Northern Ireland Assembly Flax Flower Logo

Northern Ireland Assembly

Tuesday 5 March 2002 (continued)

My Department issued a consultation paper last autumn on the further exploitation of our renewable resources. The results of that consultation are currently being analysed. Harnessing new renewables potential must play a key part in progressing the energy agenda. My plans for the greater use of renewables, including revised trading arrangements and the possible introduction of renewables obligation, will be contained in the draft energy strategy statement planned for later this year.

3.15 pm

My Department will also contribute to a study into the capacity of the electricity network to cope with increasing amounts of renewable energy, especially wind energy. My overall aim is to stimulate rapid deployment of renewable energy resources without an unacceptable increase in the price of electricity.

The announcement from the Executive and the Irish Government last autumn supporting the north-west and South/North gas pipeline project was probably the main and most exciting achievement of the past 12 months. The Committee, working in the background, played no small part in helping to achieve that important breakthrough, and I pay tribute to its efforts. The regulator has recently granted a gas conveyance licence to Bord Gáis in respect of the project, and I shall shortly ask the regulator to invite expressions of interest for the distribution of gas into towns along the pipeline route. Many Members have been pressing for that as it will indicate whether there is any interest in supplying gas to those towns.

On many occasions, I have made clear my commitment to the creation of a more integrated and competitive energy market on the island of Ireland, within a European context. I was grateful for the report published by IPA Energy Consulting last autumn. My counterpart in Dublin, Mrs O'Rourke, and I hope to announce an action plan arising from that report in the near future.

An all-island market is not a panacea for the problems in the local energy market, nor will the benefits of an all-island market appear overnight. A great deal of careful consideration must be given to the wide range of technical, financial and legal issues involved. It is vital that the transition to an all-island market is properly planned, bearing in mind that there is almost a public monopoly in the Republic and a privatised sector here. We must also remember that an energy market of five million people is fairly minute. Through Great Britain, major links to the EU must be maintained if we are to get the properly open market that we need.

The Committee has made an impressive number of detailed and wide-ranging recommendations. Approximately three quarters of them will fall to my Department for response, with the remainder falling to other Departments. My initial view is that many recommendations are sensible, including those on revised consumer representation arrangements, the greater use of renewable energy, the benefit of energy efficiency and the support for the extension of the gas industry. Others cause me more difficulty, including the recommendation that all new gas-fired power stations should be combined heat and power stations and the provision of grant aid to domestic consumers who are seeking to avail themselves of energy from renewable sources.

I shall reflect on the Committee's report, and I shall seek the views of my ministerial Colleagues before preparing my formal response. It would be sensible if I were to take additional time to incorporate, where appropriate, the responses to the Department's energy strategy consultation paper, which will be issued in the next few days. Responses to that paper will be requested by 30 April.

In his opening remarks, the Committee Chairperson set the scene for the report, but he and several other Members emphasised the issue of fuel poverty. The statistics are shocking - 28% of households fall into that category. An initial consultation paper on proposals for the new energy strategy and the accompanying legislation will include an invitation of views on a possible increase in the £2 levy, which is currently collected by NIE from customers for investment in energy- efficiency projects under the regulated scheme. We shall carefully consider recommendations in the light of responses and discuss them with the regulator - who has also recently consulted on the proposals - and with the Department of Finance and Personnel. A formal written response will be given to the Committee's report.

I shall give details of an anecdotal case. In my constituency, Willowfield is a target area of the warm homes scheme, and it is twinned with Turf Lodge in west Belfast. A few weeks ago, I was present at the opening of a house that had all the benefits of the scheme.

Gas central heating had been installed. Extra insulation, loft installation, low-energy bulbs and electric kettles, and a whole range of other things were also installed. That was a fantastic job for the elderly resident, who no longer had to worry about bags of coal. It was much cheaper. The sad thing is that there are insufficient applicants for the scheme. We have not got the message through to the grass roots.

We were unable to implement the scheme in that area, even though funds were available. Therefore, money is not the only issue. We must get the message across to people. It is a fantastic scheme and a wonderful example of what can be achieved. There are savings in convenience, health and cost. The money is lying there, yet the Housing Executive is unable to spend it because of the insufficient number of applicants. That is something that we must take on board.

Like other Members, I am pleased to see Mr Neeson in his place again. I am aware of his long-term interest in the gas sector. I appreciate that his constituency plays a significant role in energy in Northern Ireland. However, one of the technical matters that he raised was that of postalisation. That may be double Dutch to many people. When people criticise us, they sometimes forget that there is postalisation for electricity. Does anyone seriously believe that it costs the same to get electricity to Carrickfergus as it does to Belleek? Of course it does not. However, is anyone seriously suggesting that Belleek residents should be charged the economic rate for getting electricity to them?

Dr McDonnell:

Yes. [Laughter]

Sir Reg Empey:

From the safety of the Malone Road, that was probably to be expected. [Laughter]. It is not something with which most Members of the House would agree.

Postalisation seems reasonable. Take the postal service. One stamp delivers everywhere, and it is exactly the same principle. The gas industry should not be discriminated against. Therefore, I fully support the concept.

Some people say that this will have an adverse impact on electricity prices. I say that to bring in gas will have a beneficial effect on electricity prices overall. There is a large fuel cost element in our electricity bills, and increases in fuel costs are automatically transferred to the customer. The more efficient the power stations are, the less fuel they use, and, therefore, less energy costs are transferred to the customer. Gas-fired electricity generation is more efficient than the old methods used in the 1960s and 1970s. There are benefits to be gained. I agree with the Deputy Chairperson that the process of postalisation should take place.

Dr Birnie raised several issues, including that of building regulations. That issue was also raised by Mr McMenamin. I shall come to that in a moment. Dr Birnie also said that I should deal with Northern Ireland companies' ability to build power stations and to supply electricity in the Republic. He said that I should raise that issue at the North/South Ministerial Council with my counterpart there. I point out to Dr Birnie that energy is not one of the matters dealt with by the implementation bodies. There are purely ad-hoc arrangements between our two Departments. I am happy to draw any of those matters to the attention of the Department of Public Enterprise in Dublin. That can be done through a phone call.

Dr Birnie raised the issue of the Kyoto protocol and the nuclear side of things. I am aware of the concerns that people have about nuclear issues. One view expressed was that no electricity generated by nuclear power should come into Northern Ireland. Just as it is impossible to tell the difference between "orange" electricity and "green" electricity, so it is impossible to tell the difference between nuclear- and coal-based electricity. Unless some testing mechanism is developed, we shall not be able to distinguish between them. What comes through the Moyle interconnector ends up in a pool in GB, and we have no control over where the electricity is generated.

Nuclear covers about 20% of generation in the UK, but if it is got rid of, it must be replaced with something else. If that is not renewables, it will be coal, oil or gas. I understand the difficulties, but there is no easy answer. The end result will be that more fossil fuels will be burned, instead of dealing with the nuclear issue.

Dr McDonnell said that the basic objective is to have a good, reliable energy supply at a reasonable price. That is exactly what we want. However, there is a misunderstanding among Members about the contracts. The generators are not necessarily evil people who have scooped a fortune and have a licence to print money. The generators had to pay more for the power stations than they were worth, and that is why we have difficulty with those contracts. When privatisation was taking place in Great Britain, the money that the Government got for the power stations was equivalent to £109,000 per megawatt. In Northern Ireland they got £166,000 per megawatt. The Government got a significant premium for selling the generation capacity in Northern Ireland in comparison to what they received in Great Britain. That is why we have difficulties now.

The power stations are being paid for availability. If they do not turn a wheel they are paid the same as when they are producing. People must understand the origins of that difficulty.

Mr Wells said that the inquiry started as a stroll and ended up as a marathon. During his remarks, I formed the conclusion that staff in my Energy Division and others were making the same contribution that he thought he was making in Magherafelt, and I tried to picture some of them in uniform going around issuing tickets for bad parking. I understand and sympathise with him that it is very difficult to draw a crowd for some of those issues. However, that does not mean that they are not important, and he is right to concentrate on it.

Mr Wells also said a lot about Orimulsion. I met the Venezuelans through their ambassador and a representative from their company. We must think also about the treatment and the working conditions of the people who produce Orimulsion. Much criticism has been directed at the state company in Venezuela, and what is deemed to have been the exploitation of the environment and the people who produce Orimulsion.

Much depends on a major environmental assessment. Unlike oil, Orimulsion sinks. Therefore, if anything happened in Belfast Lough, Orimulsion would not float and be contained in the usual way - it would sink. I am not yet satisfied that a mechanism or procedure exists to deal with it in those circumstances. Whether those circumstances are better than what we have with oil, or whether they are worse, I am not sure.

3.30 pm

However, much will depend on its environmental impact. I have an open mind on the Orimulsion option, as does Mr Wells, because it could possibly cost less and result in environmental improvements. I also accept the need to consider fuel diversity, so that we do not return to being wholly dependent on fuel oil, which was the position a few years ago.

Any decision to convert to the triple firing of coal, oil and Orimulsion in Kilroot, and the accompanying refinancing of the existing contract to 2024, which would be required to allow the providers to recoup their investment, requires the agreement of the owners, AES Kilroot, and NIE. The decision would be subject to the satisfactory outcome of economic appraisals by the independent regulator and the granting of the necessary statutory consents from my Department under the Electricity (Northern Ireland) Order 1992, and planning approval. There is a long way to go, but I do not underestimate its significance.

Ms Morrice spoke about the complexities of the industry. I have come to that conclusion independently, and I can assure the Member that it is highly complex. The targets for renewable energy have been set at 15% by 2010 and 35% by 2020. The responses to the recent consultation paper 'Renewable Energy in Northern Ireland - Realising the Potential' are currently being evaluated. In addition to that, the Department and NIE will sponsor a comprehensive study of the electricity network to determine the extent to which renewable energy sources can contribute safely to mainstream electricity supply. Part of the problem is that when the wind is blowing, a surge is created. When the wind is not blowing, the supply stops. There are technical reasons to be considered, which will be addressed in that comprehensive study. We will learn as we go, but the possibilities of renewable sources of energy will require us to smarten up and deal with that matter.

Dr O'Hagan dealt with generator contracts and the all-island market, and the fact that we face a public sector versus private sector situation. With regard to the all-island market, my counterpart Mrs O'Rourke and I commissioned a study last year to assess existing arrangements, to identify barriers to trade and to consider the options for collaborative progress. We will have to await the outcome of that study before I can take matters further.

Mr McClarty mentioned the European dimension. Major energy projects, including the Moyle interconnector and the Scotland to Northern Ireland pipeline (SNIPS), have had European support in the past. It is yet to be determined what the European situation will be with regard to the gas pipelines. The issue will be progressed, but I am not yet in a position to determine whether there will be a European dimension to that project.

Mr McMenamin and other Members referred to the building regulations, which will affect the future. He also mentioned the lifespan of houses; I live in a house that is considerably older than that which he spoke about, but I am aware of the issues. Responsibility for building regulations rests with the Department of Finance and Personnel. I shall consult Dr Farren on the relevant recommendation and include the outcome of that consultation in my written response to the report. I shall deal with that matter later.

Mr Clyde spoke about greenhouse gases and renewable energy. Mr Armstrong spoke about waste. One gets the impression that he has a connection with the agriculture industry, but he made a valid point that is high on the agenda, and which I take seriously. My Colleagues in the Department of Agriculture and Rural Development have a problem with the tightening of the regulations governing the disposal of slurry, and anaerobic digesters are a possible solution. Arthur Doherty spoke about lignite. If the power providers at Ballymoney make an application, it will have to be treated in the same way as other applications, but there are significant environmental concerns.

A Government support fund of £60 million was announced in 1995 to help to reduce electricity prices. The use of that fund was determined by direct rule Ministers. An initial £15 million was spent to reduce the level of tariff increases in 1996-97. A further £5 million was set aside in 1997 to fund long-term energy efficiency programmes, such as the warm homes scheme, which are now managed by the Department for Social Development.

The final £40 million was used to buy down some of the costs of generator contracts. Some £10 million was spent at Ballylumford and £30 million at Kilroot. Adam Ingram, the then Economic Development Minister, announced that decision in March 2000. My role was to confirm that this offered the best long-term benefit for customers from the final tranche of money. I did that in June 2001, when various tripartite legal agreements had been drawn up and VAT issues had been resolved. There is a great deal of misinformation about that fund.

I thank the members of the Committee and Members of the Assembly for their participation today. We will take the comments seriously, and we will respond in full. I will be seeking the co-operation of Members and the Committee when I introduce the legislation that is necessary to implement as much as possible. I intend to have it done in the lifetime of this Assembly, but I will require the co-operation and goodwill of Members if I am to achieve that.

The Chairperson of the Committee for Enterprise, Trade and Investment (Mr P Doherty):

Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister and the Members who participated in the debate. I am greatly encouraged by the Minister's support for the report. We covered a huge range of issues, such as bonds, renewables, nuclear energy, Orimulsion, fuel poverty, Coolkeeragh, the gas pipeline to the north-west, the 1992 contracts, human energy, postalisation, EU support, building standards, biomass, combined heat and power and the generation of heat and power from waste.

Everyone who spoke touched on those issues to some extent. However, before I deal with the individual comments I thank the members of the Committee for the enormous amount of work and energy that they put in collectively over the past year to produce the report and to produce - and I reflect the Minister's words - this mature debate. It is a credit to the Committee that it has presented the report in the way that it has. I also thank the Special Adviser to the Committee for his enormous help as we waded through seven or eight drafts to come to this final conclusion.

The Committee's Deputy Chairperson, Mr Neeson, spoke clearly about the licensing of the pipeline to the north-west and his support for that, and of Coolkeeragh and the absolute need for postalisation and support for the pipeline going through the towns in the north-west. He also mentioned Orimulsion, the strong environmental and Assembly guidelines to be met and the need for us to not put all our eggs in one basket.

I will come back to the question of Orimulsion and the subject of bonds, because at times during the debate one might have thought that we had a slight difference of opinion on those subjects. We agreed to have a "triple lock" on the question of Orimulsion. Some Members approached the triple lock by way of unlocking it, others approached it by way of leaving the lock on. We recognised that that issue had potential, but huge issues with regard to the economy and the environment had to be dealt with. Likewise when we touched on bonds we correctly decided that, as the Minister was about to launch a fairly major inquiry - and he has many more resources than we have - we should await the outcome of his review.

Dr Birnie spoke about the building regulations, nuclear power, and ESB's monopoly in the South, which is true. The Committee decided not to take evidence on the use of nuclear power, which we are unanimously against. We knew that we were leaving ourselves open to a challenge on that, but the political view was strong, and we stated that in the report.

Dr McDonnell summed up the strong view of the Committee with the phrase "scandalous contracts". However, he also pointed out that even though the ESB has a monopoly in the South, NIE has an effective monopoly in the North and we are dealing with two big, strong companies as we move into this new era. He also said that this is but a stage in the debate, which is another strong point, as we will undoubtedly return to the matter often.

Mr Wells talked about nuclear power, the triple lock in Orimulsion, fuel poverty and renewable sources of energy. He contributed a good deal to the debates on Orimulsion and fuel poverty, and I thank him for his clear views on those serious issues.

Ms Morrice spoke on renewable sources, which became her main issue. We deferred to her views often and leaned on her sometimes to produce additional papers for the Committee - we thank her for that effort. She said that we are blessed - or some would say not so blessed - with high winds that we could harness and match to local skills that have always existed in the North. She made a key point when combining all those factors - that we should use the will, the political will and the confidence to tackle all those issues, match our human energies with our natural wind, with emerging skills and those that have existed here in abundance for some time.

Dr O'Hagan talked about renewable sources and Orimulsion; she came up with a different perspective on the triple lock. She spoke clearly about the generation contracts and queried whether there is potential within EU legislation for legal options that might help us deal with the contracts. She also spoke of the abiding problem of fuel poverty and how we can overcome it.

Mr McClarty spoke clearly about postalisation, his and the Committee's support for that, fuel poverty, his clear support for the north-west pipeline and the economic imperative for that to go ahead, together with the need for European support to build it.

The newest member of the Committee, Mr McMenamin, talked about "warm homes", a simple phrase that sums up much of the debate on fuel poverty. He also spoke of the need to upgrade building standards and the need to try to expand the scope to opt-out on the climate change levy.

Mr Clyde spoke of the cost of electricity, and it was that very question - "Why is the cost of electricity so high?" - that began our inquiry into energy. That core issue kept us focused on our deliberations. Mr Clyde also spoke about Orimulsion and the potential development of the biomass process given Ireland's agricultural background.

3.45 pm

Mr Billy Armstrong talked about waste management and the potential for using waste to generate heat and power. He also spoke about the biomass and biogas processes. Arthur Doherty spoke about tilting at people who tilt at windmills, and left me wondering what he really meant by that. He was clearly against Orimulsion, nuclear energy and lignite but strongly supported the development of wind energy.

The Minister described this as a mature debate. I thank him for that, because the Committee worked maturely and produced a mature report. He spoke of the gas network, the Moyle interconnector, the revised energy strategy and legislation within the lifetime of the Assembly.

There were five key points: electricity costs; improving energy efficiency; renewable energy resources; gas network extensions; and the all-island energy market in an EU context. We all recognise that there are technical and legal issues. The Minister acknowledged that three quarters of the 45 recommendations were within his Department's remit.

The Minister gave us more information about the problems associated with Orimulsion - such as workers in Venezuela who are badly treated, and some technical aspects, which we need to consider carefully. He also gave us more information about how those bad contracts came about in the first place. He blamed the direct rule Ministers, and there is no harm in that.

I thank Members for the way in which they approached the debate and recommend the report to the House.

Question put and agreed to.


That this Assembly approves the report of the Committee for Enterprise, Trade and Investment on their inquiry into the Energy Report (3/01R) and calls on the Minister of Enterprise, Trade and Investment to implement the Committee's recommendations at the earliest opportunity.

Committee for Health, Social Services and Public Safety:
Report on Cancer Services


The Chairperson of the Committee for Health, Social Services and Public Safety (Dr Hendron):

I beg to move

That this Assembly approves the Second Report of the Committee for Health, Social Services and Public Safety (2/01R) on the Delivery of Cancer Services in Northern Ireland and calls on the Minister of Health, Social Services and Public Safety to implement the Report's recommendations at the earliest opportunity.

I am pleased to bring the Committee's second report of this session before the Assembly. The report examines the delivery of cancer services in Northern Ireland, and I am gratified that it enjoyed the unanimous support of Committee members. I thank them for their hard work and positive support throughout the inquiry, which began in May 2001. I thank the Committee Clerk and staff, in particular the Assistant Clerk who worked so hard for the last nine months to produce the report. The Committee also wants to record its gratitude to the 31 organisations and individuals who gave evidence orally and made excellent written submissions, which were most enlightening. Those witnesses included representatives from the Ulster Cancer Foundation, Action Cancer, Macmillan Cancer Relief and many other bodies.

The Committee undertook an inquiry into cancer services primarily for three reasons. First, there was consensus on the need to focus on a disease that is expected to overtake coronary artery disease to become the number one killer in Northern Ireland in the next five years. Every Member, I am sure, has someone in his or her immediate or extended family who has had, or has, cancer.

Secondly, the Committee was aware of the considerable public concern about the quality of, and access to, cancer treatment. There have been widespread reports of the most intense pressures on staff and equipment at Belvoir Park Hospital. The hospital staff are doing their best to cope until the new regional cancer centre is built. The pressures have led to much frustration and disquiet for patients and staff. Members may have heard Dr Russell Houston talk about that problem on the radio this morning. The Committee visited Belvoir Park Hospital, and it has been debating the issue of whether to invest in Belvoir Park or to wait until the new cancer centre is completed at Belfast City Hospital. There are major problems in that area.

Thirdly, it was felt that such an inquiry would be a timely opportunity to review the progress on the recommendations for cancer services that arose from the Campbell Report of 1996. Although there have been welcome advances in cancer treatment since then, the evidence points equally to continuing variations in quality and provision of treatment for different cancers across Northern Ireland.

I will not give anecdotal evidence about cancer patients, but I want to emphasise the lack of uniformity of treatment across Northern Ireland. Some people die of cancer unnecessarily, and there is difficulty in obtaining early diagnosis, which is a key element of successful treatment.

The report is wide-ranging and covers matter such as the needs of patients and palliative care and important strategic issues such as cancer prevention and information management. However, in the limited time available, I want to concentrate on three areas. No doubt my Committee Colleagues and Members will pick up on other important points. I will restrict my comments to the key areas of the report: resources, the regional cancer centre and - an area in which I must declare a personal interest - primary care and the role of the general practitioner.

Cancer is a major public health problem. The financial cost of early diagnosis, treatment, care and support for patients is huge. A combination of clinical advances, an ageing population and an increase in patient expectations will contribute to increased pressures on cancer services for the foreseeable future. Therefore it is imperative that the ambitious plans for the new regional cancer centre, an expanded cancer workforce, new diagnostic equipment, drugs and information systems be accompanied by the requisite funding levels, if they are to meet the long- term needs of the population successfully. That will be no easy task in the current climate of tough governmental budgetary constraints.

The question of funding for cancer services is a microcosm of the wider debate on the long-term resourcing of the Health Service. In that context, it is worth pointing out that the UK Government spend just under 7% of GDP on health, by comparison to an average of 8·6% in other Western countries. In France the figure is 9·6%, and in the United States of America it is 14%. Recently I was told that, in the USA, $1 is spent on diabetes- related conditions for every $7 that is spent on health.

We must face the reality that securing a first-class health service for the future and for the treatment of cancer will be achieved only at considerable cost. However, our people deserve the best.

There is no dispute that significant funding has been ploughed into cancer services since the Campbell Report of 1996 to help to bring about a patient-focused realignment of services. Some £13 million of additional funding per annum has helped to meet the escalating drug costs, brought about improvements in infrastructure and provided for the appointment of over 200 additional cancer staff. The provision of an extra £3 million this year for the development of local cancer services, on top of £7 million in 1999-2000 and £8 million in 2000-01, has helped to provide a welcome boost to specialist staffing, including two additional consultant oncologists and 70 nurses.

The Committee also welcomed the provision in July 2001, by the new opportunities fund, of £6·4 million towards a range of innovative projects aimed at cancer prevention, detection, treatment and care, including funding for four much-needed magnetic resonance imaging (MRI) scanners. However, that is no substitute for the provision of mainstream Government funding for cancer services in a planned and rational way. I appreciate that the Minister has put in much effort to provide MRI scanners, and I thank her for being present at today's debate.

The Committee notes the vital financial contribution made by the voluntary sector to cancer services. However, it also recognises that there has been an over- reliance on that sector, particularly for palliative care and information services. It is clear that the increasing demand for cancer treatment year-on-year, and the rapid development of new drugs, will require an increasing level of resources. Drug costs are currently estimated to increase annually by £7·5 million over the next three years. The number of referrals to oncologists has risen from around 3,400 in 1996 to over 4,000 in 2000. The figure is eventually expected to rise to some 6,500. The cancer workforce plan, including training, will require considerable resource commitment. The latest figures for the regional cancer centre are £57 million for the capital build and £10·5 million for annual revenue costs.

In view of the patent need for substantial additional investment in cancer services, the Committee was shocked to learn of the growing disparity in funding allocations for health services between here and England. The inquiry highlighted an alarming gap in expenditure on health and personal social services between Northern Ireland and Great Britain, where the growth in expenditure in real terms amounted to 35% and 57% respectively during the 1990s. I refer Members to the recent report by the Northern Ireland Confederation for Health and Social Services (NICON) - the organisation that represents the four health boards. Mr Brendan Cunningham, the chief executive of the Southern Health and Social Services Board, acts as its spokesperson. Members may want to examine that report, as it gives direct comparisons between funding for the Health Service in England and Wales with that in Northern Ireland. It makes fascinating reading, and it shows how badly done by Northern Ireland has been.

If Northern Ireland had matched the increases for England, the health and personal social services would have gained an extra £83 million for this year, £138 million for 2002-03 and £214 million for 2003-04. To that end, the Committee fully supports the Minister and the Executive in pressing for a fair allocation of UK public expenditure to Northern Ireland. The Barnett formula, which is used to determine our levels of expenditure, is recognised as resulting in lower levels of public expenditure in Northern Ireland than in Great Britain.

Significant additional resources, amounting to over £1·2 billion, have been allocated for the next three years to support the ambitious National Health Service cancer plan, published in 2000, for England and Wales, which is designed to deliver the fastest improving cancer services in Europe over the next five years. Given Northern Ireland's well-documented problems of poverty, social deprivation and historical lack of investment, it is unacceptable that cancer services here should not enjoy a similar pro-rata spending increase to support a strategic plan to improve staffing levels, equipment, facilities, drugs and information systems.

The Committee supports the work of the Minister of Health, Social Services and Public Safety to secure extra funds to improve the quality of health treatment and care.

That is a priority in the Executive's Programme for Government. The Minister has achieved a measure of success in obtaining extra funding from increased Budget allocations and Executive programme funds since devolution.

(Madam Deputy Speaker [Ms Morrice] in the Chair).

4.00 pm

Any future departmental commitment to substantially increase resources for cancer services must be accompanied by robust monitoring mechanisms with clearly defined goals and objectives. A rigorous audit of cancer services must be conducted annually, both regionally and in cancer units, to ensure that outcomes and improvements are properly measured and demonstrate value for money.

The issue of funding leads me to the biggest area of public concern about cancer services - the absence of the long-promised regional cancer centre. The centre of excellence was a major recommendation of the Campbell Report, and it is increasingly concerning that, some six years later, not a brick has been laid.

The Committee welcomes the fact that the four cancer units have been operational since October 1999, providing more than 50% of all day-patient chemotherapy treatment and specialist services for breast, lung and colorectal cancers. However, the lack of movement on the regional cancer centre is a critical issue that impacts on patients' treatment and care. It also affects the morale of the hard-pressed cancer care professionals.

At this point, I want to mention Prof Patrick Johnston and his team at Belfast City Hospital, and Prof Roy Spence, the senior cancer surgeon. I am sure that many people in Northern Ireland appreciate that we have some of the top cancer specialists in the world, particularly in Prof Johnston, who heads the team. He worked along with Dr Rick Klausner, director of the National Cancer Institute (NCI) in Bethesda, Maryland, USA. That institute is the largest of its kind in the world.

I also remind Members of the Dublin-Belfast- Washington memorandum of understanding, signed in October 1999, concerning cancer research. The Committee and I recently received a letter from Prof Johnston about the research in which he and his team are engaged. He said that the cancer research effort at Queen's University, which includes work at Belfast City Hospital and the Royal Victoria Hospital, has achieved a very high score in the latest university research assessment exercise in one of the most difficult units of assessment - unit of assessment 1.

That assessment puts the cancer research programme at Queen's University at the top of the national and international research effort, and it recognises the pioneering achievements of the clinical and basic scientific staff within the centre, whose dedication and hard work on behalf of cancer patients is beginning to pay off. We recognise that we have world-class research, but today's report is about the delivery of cancer services.

The regional cancer centre is the key missing link to a modern, fully integrated, patient-centred cancer service for all people in Northern Ireland. It should be seen as a symbol of quality, and it should provide central leadership and direction to the cancer units and hospitals that deal with cancer patients.

The Committee was most concerned about the unacceptable delays in getting the new centre off the ground. The first report of the Regional Advisory Committee on Cancer anticipated that the new cancer facility would open in 2003. Given that it will take at least three years for the centre to be built, the completion date will be a long way off that originally envisaged.

The rapid increases in the estimated costs of the new centre are a cause for considerable concern. The figure has risen from £32 million in 1999 to the latest estimate of £57 million, which underlines the need to move rapidly on the project. The massive hike in costs has been attributed to substantial changes in the specifications to take account of clinical advances, new equipment and patient numbers.

The Committee accepts the importance of getting the design and shape of the centre, together with its equipment, right from the outset to ensure the optimum configuration. However, why is it taking so long to settle on a final plan? Thousands of people in Northern Ireland want an answer to that - not only patients and their families, but those who are working at the coalface of cancer services.

The Committee notes that a final business plan has now been approved. The latest information that I have says that the Department of Health, Social Services and Public Safety and the Department of Finance and Personnel have passed the previous business plan, which, I believe, was issued in September 2001. I understand that the private finance initiative is now under way. The Minister will refer to that point later.

The Minister must tell the Assembly how quickly the centre will be built if the private finance initiative option is used, and at what final cost to the public purse. She must reassure the Assembly and the public that value for money will be a prime consideration of any funding route taken.

Given that once approval to proceed has been granted it will take some three years to construct and equip the centre, it is imperative that the necessary funds are urgently secured regardless of the option pursued. The Committee had a detailed discussion with the Minister on the potential of the Executive programme funds, in particular infrastructure funds, to assist in the building of the new centre, and supports her efforts to explore that. There is a compelling case for funding a flagship project that will provide all the people of Northern Ireland with a centre of excellence for years to come. The centre will also act as a magnet for expert staff and research funding, which is also important. I referred earlier to the top class research efforts already in place here.

The Campbell Report recognised that primary care has a crucial role to play in the delivery of high quality cancer care. More than 90% of cancer patients spend most of their time at home, and primary care teams meet most of their needs. Apart from GPs, the teams comprise such different professionals in cancer care as community and Macmillan nurses, and specialists in speech therapy, dietetics, occupational therapy and social care, all of whom play a pivotal role in a cancer patient's rehabilitation process. The Committee supports the development of the multidisciplinary-team approach to primary care so that good practices in cancer care can be disseminated across the health boards and trusts.

The Committee welcomes such schemes as the Northern Target initiative in the Northern Health Board, which involves closing down GP practices for one afternoon a month for the entire multidisciplinary team to meet away from the workplace to discuss such common issues as education, communication and guidelines.

GPs make a significant contribution to the delivery of cancer services as they are normally the first point of contact for cancer patients and their families. They can play a pivotal role in successful early detection, prompt referral, interface with secondary care and out-of-hours care. As many cancers can be successfully treated if detected in time, public awareness and knowledge of early symptoms are important. Therefore, it is vital that GPs be kept fully up to date with the latest developments, especially those that concern treatment and recognition of symptoms. The Committee was encouraged to learn that the Campbell commissioning project is developing guidelines for the symptoms of each cancer to help GPs decide whether to make urgent referrals.

The British Medical Association (NI) General Practitioners' Committee highlighted pressures on time and backlog of work as obstacles to improved cancer services, and pointed to the need for more GPs and nurses to speed up the process for referral and investigation. Given the pressures under which GPs operate, the Committee accepts the Campbell commissioning project's argument for GPs to have adequate time to see their patients.

The Committee commends the initiative by Macmillan Cancer Relief in providing a network of GP facilitators across the four health and social services boards' areas. They will act as advocates on behalf of the GPs in their areas, by highlighting concerns and by working with colleagues in hospital and community settings to resolve problems in the system and to effect innovative improvements in the delivery of cancer services. At this point, I draw attention to the officials from the Southern Health Board who met with us recently. They have adopted an initiative that includes pharmacists. It is to do with palliative care for people with cancer, and the aim is to ensure that such people who need drugs such as morphine at night time, through the night, and on Saturdays and Sundays can get them and will not be left uncared for.

The Committee learned that a major issue for GPs is their frustration with blockages in the referral system as a result of lengthy waiting lists for CAT or MRI scans.

The British Medical Association (NI) General Practitioners' Committee reports that the increasing specialisation of cancer consultants can make it difficult for GPs and their patients to identify the best referral pathway. Therefore, the Committee for Health, Social Services and Public Safety sees considerable merit in the argument for a simple electronic referral system in various sites in Northern Ireland complemented by a cancer registry of specialist services that lists the availability of multidisciplinary cancer teams, in order to minimise delays. As early diagnosis is so important, there must be a robust system to monitor the implementation of referral guidelines.

There is considerable scope for improvement in the interface between primary and secondary care. In May 2000, a survey of GPs revealed a general perception that access, transport, information flow, the co-ordination of services provided to patients, the accessibility of consultant staff to GPs and the discharge/outpatient information that GPs are given had deteriorated in the preceding year.

Those views echo witnesses' evidence that their "cancer journey" can be chaotic, with delays in referral from the GP to the hospital, long waits for consultation at hospital, delays and confusion over tests, lost records and failure to transfer information to the GP. The apparent lack of a seamless, patient-centred cancer service is a matter of deep concern to the Committee. There must be effective two-way communication channels between primary care professionals and their secondary care colleagues. The Committee believes that there must be a change of culture between the primary and secondary sectors from one of competition to one of collaboration, with a view to promoting the needs of cancer patients above all else.

Recently, officials at Antrim Area Hospital told the Committee that, following referral by a GP, it can take up to nine months for a patient to receive an endoscopy to diagnose cancer. If someone has a growth in his or her colon, imagine what can happen in nine months.

The Committee was dismayed to learn that the first details that GPs receive about cancer patients are frequently contained in a handwritten discharge letter given to them when they carry out a home visit. It would greatly benefit primary care practitioners if a minimum set of data relating to each patient were made available. To that end, the Committee warmly welcomes the initiative taken by the Campbell Commissioning Project in the development of patient-held records. That should help to improve the speed of communication between hospitals and doctors. It would also help to inform patients about the management of their treatment. The Committee recommends that the Department introduce that initiative across Northern Ireland as soon as possible.

Given that 90% of all cancer patients are looked after in the community, there is a need for a fully integrated out-of-hours service. Out-of-hours care is the single most important issue raised by GPs. The Committee is concerned that in many parts of Northern Ireland there is no cover after 5.00 pm. That is totally unacceptable, and the Department should ensure a fully integrated, equitable, out-of-hours service for cancer patients throughout Northern Ireland. Lessons can be learned from the model of excellence in the South and East Belfast Health and Social Services Trust, which offers 24-hour nursing care and a rapid response team.

Specialist and district nurses have a central role to play in the delivery of cancer services in the primary care setting. Meaningful investment in community nursing services would make a significant impact on cancer services provision in the primary care setting and would be an important step towards achieving a more equitable service.

The Committee trusts that the report's 41 recommendations will form part of a co-ordinated, inclusive approach to improving the quality of cancer services and outcomes for patients, and to eradicating inequities in the system. The recommendations recognise fully the need for cross-departmental collaboration and for close liaison between the statutory and voluntary sectors on strategic planning.

I look forward to today's debate, which will lend a timely platform to this extremely important health matter. The people of Northern Ireland deserve the best facilities possible. I commend the report to the House.


<< Prev / Next >>