a knee-jerk reaction against Islam and against Muslims. The ISIS strategy is to divide humanity. Not all those people are bad people. We must find a way to show our humanity and our support. We must win hearts and minds. That is the way forward, and it requires cool, calm and calculated thought and not necessarily a knee-jerk reaction.
Mr Poots: As we all realised the scale of what happened on Friday evening, we were shocked and stunned at the events. The fact that so many people lost their lives is something that we should all draw on, as well as the pain that has been caused to all the families that are involved. Such an unmitigated waste of human life is an absolute tragedy.
It makes us think back a little to the 7/7 murders that took place in London and the 9/11 murders in New York, which emanated from similar sources. A little further back, we go back to the murders in Omagh, Teebane, on Bloody Friday, in McGurk's bar, and the Shankill bombing. These things are all the same; they all happen when someone else thinks that they have a right, for a cause, to go out and take other people's lives — innocent people's lives. Of the 129 people who are reported dead, eight of those are not innocent victims but murdering terrorists, and we must always remember that. Those people are not in the same classification as the innocent victims in Paris from many parts of the world.
We need to reflect on our policies. Mr McCrea and Mr Allister spoke about that from different angles, but the foolishness of opening up borders without having any checks or balances is ludicrously stupid. We need to be compassionate to people who are in desperate situations, and we need to support them, but allowing an absolute free flow across our borders without any checks or balances being put in place will inevitably lead to more people with a terrorist background coming into Europe. That is totally unacceptable.
I have taken my family on holiday to France many times, and we have spent many wonderful times in that beautiful country. Today, we stand with the people of France. Vive la France, vive la liberté.
Ms Sugden: I take no pleasure in joining Members of this House to express my horror and deep sadness at the events in Paris on Friday evening. I offer my sincere condolences to those who have been bereaved of those lives that were taken so callously by others. When a loved one is taken from you at the hands of another, the pain sears through your whole being and that pain never leaves you; it scars you. Mr Speaker, it takes a special kind of bastard to inflict that pain on so many. I apologise for my language, but I really cannot think of any other word to describe them. Friday's events were inhumane. They were carried out by bad people driven by a gross misinterpretation of religion and God. They have no place among us. I stand by the people of France and all the people of the world who are fighting against this evil.
Mr D McIlveen: I, too, offer our sincere sympathies to the people of Paris today, who no doubt find themselves still under an immense shadow of darkness over the events that unfolded over the weekend. I remember that, on 26 June last year, I had the opportunity to go to a concert in the Bataclan, and it was a place of happiness and celebration. It was a place where people of all different creeds, colours and races gathered together to enjoy an event. For those who have not been in the venue, it is comparable in size and layout to the Ulster Hall in Belfast and has limited points of exit. To think of those cowardly, grotesque, inhumane people coming into the building and opening fire indiscriminately while the poor people who were contained therein had really no easy means of escape is just horrific beyond any description or explanation.
One of the founding principles of France was the principle of liberty and of freedom. This was an attack on freedom. It was an attack on those of us who believe in the right of each individual country and each individual people to determine their own direction of travel. It was a grotesque attack on that principle. The rise of Islamic terrorism throughout the world has spread like a cancer. There have been attacks throughout many cities in many places — everywhere from New York to Jerusalem to Paris to Beirut. We have seen it in London, and we have seen it right across many major cities in the world.
I find myself agreeing with what a number of colleagues have expressed today. With cancer in a physical sense, you do not talk to cancer. You do not persuade cancer to leave a person's body. You have to deal with it aggressively. You have to deal with it in the right way. We have to be very careful, Mr Speaker. This is not a war on Islam or on any religion, but this is and should be a war on terrorism and on the very people who threaten the liberty of the people of France and on the people who threaten the freedom of the people of Europe and the Western World. I urge our Government in Westminster to step up to the mark now and rally behind those countries that are taking a forward-thinking approach to dealing with this blight of terrorism that we find in our country at this time.
Mr Speaker: Thank you. I will make one point. We are talking about very emotional and terrible circumstances, and I regret the fact that one Member departed from what I thought was a very appropriate level of discussion and conversation. Despite the circumstances, I see no excuse for that departure, and I hope that it does not happen again.
Mr Speaker: As with similar motions, the motion will be treated as a business motion, and there will be no debate.
That Lord Morrow replace Mr Paul Girvan as a member of the Committee for Enterprise, Trade and Investment; and that Mr Paul Girvan replace Lord Morrow as a member of the Committee for the Environment. — [Mr Weir.]
Mr Speaker: I call on the Minister for Social Development to move the Consideration Stage of the Pension Schemes Bill.
Moved. — [Mr Storey (The Minister for Social Development).]
Mr Speaker: No amendments have been tabled to the Bill. I propose, therefore, by leave of the Assembly, to group the 53 clauses of the Bill for the Question on stand part, followed by the two schedules and the long title.
Clauses 1 to 53 ordered to stand part of the Bill.
Schedules 1 and 2 agreed to.
Mr Speaker: That concludes the Consideration Stage of the Pension Schemes Bill. The Bill stands referred to the Speaker. Thank you, Minister.
Mr Speaker: I call Mrs Jo-Anne Dobson to move the Second Stage of the Human Transplantation Bill and to open the debate.
That the Second Stage of the Human Transplantation Bill [NIA 64/11-16] be agreed.
I welcome the opportunity to move the Bill. I rise to speak, first, as a mother of a transplant recipient and as an unashamed lifelong supporter of the life-saving and life-giving power of organ transplantation. I feel that it is only right that, in the Chamber, we reflect our life's experiences in what we do and seek to achieve as elected Members, in the interests of all our constituents.
If Members will allow me to be personal for a moment, long before I entered politics, our life as a family was turned upside down with the birth of our second son, Mark. We knew when he was five weeks old and diagnosed with severe reflux of the kidneys that he would be very ill throughout his young life and would eventually need a kidney transplant. We never knew when that would happen but, at the age of 13, his kidneys began to slowly shut down. The wonderful staff at Craigavon Area Hospital and then the Royal Belfast Hospital for Sick Children, including the amazing Professor Maurice Savage, Dr Mary O'Connor, renal nurse Hazel Gibson and her team, became our second family. They loved and cared for Mark as if he was their own. I will never ever be able to repay those 15 years of care that we received during the seemingly endless journeys to and from, initially, Craigavon, and then the children's hospital, before his transplant.
Like every transplant patient, Mark celebrates two birthdays each year: his real birthday on 20 March, and the birthday of his new life on 5 February. In all life's experiences — birth, marriage and, ultimately and unfortunately, death — nothing can, could or should ever prepare a young mother, as I was, to look at the very real prospect of losing her son or daughter. I faced that prospect, and I firmly believe that it shapes you as a person for the rest of your life. It gives a real sense of priority and focus, and, in our case, it strengthened an already strong faith at that time and has done so ever since.
Now that Mark is through his transplant and has returned to his fit and generally healthy self, he knows too well the responsibility that comes with looking after the precious gift that saved his life. I know countless transplant patients who, in their daily lives, seek to honour that gift and honour the donor in all that they do. Three years after his transplant, when he became 18, Mark moved from the care of the children's hospital to the wonderful care of Dr Aisling Courtney, the clinical lead for transplantation in Belfast City Hospital, and, more recently, to Dr Neil Morgan, consultant nephrologist at Daisy Hill Hospital, Newry.
In our home, we know what it is like to have someone save the life of our son because of a kidney donated by someone who died in England on 4 February 2009. We think of that person and their family every single day, but we will never know who they are. Like many families, we have sent a letter, and we hope that they have received comfort in knowing how we appreciate, from the bottom of our hearts, the gift of new life that Mark has received.
Medical staff have played an important part in Mark's life and my family's life, and they play an equally important role in the lives of countless families touched by organ donation across Northern Ireland. It is for that very personal reason that I took the decision to bring forward the private Member's Bill. I want more parents to be able to see their son or daughter transformed back to having a fit and healthy life before their eyes, just as we saw with Mark, to move back from being a mere shadow of themselves, which they become following organ failure, and to see more people being released from a life sentence of dialysis and returning to as normal a life as possible.
The plain truth about organ donation is that the number of available organs does not meet the demand; and that, in a nutshell, is the reason why a change in legislation is required. I fully appreciate that this will be an emotional and, for many, a sensitive debate. I encourage Members to keep the recipients and donors at the forefront of their thoughts when making their contributions today.
I will spend a little time laying out the current stark reality facing local people when it comes to organ transplantation. The first and perhaps most striking thing is that 17 people from Northern Ireland died last year while waiting on a life-saving transplant. The local average is 15 people every year. In 2013, 932 local people underwent kidney dialysis, which is a three-times-a-week life sentence. In a sense, they are the luckier ones. There is no dialysis for people who need a heart, liver, lung or other organ. The only option for them is to receive an organ or to die.
Figures from National Health Service Blood and Transplant (NHSBT) provided to us by Assembly Research — and I pay tribute to it for the pack it has provided us with for this debate — show that, at the end of September this year, 162 local people were on the transplant waiting list. That is made up of 117 patients waiting for a kidney, five for a kidney and pancreas, seven for a heart, 13 for lungs, one for a heart and lung and 19 for a liver. Indeed, the figures for September this year see the highest number of patients waiting on a transplant for organs other than a kidney in the last four years where we have available figures.
It is also equally important to point out that the figures show us that there were no heart transplants conducted in Northern Ireland for Northern Ireland patients last year. That is a point that I know is being highlighted by the British Heart Foundation. That is despite five local patients receiving a heart transplant in each of the two previous years and four in 2011-12. Focusing on the transplant waiting list, that is 162 local people and their families who are waiting, watching and wondering when that all-important call will come to let them know that a match organ has been found.
Statistics should never be used to mask or hide the human reality felt by patients. Behind each and every one of those patients is an individual story of pain and anguish. None of us know when and if we may need an organ at some stage to save our lives. Anyone could be waiting on that life-saving telephone call; and those who have been in that position — and I know what it feels like — are best placed to describe it; but they are the lucky ones because, for them, that call came. For others, it is too late, that time has passed and that call will never ever come.
I well remember presenting to the Health Committee in 2013, and I was joined by Mr William Johnston, who is now chairman of the Northern Ireland Kidney Patients' Association. William waited for over 17 years until he received that call and had his transplant last year; but, on that day, when he presented to the Health Committee and the security guard at the door of the Senate Chamber asked him to turn off his mobile phone before he entered the room to present to the Committee, William fixed him with a stare and said, "My phone is never switched off. I never ever know when that call might come". I think that that highlights starkly for us the human reality behind the statistics and figures.
Last year, 17 people from Northern Ireland died while they were waiting on that telephone call to let them know that a match organ had become available. Members, for them, that call will never come. It is for them and for future generations that we need to adopt a different approach; to lift our eyes from the present to a future where organ donation is not viewed an exception but rather the norm.
Members, we often get much criticism in this Building for failing to bring forward legislation that brings a real benefit to the lives of people right across Northern Ireland. Few issues could be more important than introducing legislation in the Chamber that increases life chances and gives all our people — our constituents — greater hope for a new life after an organ transplant. Medicine has moved on considerably since the organ donor register was first introduced some decades ago. I believe that, as a devolved region of the United Kingdom with the right to frame our own legislation, we should follow the lead of the Welsh Government, through their Health Minister, Mark Drakeford AM, and my colleague Anne McTaggart MSP in Scotland, and work together to achieve the right Bill for Northern Ireland.
I am, however, a single MLA working alongside the Bill Office to bring forward a Bill of this extent and importance. I obviously do not have the Health Minister's army of staff and resources or, indeed, the equal armies of staff of the First Minister or deputy First Minister to bring forward this Bill. That is why I want to say at the outset that I am happy to work alongside any Member on any aspect of the Bill and would welcome input, help and assistance in bringing it further through the Assembly processes. I am also looking forward to a close working relationship with the Department of Health, and the Minister will be aware that, two weeks ago, I had a preliminary meeting with one of his directors. I am hopeful that this will provide help and assistance in the weeks and months ahead.
I am certainly open to improvements and changes that will achieve the right Bill for Northern Ireland. I very much welcome the support of the First Minister and recognise that he has given a clear commitment to me in the House to support the Bill. His views on the soft opt-out system were clear when, in response to Joe Brolly and Shane Finnegan when they asked him about the movement to change the law, he said:
"If somebody dies in hospital, they need an organ, so the family are asked. How is that different from the family being asked in an opt-out situation?"
That is a key point. I welcome the support for the Bill from the First Minister and the deputy First Minister, from Members across the Chamber, from councils and from MPs from all the local parties at Westminster. I would also like to commend the support that I have received from the volunteers and officers of the local and national charities, who work so hard to promote organ donation and for whom the donor families are the real heroes.
Each year, Dame Mary Peters, who until last year was Lord Lieutenant of Belfast, presents certificates to families of those who have donated life-saving organs following the death of a loved one. That is a fitting tribute to our amazing donor families in Northern Ireland by Northern Ireland's own ambassador, who is a lady in every sense of the word. I was delighted to receive her support for the Bill progressing today, and she joins a long list, including the majority of the public, in supporting the move to a soft opt-out system for Northern Ireland.
Looking through political party websites and manifestos is not something that I often find the time to do. However, they make for interesting reading. I have been delighted to see reference in manifestos, on party websites and in press releases to organ donation policies and, specifically, to support for the soft opt-out system. To give a flavour, I welcome its inclusion in the Green Party's policies as well as in the Alliance Party's 2012 manifesto. I welcome the support of Sinn Féin and the SDLP for the issue, and I know that Mark Durkan MP has been a regular attender and supporter at the all-party parliamentary group for transplantation at Westminster.
Equally, the DUP's 2010 Westminster manifesto included the line:
"In order to improve public health the DUP supports ... presumed consent for organ donation."
I welcome my party's continued support for the introduction of a soft opt-out system at a policy and personal level, and I thank all political parties that responded to the consultation.
Whilst discussing the political stances towards organ donation, I am conscious that this matter should — and, in my opinion, will — remain well above party politics. We have more than enough policy issues that divide us in the Chamber, but on this issue, surely, as the Second Stage goes forward, we can unite and work together to introduce something that the public, our constituents, supports.
I like nothing more than taking time to visit renal units and chat to patients undergoing dialysis. For some, a transplant is not an option, and they are resigned to the fact that they will end their days on dialysis. For others, it is all about giving them hope. I am thinking of one family that I know where 12 members have a genetic renal condition. It is a family that never knows how long their children, or any family member, will have until their kidneys fail.
Imagine what providing hope to that family would mean to them when faced with a possible future on dialysis for any family member — hope that a new life will come. I firmly believe that, working together, we can deliver that hope to them, their family members and other families in the same position across Northern Ireland.
Let us also remember that one kidney transplant does not last a lifetime; kidney patients often require two or three transplants during their life. They are also required to take a permanent course of immunosuppressive drugs to suppress the immune system, meaning that kidney transplant patients are prone to infection.
I was not alone in the House or among the organ donation community in being absolutely delighted to hear that the fantastic team at the City Hospital undertook five kidney transplants in one day in September. Whilst a one-off, it shows that we have the expertise and capacity for kidney transplants. However, I am conscious that that was a fantastic one-off event. We all want to see more people being given that chance of a new life and the hope that they need to go on. I firmly believe that a soft opt-out system will deliver that hope. I have nothing but admiration for the amazing staff in the renal units. We should be equally proud that our live donor programme at the City Hospital under Dr Aisling Courtney is the envy of clinicians across the world. I visited it on a number of occasions and pay tribute to everyone involved in that programme and wish it continued success.
However, Luc Colenbie, head of Belgium's successful transplant strategy, told me in Brussels at the beginning of the year that their experience was that live donor programmes will eventually reach a plateau. Belgium has a positive culture towards organ donation, in part because policymakers made the issue a national priority. When they switched to an opt-out system in 1986, there was an 86% rise in the number of kidneys retrieved for life-saving transplants. That change generated a positive change in the public's perception of organ donation that resulted in roughly 2% of their 11 million population saying that they did not wish to donate organs after death.
I apologise to my fellow Committee members if some of my contribution overlaps with my presentation to the Committee two Wednesdays ago, but these are important issues and central to the reasons behind the Bill.
One thing that I learnt over the past few years in bringing forward the Bill is that our local organ donation system is complex and confusing.
Indeed, a greater proportion of our transplants, currently 68%, come from people who have had no interaction at all with the organ donor register during their lifetime than from those who have.
Another aspect of our current system is that, even though we are one of the most giving people, with wide support in society for organ donation, we still have a relatively high bedside refusal rate, roughly 40% to 45%. That is another aspect where figures differ between opt-in and opt-out countries across Europe. Our high rate suggests that, prior to death, people often have not had that all-important conversation with their loved ones about their wishes. In other opt-in countries in Europe, the average refusal rate is roughly between 40% and 60%. As I said, in Northern Ireland ,we are around 40% to 45%.
In opt-out societies, however, the rejection rate tends to be much lower, at between 2% and 15%. The bedside rejection rate in Belgium, incidentally, is closer to 2%. That fits in very well with the PHA's findings that 96% of local families agree to donation, if they know their loved one's wishes. So, the figures suggest that, in opt-out countries, such conversations are taking place and, when it comes to asking the family whether they know and can confirm the wishes of their loved ones, they will be in a better place to understand and articulate those wishes.
Mr Ross: I appreciate the Member giving way. She highlights some of the opt-out countries where there has clearly been success, though I would contend that that success is to do with other mechanisms in their systems, rather than just the opt-out. She would, of course, acknowledge that there are other countries, such as Sweden, Brazil, Chile and a raft of others, that have moved to an opt-out system and their rates are worse than those we have in the United Kingdom and far worse than those in Northern Ireland. So, there is no real correlation between whether you have an opt-in or opt-out system. It is more to do with other issues, such as public awareness and experts in hospitals.
Mrs Dobson: I thank the Member for his intervention. That is precisely why clause 1 sets out that we need an education programme as well. If he reads the Hansard report of my speech, he will find that I referred to the fact that opt-out should go in line with the education programme as well, which is crucial for everyone to make their wishes known.
I take a moment to break down the main aspects of the Bill's content for Members. It is fair to say that, of the 22 clauses, the most important are towards the beginning of the Bill. The first clause places a duty on the Health Minister to promote human transplantation and to conduct a yearly campaign to inform the public how the new opt-out system would operate in practice, including the role of the family in affirming consent. The second, third and fourth clauses set out the requirement for there to be appropriate consent before a transplant can be lawfully conducted and cover, in detail, the two types of consent.
"Express consent" is where the individual can provide their own consent for a live donation; has engaged with the organ donor register to make their wishes known; appoints two advocates; or has placed their wishes in a will. That is the current procedure and, for donations after death, is subject to a procedure conducted by clinicians, where the family is required to provide express written consent to confirm the individual's wishes prior to donation proceeding. The Bill makes no change whatsoever to that current practice. If someone, for whatever reason, is opposed organ donation, they will, for the first time, be able to engage with the register to opt off and their family will not be approached at the time of their death.
The second form of consent is "deemed consent", where there was no interaction between the individual and the organ donor register during their lifetime. Following death, and in the knowledge that they have not engaged with the organ donor register during their lifetime, it will be deemed that they have provided the necessary consent for transplantation to proceed.
However, crucially, and I have always said this, consent is subject to family affirmation prior to donation taking place. This is included in clause 4. That is why having the conversation amongst family members and loved ones is so important, and I have always said that a duty to promote, as contained in clause 1, would be central to increasing public awareness.
Mrs Dobson: No, I want to make my points.
It has been said many times in the Chamber that education is critical as we look to the future of organ donation in Northern Ireland. We should be focusing now on the needs of local families in five, 10, 15 or even 20 years' time.
There are certainly many lessons that I believe we can and should learn from the experiences of other countries. I come back to Belgium for a moment. It has a fantastic programme in its schools, where, from an early age, the power of saving lives through donation is introduced into the curriculum. I wrote some time ago to the Education Minister calling for the introduction of a similar system in our schools. In Belgium, they have changed the public view of organ donation from being an exception to being the norm. I believe that we can learn from those experiences.
I will now address some of the concerns raised during the recent Committee meeting. I commend the idea of people being able to nominate advocates when they sign up to the organ donor register. Concerns were raised about family members who may have an opposing view on organ donation. This is where advocates play such an important role. Advocates provide people with the opportunity to nominate someone to make the decision if they do not want to make it themselves at the time. The Public Health Agency's (PHA) consultation identified what it termed the "ick" factor amongst some respondents who simply did not want to make a decision or consider the issue.
The advocate would also have a role where someone has a specific wish or instruction that they wanted carried out after death. They could appoint someone to make that decision for them. If the person were to die in circumstances where donation is possible, their advocates would be asked if organs should be donated. Equally, if the advocates nominated have predeceased the person or cannot be contacted at the time, a family member or relation could be contacted and asked to provide consent. This is similar to the current situation when someone has interacted with the register during their lifetime.
We should also remember that there is a window of time after death during which clinicians may use an organ for transplantation. I stand to be corrected, but I believe that it is roughly 24 hours for a kidney, which is one of the most robust organs under the circumstances. That is why I feel that it is not advisable for people to make their wishes known in a will, because by the time it is actioned, the window may well be closed and transplantation will not be able to take place.
Concerns were also raised to the Committee about conflict between family members over providing consent for donation, something that can arise at present, albeit rarely. This is more likely when a family has not had that important conversation, and that situation is one the Bill seeks to resolve through greater public awareness. Initially, having the conversation between family members is the best way to avoid the situation. However, we have exceptional specialist nurses in organ donation, who are trained to deal with these situations and advise families at the time.
I support the crucial role that family plays in the process, not least because death does not just affect the person who has died but the whole family, who have a role to play. The consultation identified a willingness to retain the crucial role of the family in providing consent for organ donation to proceed, and that is clearly in place at present for express, as it is in the Bill for deemed, consent.
On 4 June 2013 I launched my public consultation for this Bill. I am also grateful to the Public Health Agency for the findings of its two consultations on public attitudes towards organ donation, conducted initially in the same year. At that time, I wrote to each Member and provided them with a copy of the consultation document. In my letter, I reiterated that my door has always been open. I thank those Members who have taken the opportunity to meet me to discuss the Bill and to respond to the consultation.
The public consultation ran for 16 weeks and received 1,366 responses. Those responses were made both online and offline, and came from a mix of the general public, charities, councils, churches, the health and social care sector, political parties and others. A summary report was produced in October of that year, giving an overview of the 10 questions and the responses to them. That report is available in the Library and details responses that were positive, as well as concerns raised in answer to each question. It showed that 82% of respondents supported a change in the law and a move to a soft opt-out system. Also, 61% supported the attainment of the key role of the family and 86% supported protecting the rights of those who lack capacity in the legislation. Those views have been well reflected in the Bill.
I want, again, to record my thanks to each and every person and organisation who took the time to respond. I also want to record my grateful thanks to the local charities of the Transplant Forum as well as the British Medical Association, the British Heart Foundation, Opt for Life and others for their support in promoting the consultation.
In addition to my own consultation, the Public Health Agency conducted a consultation on public attitudes, also in June 2013. More recently, a PHA survey with figures from February this year again highlighted public attitudes to organ donation. The Public Health Agency survey highlighted 56% support for a move to a soft opt-out system in June 2013. That grew in the PHA's most recent survey to 61% of the public supporting a move to a soft opt-out system. Again, in 2013, 18% of the 1,012 respondents to the Public Health Agency's consultation were opposed to a change in the law geared towards soft opt-out. In 2015, that figure dropped to 10%, signalling a clear change in attitude, with the percentage of those opposed almost halved. That reduction could, possibly, be a result of the continued hard work of local charities, as well as the PHA's important 'Speak up and save a life' campaign, with its two powerful television adverts and associated campaigns. Few people can have failed to see the leaflets, posters and billboards, and that is precisely what clause 1 of the Bill envisages when it comes to public education. A continued programme such as that must be central to the future of organ donation.
It is also noteworthy that, in responses to the PHA's 2015 survey, 79% of the public agreed with the statement: "The soft OPT-OUT system will result in more lives being saved". The equivalent figure in 2013 was lower, at 74%, and I pay tribute to all of those involved in the charities associated with the continued promotion that is having an impact on the public's view on this issue.
When the Welsh Government decided to go down the route of a soft opt-out system, their surveys concluded that 49% of the public in Wales supported changing the law. As I said, the equivalent figure here was 56% in 2013 and at present, from the 2015 figures, we have a figure of 61%, according to the Public Health Agency. That shows clear evidence of public support from the majority of people for changing the law and that they believe that the move to a soft opt-out system will result in more lives being saved.
I would like now to focus on the finances. No one can ever put a price on what it is like for a transplant recipient to receive a new life; as a family, we know this in our home. However, there will inevitably be cost implications with this Bill. The Assembly research service has produced a research paper that looked into the implementation costs of the legislation.
The paper, which is entitled 'Organ Donation Bill: Estimated Financial Costs and Benefits' is available in the Assembly Library. I should also say that I look forward to working with the Department as we look in greater detail to the cost figures.
Assembly research estimated that implementation costs for the Bill would be between £2 million and £5 million over a 10-year period. Based on the assumption that implementation would be two years after the passage of the Bill, it reached the conclusion that the net discounted financial benefits from achieving one additional transplant a year over a 10-year period by organ type are as follows: £4·6 million for kidney; £6·3 million for liver; £2·3 million for heart; and £1·4 million for lung. More up-to-date figures from the Department will help to provide greater clarity. However, the paper's conclusion on the cost benefit to the health service of increasing transplant numbers is startling; it could be as much as £7·4 million net benefit to the Northern Ireland economy.
To give just one example, focusing on kidney patients for a moment, the average cost of keeping a patient alive through renal dialysis is £30,800 per patient per year. It is roughly £17,500 per patient per year for a patient on peritoneal dialysis and £35,000 per patient per year for a patient on hospital haemodialysis.
In response to an oral question that I asked in the Chamber, the then Health Minister, Mr Poots, confirmed that, in 2013, 932 local patients underwent dialysis. That meant a total cost of over £29 million to the health budget, based on NHS cost estimates, in one year alone. Each kidney transplant costs roughly £17,000 per patient. Post-transplant, the yearly cost of immunosuppressive medication is roughly £5,000 per patient, meaning that, for each kidney patient who receives a transplant, the NHS estimates that it receives a saving of £25,800 in the second and subsequent years. That obviously does not take into account the benefits of people returning to a normal life and the impact on their families, community and wider society.
It is very clear that the lack of available organs is placing major stresses and strains on local patients' families. One of the major reasons for that is that all transplants for local patients, with the exception of kidney transplants, are conducted in hospitals in other regions of the United Kingdom. Liver transplants for adults are conducted in King's College Hospital, London, and for children in Birmingham Children's Hospital. Heart and lung transplants take place at Freeman Hospital in Newcastle. Imagine the long and difficult trips back and forward to those hospitals and the anguish and pain while they live with their condition while waiting on an organ.
The lack of available organs means that patients must endure a greater number of trips from home to hospitals across the country, at considerable strain to them and their families, and considerable cost to the health service. Increasing the availability of organs increases life chances and decreases stress, as well as reducing financial costs. I believe that the Bill will achieve that.
Recent figures from the British Heart Foundation reveal that there are 10 people in Northern Ireland on the waiting list for a heart transplant and one person waiting for a heart and lung transplant. According to the latest NHS transplant statistics — I mentioned this earlier — no one from Northern Ireland received a heart transplant last year. Can you imagine the stress and worry of those 10 patients and their families, often making multiple journeys to hospitals far away from home? They are arduous journeys for seriously ill patients. In some cases — I know this from experience — it is with hopes built up, only to be dashed when, for any number of reasons, a transplant cannot take place. That is sadly more common than it may seem. The arrangements for transporting patients from Northern Ireland to hospitals across England are complex.
Last year, I had the opportunity to visit the NHS Blood and Transplant organ donation and transplantation directorate in Bristol. It is miraculous to see that all transplants in the UK are coordinated through one tiny room in the middle of an industrial estate in Bristol. We are very fortunate to be part of the wider UK network, which allows patients to benefit from organs that are donated in the rest of the UK and vice versa.
Mark's kidney came from a donor in England and was held up by snow. That meant that, even though we had reached the hospital, his kidney had not. The team in NHSBT would have allocated the kidney to the next match on the list if the weather conditions had not improved. Thankfully, conditions improved and the organ arrived in Belfast healthy and within the timescale window for transplant.
Those are issues that few tend to consider when thinking about organ donation, albeit that they are important issues. That office in Bristol is where they match an organ to a patient and start the process by which patients receive the call, which I spoke about earlier. For me, visiting that room was quite a surreal experience, because I knew that that was where, with the call on 4 February 2009, the process started when an organ had been found for Mark. It was an emotional visit for me, and I was delighted to spend time with staff who operate that vital service 24 hours a day, 365 days a year. I was also delighted to meet Sally Johnson, NHSBT's director of organ donation and transplantation, and her team who maintain the organ donor register database. We discussed the future of the register and the likely impact of the Human Transplantation (Wales) Bill being passed at the Welsh Assembly.
I understand that — the then Minister Poots confirmed it — local patients can register on the Republic of Ireland's transplant register, but that means that they cannot be on the UK register at the same time. I also understand that arrangements are in place that make it possible for organ retrieval teams from the Republic of Ireland to operate in Northern Ireland. It may be useful to seek clarity on that issue from the Department.
Last year, I was also grateful for the opportunity to meet the Welsh Health Minister, Mark Drakeford AM, in Cardiff. I also hosted Mark and Anne McTaggart MSP at a Long Gallery event just over a year ago.
Following my conversations with Sally at NHSBT, I was absolutely delighted when the new organ donor register was launched across the United Kingdom in July. That was a direct result of the Welsh legislation that comes into force next month, two years after being passed by the Assembly there, which is the same timescale that I have proposed in the Bill. The changes to the register included the provision for people to be a donor, to not be a donor or to nominate two advocates to help affirm and make that decision for them after death. I also very much welcome the fact that the Health Minister warmly welcomed those changes. However, it is important to note that we would need legislation to come into place through the Assembly here to enable us to avail ourselves of the changes, which, I understand, our health service has rightly paid its portion towards. This Bill makes those changes.
Under the current opt-in system, we have never broken through the glass ceiling of the mid-30%s of the public in Northern Ireland signing the organ donor register and consenting to donation after death. That is despite decades of promotion by the charities and the recent campaign by the Public Health Agency. From the perspective of someone who has been working alongside the charities for over 20 years, I know that that campaign was very much welcomed, given the heavy lifting that the charities have been doing and continue to do, day in and day out.
One of the little-known facts is that signing the register does not guarantee that a person's organs can or will be used after their death. That is because the manner of an individual's death often determines whether it is possible. The donation rate in the UK is 26 donors per million of our population. People often assume that, if they join the register, it automatically means that they will donate their organs.
The facts are very different indeed. Donald Cairnduff, whose son Philip had a successful liver transplant in 2004, joined me in presenting to the Health Committee two weeks ago. I believe he explained it best when he used a footballing analogy. He asked the Committee to imagine, on the last day of the Premier League season, when all the games kick off at the same time, that every stadium hosting a home game is packed to capacity. Only 26 people among all those spectators in all those stadiums will become organ donors. Just 26; very long odds indeed.
That gives you a vivid idea of how rare it is for people to die in circumstances in which they can donate their organs. However, with over 90% of the population consistently supporting organ donation and people in their mid-30s pledging in the register, there is a considerable difference between pledges to donate and support for donation. Indeed, as I mentioned earlier, 68% of our donations come from people who have never interacted with the organ donor register during their lifetime. That feeds into the argument that I laid out earlier on our currently high bedside rejection rates, standing as they are between 40% and 45%. This is frighteningly high and shows that families have perhaps not had the crucial conversation about donating that would have enabled them to better know what their loved ones' wishes were. They could then have confirmed and honoured those wishes by signing a document that is required by clinicians prior the loved ones' organs being donated.
The Bill does not propose to make any changes to the current system operated by clinicians, when an individual has already signed the organ donor register and has consented to donate their organs after death. I am also pleased by the three local public consultations into the issue of organ donation in Northern Ireland. The findings of the two PHA consultations into the issue of organ donation in Northern Ireland have been largely in line with the findings of my consultation for the Bill. I am also thankful that these consultations were conducted in parallel, as I believe that they too show that public support for a new opt-out system is rising. They also provide an independent assessment of the public's views on this issue.
It stood out for me that, when asked, only 36% of the public knew that the organ donor register existed in the first place. If you ask any of the countless local transplant volunteers, many of them are waiting for an organ transplant themselves, are successful recipients of a transplant, are family members of those who have donated or been recipients of an organ, or are people who, in some way, have an emotional connection with organ donation. They will tell you that it is their sole life's purpose and drive to increase the number of organs available for transplantation. Members, these people deserve our respect, gratitude and praise. They are the true heroes in Northern Ireland, and they have absolutely nothing but my admiration and praise for all that they do to help increase the life chances of others.
It must never, ever be forgotten that behind each volunteer is an individual story of emotion and one that will tug at the very heartstrings. We have heard so many of their stories through the all-party group, which I am honoured to chair. I am delighted by the fact that it has become an efficient vehicle to bring to the Assembly the stories behind human transplantation, whether it be an individual's story, the fantastic success of the transplant games athletes from Northern Ireland or the views of individual groups and charities.
Organ donation has a voice in this Building. I, for one, am truly glad that that is, and will continue to be, the case. I am truly humbled and delighted, as a mother of a transplant recipient, to be included in their number, and to work towards an aim that many of them have held close to their hearts for many decades. Members, I am asking you to join this campaign today. I will say in the House again what I have said many times before, that I bring the Bill forward first as a mother of a transplant recipient and as an organ donation campaigner who happens to be a Member of this legislative Assembly.
It is with a deep sense of pride and purpose that I commend the Second Stage of the Human Transplantation Bill to the House. I look forward to Members' contributions to the debate and the ongoing help and assistance to deliver the best Bill possible for the people of Northern Ireland. We owe it to the present generation who are awaiting a transplant, and we owe it to future generations to come, to change the law and to improve the life chances for all our people.
Some Members: Hear, hear.
Ms Maeve McLaughlin (The Chairperson of the Committee for Health, Social Services and Public Safety): Go raibh maith agat, a Cheann Comhairle. I thank the Bill sponsor for that very detailed overview of the Second Stage. On behalf of the Committee for Health, Social Services and Public Safety, I note the introduction of the Human Transplantation Bill. As the Bill sponsor outlined, the principal objective of the Bill is to save lives — that is very clear — by changing organ donation laws, by introducing a new soft opt-out option with safeguards and by placing an additional duty on the Department to educate the public on organ transplantation.
The Committee heard evidence from the Bill sponsor on 4 November 2015, accompanied by the father of a recipient of a successful liver transplant. We heard at first hand how successful organ transplants not only save lives but enable people to live their lives more fully — for example, by freeing them from the need for dialysis. The Bill sponsor also spoke about the differences between express consent and deemed consent and the role that families and advocates would play in decision-making under the Bill. The Bill sponsor provided the Committee with a range of statistical information, some of which has been referred to today. It is quite stark when we hear that, on average, 15 people die waiting for a life-saving transplant locally each year; in fact, 17 people died waiting last year. That is a stark reminder for all of us. We also heard about the results of the three consultations on organ donation that have taken place in the last year — the consultation on the Bill and the two consultations by the Public Health Agency. During the evidence session, the Bill sponsor stated that the majority of respondents to the consultation on the Bill and the PHA's attitudes surveys were supportive of some sort of soft opt-out option.
The Committee appreciates the importance of the issue of human organ transplantation, and there is an acceptance that more must be done to improve donor levels and transplantation rates. The Bill has the potential to affect every one of us, and that was emphasised by Committee members. It has to be acknowledged that there are wide-ranging opinions and feelings on the subject of organ donation. Regardless of whether people support organ donation itself or are themselves on the organ donor register, there are differing views on the soft opt-out option proposed in the Bill.
Some Committee members have some concerns around the Bill, and there are a number of areas that will need further exploration and clarification. Some of those areas were raised during the recent evidence session with the Bill sponsor. An obvious concern was that of consent. The introduction of the soft opt-out option was discussed, and members spoke of how organ donation is approached in other countries — the Bill sponsor has referred to some of that today — such as Wales, Belgium and Spain, and what levels of success they have had in relation to donor and transplantation rates.
We also know that further affirmation will be sought after death unless a person had already taken their name off the register before death. That affirmation can come from family members, advocates or others as outlined in the Bill. Although the affirmation is intended as a safeguard, it has the potential to raise issues. Consent to organ donation is a difficult decision for families to take, particularly at a time of terrible grief and loss, and it is made even more difficult if there are differences of opinion between family members or others involved. During our evidence session with the Bill sponsor, a number of members outlined possible scenarios whereby consent might be disputed; for example, where there is a potential donor who has expressed consent to organ donation and has perhaps appointed advocates, but whose family is opposed.
Other scenarios include those where family cannot be located or where there is disagreement between the next of kin. In those circumstances, who has the balance of power?
Another issue raised was the role that clinicians play. Are they expected to make decisions that may go against families’ wishes? Importantly, how do they feel about the proposed legislation? Should the Bill pass Second Stage, the Committee will want to hear from those clinicians who will be making the judgements and decisions on the ground.
Some Members raised the point that many people view organ donation as a gift freely given and expressed concern that the proposed changes to the law could alter that. Another issue discussed in our evidence session was finance, and the Bill's sponsor alluded to some of the statistics, and whilst it is apparent, no one can put a price on good health. The issue of finance needs to be considered.
The Committee heard evidence on the cost of implementing the Bill, the cost of dialysis for kidney patients, and the cost of transplant surgery. Initial figures produced by the Assembly Research and Information Service indicate that it would take between £2 million and £5 million to implement the Bill. However, the Bill's sponsor advised that the net benefit to the health service and the local economy of increasing transplants could be as much as a £7·4 million.
The Bill proposes to place additional duties on the Department to promote transplantation and to provide information about transplantation through a campaign at least once a year. That is intended to raise public understanding of organ donation and to make it more socially acceptable to discuss the issue. It is clear that education and communication are key if any change is to be effected in donor and transplantation rates. Some feel that a cultural change is also needed so that organ donation is discussed openly and frankly, particularly between family members, and the wishes of potential donors may be known, making it easier for next of kin to take that difficult decision if the time comes.
The Human Transplantation Bill is an emotive and complex piece of legislation, and, should it pass Second Stage, the Committee will consider all the issues raised and report its opinion to the Assembly.
Mr Ross: I thank the Member for giving way. I have listened intently to what she said. She mentioned consent being raised as a concern by some Members. The Health Committee has looked at this Bill and at a range of other Bills in which consent is an issue. Is she aware of any other area of medicine in which silence from an individual on an issue is deemed as their consent to do something to their body?
Ms Maeve McLaughlin: Go raibh maith agat. I thank the Member for his intervention. I was going mention consent in my comments as an MLA. We need to be very clear not only on the issue of consent but on the issue of conflict, as it may arise. I was about to say that I hope that some of the issues that need to be reflected in the Bill will be progressed in that manner.
I thank the Bill's sponsor for bringing the Bill to the House today. The Committee notes the Second Stage of the Bill. As a constituency MLA, I look forward to engaging with, and maybe enhancing and strengthening, the Bill as it passes further stages. Go raibh maith agat.
Mr Easton: The Human Transplantation Bill makes provision concerning the consent required for the removal, storage and use of human organs and tissue for transplantation and connected purposes. It must be enacted by the Northern Ireland Assembly and assented to by Her Majesty The Queen.
Under the Bill, the Department of Health, Social Services and Public Safety must promote transplantation. It must also provide information and increase awareness of transplantation and inform the public about the circumstances where consent to transplantation is deemed to have been given and the role of relatives and friends in affirming that deemed consent. That also includes a duty to promote a campaign informing the public at least once a year.
The Bill contains 22 clauses and one schedule. It is proposed that the Bill will seek to increase the availability of organs for the purpose of transplantation through a consent process requiring affirmation after death unless the person has already taken their name off the organ donor register.
At the moment, human transplantation is governed by the Human Tissue Act 2004, which is a piece of law that applies to England, Wales and Northern Ireland. It is stated that, if the Bill becomes law, it will fit into the general framework already established by that Act. Some parts of the Bill repeat the provisions of that Act and make them apply to transplants under the Bill. Some parts follow the approach taken by the Human Transplantation (Wales) Act 2013. The Human Transplantation Bill will result in consequential amendments to the Human Tissue Act 2004. Those amendments will see a number of sections of the Human Tissue Act becoming non applicable to Northern Ireland, and restrictions will be put in place where consent is required.
The sponsor of the Bill undertook an extensive public consultation over 16 weeks on the policy objectives and proposed approaches of the Bill. A total of 1,366 responses were registered, from which it is said that a sizeable majority agreed with the objectives of the Bill. The majority of respondents stated that they believed that legislation and the introduction of a soft opt-out system would make a greater number of organs available for transplantation and therefore increase the chance of saving lives. A clear majority of respondents to the consultation also agreed that the family should continue to play a key role in the decision as to whether donors should have their organs removed.
At the end of the consultation, the sponsor gave a detailed overview of the responses to each of the questions available to the public. The overview included the number and percentage of each response and an overview of positive comments made and concerns expressed about each. The sponsor also briefed the Stormont all-party group on organ donation as to the findings of the consultation. I ask the sponsor this: how many of those who undertook the public consultation were from a medical background or worked in the field of medicine? The Royal College of Surgeons has expressed concerns in a recent article. I wish to hear from it. We need to hear more from the medical world on this issue before any final decision is made on the Bill.
I also note a letter sent to me by Dr John D Woods, the BMA Northern Ireland council chair, in which he mentions concerns over clause 4(2). He states:
"We realise that family involvement is a sensitive issue but the proposal at clause 4(2), Deemed Consent: deceased adults, we believe could lead to confusion."
He then goes on to offer an amendment. It is something that we maybe need to examine.
The Bill before us today has the potential to affect every single person across Northern Ireland at some stage. The sponsor of the Bill is bringing it forward with good intent. However, I still need to have further information on various issues as the Bill reaches the Committee Stage for scrutiny and clarification and to gain a better knowledge of the facts for myself before I can reach a conclusion. I am open-minded, but I need to be sure on issues such as costs. How will everybody be informed? How will people be able to take themselves off the list? What about dealing with sensitive issues of asking loved ones to give consent after their family member has passed away? What about training for staff on these issues? Will this boost organ donation? We see from some countries that it actually has not but that it has in others. Will there be too many donors? If so, will organs be sent to other regions of the United Kingdom or even further afield? I am also keen to see what it means under the Welsh model and how it is going to work there. I want to speak to the transplantation teams and explore the Welsh model.
Those are all questions that need to be explored. I ask that the Bill be given the proper time at Committee Stage, rather than being rushed through, so that we get all the facts. It is a vital issue. I thank the sponsor of the Bill for bringing it forward for consideration to the House. I hope to get a better understanding of the Bill as it progresses.
Mr McKinney: I welcome the opportunity to contribute to today's extremely important debate, and I am grateful to Mrs Dobson for bringing it to the Chamber. I know that she has worked extremely hard over the last few years in pushing for a legislative change to organ donation law to ensure that the many people on waiting lists have the best possible prospects for receiving a life-changing transplant. I encourage Members to think about that as we continue our discourse around the subject. Mrs Dobson and her staff deserve the highest recognition in the Chamber for their sustained hard work in bringing forward the Bill. Indeed, their contribution to the Committee reflected the depth and breadth of that hard work, and that has been reflected again, today, with the weight of her contribution.
As we have heard, about 200 people in Northern Ireland are waiting for an organ transplant. Sadly, 17 died last year, as we have heard, long before being offered one. So, it is important that the Chamber does everything it can to ensure that people on waiting lists have the best chance of receiving a life-changing organ. As I said, I urge Members to consider those lost lives and the, potentially, increasing number of lost lives, when they reflect on all these issues.
I welcome today's debate. Perhaps, the most important aspect of it is whether we move from an opt-in to an opt-out system. An opt-out system, as we have heard, requires an individual to explicitly make it known while they are alive that they are not in favour of their organs being used for transplant when they die. The key difference is that an opt-in system involves people expressly stating a wish that their organs and tissues be used for transplant on their death, while an opt-out system assumes that organs and tissues are available for transplant, unless there is a specific instruction to the contrary. At the moment, the fundamental principle is that organs are donated actively, freely, voluntarily and unconditionally using a soft opt-in system.
The proposed change is to promote organ donation more widely and raise levels of consent, improve public awareness and ensure best practice at all stages of the donation process, but the decision that we in Northern Ireland need to make around a change in the law involving organ donation involves ethical, legal, medical, organisational and societal components. The important balance to be struck is between respecting the views and rights of a potential donor and their respective families, and obtaining organs in an efficient manner. As I said, the weight of the contribution by Mrs Dobson and her team, at Committee and the Assembly, reflects real depth and a consideration of those issues.
In considering the change to an opt-out system, the Welsh system, which comes into effect next month, provides key guidance. Welsh authorities have stated that the process for opting out would be very straightforward, with people being able to opt out at general practitioner surgeries, online or by phone. The Welsh system presumes consent, but allows people to opt out. They can also confirm their wish to opt in. If no preference is registered, the assumption is that they wish to donate. At the time of death, the family is asked whether they know whether the person wished to opt out. They are not asked to make a choice, but simply to confirm, if they can, their loved one's wishes. If they do not know their loved one's wishes, donation is presumed. However, I welcome the concept around the proposer of the Bill's ideas on advocates.
During the past two years between —
Mr Ross: The Member has been on the Health Committee and has been a health spokesperson for some time. Does he share the concern that the Bill would make the absence of an objection to being considered as an organ donor equal to somebody who has expressly said that they wish to be an organ donor? Is he not concerned that silence on the issue is going to be deemed as consent? As I asked the Chair, earlier; is he aware of anywhere else in medicine where consent is presumed or deemed by any member of staff?
Mr McKinney: I do not share the concern. I am interested in the way that the Member phrases it. He asks if I have a concern. I do not have a concern. Clearly, he does have a concern, and he has the right to reflect it. I think that that is the importance of this discussion; we must have the debate and put in as many safeguards as we can around this. As I said at the outset of my remarks, we are talking here about lost lives and the ability to do something about that; trying to reach out to the community in a way that allows people to make decisions about potential organ donation and raising public awareness of it.
Fundamentally, I understand — I will get to some of the finances in a moment — that it is very important that we treat this debate in the most respectful way possible. I re-emphasise that the depth and breadth of the work here, and the outreach that is being done by the proposer of the Bill — the scale of that work and interrogation of the issues — will allow us, particularly me and lots of people in the community who will have concerns about this, to move forward in the most comfortable way possible, so that we do not allow fears to be raised where potentially they could be allayed. That is an important and mature way to approach this debate. I know that the Member will also want to approach the debate in that way.
During the past two years, between passing the Act and its coming into force, the Welsh Government and health authorities have engaged in that process of awareness raising and education to ensure that people in Wales are aware of the changes to the law and the new choices that they will have.
As I said, I would just like to touch on the finances. We know that the costs involved with the introduction of the new system in Wales, estimated to be £7·5 million, are being set aside to support a range of activities around the change there. I know that the Member has touched on this. We would have to have meaningful funding for awareness campaigns as well. The Welsh Health Minister has advised that all the evidence that is available suggests that if Wales were able to secure just two more kidney donations, the system would pay for itself, given the cost of kidney dialysis. While I would not want anybody to set aside their concerns and worries about some of the proposals, I think that there is weight in the Bill's proposers taking that money-saving aspect of it very much into consideration. If two people could be taken off dialysis, the cost savings would cover the cost of the law change. It is extremely significant. In fact, it seems almost incredible that such a small change in the number of donations could cover the cost of that legislation. In fairness, that did indeed grab the Committee's attention.
There is much to do from this point to ensure that the Bill is right. I repeat that I think that we should welcome the debate. Moving forward, let us interrogate the issues at Committee in a respectful and mature way so that the people of Northern Ireland know that when it comes to looking at saving people's lives, the Assembly has arrived at the most mature point that it can in a positive way, with full public awareness and the right resources being directed towards these new proposals, and so that the people of Northern Ireland know that we have done it for their benefit and for the very vulnerable people who, as I said at the outset, are still waiting on that phone call. Let us see whether we can arrive at a point where more phone calls can be made and more lives can be saved.
Mr Speaker: Not to curtail or discourage your contribution in any way, Mr McGimpsey, especially as you were a previous Minister in this brief, I will just indicate briefly that Question Time is at 2.00 pm, and I may need to interrupt you to allow it to proceed.
Mr McGimpsey: Thank you, Mr Speaker. I rise to support the Bill's Second Stage and indeed to thank Mrs Dobson for bringing it forward. I know the huge amount of work that has gone on in the background to get it to this stage. The situation can of course simply be put by the fact that we are losing patients annually for want of appropriate organs for transplant. Organs are absolutely life-saving in situations. We often talk about kidney dialysis. We assume that patients with kidney failure go on dialysis and that although it is inconvenient and might be difficult for them, it offers them a way out. In fact, the process has a limit. There is a limiting factor in it. Without appropriate donation, it lasts only so long.
Without organ donation and kidney transplant, patients will perish. I know that from personal experience of a friend of mine whom we lost last summer; he had been on dialysis for about five years but perished after that for want of a kidney.
That is particularly difficult for individuals and families, but it is especially difficult for children. We have situations in Northern Ireland where we are losing wee ones with their entire lives ahead of them and who could have their lives back and could be saved for want of the appropriate donation. Again, I had experience of that when I was Health Minister. I have no doubt that the Health Minister, when he visits the Children's Hospital now, will meet children in exactly that situation. If they had the appropriate support, by which I mean organ donation, those children would get their lives back. When you are looking at wee ones of two, three and four years of age and think that they have a prognosis of only a year or two because of this situation, that is very difficult for families and for the doctors, nurses and staff dealing with that situation.
We have an opportunity here, through this process. The Bill is by no means done and dusted, and very important points were raised by Mr Easton and others that we need further information. We will want that information at Committee Stage to allow us to come to an informed decision. That is appropriate; that is what should happen with a Bill such as this. That is exactly what we should be doing, and I believe that that is exactly what the Committee will be doing. That is the appropriate way forward.
Issues have also been raised about consent and how it is freely given. We need to ensure that we have the views of donors, families and relatives. That is particularly important when talking about children, who do not have the capacity and who rely on their families. Those are all key issues. They are very difficult issues for the families concerned and for many adults in that situation. Those are things that we need to face. By facing them, we are saving lives, and that is what our health service is about and what we are about in the House. We must find a way forward that can provide life-saving interventions for patients who would not survive without them, and if we decide not to go forward with this legislation, that is, in effect, what we will be doing. We will be saying to a number of patients that we cannot help them, knowing that their prognosis will certainly be that they will come to harm.
I support the Bill and will continue to do so through its Committee Stage. There are important questions that have to be asked, and information is required. I believe that all those questions can be answered satisfactorily to allow us to go forward. It will be ground-breaking for us in the Assembly, and for our health service, to take those steps. It will also be strongly welcomed by our doctors and nurses working in the health service, who will have an opportunity to provide that key, special intervention. We have a workforce that is, by and large, dedicated to providing the very best support that they possibly can for their patients. It is up to us to give them the support and resources to allow them to deliver that.
Mr Speaker, I got your warning at the beginning about time. I do not need a huge amount of time to deliberate this through. I think that the Committee Stage is an appropriate stage to take it to and at which to deal with a number of these issues. In principle, for the prize that we get out of this, for the gain that we will make, for the lives that we will save and for the lives that will be lost if we do not go forward with this piece of legislation, I am happy to stop there, Mr Speaker, for the moment as far as this Bill is concerned other than to indicate again that I fully support this proposal.
Mr Speaker: Can I assume that you have completed your contribution?
Mr Speaker: Thank you very much. As Question Time begins at 2.00 pm, I suggest that the House takes its ease until then. This debate will continue after Question Time, when the next listed Member to speak is Mr Stewart Dickson.
The debate stood suspended.
(Mr Deputy Speaker [Mr Beggs] in the Chair)
Mrs Foster (The Minister of Finance and Personnel): The UK spending review 2015 will determine the Executive’s Budget allocation for the five years commencing 2016-17. The outcome of the spending review will be announced on 25 November 2015. I will bring a Budget to the Executive and the Assembly for consideration after that date.
Mr McCarthy: I thank the Minister for her response. Given the very tight timings between now and the start of the next financial year, how can she ensure that a strategic approach will be adopted that reflects emerging priorities such as investing in skills and, indeed, growing our economy?
Mrs Foster: I thank the Member for his question. He has put his finger on the problem that faces us in this spending review. Ordinarily, we would issue and consult on a draft Budget, and that would give us time to listen to all the stakeholders and, indeed, all the Members here about how to address strategic priorities. However, given the lateness of the spending review, on 25 November, we are having to look at different ways of engaging with stakeholders. We cannot go through the process that we normally go through for the draft Budget and confirming the Budget, so I am considering alternative ways of seeking the views of stakeholders to make sure that we hear from all the voices about what the priorities should be.
As for whether it should be a one-year Budget or a multi-year Budget, obviously, I am of the opinion that it should be a one-year Budget because we will be entering a new mandate after May next year, and it would not be right to set budgetary priorities without allowing the new Executive to set those in the new Programme for Government. Of course, it is a matter for the Executive as a whole, but it is my opinion that we should just set a one-year Budget.
Mr D Bradley: Go raibh míle maith agat, a LeasCheann Comhairle. I thank the Minister for her answers up to now. If she is not to hold a formal consultation on her draft Budget, how will she engage with stakeholders?
Mrs Foster: That is what we are considering at present. As I said, the preferable way would be to have the usual 12-week consultation on the draft Budget and allow people from all the different sectors affected to put forward what they believe is the right way to move ahead. However, we will have to be more targeted. Presumably, we will hold events to go out and engage with different sectors on what we think are the emerging priorities for the Budget. We simply do not have the time to engage in a draft Budget process, and I regret that. Indeed, I regret the fact that we do not have clarity on where Westminster is going in the comprehensive spending review. There has been not much negotiation, or meetings, on how the devolved institutions will be treated in the comprehensive spending review. We have heard a lot about how some Departments at Westminster are facing cuts of up to 30%, which is an incredible amount of savings. Unfortunately, we have not had much engagement with the Treasury or, indeed, the Chief Secretary to the Treasury on how this will impact the devolved Administrations. That is a frustration that is shared by not only my Welsh colleague but my Scottish colleague, and we have raised it directly in correspondence.
Mr Lyons: Can the Minister give the House her assessment of the Budget envelope for the next five years?
Mrs Foster: Of course, we will not know what the Budget envelope will be until it is announced by the Chancellor on 25 November. Whilst we do not have the exact Budget envelope, the economic and fiscal outlook, as published by the Office for Budget Responsibility in July indicates that, once again, we in Northern Ireland will be largely protected from the worst of the cuts that will come to UK public expenditure. However, we will continue to see a real-term reduction until around 2020-21. That is when the Office for Budget Responsibility thinks that things will start to move in the opposite direction, but, as I said, we will have more clarity on 25 November when we will be able to look at how we are going to be directly impacted.
Ms Boyle: What revenue-raising measures are the Executive considering, if any, ahead of a new Programme for Government? Go raibh maith agat.
Mrs Foster: Hopefully, once we have completed the current talks process — I use the term "current", but, hopefully, it is the last talks process — in relation to the difficulties that we currently face, we will turn to looking at the Programme for Government for the next Administration and what the outcomes should be around all that. Indeed, revenue raising will be looked at, but it is a very controversial area, and many in this House share with me the view that some of the revenue-raising options that have been suggested by others are simply not something that we would engage in, such as water charging. This party has been very clear in relation to water charging. We believe that it would be a retrograde step, particularly for householders who have been through a very difficult time over the past couple of years. However, there is scope to look at other issues, and I think that we should look at other issues when we are thinking about the next Programme for Government.
Mrs Foster: With your permission, Mr Deputy Speaker, I will answer questions 2, 7 and 10 together.
I have commissioned a November monitoring round, with a view to seeking Executive agreement on outstanding budgetary issues in this financial year. Departmental returns submitted as part of the process indicate that significant progress has been made in managing the significant pressures identified early in this financial year. I will update the Assembly in due course, once Executive agreement on the November monitoring round has been secured.
Mr Givan: The Minister will be aware that critical to the completion of this financial year is the implementation of the Stormont House Agreement. Can the Minister outline the financial impact to the Northern Ireland Executive's Budget if a deal is not reached?
Mrs Foster: I thank the Member for his question. He will know that the Budget for this year — 2015-16 — is predicated on the Stormont House Agreement being implemented. The financial consequences would be significant, if not dire, if the December 2014 Stormont House Agreement was not honoured. There is no realistic way in which we could live within the 2015-16 DEL control total if the Stormont House Agreement flexibilities in particular are not dealt with. The key financial pressures that would bite would be the need to pay a £100 million reserve claim for 2014-15 and the welfare reform costs, both of which would come out of our resource DEL. It is very important that we reach agreement in relation to Stormont House and that we do so as soon as possible.
Mr Cree: Further to question 7, can you advise how, with the difficult and very short time remaining, capital, including conventional and financial transactions, can be utilised before the end of March? Is there a serious risk of money being returned to the Treasury?
Mrs Foster: I am sorry; I did not catch the very last part of that about the Treasury.
Mr Cree: Will there be capital moneys returned to the Treasury at the end of March?
Mrs Foster: That is certainly not our plan in relation to the capital funding. As I said, in June monitoring, there was a significant pressure appearing. Very significant monitoring bids were made at that particular time. I took the decision to write to all Departments to say to them that they needed to stop all discretionary spend. I am very pleased to say that that had an impact and there is a greatly reduced monitoring round now in November, and we will be able to deal with that, hopefully, in the coming days when we will be able to make announcements.
As he knows, we are hoping to find a home for the financial transactions capital in the Northern Ireland investment fund so that we do not lose any financial transactions capital. We believe that we have a home for normal capital, if I can call it that, as well, so we do not foresee any capital being handed back to the Treasury.
Mrs Foster: Eight hundred and sixty-six employees left the Civil Service on 30 September; a further 1,540 will leave between 30 November and 31 January. Those exits will deliver a pay bill saving in 2015-16 of £23·6 million and £69·1 million per annum thereafter. The compensation cost will be £68·4 million. Further offers will be made at the end of November for exits at the end of March.
Mr Buchanan: I thank the Minister for her response. Can she advise how staff are selected to leave?
Mrs Foster: Essentially, the selection criteria are being applied in order by Department grade, analogous grade and by discipline, where necessary, based on the numbers required by each Department to determine those who will exit under the scheme. The first criterion is the best value for money score, using the least cost, which is upfront compensation payment, and the maximum payback — the resultant wage savings in a one-year period. Where individuals are tied on that criterion, random selection is used thereafter. The decision on which staff are to leave has been devolved to departmental level because we felt that Departments were best placed to make the decisions on the staff that they need.
Mr Milne: Go raibh maith agat, a LeasCheann Comhairle. Is the Minister confident that the scheme will not be subject to a legal challenge by the unions?
Mrs Foster: Yes, as much as one can be confident that it will not be challenged by the unions. We engaged, as you would expect, with our lawyers before the scheme was put in place, and, therefore, we very much believe that the legal basis is robust. However, that does not stop others thinking that they may want to challenge, but I believe that we will be able to defend against any challenge that is brought.
Mr McGlone: Go raibh maith agat, a LeasCheann Comhairle. Mo bhuíochas leis an Aire as a freagraí. I thank the Minister for her answers. Can the Minister give an assurance that the reduction in personnel will not have a detrimental effect on front-line services, particularly given the experienced personnel who are leaving, or who are projected to leave, the service?
Mrs Foster: I made the point that we had devolved the decision to departmental level, and one reason that we did that was because the sheer scale of the exits and the speed with which they needed to happen meant that Departments had to be able to make sure that they would maintain appropriate service delivery. Therefore, we wanted to ensure that essential employees, for example, were exempted from the scheme and wanted to allow Departments to deploy quotas, if that was considered necessary. We did not allow employees to go all in one tranche.
As you know, it has been spread across the year, and they will be released over four tranches. As I say, employees are released on a departmental basis. Some Departments are allowing more to go than others, and constituents have been in touch with me about why the Department for Social Development is not allowing as many people to go as the Department for Employment and Learning. Those are departmental decisions that they believe they can stand over. It is a mixture of all those things, but it is about ensuring that Departments have resilience after the voluntary exit scheme has finished and to make sure that they can continue to deliver and maintain the public service that we expect from them.
Mrs Overend: It seems that certain grades of civil servants are not being allowed to leave at this time, and she has maybe touched on the reasoning for that. Can she confirm whether that is true and whether everyone who wants to leave will be allowed to leave at some stage?
Mrs Foster: There may be grades that a Department feels are necessary to keep it functioning in the proper fashion, and some of those have been exempted from the scheme. Each Department determined the numbers by grade that it needed to release under the scheme to secure the pay bill savings. Corporate HR and my Department acted on those instructions.
Offers were made commensurate with the numbers to be released as determined by Departments rather than with reference to the total number of applicants within a business area or grade. Some staff may be disappointed that they are not being allowed to avail themselves of the voluntary exit scheme, but we have to be mindful that we have a Civil Service to run and maintain, and that the public expect to have a level of service from their Civil Service. Some will be disappointed, but that is tied in with the voluntary exit scheme.
Mr Allister: Is the Minister monitoring the impact of the exit scheme on the community background of the Civil Service composition? If so, has she any grounds for concern, and when will that be revealed to the public?
Mrs Foster: That information will be fed into human resources and go to the Civil Service board, which will report on that. I do not have figures at present, but I am sure that the Member will monitor that and ask me again, when I will be able to answer in more detail.
Mrs Foster: The Northern Ireland Law Commission was asked to assess the law of defamation by reference to the 2013 Act. However, the commission ceased operations before it completed the review. I have asked Dr Andrew Scott, who was undertaking the review on behalf of the commission, to produce a final report, and that report will help to inform policy direction.
Ms Lo: I am pleased to hear about the review. I am sure the Minister is aware that the law in England and Wales has helped not only to ensure free speech but to deter reckless defamation claims. Are there any clauses in the Bill that the Minister particularly objects to?
Mrs Foster: No. I have no preconceptions about what should or should not be done. Dr Scott is taking an independent look at what the needs are in Northern Ireland. I was disappointed that he was not able to complete the review under the Law Commission. However, we have asked him to complete that work. Unfortunately, it will have to fit around his teaching commitments, but we hope that he will be able to deliver it in the new year. I took forward to receiving it, considering it and looking at his recommendations.
Mr Nesbitt: The Minister makes reference to Dr Scott and the commission, which, as she will be aware, undertook a consultation. Is she prepared to publish that consultation?
Mrs Foster: As I understand it, there were around 32 responses to that consultation. I do not think that we should pre-empt Dr Scott's independent review. Therefore, I will not be letting those consultation responses come out until Dr Scott has finished his review. He is a very thorough individual, and I look forward to the work. As I said, the review will have to fit around his teaching commitments at the London School of Economics. I hope that the final report will be complete and available in the first months of 2016.
Mr A Maginness: I thank the Minister for her interesting answer. When the work done by Dr Scott comes into being, will the Minister go out to further consultation, or what process will she follow on foot of the report?
Mrs Foster: First of all, the Committee will receive a copy of the independent report, so it will be free to comment on it. As Minister, I will have decisions to take on the foot of the report. We do not know what those will be until we receive it.
If there are changes to be made, we will move into policy development to consider how we make them. I do not think that it would be right to follow the Defamation Act 2013 slavishly. Obviously, it will inform what we do, but we need to wait on the report and decide how to move forward, because, of course, it depends on what is in the report.
Mrs Foster: The review will re-examine all non-domestic rate reliefs and their continued relevance. Currently, manufacturing companies in a wide range of the sector benefit from 70% industrial derating if the premises are used primarily for factory purposes and involve the use of manual labour. That relief extends to the food sector. Life sciences companies may also be entitled to it if a production process is involved. However, research does not normally qualify for derating. The public consultation paper sets out the case for retaining that support, recognising the importance of Northern Ireland maintaining its competitive position for manufacturing.
Mr Anderson: I thank the Minister for that response. Will she update the House on how the Executive support the manufacturing sector through rate relief?
Mrs Foster: Early in the last mandate, we took a decision to keep industrial derating, and that helps a lot of our companies across Northern Ireland. Some 70% of their rates bill is given rate relief and, therefore, they pay 30% of what they would pay if they were in England, Wales or wherever. We believe that that is of great assistance to manufacturing companies across Northern Ireland, whatever manufacturing sub-sector they are in. As I said in the paper that has been put forward, we will not be changing that; we will keep it. Some people have suggested that this review will lead to the end of industrial derating. That is not the case, and I want to make that very clear today.
Mr Ó Muilleoir: I thank the Minister, especially for her commitment to keep industrial derating. Following the review and the public consultation, does she believe that we will be able to come up with solutions to tackle some of the real problems facing small businesses in our high streets and main streets? I think, in particular, of the number of empty stores and shops that pepper many of the main roads and streets in our towns and cities.
Mrs Foster: Absolutely. The Member took part in a debate that we had recently in relation to the impact of rates on small businesses in South Belfast. That was very worthwhile and useful because it allowed us to set out what is happening in relation to rate relief and the rating system in that constituency. As he knows, small business rate relief has had a very good impact for many businesses across Northern Ireland. Some say that it does not go far enough; some want us to change the system. The current small business rate relief system runs only to the end of this financial year and then we will have to decide whether to keep it in its current form or to engage and do something slightly different for town centres. That has been suggested to me. The Member will know that the Ulster University economic policy centre suggested that we should do something different, rather than continue with the small business rate relief scheme. I will take that decision in conjunction with colleagues in the Department for Social Development and the Department of Enterprise, Trade and Investment. I have already met with both Ministers to see whether there is something we can do that would have more of an impact. Certainly, moving into the future, we will continue to support small businesses. It is just how we do it, whether through rates or another system.
Mr Kennedy: I am grateful to the Minister for her previous answers, particularly the latest. Can she advise at this time whether all the existing rate relief schemes are likely to be extended to 2016-17.
Mrs Foster: No, I cannot say that. There would not be much point in us having a review if I were to stand up and say that everything that is there at the moment will continue to be there in 2016-17. It is important that we reiterate the situation in relation to manufacturing because of the difficult week that manufacturing has just been through with the number of job losses. That is not to take away from the fact that, while last week and, indeed, the week before were particularly bad weeks for manufacturing, manufacturing is actually on the up in Northern Ireland, based on the number of jobs that have come to, and been created in, Northern Ireland over the past year. However, I believe that, given other pressures, not least energy costs, it is right to keep derating for manufacturing businesses. As I have said, small business rate relief is something we are looking at. Whether it would be better to use the £20 million that was set aside for small business rate relief in a different way is a discussion that is ongoing.
Mrs Foster: My Department introduced new public contracts regulations in February 2015. These are intended to facilitate the participation of small and medium-sized businesses by, for example, limiting turnover requirements to twice the contract value. The Central Procurement Directorate (CPD) has also worked with the construction industry to simplify the pre-qualification process and reduce the effort needed to tender. SMEs are now winning around 85% of construction contracts. CPD has also published guidance to help SMEs benefit from subcontracting opportunities.
Ms Maeve McLaughlin: Go raibh maith agat. I thank the Minister for her answer. Specifically on procurement and tendering, is the Minister minded to look at the Public Services (Social Value) Act 2012 in England?
Mrs Foster: Actually I held a procurement board meeting last week, and that was the subject of the discussion. I received a very helpful report from a group of people, including the Strategic Investment Board, who have been running social contract pilots. One of the queries was whether we go down the route of legislation or of guidance. That discussion has really just begun. I have asked for an Executive memorandum to go round colleagues asking what they feel is the best way forward on the issue. The procurement board is looking at this issue at present.
Mrs McKevitt: What has been done to remove prohibitive criteria that prevent companies winning tenders for the first time?
Mrs Foster: CPD has introduced a range of measures to increase opportunities for small and medium-sized companies, including those dipping their toes into the market for the first time. A single web-based procurement portal, eTendersNI, has been introduced. It shows all the public-sector procurement opportunities that are available and alerts firms to tender opportunities in which they may be interested. It also allows them to store their profile information for use when completing further tenders.
Breaking larger contracts into lots is a very important method of allowing small and medium-sized businesses to come forward on their own behalf. For a while it seemed that the only way that you could obtain a government contract was if you were part of a big partnership that went forward together. However, we are now breaking larger contracts into lots to allow SMEs to come forward on their own behalf.
As I said, we are making sure that the turnover requirements are only twice the contract value. Again, that was a big challenge for a lot of small and medium-sized businesses. Indeed, I came across it in my constituency. Setting proportionate minimum standards for experience and financial standing is also important. In the past, standards were, quite rightly, being asked for, but when we looked at them we did not think that they were proportionate to the size of the contract. We have tried to increase the opportunities for small and medium-sized businesses in a range of ways. It is something that I feel very strongly about and take a particular interest in, having come from the Department of Enterprise, Trade and Investment.
Mrs Foster: The Children’s Services Co-operation Bill 2015 states that the Department of Finance and Personnel may, by regulations, make provision for the procedures to be followed on the sharing of resources or pooling of funds. Such regulations will be used to ensure that the handling of shared resources or pooled funds complies with DFP public expenditure and financial management guidance. Accountability and governance issues will also be addressed. Subject to the Bill receiving Royal Assent, DFP will work with OFMDFM and other stakeholders to draft such regulations.
T1. Ms McCorley asked the Minister of Finance and Personnel to detail the implications of the new minimum wage for departmental budgets. (AQT 3121/11-16)
Ms McCorley: An dtig liom iarraidh ar an Aire cad iad na himpleachtaí do bhuiséad a Roinne mar gheall ar an tuarastal is ísle nua?
Mrs Foster: I am not sure that the new minimum wage will have a big impact on departmental budgets. When it comes in, the living wage will have an impact, particularly on the Department of Health and Social Services, because many of our care workers, for example, are paid in and around the minimum wage. When they move on to the living wage, that will obviously be more expensive for the Department, and that will have to be taken into account when we set its budget.
Ms McCorley: Go raibh maith agat. Gabhaim buíochas leis an Aire as a freagra.
I thank the Minister for her answer. What challenges will that pose for arm's-length bodies and community organisations? What can government do to support those groups?
Mrs Foster: We must be aware of the scale of the issue. I was recently contacted by some of the groups involved in the social care sector to say that it will have a big impact on them. I know from the tourism and hospitality sector that it will be a big challenge there as well. While we all welcome the fact that we are moving towards having a living-wage economy, we should be aware that there are challenges associated with it, particularly for the lower-paid sectors. Whilst bigger employers in the private sector will be able to absorb those costs, it will be a challenge for us in the public sector.
T2. Mr McKay asked the Minister of Finance and Personnel to take up the case of Mr William Owens of Broughshane, who worked for the Fisheries Conservancy Board (FCB) during the ‘80s, given that, even though he has evidence of his membership of the FCB pension scheme dated 1987, he has been denied his pension payable to age 64, even though other members of the scheme received same; and will she help Mr Owens and other people in that position to get the four years’ pension that they have been unjustly denied. (AQT 3122/11-16)
Mrs Foster: I thank the Member for his question. I am aware of the individual whom he has brought before the House this afternoon; indeed, my colleagues have written to me about the issue, and Mr Owens has written to me directly about it. It is being investigated by the Department. I know that he may be a bit frustrated about the time that it has taken to look into the matter, but the Department is looking at it.
Mr McKay: Go raibh maith agat, a LeasCheann Comhairle. Many Members will be aware of Mr Owens's case; he has campaigned and canvassed for many years on the matter. Is the Minister willing to meet Mr Owens to move the matter on?
Mrs Foster: I am prepared to come back to you and, indeed, to the other Members who have written to me about the matter, once the Department has finished its investigations and we can see where it is at at present.
T3. Mr Campbell asked the Minister of Finance and Personnel to keep monitoring and under review the breakdown of community balance of people coming into the Civil Service, given that she will be aware that by far the majority of people recruited are at the administrative assistant (AA) and administrative officer (AO) grades. (AQT 3123/11-16)
Mrs Foster: Absolutely. I know that the -matter concerns the Member greatly, and I will communicate with him on it once I have had a chance to look at the figures again for this year. We will certainly look at whether there is a need for intervention in some way in relation to the recruitment of AOs and AAs.
Mr Campbell: The Minister will be aware that, a considerable number of years ago, there was a concern because there were too few Protestant employees in the much larger section of the Civil Service than in any of the other sections. Hopefully, she will be able to keep that matter under review and, if required, adopt a policy that other public-sector bodies have had to adopt, which is intervention to ensure that there is equitable treatment across the communities.
Mrs Foster: Absolutely. I am aware that some arm's-length bodies have had to adopt that process, but, unfortunately, it has not had as much of an impact as I would have liked, because, in the circumstance that I am thinking of, that organisation was capped at 49 employees and, therefore, there was little room for movement on that matter. I take the Member's point and will certainly keep it under review.
T4. Ms Boyle asked the Minister of Finance and Personnel whether she has given any thought to how, under the rates review, we might bring in some changes that would help to bring more businesses into empty premises across our towns and cities. (AQT 3124/11-16)
Mrs Foster: The Member will be aware that we already have provision that, if someone moves into an empty shop, they are able to avail themselves of rates relief for a limited time. I accept that it is a limited time, but it helps when someone is starting up a new business. I know of businesses in my constituency that have really appreciated that. The non-domestic review has only started. It runs, I think, until the middle of January, so I hope that Members and, indeed, stakeholders will come forward with new and innovative ideas, not just around rates relief but around all the other areas.
Ms Boyle: I thank the Minister for her answer. Minister, would you ever consider specifying certain areas — for example, a street in a town centre — where a special rates exemption would apply to empty stores?
Mrs Foster: Again, that is the kind of thing that we need to think about. I mentioned the small business rate relief scheme. Indeed, some town centre organisations believe that, instead of just having a generalised small business rate relief scheme, we should target it on the area in the town centre that, at present, is having difficulty, frankly, in filling spaces because of the level of rates that have been levied on the shops.
One area that has also been raised with me — it is a controversial area — is in the realm of charity shops. Since the review went out, I have already had a number of charities in contact with me, worried about the fact that they will not be able to avail themselves of rates relief. However, on the other hand, I have small businesses saying to me, "They are not paying any rates. I am next door, and I pay full rates". Those are the difficult decisions that we will have to grapple with, but we can and should look at doing things differently. We should not just be driven by what everybody else does. If there is a challenge in relation to town centres — frankly, some of our town centres are struggling — we should look at those and see if they can make a difference.
T6. Mr Hilditch asked the Minister of Finance and Personnel what progress has been made on rate relief for sports clubs since the private Member's Bill failed to pass. (AQT 3126/11-16)
Mrs Foster: The Bill that I intend to bring forward will contain an enabling power that will permit enhanced rate relief for sports clubs, subject to conditions. My current intention is to use the power to permit enhanced relief of 100% for community amateur sports clubs that do not have a permanent liquor licence. That deals with the issue of competition with hotels, pubs and clubs. It would align them with the rating treatment of community halls legislation rather than putting them into competition with pubs and clubs.
Mr Hilditch: I and some of my colleagues met the Northern Ireland Federation of Clubs, which expressed some disappointment at the lack of consultation on the previous process. Can the Minister ensure that the likes of those people will have the opportunity to fully engage in any new process?
Mrs Foster: Absolutely. I hope that they will understand that, because of the short time that we have available, it will be a targeted consultation rather than the full 12 weeks of consultation. I hope to go — indeed, I am going, God willing — to the Committee tomorrow morning to talk about my proposals. It will be a matter for the Committee whether it grants accelerated passage. If it grants accelerated passage, we can get the Bill through; if it decides against it, it will probably be a matter for the next mandate. I will regret that, but it is a matter for the Committee.
T9. Mr Givan asked the Minister of Finance and Personnel, given that she will be aware of the case involving his constituent Amanda Jackson, who was subject to a £77,000 fraud, to outline to the public and to all the professional organisations involved in such transactions the need to be vigilant and the need to ensure that robust systems are in place to prevent such fraud in the future. (AQT 3129/11-16)
Mrs Foster: Yes, I am aware of your constituent's case. It was, of course, raised publicly, but I also know that you corresponded with me on the matter. I suppose that it really is a matter for my colleague the Enterprise Minister and about making sure that everything is in place in Trading Standards. I urge vigilance on the issue that was brought to my attention. There was an awful lot of money involved in that case, but, you know, small amounts of money in other cases mean a big lot to those individuals who have been defrauded. We should be alert and aware of the dangers online.
Mr Givan: I thank the Minister for that response and for undertaking in her written correspondence to write on the issue to the Law Society, owing to its oversight of the legal profession. Of particular concern is that, for electronic transfers, Barclays, with which I and the Member of Parliament have corresponded, does not check the name of accounts. That is prevalent across all electronic transactions. Is that something that the Minister could undertake to correspond on with the banking institutions? Danske Bank was the organisation that allowed the money to go out, and Barclays allowed the money to be received into what was ultimately a fraudulent account that was set up in its organisation.
Mrs Foster: I am more than happy to do that if the Member wishes to give me the fuller details of that side of it. I undertook to write to the Law Society as that end of it caused me a great deal of concern. As he knows, we do not have any control over the banking systems in Northern Ireland. That falls to the Westminster Government. I am more than happy, however, to correspond with those banks about the incident.
Thousands if not millions of people transact their banking online every day. We should not forget that that is the way in which people chose to do their business nowadays, and 99% of it is carried out in a very safe manner. If there are instances in which there are difficulties — clearly, this is a case in which something went fundamentally wrong — we should raise it and make sure that it does not happen again.
T10. Mr McCarthy asked the Minister of Finance and Personnel whether she is willing and able to invest further in the health service to enable patients to be seen in a more reasonable time, bearing in mind that a request went to her Department during the June monitoring round for £45 million and the fact that she will be aware of the dire position with the ever-growing waiting lists. (AQT 3130/11-16)
Mrs Foster: In the 2015-16 Budget, I and my Executive colleagues demonstrated our commitment to improving health and social care by protecting front-line health and social care from budgetary reductions. Further to that, some £200 million of additional funding was provided to the Department for front-line health and social care. I am glad that my colleague is here to hear about all that great funding that has been provided to him by the Department of Finance.
Unfortunately, the deterioration in waiting times is due to a number of factors that are placing increasing pressures on our health service. Those include demographic changes, which I have talked about in the House before, an ageing population and increasing demand for healthcare interventions. However, all of that has been made worse by the fact that we have been incurring welfare fines that otherwise could have gone to the Department of Health. I make no apology for saying that. I hope that we are able to find a solution to the difficulties that we have found ourselves in over welfare so that money can be allocated to the Department of Health to deal with those issues.
Mr McCarthy: I thank the Minister for her response. She will remember that a former Finance Minister criticised a former Health Minister for not providing value for money. Can the present Finance Minister assure the Assembly that the present Health Minister will deliver a better service for all our people, particularly on the waiting lists that we have just been talking about?
Mrs Foster: He is saying that I have every confidence. [Laughter.]
I do have every confidence in my colleague the Minister of Health on the issue. The key to all of this is to make sure that, after the talks have finished — we hope that they will finish very soon and that we will have an agreement in place — we can move to a sustainable budgetary position, where we can allocate the appropriate amount of money to the Department of Health and are able to deal with those waiting lists, which have accumulated and are unacceptable. I think that we all accept that, but we are where we are. Now, we have to deal with the issue, and I look forward to being able to make a statement in relation to November monitoring in the next number of days.
Mr Hamilton (The Minister of Health, Social Services and Public Safety): With your permission, Mr Deputy Speaker, I would like to answer questions 1, 5 and 15 together.
It has been clear for a number of years that our health and social care services in Northern Ireland are facing the significant challenges of rising demand, rising expectations and tightening finances. We cannot hope to respond to those challenges unless we are focused on ensuring the highest quality and safety of care, configure our services correctly and have an appropriate administrative structure.
There are simply too many layers of administration in our system, which are making it difficult to meet those challenges to drive change and weakening accountability. I want to drastically delayer the system to remove complexity and bring about greater accountability and better responsiveness. I want our trusts to be responsible for the planning of care in their areas and to have the operational independence to deliver it. I want to see my Department take firmer strategic control of the health and social care system. I have therefore announced that we will close the Health and Social Care Board, as I believe that we no longer need a stand-alone organisation. I intend to retain a Public Health Agency, with a renewed focus on early intervention and prevention, which will work more closely alongside the Department in that essential work. I have also announced a panel to lead a debate on the best configuration of health and social care services in Northern Ireland.
It is important that this is a clinically led debate with clinical evidence for any proposed changes to services and evidence about the implications of failing to make changes. I envisage a panel comprising around half a dozen experts drawn from across the sphere of health and social care. I hope to be able to announce the membership of the panel shortly and that it will begin its work before Christmas. One of its first tasks will be to convene a summit involving political parties to gather ideas, suggest solutions and, I hope, collectively reach agreement on a shared vision for the future of health and social care in Northern Ireland.
As I have said before, these changes are about moving towards a more streamlined and accountable structure so that we can make the most of the talent of our staff, encourage innovation and create a more efficient system. Although there may be some savings, my focus is on getting the structures right. All health and social care bodies are subject to challenging efficiency savings and, until detailed work is completed —
Mr Hamilton: Yes. Sorry, Mr Deputy Speaker, I thought that that was requested beforehand, but I appreciate that. Thank you.
All health and social care bodies are subject to challenging efficiency savings and, until detailed work has been completed, it is not possible to identify whether any additional savings can be delivered. I hope that all political parties will embrace the opportunity for change and work positively to create a world-class health and social care system in Northern Ireland.
Ms Maeve McLaughlin: Go raibh maith agat. I thank the Minister for that detail. I have been very welcoming of the reform agenda that he is taking forward. The board's figures on waiting times for elective care were published for the period from April to August. The figures showed that all trusts were failing to reach their targets and that one trust was actually 17% behind target. Specifically, how will this reform proposal tackle that very direct need?
Mr Hamilton: I, again, welcome her welcome of the proposals that I put forward nearly a fortnight ago. I particularly welcome that because I think that the Chair has taken the proposals that I put forward in the proper spirit, recognising the fact that there is an additional layer of bureaucracy in our system that is getting in the way of front-line delivery, which is what she focused on. In the past, that has also proved a barrier to innovation across our health and social care system. I think that she and I are as one in wanting to see that bureaucracy removed from our system.
The Finance Minister was just in her place, outlining the difficulties that we have this year with finances. Pressures are increasing, driving up demand and our waiting lists, but we have also had the situation of losing money through welfare reform penalties. I, like her, do not wish to dwell on that. I hope that, in other parts of this Building and this estate, we will be able to reach a swift conclusion to the issues around our Budget and welfare reform that have been bedevilling us.
That will then result in a resolution of welfare reform, which will result in more money for waiting lists, and that is what I have been lobbying my colleague the Finance Minister for. In the short and the long term, we need an injection of resources to tackle waiting lists. That is what I am seeking, that is what I want, and that is what I hope will happen. In and of themselves, those changes will not address that, other than the fact that they will make the £4·7 billion health and social care system in Northern Ireland work more efficiently. By taking out the layer of bureaucracy that she and I have focused on, we can make that system — which has not been working to the full and to the optimum over the last number of years since its inception in 2009 — work more efficiently and get more resources into the front line. I want to see any savings that are realised going back into the front line to help patients and people across Northern Ireland.
Mr Weir: In order to make the necessary changes, the Minister has always referred to the need for a transformation fund. Will he advise us whether he envisages that extra income-generation measures will also be required?
Mr Hamilton: We need to be clear that in wanting to transform our health and social care system we need more resources. That might seem almost counter-intuitive to wanting to get the most efficient use out of the resources that we have. Understanding the pressures we face across our entire budget, we need to see more money going into health and social care in order to get a more efficient system. In the short term, in order to make the changes that might come forward as a result of the recommendations from any panel a reality, we need a boost and an injection of cash over the next number of years.
If we want to do some of the innovative things that many of our trusts are doing, then we need to have money to do it, which is not money that is coming away from the front line. That has been the challenge in the past. We have had to fund innovation, and money has had to come from the front line, and that is never an easy thing to do.
In and of themselves, the reforms do not depend on more income generation. The reintroduction of prescription charges might have been a way of getting more money into the system in the short term. I am aware that a campaign has been running recently that is opposed to the reintroduction of prescription charges or, perhaps more accurately, wants to exempt certain people from prescription charges. My view is that, if we were to reintroduce prescription charges, it should be for everyone, or we should stick with no one and have no exemptions. Unfortunately, there has been a misunderstanding with the campaign; the proposal that was made in a recent consultation was for a small charge of around 50p or £1 up to a maximum of about £20 or £25 a year. Given the lack of political consensus, I do not think that there will be any reintroduction of prescription charges in my time as Minister, but there will be consequences. Not having the income from prescription charges is not without consequences in terms of paying for some of the very expensive new drugs and treatments that are out there. Some people may see some success in not having prescription charges reintroduced, but there will be consequences, sometimes even for those —
Mr McQuillan: Minister, what impact, if any, will abolishing the board have on front-line services?
Mr Hamilton: There will be an impact on creating a more efficient system, which is what I want to see, and that is where the impact of the reforms that I have put forward will be most targeted on. I do not want to dwell on staffing issues, because, as I said during my statement in Ballymena a couple of weeks ago, we have some tremendous staff in our system who are working exceptionally well and doing some exceptional things, but we are not getting the best out of their talents because of the system that they operate in — that very bureaucratic system that we have.
Some have wanted to focus on the issue of staff, saying that it was an easy decision to get rid of the board because its numbers had become big. Yes, the numbers have risen. It started pretty high; under the tenure of Mr McGimpsey when he was Health Minister, it started with around 390 full-time equivalents in the board, and it has grown to 600. It was always quite a big beast no matter what his intentions were for it.
Over the same period — since 2010 — the number of staff in the Department of Health, Social Services and Public Safety has dropped dramatically. In March 2010, the number of full-time equivalents in the Department was 670. In November 2015 — the most up-to-date figure we have — the number of staff within the Department is 466. So there has been a one-third reduction in the number of staff in the Department over the last four years, and that number is set to go down further.
The voluntary exit scheme, which my colleague the Finance Minister referenced earlier, will see 43 full-time equivalent posts removed from the Department by the end of 2015-16, which will make £0·5 million of savings in-year and £1·5 million recurring savings thereafter. So, on the issue of the board's staffing levels, yes, it has grown in size, but a reduction in the number of staff in the Department has occurred over the same period.
Mr McKinney: The Transforming Your Care (TYC) plan had consensus but not enough money. He is seeking further consensus and is pointing to the potential for money, but there is no guarantee that he can get it. Is that not a fatal flaw in his plan?
Mr Hamilton: No, and we should not be looking for fatal flaws in the plan. We should be seeking to build political consensus.
Sorry, I have not had the chance to formally congratulate the Member — I did so very informally earlier — on his victory at the weekend. I will not say too much, given who is sitting directly behind him. I congratulate him and I also congratulate Mr Eastwood, which makes me sound like a famous boxer thanking Mr Eastwood in the past. Taking over the reins of the SDLP so close to an election is like taking over managerial office at a Premier League club that is sitting at the bottom of the table with only about 10 matches to go. I am sure the Member and his party colleagues hope that he is more Tony Pulis than Felix Magath, but time will tell. I wish him well.
We should be looking for a political consensus, because the prize from that is the crafting, building and putting in place of that world-class health and social care system. We know what we can have in Northern Ireland, and Sir Liam Donaldson pointed to that in his report, and we all want to see that happen. Yes, it absolutely does depend on resources. I do not want to labour the points that I made to Mr Weir, but is absolutely requires resources to make that transformation. That will require some difficult decisions by me and the Executive, but I hope that, given the extent of the prize and the size of the challenges that are facing our health and social care system, we can all unite as one to lobby for those additional resources so that we can put in place a transformation fund that will make the vision of a world-class health and social care system a reality. I look to the Member as much as I look to any other Member for support in trying to realise that goal.
Mr McGimpsey: The changes that you propose are contained in Liam Donaldson's proposals. At the Committee and in previous utterances you estimated that it would take 18 months to deliver this change. I saw Liam Donaldson in the press over the weekend saying that that is far too long a time and that you must shorten it. Have you reconsidered your time frame?
Mr Hamilton: I welcomed what Sir Liam Donaldson said when I made my speech, and I welcome the comments that he made last week. He welcomed my decision to get rid of the board, and he did make the points about the timescale. It is significant that he said we absolutely should be getting rid of the additional layer of bureaucracy in our health and social care system that was created, as the Member knows very well, back in 2009, so I welcome what Sir Liam said in respect of that.
I made the point about the implementation of possible recommendations that might flow from the work of a panel, namely that they may take between five years and 10 years to be implemented in full. I used the 18-month figure for practical considerations: it will be the time within which to pass and implement the legislation that will be required to do away with the board. In between, officials have been tasked with scoping out what steps can be taken without the need for legislation to be passed and start to implement them as quickly as possible. That is so that we can have the effect of the reforms that I have proposed, which are about taking out bureaucracy and focusing and encouraging innovation. We can have all of that without needing to pass legislation. Where we need to pass legislation, we will do so. Being realistic about the timescale so close to an election and the dissolution of the Assembly, I do not believe that legislation will be able to be passed by the end of March.
Realistically, it will have to be introduced very quickly after the next election and implemented at the beginning of the next financial year. The 18 months is a practical point. I would like to see it happen more quickly; I wish that I could click my fingers and make it happen overnight, but, unfortunately, it cannot.
Mr Hamilton: The Autism Act (NI) 2011 required my Department to lead on the development and implementation of a cross-departmental autism strategy. Every Department has signed up to the strategy, and it is an important commitment for the Executive. Although a report is not due until January 2017, given the focus on the issue, I have decided to provide Members with a detailed report on progress against the autism action plan. I have therefore issued a written statement to Members advising that a progress report on the cross-departmental autism strategy 2013–2020 and action plan 2013-16 has been placed in the Assembly Library and has been published.
Many aspects of the strategy are progressing well, with better access to services for people with autism and their families and carers; the appointment of a regional ASD coordinator; and training for front-line staff, education professionals, youth workers, parents and carers. There is also better awareness of support services through signposting by HSC trusts as part of their triaging process. However, it is undoubtedly the case that the unprecedented increase in referrals has created a major challenge for the system. Over the past six years, referrals of children and young people for assessment have nearly doubled from around 1,500 to 2,936 per year. That has inevitably resulted in longer waiting times for the first assessment and ultimate diagnosis. Therefore, while I am pleased with the progress made to date, there is no room for complacency. I will continue to work with the board and the trusts to tackle the current difficulties and to improve access to services.
Mr D Bradley: Go raibh maith agat, a LeasCheann Comhairle. Considering the importance of early diagnosis and intervention for people who have autism, does the Minister, since he is so fond of footballing metaphors, not see that he is in the bottom league regarding autism, given the fact that 1,400 people await diagnosis?
Mr Hamilton: I do not come to the House to give those figures or statistics with any sense of pride: far from it. The Act has helped, along with many charities working in the field, to raise awareness of autism. It is a positive thing that that has happened. It has created a significant increase in demand: a doubling of the number of referrals. As I said in my original answer, there has been an increase from 1,500 to nearly 3,000 this year. Obviously, that puts an understandable pressure and strain on the resources that I have at my disposal.
I accept the point about early diagnosis. Just because an ultimate diagnosis has not happened, that does not mean that there are not supports or interventions — quite the opposite. There are interventions that take place prior to ultimate diagnosis. There is much work from community paediatrics, speech and language therapy, occupational therapy, social services and educational psychology as appropriate as an intervention, even in advance of diagnosis. We are working hard to reduce the impact of the long waits by looking and reviewing autism assessment processes, which is quite a long and extensive process. We are looking at what we can do to streamline that as much as possible while still having a high quality of diagnosis. We are also looking at standardising autism service models across all trusts and extending service capacity through the greater integration and alignment of autism services with other child development and young people's mental health services. It is not that we have sat back and done nothing; it is not even as if, before diagnosis, nothing happens with interventions. More could be done, but to deliver more we need more resources. The Member knows full well the pressure on resources in the Department. I hope that he will also appreciate and understand that the £9·5 million a month being lost through welfare reform penalties because of the failure of his party and others to live up to their commitments on welfare reform is costing —
Mr Hamilton: The Member rolls his eyes, but it is a serious issue. We cannot afford to lose that amount of money that could be going to the front line.
Mr Middleton: I thank the Minister for his answer so far. Will the Minister outline how the numbers of assessments provided and the numbers of diagnoses of autism made have changed in recent years?
Mr Hamilton: The Bill became an Act in 2011. Since just before that, as I mentioned to Mr Bradley, the number of referrals of children and young people for assessment has nearly doubled from around 1,500 to close to 3,000 this year, but resources have not increased at a commensurate rate. We need to invest more. I accept the point that Members have made: we absolutely need to invest more in getting staff into the front line. We estimate that around 20 to 23 whole-time equivalent clinical staff are required. The cost of doing that would be around £1 million of additional expenditure, so, when Members opposite roll their eyes about raising issues around welfare reform and the loss of £9·5 million every month, they should consider that £1 million out of that £9·5 million that is lost in one month would cover the increased costs. People take their positions on opposing welfare reform, but I hope that we can resolve those issues over the next number of days. That will, I hope, free up more resources to go into the front line to deal with waiting lists and other problems. There are consequences of taking the ideological position that some have taken in respect of welfare reform and not living up to the commitments that they made last year: we can see that in autism services, in waiting lists and elsewhere.
Mr McCarthy: The Minister will be aware of the old saying "Prevention is better than cure". The figures that the Minister has given us for youngsters being diagnosed with autism, which we know to be fact, are absolutely staggering. Will the Minister advise the House whether proper investment is going to scientists and universities etc to try to establish the cause? The numbers are staggering, and it is going from bad to worse as the years go on.
Mr Hamilton: I do not have the expertise to delve into why there has been a doubling in a very short period. It is a six-year period; it is not a lengthy period. It is a very, very short period, during which we have had a doubling in referrals. Perhaps, the fact that there is increased awareness of the existence of autism is one of the contributing factors; I think that that is fair to say. I am free enough to say that there is, obviously, support and work going on in research. The extent to which my Department contributes to, funds or supports that, I cannot say, but I am happy to write to the Member and inform him of what support we are involved in. I know that we will be supporting in various ways through trusts, the PHA and others and in helping autism charities across Northern Ireland. He and I will know of some that operate in our constituency. I am sure that that is replicated around Northern Ireland. I am sure that support is going to those from the health and social care sector, but I will inform the Member of the extent to which that is happening.
Mr Boylan: Go raibh maith agat, a LeasCheann Comhairle. Will the Minister ensure that all the partners in the autism plan will commit to playing their role in addressing autism?
Mr Hamilton: As I said in my original response, all Departments have bought into the strategy and action plan. I know that officials from my Department have been working closely with officials from the Department of Education because of the direct read-across of children and young people who are at school and the impact on their education. I know that work is going on at a practical level, as well as agreement on the strategy and action plan. Following the passage of the Act in 2011, good cross-departmental work has been going on in respect of autism.
Mr Hamilton: I have not held any discussions with the current provider of the service. The Public Health Agency commissions Lifeline and is undertaking the consultation process on the new service model. The agency participated in a Contact NI staff workshop on 10 October to outline the proposals and offered to attend a second workshop, which was subsequently cancelled by Contact NI. Contact NI staff have attended a number of the public consultation workshops organised by the Public Health Agency and have expressed their views at those events.
The proposed model retains the core elements of the existing service, namely the free-to-call crisis telephone helpline, which will be accessible 24 hours a day; qualified helpline operatives who are skilled in talking to people in crisis and have professional skills in listening and in assessing suicide risk; the ability to direct callers to the most appropriate service for their needs; and, finally, follow-on support from locally based suicide prevention organisations, enhanced with complementary therapies and local face-to-face immediate support.
For callers at high risk, helpline staff would directly arrange further care through to emergency mental health services.
By splitting the management of immediate helpline support from follow-up support, the proposals avoid a potential perverse incentive, whereby the helpline provider would potentially gain financially from referring a client to follow-up support that it also delivers. That does not imply in any way that Contact NI has sought financial gain in that manner.
Ms McGahan: Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his response. Will he give serious consideration to an extension to the Lifeline contract to allow for further consultation on the future of its services?
Mr Hamilton: There have actually been three offers made of an extension to the existing contract. Two offers were turned down. As the Member may know, the contract expires on 31 December. I am glad to say that the third offer of a contract extension, until the end of September 2016, has been agreed. Obviously, that allows for continuity of service while we move to a new model of service delivery.
Mr Lyons: Further to the Minister's answer, can he confirm that a Lifeline service will continue and that this is about the way in which it is delivered and the organisations that deliver it?
Mr Hamilton: Yes, I can. Again, the nature of the campaign and the way in which it was styled was about protecting Lifeline. I want to make it absolutely clear — I have done so previously in the House and will do so again now — that the Lifeline service and brand will remain. As the Member said in his question, this is entirely about getting the best possible service moving forward, getting it better integrated with other emergency services right across the system and extending it out much more into the whole of Northern Ireland, particularly rural areas. As I mentioned, there is an important governance point about the possible perverse incentive that exists. On a governance basis, I do not think that that can be allowed to continue to be the case. The PHA is right to consider that. Let no one be under any illusion here: this is not about doing away with a Lifeline service. This is about how that service might operate and who might operate it. It is not about doing away with Lifeline and the important work that needs to be done to provide that service for people who are contemplating suicide.
Mrs Overend: Does the Minister accept that the Lifeline service plays a truly invaluable role in every corner of Northern Ireland and that allegations or insinuations of its being a Belfastcentric service are truly inaccurate?
Mr Hamilton: Given that the Member represents a rural constituency, I would think that the issue of rurality is something that she is concerned about and interested in. Allegations have certainly been put to me about whether it serves the whole of Northern Ireland as well as it perhaps does some bits of it. If it is a criticism that has been put to me, I think that that is well worth examining, because, as the Member will know, there are sometimes, particularly in rural communities, hidden mental health problems. There can be suicides. In my constituency, I know of members of the farming community taking their own life. We should seek to do the best that we can to ensure that services such as Lifeline are spread right across Northern Ireland. That is certainly what I want to see as an outcome of the process. It is certainly something that I will be carefully keeping an eye on as any final recommendation comes to me to sign off on as Minister. Again, this is about getting the best possible service for people in Northern Ireland. It is about protecting what is best and also improving the service that can be delivered.
Mr Hamilton: I have indicated consistently over the past weeks and months that immediate pressures surrounding waiting lists and our emergency departments can be resolved only with the injection of funding as quickly as possible.
The Health and Social Care Board and trusts are already putting in place plans should additional funding become available, and that will, of course, be focused on patients with the greatest clinical need. However, even with additional funding, there are limits to what the system can deliver before the end of the year.
For the longer term, I have asked the board to examine how we can deal with demand and stabilise waiting times to put them on a more sustainable footing over the next few years. That elective care work will set out what areas need to be stabilised, how and when that can be achieved, and what it will cost to get performance back to the nine, nine and 13-week positions that the health service previously achieved. I expect to receive the conclusions of that work soon.
Of course, it is a great frustration to me that we have wasted close to £200 million of taxpayers' money during the last three years in penalties because of the continued failure to implement welfare reform. That has affected thousands of vulnerable people who have not been able to obtain the operations that they desperately need. Every month, we are losing £9·5 million, which could pay for over 1,800 hip operations or 2,100 knee operations.
T1. Ms Fearon asked the Minister of Health, Social Services and Public Safety to do all in his power to protect the Daisy Hill Hospital emergency department (ED), given that she cannot underestimate the importance of a fully functioning, 24/7 ED, particularly for rural communities such as hers. (AQT 3131/11-16)
Mr Hamilton: I am aware of the issue that the Member raises. I have spoken to her colleague Mr Murphy about this. I have no desire to see emergency services reduced at Daisy Hill Hospital but, as the Member will appreciate, my priority will always be to try to ensure the highest possible levels of quality and safety in our health and social care services.
I know, and the Member will appreciate, that there have been issues around recruitment and retention in the emergency department at Daisy Hill Hospital. The trust has undertaken work to alleviate that, but the hospital has been dealt a further blow by the decision of a member of staff to leave early next year. I know that Members who represent that area, or the area that is covered by Daisy Hill Hospital, were informed of that last week.
The letter that went to Members of this House and, perhaps, MPs as well, was right to point out that, in raising this issue, we are right to be concerned. The letter said:
"While we appreciate the concerns of the local community, we would worry that further speculation over the future of the emergency department will significantly hinder our ability to attract medical staff to help the situation."
The Member appreciates that point and she is right to raise it today, but it is unfortunate that others ran to the press within 24 hours, creating additional problems and doing exactly what they were advised not to do. If we are to resolve the issue around recruiting and retaining staff at Daisy Hill Hospital, which I want to do, as does the Member and, I am sure, everybody who represents the area and lives there, it is not helped by scaremongering by some in the press. We should all be trying to collectively work together to address the issues and work with the trust, the board and others to alleviate the problems.
Ms Fearon: Go raibh maith agat. I thank the Minister for his answer. This is especially important, given the completely inadequate Ambulance Service cover that there has been in south Armagh. Recently, the south Armagh first responders were set up as a community innovation to tackle the problem, but the Health Minister needs to bring his own innovation to recruitment, and new and fresh —
Ms Fearon: I am getting there. To date, his predecessors have failed to tackle the recruitment problem that has been bubbling up in the health service.
Mr Hamilton: It predates my time — both my immediate predecessors are in the House — but work was done to address the overall problems that emergency departments are having with recruitment. It is a very difficult area to work in. We all appreciate and understand that, and it can be challenging to recruit sufficient numbers.
I met representatives of the Royal College of Emergency Medicine last week to discuss not specifically the issue at Daisy Hill Hospital but a range of issues. They welcomed the efforts that had been put in over the last number of years to attract more staff to emergency medicine. They did not, by any means, conclude that we were out of the woods or that we had solved all the problems. There were still issues, but I am sure that they would agree that the most important thing is to serve all our people, wherever they are, whether in Newry or Newtownards, and that they have the highest standard of care and safety of care. I would be irresponsible in my job and would be going against my duty if staff were coming to me and saying that there were issues with patient safety and I did not act on that.
There are issues and challenges at Daisy Hill Hospital, and I am aware of them. I look to the trusts to work at resolving those issues and I am happy to make my own suggestions if I have them. Indeed, I am prepared to listen to others who come forward with suggestions. If the Member or anybody in the House has ideas or suggestions about how we might resolve the issues at Daisy Hill Hospital, I am happy to listen to them.
T2. Mr I McCrea asked the Minister of Health, Social Services and Public Safety whether he has had any discussions with Sir Liam Donaldson about the recommendations in his report. (AQT 3132/11-16)
Mr Hamilton: I met Sir Liam Donaldson at a conference that he was in Belfast to speak at last Thursday. It was organised by the Faculty of Medical Leadership and Management. He spoke in the morning and I spoke in the afternoon, and I had an opportunity in between to have a brief conversation with him. I began by welcoming his positive response to the reforms that I put forward in my speech in Ballymena almost a fortnight ago.
Obviously, he gave some comment to the media as well, about which I responded to Mr McGimpsey. I think that Sir Liam has been incredibly positive in his response. The report he produced was very useful, and, whilst I do not think that all of us will have agreed 100% with everything he suggested in it, I welcome the fact that he has acknowledged that the spirit of what he was putting forward has been agreed and taken forward in the proposals that I made. I have had a useful conversation with him, and I have welcomed the comments he made. I am sure that, given the work he has done here and the interest he has, he will continue to take a keen interest in Northern Ireland, particularly in how we roll out the reforms that I have put forward.
Mr I McCrea: Given the reforms that the Minister has put forward, many of which will no doubt bring financial benefits to the health service, can he outline how he sees the speed of this process and how we can get and feel some real change as quickly as possible?
Mr Hamilton: I know that urgent change is required in our health and social care system because of the extent of the looming challenges that we face in health and social care. We know and have discussed at length today the financial pressures that our budget and, indeed, all budgets in this place are under. Coupled with that, in health, we have a growing and an ageing population, which presents a series of challenges. We have a ticking time bomb of unhealthy lifestyles, and even good things like medical and technological advances are putting additional pressures on costs and increasing demand. I know that urgent action is required.
I put out a road map of reform in the speech I made on getting rid of unnecessary bureaucracy in our system and seeking to configure our hospital services in the most appropriate way to deal with those challenges and give the beneficial outcome of world-class health and social care system to people in Northern Ireland. That is not easy to do. It takes time. I wish that I could make it happen overnight, but I cannot do that. I do not have the magic ability to do that. If I could, I would, and I will not take a minute longer to do it than is necessary.
We need to be mindful that there are processes that we need to go through in closing down organisations in the public sector, but, as I said previously, I will make sure that whatever can be done without the need for legislation will be done and will be implemented as quickly as possible. The work on the panel's recommendations will take longer, and that is why I have said that that might take half a decade or even up to 10 years. That is work that is very much long term, but, even though it is long term, we cannot lose sight of the need to do it.
T3. Mr Girvan asked the Minister of Health, Social Services and Public Safety for an update on the air ambulance service that he announced to the House a few weeks ago. (AQT 3133/11-16)
Mr Hamilton: In September, I was very glad to announce my commitment to introducing an air ambulance service for Northern Ireland. I think that that announcement has been very well received across Northern Ireland. I committed to carrying out a consultation. I hope to be in a position this week to launch that consultation and that it will look at a range of important issues on which it is pivotal that we come to a conclusion in respect of an air ambulance. Those issues include where it might be based, how it might be funded and to what level it should be staffed with clinical involvement. There is a range of serious issues beyond the basic commitment to do it that need to be ironed out, and I hope that a consultation can do that.
I encourage everyone with an interest in this to contribute to the consultation, and I am sure that there will be a range of very different views around what it might be. The important thing is that we realise the vision set out by Dr John Hinds and, indeed, by many of his colleagues that Northern Ireland can sustain an air ambulance service and, indeed, that it needs one.
Mr Girvan: I thank the Minister for his answer, and I appreciate the positive approach that is being taken to this matter. All politics being local, I am putting forward a good suggestion that the international airport, which is located in my constituency, is the ideal location for such a service. Does the Minister consider that to be possible?
Some Members: Hear, hear.
Mr Hamilton: There seems to be common accord for that suggestion, even from Members from other constituencies around the Chamber. I want to leave it to the consultation to look at issues such as where it might be located. I do not want to make a commitment here or there today. I might be tempted to say Newtownards airport, actually. I think that it is incredibly important that, in taking forward such a serious thing which will benefit people in Northern Ireland in the years ahead, we get it right in terms of how it is funded, how it is operated clinically and where it is located. I do not want to prejudge the consultation. I acknowledge that there are certain advantages with Aldergrove, given the collocation with the Police Service of Northern Ireland, which has a series of helicopters there. I am not sure of the exact number, but I know that there is a handful. There are certain advantages there — good geographical advantages, as well — but I certainly do not want to rule out anywhere. There may be other considerations as to the total geographical area that a helicopter emergency medical service might cover. Certainly, your bid for Aldergrove has been heard loudly and clearly.
T4. Mr F McCann asked the Minister of Health, Social Services and Public Safety what he is doing to address the shortage of consultants in the Mater Hospital. (AQT 3134/11-16)
Mr Hamilton: I thought that this issue might come up today because it has obviously developed over the last number of days, so it is the very definition of a topical question. Much as Ms Fearon raised concerns about consultant cover at Daisy Hill, similar issues have arisen in the emergency department at the Mater Hospital. As I said to her, my job — indeed, this goes for anybody who holds this post — should be, I believe, to ensure the highest possible levels of quality and safety in our health and social care services.
The Belfast Health and Social Care Trust advised my Department last week of service difficulties at the Mater Hospital emergency department. As a precautionary measure, in response to concerns raised by senior medical staff about medical cover in the evening and overnight and the management of paediatric patients, the Belfast Trust has instigated short-term measures to ensure that safe, effective arrangements are in place outside normal working hours and to ensure that children needing emergency treatment get that treatment in the most appropriate place.
Belfast Trust emergency departments are managed as a full, joined-up service, and this precautionary measure was implemented on a coordinated basis to ensure continuity of service in Belfast. Overnight ambulance diverts from the Mater are expected to remain in place as a temporary measure. Children will be redirected to the nearby Royal Belfast Hospital for Sick Children, which has a dedicated paediatric emergency department, while the Belfast Trust seeks to resolve the concerns identified and recruit senior medical staff. I made the point to Ms Fearon that, if clinicians come to me and my Department and say that a service being run in the short or longer term is unsafe, I have a duty to listen to them and to act.
Mr F McCann: I thank the Minister for his answer. I accept and appreciate that there are many difficulties in this, but can he assure us that he will do all within his power to try to ensure that consultancy posts are filled to meet the demand in the Mater Hospital?
Mr Hamilton: Absolutely. I am certainly committed to doing that and to ensuring that the highest quality of care and safety of care can be carried out in the Mater, Daisy Hill or wherever. I am certainly committed to doing that. He should acknowledge, as I am sure he does, the challenges with recruitment. There is much competition inside Northern Ireland, never mind outside it. I will certainly do my best.
As I mentioned before, I had a conversation last week with the Royal College of Emergency Medicine, which has acknowledged — I hope that I can speak for it — the good work that has been done by my predecessors in trying to recruit more people to emergency medicine. Certainly, it warned me that there is a risk that some of the things that we talked about today around Daisy Hill and the Mater Hospital may happen, and we need to do our very best to ensure that they do not happen. I have tried to put in place the appropriate resources, particularly in terms of staff. I will certainly make a commitment to do all that I can to ensure that the issue in the Mater Hospital is resolved in the short term and is made sustainable in the longer term.
T5. Mr Wells asked the Minister of Health, Social Services and Public Safety for an update on the Southern Trust’s consultation on the future of Slieve Roe House in Kilkeel, given that he will be aware of the concerns. (AQT 3135/11-16)
Mr Hamilton: I thank the Member for his question. I know that Slieve Roe House in Kilkeel is an issue that he has a deep and long-standing interest in. As he will know, the recommendation from the trust, which went out to consultation, was that Slieve Roe should close. However, the board recognises that there are limited alternative options available in the Mourne and Kilkeel area, and it has agreed to reopen it to admissions until alternative options, in particular the proposed 12-unit supported living facility, become available in the spring of 2017. Those proposals have gone to the board, and they will come to me as Minister to ultimately sign off on. I will consider a range of factors before making my final decision.
It is worth re-emphasising, if I may, his commitment and that of Minister Poots when he was in post, and which I have reiterated: if a final decision is taken for closure, no resident in any of the homes that are earmarked for closure will be moved if they do not wish to move.
Mr Deputy Speaker (Mr Beggs): I have received notification from members of the Business Committee of a motion to extend the sitting past 7.00 pm under Standing Order 10(3A).
That, in accordance with Standing Order 10(3A), the sitting on Monday 16 November 2015 be extended to no later than 9.00 pm. — [Ms Ruane.]
(Mr Deputy Speaker [Mr Dallat] in the Chair)
Debate resumed on motion:
That the Second Stage of the Human Transplantation Bill [NIA 64/11-16] be agreed. — [Mrs Dobson.]
Mr Dickson: First, I thank Mrs Dobson for bringing the Bill to the House today and for the tremendous work that she has done in preparation for what is a very difficult and emotional subject for her personally, and which is also of great importance to many people who have had to face the trauma of a transplant or, indeed, make the decision with a loved one that donation is the appropriate thing that they wish to do when death occurs or, as is the situation now, where many people will make live donations for kidney transplants.
I want to be very brief and say a few things about this issue. The Alliance Party is supportive of the Bill. We will listen in detail to the work done in the Committee and follow its progress with interest, but, in broad principle terms, we are very supportive of the Bill as proposed. I will refer to a number of personal experiences that have taken me to the conclusion that this Bill is of benefit and should be encouraged.
Over 20 years ago, I remember two young men from my constituency who, coincidentally, knew each other through youth activities and the Boys' Brigade, one from Carrickfergus and one from Greenisland. They were two very early recipients of heart transplants at Harefield Hospital. Sadly, in time, both of them died, but both were brave in the operation that they faced and both had an extension to their lives that would not have been granted to them had their illnesses continued. I have no doubt that, as their families look back on what they did at that time, they will realise that they made an immense contribution not only to their lives but to medical science and to the team that was working at Harefield Hospital.
I also want to refer to a friend who has now received the second kidney transplant of his lifetime and to attest to the life-giving powers that that has brought to someone who is in their working years; is fit and able to return to work and to make a contribution to this society and community, and is able be a taxpayer and not a burden on our health service as he is fully fit and able to make a contribution.
I encourage anyone who today wishes to be an organ donor to give serious consideration to that. I carry a donor card with me. I have given consent on my driving licence application form just in case anybody is not sure what the card in my wallet is for or it cannot be found, and I have told my family and friends that I wish to consent to donation after my death, if that is appropriate. As Mrs Dobson pointed out, there are many circumstances where, sadly, it is not appropriate. A small number of people can become donors. For those who actively do not wish to be donors, I believe that the soft opt-out is the right approach. No one will be forced into making a donation. Family members should not feel under pressure. It should be a decision made at a particular time and one that the donor should hopefully have given consideration to, but, nevertheless, families and close relatives will have a final say.
I am delighted to support Mrs Dobson in the work that she has done and in the research that she has undertaken, which has been meticulous. She has consulted widely, and the consultation has, I think, delivered a very clear message to the Assembly. I have no doubt that the Welsh model, which is one that is proposed, carries a great deal of merit. I encourage the House to unite today in support of the motion.
Mr Middleton: I, too, welcome the opportunity to speak on the Human Transplantation Bill this afternoon. Around the world, organ donation policies vary greatly. There are arguments for and against whether an opt-in donation system, like the one we currently have, or an opt-out system, which exists in other countries, is better. With the current opt-in system, people have to actively sign the organ donation register to donate their organs after death, and, of course, with the opt-out system, organ donation will occur automatically unless a specific request is made before death for organs not to be taken. Whilst I have no doubt that there are positives and negatives with both systems, the fact that both are reliant on active decisions from individuals can lead to drawbacks. Inaction in an opt-in system can lead to individuals who want to donate their organs not donating. In contrast, the inaction in an opt-out system can potentially lead to an individual who does not want to donate becoming a donor. There are numerous reasons why people may not act, whether it be through lack of awareness, because of loss aversion or because of a belief that the policymakers have got it right and that there is no need to do anything.
Whilst I have opted in for organ donation by signing the register, it is only when I hear the personal stories of those who are waiting for an organ transplant or those who have received an organ that it truly hits home how life-changing and life-saving the decision is. One such story that I wish to touch on today is that of Andrew Duncan. At the age of 23, Andrew was diagnosed with a hereditary condition called dilated cardiomyopathy. Andrew lived in the Waterside area of the Foyle constituency, in which I reside, with his wife and two children. He had been on the waiting list for a heart transplant since 2011. Andrew was a strong advocate in principle for the new legislation on the opt-out system for organ donation in Northern Ireland. Even though he suffered from a heart condition that made it difficult for him to walk, last February, he carried out a sponsored walk to raise awareness and to raise money for the British Heart Foundation.
He made a poignant video for the British Heart Foundation, appealing for people to consider donating their organs. I encourage anybody who has not yet signed the register to watch Andy's video. Sadly, one year ago to this very day, Andrew's time ran out, and he lost his fight for life. My sympathies today go to his wife, family and friends. There is no doubt that many others out there have lost loved ones.
As we debate the Bill, it is impossible to ignore the personal stories and those who have been directly affected by organ failure and are reliant on organ donation, just like Andrew. Although it is important to listen to personal stories, we should not let emotion dictate the legislation.
With nine out of 10 people in the UK saying that they support organ donation, and only three out of 10 having signed the organ donation register, more needs to be done. I support the elements of the Bill that ensure that the Department of Health further promote transplantation, in particular that it carry out a public campaign at least once a year.
However, a report on organ donation systems by Professor Eamonn Ferguson of the University of Nottingham, noted that countries that used opt-out consent still experienced organ donor shortages. Completely changing the system of consent was therefore unlikely to solve such a problem. The report suggested that consent legislation or adopting aspects of the Spanish model could be ways of improving donor rates.
Spain currently has the highest organ donation rate in the world. The Spanish utilise opt-out consent, but their success is accredited by experts to measures such as a transplant coordination network that works locally and nationally and improving the quality of public information available about organ donation.
More thorough research is needed on the use of the opt-out system, particularly the soft opt-out system that is going through in Wales, which we hope to relate to closely when looking at the Bill. I expect that we will be able to learn from Wales's experience and use it to carefully consider the future of organ donation in Northern Ireland. It is vital that we hear further on this very important matter from clinicians and health professionals.
As was made clear from the consultation on the Bill, it is vital that safeguards be put in place to protect children and young people, vulnerable adults, those whose identity is unknown and those who are not normally resident in Northern Ireland. The report 'The potential impact of an opt out system for organ donation in the UK' stated that data protection and privacy were of concern to many individuals. Assurances need to be in place for members of the public who feel concerned about the security of key pieces of personal information.
The report also stated:
"An opt out system has the potential to erode the trust between clinicians and families at a distressing time. The concept of a gift freely given is an important one to both donor families and transplant recipients. The Taskforce feels that an opt out system of consent has the potential to undermine this concept."
Although there are many concerns about the opt-out system, if we can get it to Committee Stage, that will give the Health Committee an opportunity to delve deeper into and scrutinise the Bill and to hear more evidence.
Ms McCorley: Go raibh maith agat, a LeasCheann Comhairle. Cuirim fáilte roimh an deis labhairt ar an rún thar a bheith tábhachtach seo inniu. I welcome the opportunity to speak on this important Bill.
I acknowledge the good work done by Jo-Anne Dobson in bringing about the Bill. It has been comprehensive, with lots and lots of hard, in-depth work, and it has raised awareness of the subject. It is an emotive subject, as we have heard from most Members. That is naturally so, because it involves lives, and lives are being lost because we do not have enough organ donors.
We have the opt-in system that allows people to opt in to be an organ donor. The soft opt-out way that is proposed is the right way to go, as it will allow for more opportunities for organ donation for people in difficult circumstances. The circumstances for everyone involved are extremely difficult.
Mr Ross: I thank the Member for giving way. I have heard from a number of Members that moving to a system of opt-out will produce more organs available for transplant. Will the Member tell us where she gets the evidence for that? The evidence from around the world is incredibly sketchy and there are many areas that operate systems of opt-out which produce a much lower level of organ donation than we have in the UK or Northern Ireland.