Jo Coburn and Mark Carruthers present. Jo Coburn speaks to security expert Will Geddes on the terrorism threat to the UK.
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Hello and welcome to Sunday Politics.
Opt in or opt out -
how should the Assembly deal with the issue of organ donation?
I'll be talking to two MLAs at the forefront of that debate.
With the great success of Titanic Belfast,
why are surrounding businesses not benefitting
from the influx of visitors?
And with me throughout today, PR consultant Sheila Davidson
and commentator Chris Donnelly.
Well, there's a high level of support for the idea of organ donation,
at around 70% of the population.
Less than half that number have actually signed up
to the donation register.
So, how can the number of organs available
for life-saving transplants be increased?
The answer could be to follow Wales where, this week, a new law
came into force which states that,
unless you make it clear to the contrary,
the assumption is that after death you are happy
to have your organs donated.
Jo-Anne Dobson's the UUP Assembly Member who's trying to introduce
a similar law here.
Alastair Ross from the DUP isn't convinced that's the path
we should go down.
You're both welcome to the programme.
Jo-Anne Dobson, why do you believe the so-called "soft opt out" system's
the right road for Northern Ireland?
Because it's worked so well in other countries across Europe, and Wales,
as you say, has gone down the route with soft opt out earlier this week.
Why should Northern Ireland be left behind?
There's widespread support, as you articulated
at the start of the presentation, for organ donation
and can I just pay tribute, Mark, to those charities that have done
the heavy lifting around organ donation?
And I know, I've been involved with them for over 20 years.
But we can't get past the plateau
in the low 30s on the organ donation register,
so to bridge that gap, we need to do something to make this happen.
You're a member of the Health Committee.
The Health Committee is dealing with this issue,
looking at your proposed legislation at the moment
and a number of very senior surgical clinicians
presented to the committee this week and they urged caution.
They suggested that we should just steady the horses
and perhaps look at the Welsh model and then make a decision
based on the data which currently, in the UK, isn't available.
Yes, we had a very, very useful presentation on Wednesday,
but every single year, we lose people.
The last year... This year, 17 local people died waiting on an organ.
The year before, it was 15.
So, for me, a wait-and-see approach,
meanwhile local people continue to die.
It was a fantastic presentation from the clinicians
and I know they had widespread support with, I think,
one exception for soft opt out.
Yeah, but here's the danger, Jo-Anne Dobson - I mean,
nobody doubts for a second what is motivating you to make things better,
that's not the issue. But I think what some of the clinicians said
in their presentation was they have a real
and very genuine fear that, if this is mishandled in any way,
the situation could be even worse
and fewer people may donate organs in future
and that would be the opposite outcome
of what you are campaigning so hard for.
Now, if those senior clinicians are saying that, you need to listen.
But if you'd listened to all of the presentation, Mark,
they have support for soft opt out.
Yes, they said it has to be the right legislation,
the right bill, and I have said from the very, very start,
and I sat here with you two years ago when I was presenting,
and Alastair was beside me then, on the bill,
it has to be the right bill and I'm open to amendments.
And I'm delighted that, led by Professor John Connolly,
those clinicians will have their input into this bill
going forward and I wouldn't have it any other way.
Alastair Ross, let's just bring you in at this stage.
What are your reservations?
As Jo-Anne Dobson says, for some people in Northern Ireland,
for too many people in Northern Ireland, the clock is ticking
and they don't have the option to wait.
Why would you want to do anything that might slow down a process
-that could save lives?
-I don't want to and I think it's unfortunate
sometimes that those of us who are opposed to presumed consent
have the inferences that we're not as interested in saving lives.
That's unfortunate that that has come into the debate.
I think we have to listen to the clinicians.
The clinicians have all urged, unanimously urged,
caution on moving towards a presumed consent model.
I listened to the presentation of the Health Committee,
I've read the letter that was sent to the minister
and why they did that is because the evidence is incredibly sketchy.
We can look at some countries where an opt out system
has better rates of organ donation, but you can also look at France
and Sweden, Brazil, places where they have a much lower rate
of organ donation but they have the presumed consent model.
And the two countries with the best rates are USA and Spain,
both of which have an opt in system, a voluntary system.
I don't think it's necessary, the clinicians have said
we've a very good rate here, we're improving all the time.
I don't think the evidence is there to suggest it would work
even if we wanted to do it.
I think the most important thing is around this issue of consent,
that there's no other area of medicine or law in which
consent would be presumed.
We have to get to a point where members of the community
are able to give their informed expressed consent
during their life for what happens to them when they die.
That'll give certainty to families
who are in very difficult circumstances
in trauma units, rather than because 108 members in the Assembly
pass a bill that consent is somehow presumed.
I don't think that's an ethically sound way of proceeding.
But, of course, there are all sorts of safety nets
in the draft legislation at the moment.
I mean, there would have to be a qualifying person who would
affirm that the deceased person wouldn't have objected to
organ donation and that's a key part to this conversation.
Nobody's suggesting that organs would be harvested
without the family fully agreeing to that.
I fully accept that, in practice,
families will have a veto even if the drafting of the bill doesn't
quite make that clear in law,
but what we want to do is make sure that those families in trauma units
have absolute certainty,
that's how we get the family consent rate higher.
And my fear is moving towards an opt out presumed consent model
means that individuals don't have to make a decision during their lives
and silence on their preference cannot ever be given
the same equation as actual consent.
And, as I've said before,
there's no other area of medicine or law in which
silence on an issue will be seen in law as actual consent.
Well, that's a very interesting point just to bring in the thoughts
of one consultant, Tim Brown.
He told the committee that he's got serious reservations
about assuming someone has given consent
when, in fact, that consent hasn't been specifically given.
Let's just take a look at what he had to say.
I personally do have an objection to soft opt out.
I think it's...
I think one of the very overarching tenets of medical ethics
is the concept of autonomy and I think that opting out...
I think assuming that somebody has given consent
when they have not given consent is a violation of autonomy
and I would have grave concern that that soft opt out
would be in direct competition with the concept of autonomy.
That's effectively what Alastair Ross is talking about.
Now, Tim Brown, as I understand, did go on to say that, if it was proved
to work, then clearly he would have to look at that again
and he clearly wants as many people to donate organs
in those circumstances as possible.
But what do you say to Tim Brown and to Alastair Ross
on that issue of assumed, presumed consent?
It's family consent. The family will have the final say
and that's always been from the very, very start...
Why are you shaking your head? That's a fact.
Because Clause Four is all about deemed consent,
-which is presumed consent.
-It's a first draft.
If this was about trying to push up family consent rates - fantastic.
If it's about public awareness - fantastic.
If it's about specialist nurses in hospitals,
which is a big driver of organ donation, fantastic, but it's not.
Clause Four makes it absolutely crystal clear in law
that consent would be presumed
and I don't think that is an ethically sound way
-to proceed for organ donation.
-Mark, can I come in here?
That was a first draft.
I'm an individual backbench MLA bringing forward a very,
very important piece of legislation
and I'm open to amendments. I would ask Alastair and others
to work with me and bring forward those amendments
and those suggestions. I'm not precious about those amendments
to make it the right bill and that was reflected
by those clinicians who presented at the Health Committee.
Yes, but it's either presumed consent or it isn't presumed consent.
I mean, you can't amend the key point,
one of the key points to your draft legislation.
I mean, if Alastair Ross brought forward an amendment
that got rid of that Clause Four issue,
then it wouldn't be Jo-Anne Dobson's proposed legislation.
But it's the Northern Ireland Assembly,
I want it to be the legislation for the people of Northern Ireland.
It's not Jo-Anne Dobson's proposed legislation,
this is a bill to save lives right here in Northern Ireland. I work...
Sorry, are you saying you're prepared to negotiate on the issue
of presumed consent?
I'm prepared to meet with anyone to bring
the right bill for Northern Ireland.
What we have with second stage was the first draft.
I will meet with anyone.
And now, Mark, can I just say finally,
the department are working with me in the last three weeks.
I asked during the committee
when we had senior department officials,
given the commitment of the First and Deputy First Minister in 2013,
to support soft opt out.
What have they done to work towards this?
-And do you know what they have done? Nothing.
Now, in the last three weeks,
they're working to get the right bill for Northern Ireland.
I'll come to Alastair Ross in a second,
but here's a very important point. Your legislation,
your draft legislation, suggests that it wouldn't in fact
come on to the statute books until the spring of 2018,
-even if it was agreed in this mandate.
So why not take the time to sit and wait
and see what happens as far as the Welsh experience is concerned
and make sure that the legislation here in Northern Ireland
is bespoke for us?
Actually wait and see, learn from the Welsh experience and get it right.
Meanwhile, local people continue to die.
But that will happen anyway because your legislation won't happen
-until the spring of 2018.
-But mine will go with the education programme
and the awareness programme around it as well. I'll...
But that's already happening.
Well, Clause One of the bill is a duty to promote that even further.
The Public Health Agency has had an awareness campaign.
They've had a fantastic campaign,
but still only in the mid 30s on the organ donation register.
For me personally, and for those people that are waiting on an organ,
a wait-and-see approach...
I think we owe it to the disserviced.
Let's get a good news story out of the Assembly,
let's do legislation that makes things happen.
But it needs to be right.
Of course it does and that's why I'm open to suggestions.
You were nodding when I was putting that point, Alastair Ross,
to Jo-Anne Dobson that we should wait and see
what happens in Wales, but here's the reality as far
as that's concerned and you need to take this on board.
Wales passed this legislation in 2013,
it came into effect last week in December 2015.
It was amended in-between.
As they realised they'd got little bits not quite right,
they actually tweaked them. So, we could look at the Welsh experience
and we could make the commitment in this mandate
to bring in presumed consent in spring 2018.
We can actually do both, that's the point.
-I don't think we need to.
-But we could do.
There's very limited time left in this Assembly,
I don't think the Health Committee has been able
to give this as much scrutiny as they should.
It's rushed evidence sessions with the Health Committee.
They've closed the number of people who they're going to invite.
I don't want to see this rushed through.
It is a controversial piece of legislation.
I don't want to see organ donation became a controversial issue
and for that reason I think we need to listen to the experts
who are telling us, "Let's be cautious about this,
"let's look and see what happens in Wales." As you've acknowledged,
Jo-Anne's bill, even if it was passed tomorrow,
wouldn't become law until 2018. What is the rush?
Why not return to this in the new mandate
once we have some of the evidence there?
Because the evidence from elsewhere in the world would suggest
that it isn't going to be the major driver for organ donation.
OK, if the Welsh model proves to be correct
and presumed consent works, will you set aside your reservations?
If that turns out to be demonstrably better for patients
in Northern Ireland, will you then support it?
At least in those circumstances it will be evidence-based
where it's not at the moment.
No, I still have concerns around presumed consent.
I think consent is important,
I don't think that the 108 members of the Assembly
have the moral right to suggest that everybody in Northern Ireland
has given their consent when they have not,
so I want to get to a point where actually we can get people
to make a decision during their lives. That will help families
and I think working alongside the public awareness campaign
that I absolutely support,
working along the specialist nurses in hospitals
-which is the key component...
-We need to leave it there.
-..that's how we push organ donation.
-Stay with us.
It's very interesting to hear your thoughts.
Let's hear what Sheila Davidson and Chris Donnelly
have to say in response.
What do you make, Sheila, of the notion of presumed consent?
I think it's absolutely fundamental that we accept that presumed consent
is the way forward for transplants.
70% of the population wants this,
but apathy reigns with most people.
When you get this into legislation, it becomes something then
that everybody has to seriously consider.
And I think the opt out option is far better because then,
if you really do have a fundamental, moral, ethical
or any other kind of objection to it, you make that happen.
But here's the point - let's say one instance is badly handled.
Some sort of confusion arises
and a family is very upset in very sensitive
and very difficult circumstances.
That could have a hugely detrimental impact on organ donation levels.
-Is that a risk worth taking?
-Yes, it is.
That's what opponents of Jo-Anne Dobson's bill say.
It is absolutely a risk worth taking because those risks are being taken
day and daily in the health service as we speak.
I mean, when you have the kinds of exposes we've had
previously of families feeling that,
when they had organ retention, which was actually just
slivers of samples and that sort of thing, became such a huge issue,
it's always going to happen, but that's not going to save lives
and I think Jo-Anne's absolutely right to pursue this.
-Chris, where do you stand on this?
-I think Jo-Anne is to be commended
for bringing this legislation.
I understand Alastair's point with the ethical argument,
but this is about saving lives and I think presumed consent,
the soft opt out model, is the way to go.
I do appreciate, if you look at the models of best practice,
particularly the Spanish system, the opt...
In terms of increasing the potential donor pool
on its own isn't normally enough.
The Spanish system, they have teams of transplant coordinators
who are very effective at ensuring that opportunities
for organ donation are not missed,
they're very good at working with the families
to ensure that consent is followed through.
So I think we need to do more than just move on the soft opt out model,
we need to move on that as well at the same time.
OK. Thanks, we'll hear more from both of you again very shortly
and thanks to the politicians.
We'll keep a very close eye on that over the next few weeks.
Let's just pause at this stage though and take a look back
at the political week in 60 seconds with Gareth Gordon.
A judge rules abortion laws here are in breach of human rights
and new draft guidelines are issued, but confusion remains.
In the face of the court decision,
we've now got a conflicting issue of guidance which seems to me
to have been out-of-date four or five hours before it was circulated.
Parliament votes to back airstrikes in Syria,
but differing views from local MPs.
We need to protect people, our own citizens now
when there is a real and present danger to them.
There is a severe risk of feeding what we are trying to fight.
The veteran SDLP MLA Pat Ramsey announces he's quitting politics
and a former finance minister
shows what he thinks of Stormont's Nama Inquiry.
Had I not made the promise, I doubt very much if I would've come along
to grace the kind of Mickey Mouse exercise which has been undertaken.
And things get a little hot under the collar
across the Assembly benches.
I'm not sure, though, how she felt my passion,
I hope it was as good for her as it was for me.
The king of the risque aside,
Mark H Durkan ending that look back at the week from Gareth Gordon.
Now, ministers took to the waters of Belfast Lough this week to support
the latest government-backed tourism project - the multimillion pound
restoration of HMS Caroline.
When the ship opens its door to the public
as a floating museum in six months, it'll be hoping to cash in
on the success of the Titanic Belfast building,
but some projects are finding that more difficult
than you might think.
We sent Kevin Magee down to the Lagan to investigate.
Titanic Belfast is a monument to our maritime past
and the flagship tourism project of the future.
Last year, 700,000 visitors passed through its doors.
Tourism is one of the Executive's key target areas for economic growth
and this building symbolises what it's trying to achieve.
Its visitor numbers are up,
but are the benefits being spread across the entire economy?
Ministers hoist the flag for the Executive
to mark the six-month countdown to the opening of the HMS Caroline,
the latest visitor attraction in Titanic Quarter.
Once completed, the First World War ship will be hoping to cash in on
the numbers visiting its much larger neighbour, the Titanic building.
The planning for the operational phase forward,
clearly we will be having a number of discussions
with Titanic Belfast on how we can mutually work together.
The Enterprise Minister Jonathan Bell
says the Executive's tourism strategy is working.
Titanic Belfast is a tremendous success,
hitting well over 90% of its targets,
bringing in 2.5 million people to this country,
bringing in the spending power of 2.5 million people.
I actually believe a rising tide lifts all boats.
But it hasn't lifted this one - a tour operator on the Lagan
believes Titanic Belfast is hoovering up all the tourist spend
along the river.
Since it opened in 2012, his public tour business has nosedived.
Since Titanic Belfast has opened, things have changed radically.
Not just for me, for a lot of small businesses, tour businesses
and stuff around the harbour particularly.
We're fighting against a multimillion pound business there
that was funded by the taxpayer and charities or whatever,
European Union, I don't know all their financials,
but, you know, it's a big marketing budget we're fighting against
and our business went down about 80% the day it opened.
Never really recovered.
It's not just the river tours that haven't shared in
the large number of tourists going to Titanic Belfast.
The Thompson Dock Pump-house and Cafe haven't experienced
much of a lift and, further up the river,
the Belfast Barge Museum, like the river tours,
has actually recorded a fall off in visitor numbers
since 2012 when the Titanic centre opened.
It's had to cut staff after its visitor numbers fell.
It was down quite dramatically,
I would say there was about a 50% drop.
Now, we've recovered some of that.
You would hope, especially with the amount of international people
that it would've brought in, that they wouldn't just see
the one place, they would go to them all.
Unfortunately, that's not what we've experienced.
I would say that the barge museum has actually been more supported
by local people that have been really invested in the story
and we haven't seen the positive effects
of, you know, increased visitor numbers internationally.
This charity cafe in the shadow of the Titanic building
is run by a church minister.
He's also behind the tram that aims to move visitors
from Titanic Belfast to other nearby attractions,
spreading the tourist pound.
The tram has only just started,
we've just had our first season of operation.
It started fairly small, yes.
So, we've had a couple of thousand people on in the first year
and that's really exciting.
Is the overspill happening to the degree that you would've hoped?
Er, I think I'll say not yet,
but I don't see that as the end of the story,
I just see it... We're on the first chapter
and there's so much work still to be done,
so many opportunities still to be explored, so I think it'll be
very exciting to see where it goes next year and in the years to come.
The Titanic building cost £77 million to construct.
Most of the funding, 60 million, came from the public purse.
So, should it be doing more to encourage its visitors
to visit other tourist-related businesses?
It says it already is.
If you look at the statistics
and the £120 million that we've generated in the local economy
in the first three years,
if you look at the occupancy rate of the hotels, which is now at 80%,
if you look at the cruise ships which has grown from 10
through to 75 next year, if you look at the coach operators,
we've got 120,000 coach operator visitors coming this year...
There is a trickle-down effect already.
You do have to be competitive
and you have to fight for your place in the market.
When Titanic Belfast took over the SS Nomadic,
its visitor numbers trebled.
But for private tour operator Derek Booker, that hasn't happened.
His main concern remains that his public tour business
won't suffer the same fate as the tragic liner herself.
Kevin Magee reporting on the challenges of surviving
in the shadow of Titanic Belfast.
Let's have a final word with Sheila and Chris.
Sheila, there's the juxtaposition, a big project built
with public money and a huge marketing budget, and the little guy.
Yes. I mean, I remember, my very first experience of Titanic anything
was on the boat tour and it was wonderful,
but the problem is the investment has not been there
and even though they are private sector businesses,
they should have had some more marketing support,
even capital support, to be able to deliver a product that is good,
because the Titanic signature building is plonked in the middle
of the Titanic area, but there's very little connectivity.
And I think that a little bit more joined-up thinking could actually
help those businesses and trickle down from the signature building.
Chris, I wanted to ask you about something separate
which is quite interesting. Sinn Fein's been under a lot of pressure,
we know, for signing up to the Fresh Start deal.
Now the party seems to have got support
from, let's say, an unlikely quarter.
Yes, I thought it was interesting during the week,
the Northern Ireland committee of the ICTU,
an umbrella trade union organisation,
released a statement which was quite stridently different in tone
from their position after the Stormont House Agreement
just 11 months ago in January, when they came out
and called the Stormont House Agreement a bad deal.
They took out newspaper advertisements very critical
of the deal at the time and that was unprecedented
at the time, that they would come out against,
the first time the unions had come out against a deal
between the representatives of the two different communities.
And we know that, at that time,
the DUP were very stung by that statement by Peter Robinson -
Sammy Wilson condemned that.
Sinn Fein, within two months however, moved away
from the Stormont House Agreement
and, in a sense, that suggested that the unions had formed
a connection with Sinn Fein, they'd influenced them.
Now, at this moment when Sinn Fein are quite vulnerable
because of the Fresh Start deal,
the unions have come out with a line which kind of reflects
-the Sinn Fein position about this being a better deal over...
..direct rule would be unimaginable consequences,
that's quite interesting.
Need to leave it there, thanks both very much indeed.
That's it from Sunday Politics for this week.
Join me for Stormont Today, that's on BBC Two at 11:20 on Monday night.
But, for now, from everyone in the team, thanks for watching.
Jo Coburn and Mark Carruthers present.
Jo Coburn speaks to security expert Will Geddes on the terrorism threat to the UK, and prominent Conservative backbencher Bernard Jenkin gives his thoughts on David Cameron's negotiation with the EU.
Shadow work and pensions secretary Owen Smith is also on the show, as well as new up-and-coming Conservative MP Heidi Allen.
Janan Ganesh of the Financial Times, Isabel Oakeshott of the Daily Mail and Nick Watt of the Guardian are on the political panel.