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Cancer Services: Deterioration

Opposition Business – in the Northern Ireland Assembly at 3:30 pm on 18th October 2016.

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Debate resumed on motion:

That this Assembly notes the recent publication of cancer waiting times, which revealed that the crisis affecting cancer services in Northern Ireland is continuing to deteriorate; further notes with anger that, in June 2016, only 6·7% of breast cancer patients in the Southern Health and Social Care Trust area were seen within 14 days, despite the target being 100%; accepts the importance of timely diagnosis and treatment of cancer, as any delay can reduce the likelihood of a successful outcome; notes that these figures are symptomatic of the wider unprecedented crisis engulfing the Northern Ireland health service, with 392,000 people now on waiting lists; and calls on the Minister of Health to intervene to ensure that patients receive swift, safe and sustainable healthcare and to ensure that patient safety is not further compromised.

Photo of Kellie Armstrong Kellie Armstrong Alliance

I have thought very hard about how to respond to the motion today, because it deals with an extremely important and emotive subject. I start by confirming that the Alliance Party supports the motion but with reservations, because, as we have heard, the figures provide a snapshot. I also declare an interest, because I completely and totally hate cancer. I detest the disease in all its forms. Cancer causes pain and suffering and, in many cases, ends lives. I support the fight against cancer and have taken part in Race for Life events here in Stormont and raised funds for research.

I am extremely thankful that, in 2015, Cancer Research UK confirmed that more than 50% of people diagnosed will survive their cancer for more than 10 years; an all-time high. More people are surviving, and thank goodness for that. It is down, in quite a large part, to the staff who work in our hospitals to protect and care for people who are diagnosed with cancer, and their families, at a time when they are at their most vulnerable.

The motion talks about the crisis affecting cancer services, but we should not forget the people, the human beings, affected by cancer, including the almost 400,000 people on waiting lists and those who sometimes fail to receive early diagnosis. I thought I would share a quick story about what it is like to live without early diagnosis. In this case, a woman started to feel unwell around her 40th birthday and was back and forward to her GP on many occasions, a scenario that others have highlighted. The GP checked her and could not find out what was wrong. She was losing a lot of weight — not pounds but stones — without dieting.

Over the following couple of years, her eyesight blurred and her appetite left her. That person was in pain and was scared. She was frustrated and worried about her family and her children. She felt that she was not being listened to, that she was being dismissed and that she was not important; and she was angry. She was in and out of hospital, and her family were worried sick for her. The diagnosis finally came. The consultant called her husband to the side and confirmed that she had cancer. He told her husband that it was so advanced that she had days rather than weeks to live and that he should prepare for her funeral. That was on the Tuesday; she died on the Saturday, the day before her 43rd birthday. Her name was Geraldine McGrattan and she was my mum.

I know first-hand the impact that cancer has on the person and on their family. Cancer can kill, but waiting for a diagnosis or being on a waiting list is torturous and unacceptable. The Minister confirmed that it is unacceptable: she knows that. If we are to receive swift, safe and sustainable healthcare to ensure patient safety and patient treatment, I urge the Minister to ensure that the expected cancer services framework includes a mechanism to systematically reduce waiting times and stringently monitor lists to ensure they do not increase to the levels we have today, where one fifth of our population are on waiting lists. We are all affected by cancer.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

I welcome the opportunity to speak. It is important that any debate of this nature should be balanced and fair. It is right that political representatives should highlight deficiencies in the healthcare system, but it is also very important that we accentuate the positive aspects of healthcare and that we are judicious in our language. We should be judicious because there are patients out there who are fearful, and we should not do or say anything that would make people who are already vulnerable or apprehensive feel even more insecure. Likewise, we need to be careful that our words, even indirectly, do not demoralise healthcare professionals and workers.

However, it is clear that the Opposition do not concur with those sentiments. The motion that they have brought to the Floor of the Assembly today is, quite frankly, a dog's dinner. It contains inaccuracies and misinformation. It is loaded with hyperbole and is an exercise in scaremongering. Breast cancer is the hook that the Opposition have used to hang this motion on and, to do so, it focuses on one small geographical area at one short period of time. In short, it is just a snapshot.

Photo of Roy Beggs Roy Beggs UUP

Will the Member give way?

Photo of Pat Sheehan Pat Sheehan Sinn Féin

No, I will not.

That in itself is unfair, as statistics should be used to discern patterns over longer periods of time. Let me offer the Opposition a statistic which Edwin Poots mentioned earlier: clinical outcomes for breast cancer patients are better here than in any other jurisdiction in these islands.

I return to the motion. It says that:

"only 6·7 per cent of breast cancer patients in the Southern Health and Social Care Trust area were seen within 14 days".

These were not breast cancer patients. They were people who had gone to their doctor and been referred to a breast clinic. They may have had a cyst or some other issue. The vast majority of patients who are referred to breast clinics are not diagnosed with breast cancer.

Photo of Naomi Long Naomi Long Alliance

I thank the Member for giving way. As Kellie has already mentioned, we have reservations about the detail of the motion but not the general thrust. Whilst I accept the point he is making, does he agree that, for those women who are referred, whether it be for a cyst, benign growths or cancer, there is a huge amount of stress for the period of time that they wait? Therefore, it is relevant to raise the issue of waiting time, whether those women are breast cancer patients or are simply not aware of their current status.

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

I thank the Member for her intervention, and I agree wholeheartedly with what she says. Waiting for a diagnosis is a difficult time. Why then did the Opposition, when it was forming its motion, not try to be accurate, instead of introducing this exaggeration and hyperbole? If that is the Opposition that we are going to face over the next few years, God help us all.

I was very disappointed with Jo-Anne Dobson earlier this morning. She said, "there is not enough emotion" here, and, "There is not enough care" among our representatives. Let me say this. I first visited the Bridgewater suite in 2002, when my wife was diagnosed with breast cancer, and I made many visits there, and to the cancer centre, between 2002 and 2006, when my wife died. So do not stand here and tell me that I do not care, and do not presume that nobody else in this House cares. We have listened to enough Members today to hear all of them say how they have been affected by cancer. All of us care.

If people really care, they should work together, be judicious in their language and be accurate with their emotions. The best way to improve the health system we have is for everybody to put their shoulder to the wheel and not make petty political points, because cancer does not discriminate along party political lines. Sin a bhfuil agam.

Photo of Gary Middleton Gary Middleton DUP

I will begin by recognising the magnificent and life-saving work being carried out by our clinicians and medical experts, who are, of course, working on the front line day and daily delivering a first-class health service. Like many others — Mr Sheehan outlined his personal circumstances — I know that cancer has affected many of our family members and friends. Of course, it does not discriminate; it affects all of us, whether old or young, male or female.

The way the motion has been tabled is unfortunate. Together with the inaccuracies, it has been done in quite a knee-jerk fashion not, of course, to improve the situation or provide solutions but to scaremonger and to score political points. That is really sad. The motion focuses specifically on one trust and one month. Unfortunately, unforeseen circumstances — I know my colleague will touch on this in a few minutes — caused that issue. Nobody is trying to justify the figures or the waiting times, but, at the same time, we have to recognise the pressures in the system as a whole. Conveniently, it was not mentioned in the motion that 100% of cancer patients have been seen on target in the Western Trust area. Of course, there are better situations in other trusts. That has been achieved by the commitment and dedication of staff and a focus on providing the best possible care.

Photo of Gary Middleton Gary Middleton DUP

I will indeed.

Photo of Sinéad Bradley Sinéad Bradley Social Democratic and Labour Party

Does the Member accept that it is a postcode lottery, given that, as he referred to, the Western Trust is able to supply healthcare, while the Southern Trust cannot?

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Gary Middleton Gary Middleton DUP

I thank the Member for the intervention, but I do not agree with that. At times, there can be particular pressures in a trust, and that is where you see issues arise, sometimes not in a fashion that you would have seen previously. That creates situations the likes of which we have seen in the Southern Trust, but those can be rectified. The Minister and the previous Minister have worked to alleviate the pressures and ensure that people are not waiting. One of the ways we have done that, particularly in the north-west, is through the opening of the radiotherapy centre at Altnagelvin, which our party was very supportive of. Thankfully, the Minister is working on that as well to reduce waiting lists. When motions like this come before the House, the signatories need to be careful about the language being used and make sure they truly think through exactly what they want to achieve by tabling it.

This morning, I attended an event and chaired a conference in the Stormont Hotel, hosted by the Policy Forum for Northern Ireland, on the reform of the health system. It was refreshing to hear from the over 150 delegates who attended it. The medical professionals talked the health system up rather than talking it down. Yes, there are challenges, and they recognise them, but they were there to work collectively to come to a solution. If the people out there — the health professionals — are working together to come to a solution, we in here should do the exact same rather than trying to score political points.

Do I believe there is a deterioration in cancer services? I do not. I believe we have one of the best systems in the world, but we can do better.

The motion calls on the Minister:

"to ensure patient safety is not further compromised."

Of course, that language again deliberately scaremongers and causes concern for people.

Photo of Roy Beggs Roy Beggs UUP

Will the Member give way?

Photo of Gary Middleton Gary Middleton DUP

I will indeed.

Photo of Roy Beggs Roy Beggs UUP

Does the Member accept that, with 392,000 people on waiting lists — one in five people in Northern Ireland — there are risks involved?

Photo of Gary Middleton Gary Middleton DUP

I accept that. Nobody is trying to justify the number of people on the waiting lists, but I question the figure of 392,000 that was stated. That is not specifically cancer-related; it is related to all conditions. The way in which the motion has been proposed is deliberately misleading. Opposition Members cannot, on one hand, say that heads should roll yet, on the other hand, say that we have great staff who should be complimented. If you want to do something for staff morale, start being thankful for the service that we have and recognise the challenges but work together to get reform. That is something that our party and the Executive and, no doubt, the Minister will do.

Photo of Carla Lockhart Carla Lockhart DUP 3:45 pm, 18th October 2016

I support much of what my colleague has already said. Cancer is a thief and a home wrecker. It steals people away all too quickly, as we have heard so eloquently today. It is no respecter of age; it is a parasite and a plague on our society. Unfortunately, it has become a word that we all hear all too often, and it is often associated with children and the death of loved ones. However, we also hear about the victories against cancer, and that should be the message of today. We are encouraged by those victories. I do not defend the indefensible, but I congratulate, commend and encourage all the staff, consultants, nurses and scientists as well as all the charities that are involved day and daily in saving lives from this terrible parasite. Just recently, Paint the Town Pink, a fantastic event in my constituency raised thousands of pounds in an effort to save lives.

Today, I want to talk to people and reassure them. The motion, unfortunately, is specific to one cancer, which does a disservice to people throughout our Province who suffer from many different forms of cancer. For instance, it was brought to my attention recently that there is no robotic surgery for urology treatment, and I am working with the Minister to resolve that. I am very content that she recognises that there is a problem with prostate cancer treatment and is working to address it. With over one hundred forms of cancer and one in three people suffering, there is a very real need for a cancer strategy that will address the overall associated problems, be it waiting times or dealing with this epidemic.

I was very disheartened and somewhat surprised by the form that the motion took. Even the title, with its talk of deterioration, will strike fear, dread, concern and anxiety into women across the country who will see these figures, which, we have been told, are incorrect. It has whipped up hysteria around this. The motion also mentions the Southern Trust, which is most unfortunate. Craigavon Area Hospital, which is in my constituency, operates in the Southern Trust. It is a fantastic hospital that runs the Mandeville unit. I encourage anyone to look at the services that the Mandeville unit provides, and they will see clearly the excellent work that is ongoing. Members should realise that the figures are very specific to a time in the Southern Trust diary when one of its members — a leading consultant — passed away. Unfortunately, you cannot plan for that. I encourage people to be reassured that the trust is back to its 100% performance on its 14-day, red-flag targets for breast cancer referrals.

We are all too aware of the fact that Northern Ireland has areas of specific speciality, and it is difficult when there is movement of staff or, as I alluded to, illness or death. In fact, we are not dissimilar to the rest of the UK and Europe in that sense. My aim today, as I said, is to provide reassurance to the women who will have concerns from today: you will be seen by the Southern Trust, and, if you are in need of surgery, you will get it.

Amazing work has been going on and continues in Northern Ireland. Since the Campbell report in 1995, cancer treatment services and diagnosis have been nothing short of transformational, and that is very evident in the survival rates.

In fact, back in March, it was reported that over 54% of all cancer patients survived five years after diagnosis between 2004 and 2008, an improvement in comparison with 1993 to 1999, and it is improving in 2010 to 2014. You have to look at the improvements in bowel cancer since the bowel screening programme began in 2012. There is no doubt that there are more cases of cancer appearing in men and women, but we have the City Hospital and places like the Mandeville unit. My colleague referred to the radiotherapy unit at Altnagelvin. We also have the cancer research lab that is doing amazing work.

The message today for the Minister is that there needs to be a wrap-around service for cancer. It is not that people are scathing of the service that they receive. Their concerns are the financial hardship, the travel costs and the counselling needed for children who lose their mums and dads early in life. That is the message that the Minister needs to hear.

Photo of Robin Newton Robin Newton Speaker

I ask the Member to conclude her remarks.

Photo of Carla Lockhart Carla Lockhart DUP

To those who are suffering from cancer, fight on. We are here to support you and to work with the Minister on this important issue.

Photo of Roy Beggs Roy Beggs UUP

I support the motion, which highlights the Northern Ireland health crisis. As I said earlier, 392,000 people are on waiting lists. This issue has not been referenced by the Back-Benchers from the Sinn Féin/DUP Government. They seem to have skated over this. The failure to address the pressures on our health service has led to this intolerable situation, with one in five of the population being on a waiting list.

This is a failure to address a basic need: healthcare. To the Health Minister, the Finance Minister and the entire Northern Ireland Executive, which is in its sixth year of being led by DUP/Sinn Féin, I say that this is unacceptable and it is time that it was addressed. What have you done about it?

Like others, I commend our health staff for the treatment that they give when patients eventually get to the top of their waiting list. However, that is the problem: too many are parked on waiting lists.

The waiting times summary report of August 2016 for the Northern Health and Social Care Trust, which covers my area, shows quite concerning figures, with 17,888 patients waiting more than nine weeks — ie 64% of patients — and 1,620 waiting for more than a year to be seen or treated. Areas of concern are ENT, gastroenterology, general surgery, gynaecology, neurology, pain management, rheumatology and thoracic medicine, with many patients waiting more than 45 weeks.

Early diagnosis and treatment will reduce the suffering of patients and produce better long-term outcomes. With lengthy waiting lists, we also get increased pressure on GP services. We get additional unplanned A&E admissions to hospitals, and there are pressures on staff because patients are not being treated in an orderly, efficient manner.

Photo of Carla Lockhart Carla Lockhart DUP

I thank the Member for giving way. Will he just confirm that the figure of 392,000 referred to in the motion is not specific to cancer and that it actually is the entire waiting times? It is important to clarify that, given that we are discussing cancer.

Photo of Robin Newton Robin Newton Speaker

The Member has an extra minute.

Photo of Roy Beggs Roy Beggs UUP

If the Member waits a moment, I will come exactly to that point. If you notice, I have been talking all about the waiting list, and there is a reason for it.

In GB, they operate using referral time to treatment. It is not how long you have been parked on one of the multiple waiting lists that Northern Ireland patients have to move along; it is your treatment plan from when you see your GP until you get treated. We operate a different system, which hides many people within the waiting system. Because we are not using that referral time to treatment, the system does not look at how to better plan and improve the patient's journey. When will Northern Ireland come out of the dark ages and adopt that modern method to improve our system and bring about efficiencies?

There are 392,000 local patients on the waiting list, but the question is this: how many of them have a more serious ailment lurking in the background that may emerge when they are on the waiting list? No blame is intended on heavily pressed GPs or specialist consultants. Indeed, some illnesses are very difficult to diagnose, but the longer that someone is on a waiting list and not being regularly seen and reviewed by the specialist, the higher the risks. Indeed, some individuals end up moving to several different specialists along their journey of diagnosis.

I can think of one constituent who was parked on such multiple waiting lists and whose long journey of diagnosis has taken some six months. Only recently, it was identified that he now has a suspected cancer. Therefore, having waited six months and visited a whole range of specialists on different waiting lists, finally a suspicion of cancer has been highlighted and an operation is planned. I hope and pray that delays will not prove to be significant to his long-term health. That is a problem with the 392,000 people on the waiting list. Many of them have different ailments, some of which may be cancer, so we ought to deal with the problems in our entire health service, as referenced in the motion but not addressed by many. Once cancer spreads, it becomes very difficult to treat. Therefore, early treatment targets are there to try to prevent that from happening.

In the Northern Trust area, I see that —

Photo of Robin Newton Robin Newton Speaker

Will the Member conclude his remarks?

Photo of Roy Beggs Roy Beggs UUP

— 75%, 64% and 63% of people with an urgent breast cancer referral were seen within 14 days in April, May and June. That is not acceptable. We need to improve our service. The service is far below that in England and Scotland.

Photo of Robin Newton Robin Newton Speaker

The Member's time is up.

Photo of Roy Beggs Roy Beggs UUP

We need to address our health service.

Photo of Ian Milne Ian Milne Sinn Féin

I begin by recording my thanks to the research team here at the Assembly for the information pack provided in advance of today's debate. I also use this opportunity to acknowledge the work and dedication of healthcare staff, who, despite the challenges and pressures, continue to work day after day to deliver the best possible outcomes for people. They are supported in that work by organisations such as Macmillan, Marie Curie and Cancer Focus, to name a few. In my area, Charis Cancer Care does exceptional work supporting patients and their families through their cancer journey.

Just two weeks ago, we had the opportunity to discuss the Department's report, which highlighted the waiting times for first consultation and, in particular, the performance in the Southern Health and Social Care Trust. Many of the facts, concerns and figures have already been heard and responded to by the Minister, so I am conscious that much of the motion has already been covered.

(Mr Deputy Speaker [Mr McGlone] in the Chair)

Many factors can contribute to extended waiting times. Some will be understandable or unavoidable, while some will be unacceptable and need to be improved on. Whatever the reasons, there can be no doubt that the waiting adds to the anxiety and stress that comes with the news that you have been red-flagged.

There are very few families untouched by cancer. Everyone understands the impact on the lives of individuals and families when cancer is thought to be a possibility. There is, quite rightly, that sense of urgency to find out whether it is or is not, and, if it is, to know exactly how serious it is and what needs to be done.

We can all agree that performance figures reported for the Southern Trust are not good enough and fall short of the targets that we all want to see achieved. We must also be careful to avoid scaremongering and adding to the anxiety by suggesting that the service is, to quote the text of the motion, experiencing an "unprecedented crisis" or is somehow unsafe. Headline-grabbing phrases such as those do nothing for the morale of the staff at the coalface who regularly go above and beyond the call of duty.

They do not praise the success of awareness-raising campaigns that encourage people to seek advice and referral at the earliest possible opportunity or the significant improvement in outcomes over the last number of years.

The Minister, in her previous contribution, acknowledged that there are challenges in our health system. They are not new and have been the subject of much debate in the House for many years. They exist not just in cancer services but in waiting times across many aspects of the service. There are issues relating to budgets, workforce planning and many other areas. Long life expectancy, early detection and treatments are a credit to medical science and to all those involved in public healthcare, but there is no doubt that the additional demand — a demand that is predicted to increase — places pressure on the service.

I welcome the commitment given by our Health Minister, Michelle O'Neill, to not just look at the potential of a cancer strategy but bring forward proposals to transform how health and care is delivered here in the North. Like other Members who spoke before me, I urge everyone in the Chamber to set aside party politics and work together to create a better health service with better outcomes for everyone.

Photo of Gerry Mullan Gerry Mullan Social Democratic and Labour Party 4:00 pm, 18th October 2016

I, too, welcome this opportunity to discuss these very important matters that affect people right across my constituency of East Derry and, indeed, people in local communities in every other constituency in the North of this island.

I would like to focus my comments on cancer care provision in Northern Ireland. At the moment, it is failing so many patients. The rate of cancer diagnosis has continued to rise, and, in 2014, some 9,000 people were diagnosed with cancer in the North. Sadly, almost 4,000 people die each year due to this horrible disease.

Like many Members, I know people who are currently suffering from cancer, have been cured of cancer or have, sadly, died from cancer. However, it has to be said that Northern Ireland has come a long way with cancer treatment and research and that there has been improvement. In 1993, breast cancer screening was established throughout the North. In 1994, the cancer registry was established. In 1999, the first cancer incidence data was compiled. In 2004, the Cancer Network was established, and, in 2006, the cancer centre was opened. The new radiotherapy unit in Altnagelvin will, hopefully, open next month. The work of individuals such as Joe O'Sullivan and Paddy Johnston has been instrumental in driving forward this change, which has been hugely beneficial for local cancer sufferers.

Those are all evidence of a progression that I welcome and one that is evermore important considering the prevalence of cancer in Northern Ireland and the increasing number of patients diagnosed every single year. However, Northern Ireland's position as a world leader in cancer research and treatment is now in jeopardy following what seems to be a crisis at the heart of the health service that is negatively impacting upon cancer services.

Some 95% of patients with an urgent GP referral are supposed to be seen within 62 days. However, since records began six years ago, the target has never been met, and the latest figures show that, between April and June this year, only 70% were seen in this time.

Breast cancer treatment targets are also falling by the wayside. The percentage of women seen within 14 days of urgent referral for breast cancer has also fallen sharply since last year. Just 64%, which equates to 914 out of 1,433, of referred patients were seen on time, compared to 80% in June 2015. In the Southern Health and Social Care Trust area, 93% of patients waited more than the target of 14 days for a first consultation following an urgent referral for suspected breast cancer.

Those figures demonstrate the very stark reality we face and show that a dark shadow is hanging over cancer provision here. The failure to meet these treatment targets is a damning indictment of the very real pressures that the wider health system faces. Rather than the Health Minister hiding behind the Bengoa report, I call on her to publish it. We can all hide behind rhetoric but these crisis conditions are literally putting people's lives at risk, and that, in itself, is unacceptable.

Time after time, we have had reports such as 'Transforming your Care: A Review of Health and Social Care in Northern Ireland' or the Donaldson review, but I have yet to witness any positive change emanating from them. The Minister should not hide behind another review. It would be more appropriate for her to commission a cancer strategy to ensure that cancer services are properly invested in and developed.

There is also a huge gap in the provision of cancer treatment here; it concerns cancer drugs that are available in Great Britain but not in Northern Ireland. Forty drugs have the potential to extend the lives of many cancer sufferers here but, rather than establishing a specialised medicines fund like they have in Scotland, a previous Health Minister decided to review —

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

I ask the Member to draw his remarks to a close, please.

Photo of Gerry Mullan Gerry Mullan Social Democratic and Labour Party

— the punitive individual funding request (IFR) process and prescription charges.

The Minister needs to take notice of the motion, take action, commission the cancer strategy —

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

The Member's time is up.

Photo of Gerry Mullan Gerry Mullan Social Democratic and Labour Party

— and offer cancer patients equality of treatment in the North.

Photo of Steve Aiken Steve Aiken UUP

I support the motion. Along with the others you have heard from, I add my concerns for the many people on waiting lists. Indeed, any delay in a cancer diagnosis has a significant impact on an individual, their family, their workmates and society as a whole. However, when our cancer services work, they can work well. In my case, I did that most unusual thing for a husband and listened to my wife, who told me that I had to go to my GP. The process for the investigation, diagnosis and surgery for my bowel cancer two years ago met all the NICE guidelines. While I understand that many have concerns about the level of care that they have received in hospitals, my care, which was delivered fully through the NHS, was first-rate. Indeed, I cannot praise the medical staff at my GP's surgery and Antrim Area Hospital, my consultant, Mr Burns, and my wife highly enough.

Based on feedback received from throughout my constituency, I am very conscious that many people feel that cancer care provision is not only limited in some areas but that there appears to be a postcode or even regional lottery in treatment and in the provision of drugs regimes. As British citizens, many people find it difficult to understand how medicines that are available in, say, Birmingham cannot be provided here. I am also concerned that levels of service between different trusts in Northern Ireland are demonstrably of concern. Indeed, some cancer sufferers living within 10 miles or so of two or three health trust areas will be even more frustrated.

As a party, we have called for a cancer strategy for Northern Ireland that is primarily based on prevention and on early diagnosis. The need for education and changes in people's lifestyles, with a healthier approach to alcohol, tobacco and other drugs, is well recognised. However, it is to an approach to early detection that I wish to turn.

I welcome Mr Poots's earlier statements on Queen's University. Its Centre for Cancer Research and Cell Biology is a globally leading research centre. As well as looking at specific treatments for various cancers, it is also looking at how diagnostics can be improved. The Ulster University's globally leading Biomedical Sciences Research Institute, which is particularly looking at gene nutrient treatments, is similarly able to do diagnostics. Furthermore — as an MLA for South Antrim I cannot resist it — in Randox we have a great company that is implementing testing procedures to identify people at risk and the early stages of the disease. It is significantly boosting our global exports while it is at it, especially to the US, where it has achieved over £1 billion in sales this year. Unbelievably, Randox cannot sell any of its services to the health services in Northern Ireland. Those testing approaches may result in real benefits but I and many in Northern Ireland cannot understand why, with globally leading research centres and one of the globally leading diagnostic companies based here, the Health Minister is reluctant to take the initiative and set up a properly resourced cross-Northern Ireland cancer education and early cancer screening process.

We cannot continue with the current failing approach; we need to evolve our cancer care rapidly. We encourage our Health Minister to adopt, at the earliest opportunity, our policies for cancer education and early cancer screening, which are set out in our cancer care document dated March 2016. As added benefits, they would also help boost the position of our great universities and companies and would be truly transformational for all our citizens by providing more effective treatment for patients already suffering from cancer and, more importantly, by enabling us to prevent cancers from presenting or reoccurring.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

Standing here, my blood boils when Members in the Chamber accuse the Opposition of political point-scoring, scaremongering or being negative in tabling this motion. That is the stock answer. You have all been well coached. That does not wash when it comes to cancer services. It has already been said that there is no home or family across this region that has not been touched by cancer. I have to empathise with those Members who have lost loved ones and who have been touched by cancer. Whilst the survival rates across the range of cancers are constantly improving globally, if you have lost a loved one those survival rates are cold comfort at a time of great loss.

Photo of Linda Dillon Linda Dillon Sinn Féin

I find it deeply offensive that you would say that anything was rehearsed or coached. I point specifically to Pat Sheehan's remarks during the debate. You are talking about people who have lost family members as though he is not one of them. Show a little bit of respect for everybody involved in this situation, please.

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

The Member has an extra minute.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

Forgive me: I empathise with all Members who have lost a loved one, and my empathy rings true.

The motion refers to the crisis affecting cancer services in the North and, in particular, the fact that only 6·7% of breast cancer patients in the Southern Health and Social Care Trust area were seen within 14 days during June of this year. Mr Deputy Speaker, if you or your loved one has been referred to a cancer specialist, be it for breast cancer or any other cancer, even 14 days seems too long. The agony, the worry and the anxiety must be terrible as a patient. If your father, mother, wife, husband, son or daughter is going through that anguish, it must be heartbreaking. We as a legislature must step up and tackle the issue.

The Southern Trust covers the area I have the privilege of representing. I know that the Minister will tell us that, as we speak, those figures have improved; in fact, 100% of patients referred are seen within 14 days. The Minister will assure us that the dip in performance in June and July of this year was due to unforeseen circumstances. Whilst I appreciate that may be the case, for those waiting for those appointments in June and July, that delay only added to the worry and anxiety.

The services offered to breast cancer sufferers at the Mandeville unit or the Macmillan cancer care unit in Craigavon Area Hospital are second to none. The compassion and care on offer are shining lights. Time and time again, families tell me of the love, the care and the attention given by the staff there. Cancer care, however, is such a specialist field. Often, the care is administered by a small specialist team; any discontinuation of health personnel can have a big impact. We are all too aware of the staffing challenges facing the different areas of our health service, from GPs in rural practices to consultants in emergency departments to nursing staff in our hospitals. I experienced the pressure on an emergency team in Newry with a loved one in the last month. I saw the pressure under which they functioned, and it was extraordinary to see the care and attention on offer from people who were working at breaking point.

I fundamentally believe we need to take a much stronger and strategic approach to workforce planning. I understand that, in this case, there is a 1·5 whole-time equivalent breast surgeon's post vacant, as well as two vacancies for breast screening radiologists in the Southern Trust area. Can I ask the Minister for an update on the recruitment to those posts? We cannot allow workforce planning issues to continue to impact cancer services, particularly in the way we have witnessed to date. Cancer care is a top priority for the people we all represent. We must see improvements in the care we offer.

Photo of Trevor Lunn Trevor Lunn Alliance 4:15 pm, 18th October 2016

I thank the proposer for bringing forward the motion. We welcome that it was done on a cross-party basis. We are, of course, fully supportive of the motion and the manner in which it is being presented. It demonstrates that the Executive can and must be challenged in a constructive manner to deliver on behalf of the people. I suggest that, perhaps within the next year on another Opposition day, we bring a similar motion to check on actions and progress.

Of course, the issue is not just a mechanical one about targets not being met, but sometimes, that is the way it seems to be approached when discussed. The issue is that human beings — close relatives, friends and carers — are being left with huge uncertainty about their well-being. That means that not only does successful treatment becomes less likely because time is passing on a waiting list but there is additional strain that only makes their health worse. There is a tendency in the Chamber and elsewhere to talk grimly of figures but not of human lives, long-term plans delayed, big life events put off or the stress and strain of uncertainty. There is also a tendency to not talk even of people who found they were clear of cancer but whose mental health had deteriorated very badly while they were waiting to find out. I would certainly exempt Pat Sheehan and Kellie Armstrong from any criticism of just talking about figures: I thought they both spoke extremely bravely today.

I am cautious about repeating the word "crisis" too often, because it serves to create the impression there is nothing right about our health service. Many thousands of people every year are superbly treated by the service and the people who work in it. Many of the outcomes are nothing short of miraculous, but that is not to say that that word is out of place here. Clearly, when a fifth of the entire population is on a waiting list, something is not working the way it should.

I asked the Health Minister — I think it was in January 2015 — about the extent of the waiting list. The figure at that time was just over 180,000. It is now double that and more at 392,000. To put that another way, there is a tendency to see solving waiting lists by allocating more resources to the people on them when, in fact, the fundamental problem is that too many people are put on waiting lists in the first place. The resources are needed so that primary care services limit the number of people who are referred at all by intervening early to identify and solve the problem. When we say:

"patients receive swift, safe and sustainable healthcare", it needs to mean it happens at the very outset. We cannot just keep dumping thousands of people on to waiting lists and then rely on secondary care, often in the independent sector, to intervene long after the issue should have been dealt with.

Again, we cannot miss the point here that the expert panel chaired by Professor Bengoa presented its report to the Minister some months ago. Since that time, the concern is that she has been busy trying to fudge the outcome by focusing solely on the needs of some of those working in the service rather than those who use it. That is no way to start the process of real, meaningful reform on behalf of the public that, frankly, should have been started after Transforming Your Care and the Donaldson report. We will wait and see what Professor Bengoa has to say, if that is ever revealed to us.

When nearly 400,000 people are on a waiting list, that means you have a systems failure. The system is broken. Just throwing resources at it will not make it less broken. In fact, by failing to recognise this is a systems failure, we are insulting the many people who do such a miraculous job on behalf of patients every day.

The fact remains, however, that reform means change. That has to be managed carefully and sensitively so that, at the end of the decade, the system is fixed by broadening primary care, ensuring that expertise is shared at single locations for entire local areas and making sure that we never again have a fifth of the population on a waiting list. I doubt that that could happen anywhere else in the world.

We have said from the outset that we are not here to oppose for the sake of doing so. The Minister will receive our support where she reforms in line with expert advice but absolutely not where she fails to do so. We will judge the Bengoa report on its merits, not on the Minister's view of it. We warmly commend the motion to the House.

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

Just before I call the next Member, I remind Members to speak directly towards the microphones. Broadcasting has advised us that it is having difficulty picking up some of the transmissions.

Photo of Rosemary Barton Rosemary Barton UUP

Over 660 cases of cancer are diagnosed in Fermanagh and South Tyrone each year. One third of cancers is caused by smoking, and it is those cancers that have the poorest survival rates. Therefore, Minister, it is essential that there is early diagnosis to start treatment as soon as possible before health further deteriorates.

The most recent statistics from the Northern Ireland Cancer Registry show that there has been an average of 205 deaths each year in Fermanagh and South Tyrone from cancer over the last five years, with the most common cancers being bowel, prostate and breast. While the Western Trust is one of the highest-performing trusts, with an average of 91% of patients first treated following an urgent GP referral for suspected cancer, it is still below the ministerial target of 95%. However, I commend the Western Trust for achieving 100% in relation to the number of patients first being treated within the 31-day target and for the 100% target being reached for the number of patients first seen by a breast care specialist following an urgent referral for suspected cancer within 14 days. While the Western Trust has reached its targets, there are still approximately 200 deaths too many from cancer in Fermanagh and South Tyrone.

Dr Gavin, a founding director of the Northern Ireland Cancer Registry, projected that cancer rates in men would remain steady in the years ahead but, among women, we would see a 7% increase by 2020 and a 13% increase by 2035 due to medical advances and people living longer. Given that information, it is essential that the Minister look immediately at a specific cancer strategy for Northern Ireland, including further screening for older people and younger people, the recruitment of extra consultants so that targets set can be further improved and the provision of extra specialist cancer nurses.

As Fermanagh and South Tyrone is registered as having the second highest number of cancer cases each year, serious thought must be given to increasing the services offered at the South West Acute Hospital, including a cancer treatment unit there. After all, Fermanagh and South Tyrone has an ageing population, and its people have the furthest to travel for day treatments. Many patients also have no direct transport to the north-west and frequently have to leave home at 6.30 am or 7.00 am to travel to Belfast, eventually returning home 12 hours later. That journey for seriously ill patients is debilitating; for them, it is unacceptable in the modern world. Given that cancer incidence in Fermanagh and South Tyrone will only increase, I appeal to the Minister to consider a third cancer treatment hospital in the south-west.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

The rising scourge of cancer in our generation is, frankly, quite frightening. I am sure it is the experience of us all that we constantly hear of individuals we know, family members or acquaintances who have got the dreaded news of a cancer diagnosis and then of their passing. Indeed, as the debate started, I got a message that a friend and member of my party in Ballymoney had this morning lost his battle with cancer. That is a persistent theme that we encounter many, many times.

The Macmillan organisation provided us all, before the Assembly election, with the Macmillan manifesto. It identified for us that, every day, 30 people get the diagnosis they dread of cancer — that is to say that twice a week we could fill the Chamber to overflowing with those diagnosed with cancer — and 4,000 people a year die from this hateful disease. Therefore, doing all that can be done is an unavoidable imperative for us all.

We should also be mindful of the dedication way beyond the call of duty of so many who tend to cancer patients, of our excellent clinical nursing staff and people like the Macmillan nurses, who bring palliative care when it is needed most. Indeed, when you watch and see the work of people like that, each one of us in the House should realise that our job here is a doddle in comparison.

Photo of George Robinson George Robinson DUP

Would the Member include the Foyle Hospice in his congratulations?

Photo of Jim Allister Jim Allister Traditional Unionist Voice

I include all hospices that give the end-of-life care that is so needed; it is done so tenderly and with such sensitivity. We all should recognise that.

Given the all-embracing nature of the issue that we are discussing — it is no respecter, like death itself, of anyone — I have been somewhat disappointed by the ill-judged, knee-jerk reaction of some Members in the House. I understand that the Executive have a very low threshold of toleration for criticism, but some of the observations made today have been so ill judged in their churlishness and in their resentment of anyone daring to point out that things could be done better that, really, they do not speak well of those who have taken that stance. It is a fact — an unpalatable fact — that there are huge waiting lists in the Province.

Photo of Christopher Stalford Christopher Stalford DUP

I am very grateful to the Member for giving way. I think that he is right about the tone of the debate: given what we are talking about, it is important that it is struck correctly. Mr McNulty had the good grace to apologise to Mr Sheehan for the comment that he made about people being coached. Does the Member agree that, when comments like that are made, leading members of the Opposition should not be sitting tee-heeing and laughing?

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

The Member has an extra minute.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

I have no knowledge of what the Member refers to, but I will say this: Members from the Member's party should not be too quick to get on their high horse about this issue, because, last year, when we were debating cancer in the House, they absented themselves, pretending that they were objecting and marking an IRA murder — a pretence that, of course, soon fell apart when the lure of office once more overcame them.

Therefore, before too many get on that particular high horse, they should remember that, when we last debated this subject, they did not even think it worthy of contribution. The fact that this motion refers to the huge waiting list is not something to be resented, as Ms Lockhart seemed to resent it, for it is a fact that there are approaching 400,000 people in this Province on waiting lists of all varieties.

Photo of Patsy McGlone Patsy McGlone Deputy Speaker 4:30 pm, 18th October 2016

Will the Member draw his remarks to a close, please?

Photo of Jim Allister Jim Allister Traditional Unionist Voice

That is an indictment of this Government, and of the Executive.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I am very grateful once again to have the opportunity to set the record straight about a number of things that have been said throughout today's debate on the provision of cancer services. I thank all those people who shared their personal cancer journey and stories. It is not easy to get up in the House and do that.

I raised a point of order at the start of the debate, a LeasCheann Comhairle, because I believe that the motion is wrong. Not only is the spirit in which it is presented wrong but the facts noted in the motion itself are wrong. The Opposition, through the motion, seems intent on talking down our health service and the all the men and women who work really, really hard to provide that service. Let me start by saying up front that I am proud of the service that all those men and women provide day and daily to the people with cancer here and all the other people who need health and social care. I am proud of the dedication and hard work of the highly trained doctors, nurses and other medical professionals who provide such a high level of care to all our people. I am proud of the quality of the full range of health and social care services that we provide, not just for cancer but across the board.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

The Opposition have had two hours now to debate things, so let me get into what I want to say in response to all the comments made throughout the day. I am sure that I will answer everything that you have set out in your contribution.

Are things perfect? No, they are not. I have never stood once in the House and said that things are perfect. There is a recognition right across the piece that we need to tackle waiting lists and deliver better outcomes for people. That is the job of government. I consistently say that there are areas in which we can improve, but unlike the Members who tabled the motion, who ducked the responsibility of choosing to take tough decisions and make things better, I am not going to be found wanting in trying to fix the problems that we have in our health and social care system. I am determined to work with colleagues who want to be constructive. I am determined to work with stakeholders to make sure that we do more to deliver the improvement that we need.

It seems unbelievable that the Opposition would put forward a motion that is factually incorrect., but they have, and it falls to me today to correct a number of issues that were highlighted in the debate. The motion:

"notes with anger that, in June 2016, only 6·7% of breast cancer patients in the Southern Health and Social Care Trust area were seen within 14 days".

That is wrong. The 6·7% figure is for urgent referrals for suspected breast cancer cases. There is a very important distinction, so let me be very clear: that statement is wrong. It would be highly irresponsible, if not outright scaremongering, to send out a message that all people given urgent referrals have cancer. Thankfully, that is not the case. We need to be very, very clear, and I am not for one minute trying to diminish poor performance. I have said before and I will say it again that any underperformance needs to be tackled. In this instance, it is important that we also correct the false impression that is being irresponsibly created by the Members who tabled the motion. Allowing politically motivated misinformation to spread is bad for the health service and demoralising for patients and staff.

I understand the worry and concern that long waiting times can cause for patients and families. Performance has not been strong enough in many, many areas, but I am committed to dealing with the problem, because that is what you do in government.

I will set out my vision for health and social care next week, and it is going to include specific actions to deliver improvements in this area. I hope that, at that stage, the Members of the House will be as up for discussing all those issues with me and that they will be up for tackling the vital tasks in the time ahead.

It is absolutely right to hold Health and Social Care to account for the level of services it provides. That is why my Department sets targets for cancer services that are so challenging, because they can drive improved performance. But the kind of inaccurate, overblown criticism contained in the text of this motion does nothing to deliver improvements for patients or for staff. Instead, it creates fear and worry in the minds of those people at home who fear that the services they need will not be there for them when they need them or that their loved ones will not receive the level of care that they need. Blanket condemnations of public services and public servants is nothing more than Project Fear politics, and I believe they have no place in any discussion of the health and social care services that our people deserve.

Improvements have been made. Cancer services have been reorganised in recent years so that professionals with an expertise in treating the most common cancers can be brought together. Patients who are treated by professionals who specialise in cancer and work together as a team have a better outcome than those not managed by such teams.

There are five cancer units for the management of patients with more-common cancers and the provision of local chemotherapy services. Specialist radiotherapy services in the North are currently provided by the cancer centre at Belfast City Hospital, which opened in March 2006. The cancer centre will, next month, be supplemented by the £66 million investment in the new radiotherapy service at Altnagelvin. This is an example of my Department's commitment to delivering the best possible services to patients. The new radiotherapy service is a significant boost for our cancer service infrastructure. It will provide radiotherapy services to 90% of clinically suitable patients in the north-west region.

I am particularly pleased that the new development at Altnagelvin brings a welcome cross-border dimension to cancer services, with some €19 million in funding coming from the South. This is a small island, and it is so vital that we work together as much as we can to pool resources, share experience and deliver the best possible outcomes for our people.

Meeting the challenges that have been posed by cancer will continue to be a key priority. I believe we have made great strides in tackling cancer and have seen significant progress in the past. I wish to see that progress continue, and I can assure Members that I will continue to give due consideration to the need for a comprehensive strategy.

The recent underperformance in the breast cancer service in the Southern Trust is due to staffing issues. The trust has had issues in recruiting key surgical staff, and I am also sorry to say that the untimely passing of a senior doctor was a further blow. In that context, it is unsurprising that there was a significant drop in performance. It is so disappointing that politicians would seek to gain political capital from such circumstances. The Opposition should be ashamed of themselves. I am not interested in the Opposition's empty rhetoric of anger. It is empty rhetoric; it means nothing. I am not sure who that serves. Instead my focus —

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Let me just get through my points, and if I can, I will give you some time towards the end.

Instead, my focus is on delivering everything I can to drive improvement and ensure that the high standards we set for our services are met. Twelve out of the 209 patients in the Southern Trust who waited longer than 14 days for a breast cancer referral in June were subsequently diagnosed with breast cancer. Thankfully, 94.3% did not have a cancer diagnosis.

All of the 12 patients with a confirmed diagnosis have commenced treatment. Ten received their first definitive cancer treatment within the target of 62 days, which means that the initial delay in diagnosis had no negative impact on their receiving treatment within a reasonable time. One received their first treatment at day 63, just outside the 62-day target. The final patient was a more complex case, and treatment did not commence until day 81.

This is not to try to downplay the seriousness of the situation, especially for those two patients who did not receive treatment within the 62-day target. While I am far from satisfied with the level of service, I want to acknowledge the sterling service that the trust’s clinical team provided for their patients and to show the public that things are not as bad as they may first appear. I want to reassure people at home who may have sick loved ones or may be unwell themselves that the level of care they will receive from the doctors and nurses here is second to none.

Of course, there are issues in the system. I am committed to working with all parties in this Chamber who are interested in that collaborative approach to address all these issues. I hope my approach will be reciprocated on all sides.

Whilst I can always take on board and fully understand any concerns that are absolutely genuine, the future of the health service is too important for one part of the system to be debated as a knee-jerk reaction or in the heat of the moment. Instead, I acknowledge that performance is not where we want it to be, and I want to work hard with partners across the system to make sure that everything that can be done is done to improve it.

The decline in performance was first reported to my Department in June this year. As soon as I became aware of the issue, I asked the board to work with trusts as a matter of priority to find ways of improving the situation for patients. The board and the trusts have now put in place innovative solutions to work together to provide additional clinics to address the poor performance in breast cancer while maintaining safety for patients. In addition, the trust has extended its working hours, and that has facilitated the operation of a fourth breast clinic. It is early days, but there are signs that their efforts are having a positive effect. The latest provisional information indicates that performance in the Southern Trust has improved to 100%. I will continue to keep the situation under review, but I want to put on record my sincere thanks to all the staff and management in the Southern Trust and beyond who have worked so hard to recover the situation.

The issues in the Southern Trust highlight the challenges that exist across the system in maintaining acceptable levels of performance. That is why a workshop will take place on 26 October, bringing together breast cancer specialists from across the North to identify options for delivering a sustainable, high-quality breast cancer service for the future. I look forward to receiving the proposals put forward by the workshop and will ensure that they are given the priority that they deserve.

I pay tribute to the staff — I thank all Members who joined me in that — the management in the board and the trusts and, most of all, the doctors, nurses and technicians on the ground, who have come together to take action to improve the situation for their patients. It is easy for others to sit in the Assembly and talk about their anger; it is another thing to be on the front line delivering the services and putting structures in place to improve patient outcomes. These actions reassure me that our system continues to function, despite the picture painted by the Opposition. Of course, it is right to keep monitoring performance and to bring any problems to attention, but we do our health service and healthcare staff a massive disservice when we ignore the actions that they take daily to deliver their services.

The picture painted by the Opposition of our cancer services bears no relation to reality. They see a crisis that is "continuing to deteriorate", whereas, in reality, our cancer service is better than it has ever been. We treat more people for cancer than ever before. The number of patients treated for cancer has risen by 32% in the past five years. The latest comparative study of international breast cancer survival rates — I thank the Members who pointed this out earlier — show that the North has the best survival rate of anywhere in Britain and Ireland. Despite the increase in waiting times, we treat more people within the timescales than ever before. The five-year survival rate for women with breast cancer has improved over time, with survival increasing from 75% in the 1993-99 diagnosis period to over 80% in the 2005-09 diagnosis period. When adjusted for age and population change, the female breast cancer mortality rate has decreased by 1·3% a year.

The Opposition talk about a "wider unprecedented crisis" in the health service and bandy about a figure of 392,000 people on waiting lists. At best, that figure is the product of a woeful misunderstanding of the statistics published by my Department; at worst, it is a mischievous attempt, once again, to scaremonger. The Opposition appear simply to have added up the waiting list figures for outpatients, inpatients and diagnostics, despite the fact that the published statistics warn against doing that. It is clearly stated on the publication. For example, 19,919 endoscopy patients are included in both the inpatient and the diagnostic waiting times. That is just one of many examples.

Of course, as I said, I recognise that our service is under strain and that the arrangements put in place to help the Southern Trust are short-term solutions. The problems that affect cancer services are the same as those that affect the wider health and social care service: the challenge of rising demands on services linked to an ageing population and the finite resources available to meet that demand. I have been making the same case for cancer and for all other health services since I took up office five months ago.

There was a 17% increase in the overall number of red flag referrals for cancer between 2014-15 and 2015-16. That includes a 25% increase in breast cancer referrals and a 21% increase in lower gastro-intestinal (GI) cancer referrals. Why did that happen? It is testament to the good work being done across our health and social care system to successfully raise awareness. The campaigns taken forward by the Public Health Agency can make a significant difference to the level of referrals in any one year. One recent campaign contributed to an increase in referrals from 13,225 to 16,312, and I think that that shows that there is a real, meaningful difference being made in relation to awareness. October is Breast Cancer Awareness Month, and I encourage all women who are invited for breast screening to consider attending.

A growing, ageing population means that the number of people who will require cancer treatment in the future will continue to rise, with consequent pressures on health services. The ever-increasing number of new technologies and treatments for cancer, whilst good news in terms of early diagnosis and treatment, also contributes to those pressures.

The focus of the motion is on cancer services. The waiting lists are not good enough. Our people have a right to have the services there for them when they need them, and I will do everything that I can to make sure that that is the case. However, as Minister for the health service, I cannot pick one service over another, and nor can I prioritise one group of patients over another. The problems causing long waiting lists for cancer patients also affect every other part of the health and social care system. We have more people living longer lives, which is something that we should celebrate and be proud of, but it inevitably puts more and more strain on our health and social care services. We have no choice but to think again about how we deliver those services and to make sure that we make the funding that is available to us work hard to deliver the best possible outcomes for our people. That means radical transformation of all of our services, using the best clinical expertise to tailor services that are patient-centred. It also means giving renewed focus to areas like mental health that have not always been given the attention they warrant.

As I have said previously in the House and during the debate today, I will announce my vision for the future of health and social care services next week. It will set out the kind of health service I want to see for our people. Success in this will depend on everyone. It will depend on us all here as politicians working together to put the needs of our people first and not seeking to protect special interests. Put simply, it will take political leadership. It depends on our excellent doctors, nurses, clinicians, technicians and other medical professionals. It will depend on the third-sector organisations that do so much to help in their own areas of interest. It will depend on our people too to get involved in shaping the services they want to see for the future. Delivering improved cancer services as part of a transformed health and social care system is a significant challenge, but it is one that we do not shy away from. It is one that we will face up to.

In conclusion, a Cheann Comhairle, thank you for the opportunity to correct some of the mistruths and scaremongering that have been put out in relation to the motion. We should all concern ourselves with being constructive, delivering better outcomes and not trying to alienate and, I suppose, put pressure on the healthcare professionals who work day and daily to deliver better services. The Opposition's time would be much better used being constructive and offering alternatives, but I did not hear one alternative here today. All I heard was them sitting on the sidelines from the safety of opposition and not being prepared to take the hard decisions that need to be taken. The Executive are committed to taking the decisions and delivering better outcomes, and I think that that is a better outcome for all of the people who elected us to come in here and make a difference.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party 4:45 pm, 18th October 2016

I rise to wind up on the motion. I thank all Members and, indeed, the Minister for their contribution to what should have been a largely constructive debate on an issue that should unite us all. I thank and pay particular tribute to those who shared personal and painful experiences with the House.

This is Opposition day, and our role as the official Opposition and, I am sure, that of members of the unofficial opposition is not to oppose everything that government does. We recognise and acknowledge the good work that has been done and the good work that is being done, and we certainly recognise the unbelievable and heroic work of people in our health service: doctors, nurses, nursing assistants, porters, the whole shebang. We could not ask for more from them. Our role is to challenge government to do better, to deliver more, to deliver better and more efficient services and, on this matter, to provide better care for people living here. There is no doubt that we can, we should and we must do better.

There has been much derision — misplaced, in my opinion — from the Government Benches about motions brought by the Opposition thus far. This is not about politics; this is about people.

We do not just want to talk about issues that matter to people; we want to see changes that have a positive effect for and on people. It is difficult to think of a more positive effect than ensuring that people get timely access to quality healthcare when they need it and reducing the number of people who need that healthcare in the first place.

The motion makes specific reference to cancer services. Yes, we heard from the Minister in the Chamber today and recently in response to a question for urgent oral answer from me on cancer services. We have had questions for urgent oral answer, but patients — people — want to see urgent action. I call on the Minister to implement the recommendations of Cancer Research UK's report on cancer services here in Northern Ireland. The Executive should conduct a review of diagnostic capacity, including direct access for GPs, and outline steps to ensure that capacity can meet rising demand.

The health service needs to develop national data sets for chemotherapy and radiotherapy. That would support ongoing evaluation of how services are performing or, in some cases, sadly, not performing. The Department should review workforce capacity and treatment services to understand where there are shortfalls in staff and set out how they will be addressed. The Department, with the trusts, should undertake work to clarify why operating standards for cancer are not being met.

Crucially — a few Members referred to this; indeed, the Minister herself referred to it — we need a new, comprehensive cancer strategy that sets ambitious goals and allocates sufficient resource to ensure that cancer services can improve outcomes, meet rising demand and reduce the undeniable variation in care that exists across the North. I welcome that the Minister has now committed to such a strategy. Obviously, she has given it the due consideration she said she would.

I will touch on some of the contributions Members made. The motion was proposed by Jo-Anne Dobson. She referred to an announcement by a previous Health Minister of £40 million that was allocated specifically to deal with waiting lists, but it was later revealed that £18·5 million of it was spent elsewhere. She spoke of the sense of fear and dread and of the impact that a cancer diagnosis has on someone and appealed for a calm and measured approach to today's debate. She highlighted the very real and serious impact of diagnosis being delayed and how that can result, ultimately, in fatal outcomes. She described the performance of some trusts as atrocious. Indeed, on occasion, they do give cause for concern. That is what led to the motion. But we all have to recognise, which we do, when trusts are doing well, and I pay tribute to the Western Trust specifically in this regard. She spoke of her own experience at the hands of cancer, and everyone in here will have their own harrowing tales of loved ones lost.

The SDLP family lost someone very dear to us; a member of staff in this Building, Stephen McKiernan. He fought a very long and hard battle with cancer. Sadly, he ultimately lost that battle. So many Members from so many parties have attended in the two years since his death coffee mornings we have run in conjunction with Macmillan in his memory. That is cancer bringing us together and making us unite. I know how touched and appreciative his wife, Julie, is that there is support for that event from right across the political spectrum.

Ms Dobson says we need to be equipped and ready to respond to the increase in demand brought about by public awareness campaigns. Indeed we do. There needs to be proper workforce planning. We need the right people in the right places, and we need enough people in every place. She spoke of the importance in that regard of longer-term budgets. That is important in the long term, as people living with cancer cannot afford to wait. She outlined, as did many contributors, the fact that there are humans behind the statistics and that people deserve better.

In her contribution, Catherine Seeley began by commending the Marie Curie nurses, and I certainly echo that commendation, having seen at first hand the tremendous work that they do. She urged women to book a screening as part of Breast Cancer Awareness Month, a call that I also echo. She spoke of the tireless efforts made by staff and the Department. We also recognise that, but, I am sorry, the figures do not lie. "This problem is not new", the Member said; therefore the problem has been not solved. We need to see it solved and we need to work together to get it solved. She actually described the motion as:

"an insult to ... hard-working ... healthcare staff"

That is completely off the mark and, in my opinion, out of order. Nobody says more about the problems in our healthcare system than our hard-working healthcare staff, and nobody wants to see them fixed more than they do. I do not know if the Member has seen any of the comments of her party colleagues in the South on waiting lists there. Are they attacking workers in hospitals and doctors in the South?

We had a very positive contribution, I thought, from Edwin Poots, a former Health Minister, who wished the current Minister well, as do I. He spoke of his role in giving the go-ahead for the radiotherapy unit in the north-west. I again thank him for that. He spoke of the work of the Pink Ladies Cancer Support Group in my constituency. They, and many other groups like them, do invaluable work; it is often unheralded and I take this opportunity to pay tribute to them too. He outlined the rationale behind his approval of the centre and said that it was not just for the people of the north-west; it was part of an overall strategy to ensure easier access to cancer services for people across the North. He spoke of the good performance here on breast cancer and the need to constantly strive to improve — that is what we are doing.

(Mr Deputy Speaker [Mr Kennedy] in the Chair)

My party colleague Sinead Bradley made a very emotive contribution. She is conscious of people waiting on lists, and the stories behind those lists, where people are living in a vacuum, awaiting a diagnosis, and then there is the tendency to cyber-self-diagnosis. She reiterated the fact that we are not, in any way, attempting to fault or slight workers. She urged the Minister, and her Government colleagues, not to go into defensive mode; but that plea has obviously fallen on deaf ears. I really cannot understand this circling of the wagons that has taken place.

Photo of Linda Dillon Linda Dillon Sinn Féin

Go raibh maith agat. I do not think that there was any defence of the waiting lists. The Minister was very clear that the waiting lists are unacceptable. The defence was around the wording of the motion and the fact that it is incorrect. There are inaccuracies in it. If we are talking about temperate debate, it would be more prudent of the Opposition to bring forward a motion that was factually correct and which everybody in the House could possibly have supported.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Member for that intervention. It is clear that, in some cases, even attack has been seen as the best form of defence, because of the number of attacks that were launched, not just on the content of the motion but on the spirit in which it was brought. Any study of today's debate in Hansard will clearly show that it was the tone and content from the Government Benches that was less than conciliatory.

Kellie Armstrong spoke of the human impact from first-hand experience. I welcome her contribution and commend her courage.

Pat Sheehan said that every debate should be balanced and fair. We should be "judicious in our language" and refrain from trying to score political points. He then proceeded to a critique of the motion in language that was a wee bit less than judicious and certainly not short on political point-scoring. I sympathise, albeit belatedly, with Pat on the loss of his wife. I am sure that that is something that hurts greatly and always will.

The best way to improve the system is to work together, and that is precisely why the motion should be supported by everyone here.

Gary Middleton said that the Opposition cannot have it both ways: we cannot praise workers and criticise services.

I did not hear anybody saying that heads should roll. When it comes to having it both ways, perhaps the Member should cast his mind back to when a Minister from his party was trying to close care homes, and they were protesting outside them.

Carla Lockhart said that the motion was too specific to one form of cancer. I have never heard any motion opposed in here on the grounds of being too specific. Other parts of her contribution were excellent, and I concur entirely, particularly on the cancer strategy.

I will move on a wee bit. Many Members made many valid points; unfortunately, I do not have time to cover them all. The Minister said she was grateful for the opportunity to set the record straight. She is proud of those working in healthcare: I think what we have established today is that we all are. She said that the Opposition ducked responsibility by not taking the Ministry. Again, I will ask this: did her party duck responsibility in the South? She has promised to set out her vision for health and social care next week, and we look forward to that. We regret, however, that the public have not had time to read the Bengoa report in advance of her vision being made public. She outlined some of the undisputed good work being done in tackling cancer here. That is great, and we all want to see more of it. The Minister's attack on the motion, its proposer and its supporters was, in my opinion, ill judged. I am not going to get dragged into a slanging match with her. We will work with her and with others in transforming the health service, if she will let us, because, every day, we see and hear more compelling evidence that it needs to be transformed.

In conclusion, I would just like to ask this: which part of the motion are Members opposed to and voting against today? Members raised and, yes, the Minister addressed the Southern Trust figures, and she described them as unacceptable. The motion notes those "with anger"; maybe it should have been more in sorrow than in anger. We have said not that cancer services are deteriorating but that the crisis affecting them is. Is it not? Have we not to respond to that crisis?

We ask that the Assembly:

"accepts the importance of timely diagnosis and treatment of cancer, as any delay can reduce the likelihood of a successful outcome".

I have not heard anything today to suggest that the Assembly does not accept that fact. The motion says that this is:

"symptomatic of the wider unprecedented crisis engulfing the ... health service".

Yes, it is a crisis and, yes, it is unprecedented. Has there been a time before when there have been 400,000 people on waiting lists, regardless, Minister, of how that is computed? The Minister said that the problems facing cancer services, increased demand and workforce planning, are reflective of pressures right across the health and social care system. We ask the Minister to intervene. Will she not? Why are parties voting against the motion today? Now, that really is opposition for opposition's sake.

Some Members:

Hear, hear.

Photo of Danny Kennedy Danny Kennedy Deputy Speaker

Order. Thank you. That concludes the debate.

Question put. The Assembly divided:

<SPAN STYLE="font-style:italic;"> Ayes 32; Noes 62

AYES

Mr Agnew, Mr Aiken, Mr Allen, Mr Allister, Ms Armstrong, Mrs Barton, Mr Beattie, Mr Beggs, Ms S Bradley, Mr Carroll, Mr Chambers, Mrs Dobson, Mr Durkan, Mr Eastwood, Dr Farry, Mr Ford, Ms Hanna, Mrs Long, Mr Lunn, Mr Lyttle, Mr E McCann, Mr McCrossan, Mr McGrath, Mr McKee, Mr McNulty, Mr McPhillips, Ms Mallon, Mr Mullan, Mr Nesbitt, Mrs Overend, Mrs Palmer, Mr Smith

Tellers for the Ayes: Mr Aiken, Mr Mullan

NOES

Mr Anderson, Ms Archibald, Mr Bell, Mr Boylan, Ms Boyle, Mr M Bradley, Ms P Bradley, Mr K Buchanan, Mr T Buchanan, Ms Bunting, Mrs Cameron, Mr Clarke, Ms Dillon, Mr Douglas, Mr Dunne, Mr Easton, Ms Fearon, Mrs Foster, Mr Frew, Ms Gildernew, Mr Girvan, Mr Givan, Mr Hazzard, Mr Hilditch, Mr Humphrey, Mr Irwin, Mr Kearney, Mr Kelly, Mrs Little Pengelly, Ms Lockhart, Mr Logan, Mr Lynch, Mr Lyons, Mr McAleer, Mr F McCann, Ms J McCann, Mr McCartney, Mr McCausland, Mr McElduff, Mr McGuigan, Mr McGuinness, Miss McIlveen, Mr McMullan, Mr Maskey, Mr Middleton, Mr Milne, Lord Morrow, Mr Murphy, Ms Ní Chuilín, Mr Ó Muilleoir, Mr O'Dowd, Mrs O'Neill, Mr Poots, Mr Robinson, Mr Ross, Ms Seeley, Mr Sheehan, Mr Stalford, Mr Storey, Ms Sugden, Mr Weir, Mr Wells

Tellers for the Noes: Mr Milne, Ms Seeley

Question accordingly negatived.

Photo of Danny Kennedy Danny Kennedy Deputy Speaker

Members may take their ease while we make changes at the Table.

Order. I ask Members, if they are leaving the Chamber, to do so quietly. Thank you.

Motion made: That the Assembly do now adjourn. — [Mr Deputy Speaker (Mr Kennedy).]