Mr J Compton

Chief Executive

Health and Social Care Board

12-22 Linenhall Street

Belfast

BT2 8BS

28 February 2012

Dear Mr Compton

External Clinical Adviser

With reference to your letter dated 23 February 2012, please find responses to questions as follows:

1.    What is your assessment of the clinical communication and collaboration across the primary/secondary care interface?

 

Trust and primary care colleagues have not yet achieved robust and resilient communication and collaboration.  There is clear goodwill and resolve to achieve this in primary and secondary care.

At grassroots level, many hospital clinicians describe good communication with GPs but this is acknowledged to be patchy – difficulties with access during the busy working day and relatively limited IT support for real time communication are cited as the main reasons.  The last two and a half years, during the accelerated reconfiguration of two of our smaller acute sites, have been a particularly difficult and disruptive time with multiple personnel changes at consultant level across the locality, changing access to services and irregular clinic schedules: this scenario is now stabilising.  Consultants are very eager to improve communication as the benefits for both patient care and clinical effectiveness are clear.

Following the hospital reconfiguration, the HSCB commissioned ‘Tribal’, a healthcare consultancy to conduct a study of unscheduled care capacity and utilisation.  The review report, broadly accepted by the Trust, with reservations on timelines for achieving change, recommended a number of significant changes in care patterns. These included the development of ambulatory care pathways within secondary care, with protocol-driven direct access for GPs.  There was considerable engagement of primary care colleagues, and expectations were raised of material change by November 2011.  Secondary care colleagues were unhappy with the quality of the final draft pathways presented, and the initiative did not proceed. This has caused considerable disappointment and frustration in both primary and secondary care.  The Trust is taking forward work on pathways and associated developments, and has sought support from NI Safety Forum and other quarters to support further joint improvement work.  Primary care colleagues are aware of these plans and have continued to engage with them.

There is recognition of shared responsibility to improve the primary-secondary interface and this has gained considerable momentum this year in the wake of a range of small shared initiatives to re-design services across traditional boundaries.

The standing ‘GP Forum’ was redesigned in the last year, with supporting ‘locality’ forums created and the groups reconstituted to foster improved communication across primary, Trust managed community care and secondary care teams.  Initial feedback is that these new fora are working well, but have been in place for a matter of months only at this time.     Some concerns have been identified at the fora, and improvement plans have been developed in response.  (See minutes of meetings, already forwarded).

There has been a positive approach to clinical engagement in planning for ‘Transforming Your Care’ with the setting up of Professional Advisory Groups which are co-chaired by GPs (Appendix 1).

2.    How can a shared culture of continuous improvement of patient safety, quality of care and patient experience be promoted, both within the Trust and across the primary/secondary care interface?

The Trust has a positive history of engaging in safety and quality focussed work, including participation in Safer Patient Initiative 2 and the Trust continues to be an active participant in the Safer Patient Network.  This work is taken on through the Patient Safety and Quality Improvement Plan (PSQIP) (Appendix 2) and progress on this is reported to the Governance Management Board (GMB) and to Trust Board through regular progress reports (Appendix 3).

The Trust had an outbreak of C Difficile in 2008 that led to a public inquiry that reported in late 2010.  The learning from that process and the report that followed has shaped the Trust’s response to quality and safety, and the focus on each patient’s experience in particular.  A dedicated Executive Director of Nursing and Patient Experience has been appointed, a broad range of action plans are in place to address the concerns identified by the experience of the outbreak, and highlighted by the inquiry (Appendix 4).

A range of quality improvement work in the nursing domain is now in place, and continues to develop.

   

The medical leadership and engagement process has been reviewed, and a revised structure and supporting processes are in place.  There is a significant agenda on clinical leadership development, and on the further development of multi-disciplinary governance, and there is a clear appetite for engagement. (Information on these areas has already been forwarded).

The HSCB Safety Forum (SF) is promoting spread of IHI methodology in the region by sponsoring places on the IHI Open school program.  A number of our staff have availed of this opportunity and we continue to actively promote participation - the Trust has confirmed that it will fund additional places for any interested clinical staff.  Nurse and consultant teams are to undergo Global Trigger Tool Training during the course of this year; this event is also sponsored by the SF.

The monthly Acute Directorate Consultants (Safety and Quality) Forum has been discussing safety and risk in secondary care – at their last meeting they were joined by the HSCB’s Assistant Director for Integrated Services.  Next month is to be a joint meeting with GP colleagues looking at incident/event reporting to change the way this is perceived and to build a safety culture.

The HSCB Safety Forum has offered to host a primary-secondary collaborative for Northern Area clinicians on pathways for unscheduled/ urgent access a part of its regional Emergency Medicine Safety Collaborative program.  This is being explored with the Dalriada Urgent Care (the local out of hours GP service) and we anticipate that work will commence in early April.

Improvement work on unscheduled care and in other service areas including Mental Health, Learning Disability and Children’s Services is focussed on promoting safe and effective patient or client journey.

3.    How can clinical safety and quality improvement be supported and measured, both from within the Trust and across the primary/secondary care interface.  How can any concerns in this regard be addressed?

 

It is recognised that safety and quality improvement across the system must be owned and delivered by frontline staff.  This requires a supportive infrastructure including organisation and goal-setting, shared learning and openly-shared transparent data to monitor system change.  The current engagement of clinical staff via Professional Advisory Groups (Appendix 1), which have been set up to assist the LCG/Trust with its response to Transforming Your Care, should provide a platform for this work.  The option for shared small change cycles is built into the consultation.

The Trust is developing a Safety and Quality Ward Dashboard to collate and share improvement metrics in a way that is clinician-friendly by being light on process.  An offline version should be in place by April and we aim to make it available on line within 2012 if clinicians can be confident its data quality.

With reference how concerns are expressed across the interface, the responses in (1) and (2) - i.e. improved day to day communication and the growth of a safety culture should improve on the current situation.

In addition to this approach, primary care reports adverse incidents to the Trust.    Approximately 20 such incidents are reported per year and the main issues are Estates problems in Trust owned Health Centres, communication difficulties related to discharge and medication issues.   The Trust is working with colleagues in the HSC Board to revise this process so that concerns raised about the primary/secondary care interface can be jointly reviewed and addressed in a way that promotes learning and avoids any form of “blame culture”.

The Trust continues to actively develop Clinical Audit and has recently established a new Audit and Effectiveness committee with a view to ensuring stronger clinical engagement with this process (Appendix 5).

Incidents and Complaints Management support this function.  Datix risk management system is the database used to capture this information.  Incidents and complaints reports are monitored and reviewed regularly by the Governance Management Board to identify trends/patterns and learning (See Appendix 6 - Complaints Annual Report, and Appendix 7 - two quarterly reports).

4.    How does the Trust secure feedback from Patients?

• Through the complaints management process (Appendix 8 Complaints Policy):

• The Complaints and Service User Feedback Policy invites comments, suggestions, compliments and complaints from those who use our service. The feedback can be given by email, phone, written, Trust website and through the Trust Feedback leaflet "Your views matter" (Appendix 9).  The Trust leaflet is available on the Trust website and across all locations within the Trust including community settings for clients/patients/relatives/visitors to access.

• Patient Experience/Feedback is being captured through the Patient Safety Leadership Walkrounds.  These walk-rounds are undertaken every month by Trust Directors and Assistant Directors.  This information is collated/ actioned and is presented to GMB (Appendix 10 LW Proforma).

• Regional Patient Experience reports - Audits are undertaken every quarter in specific areas across the Trust.  This programme is set regionally and reports to the PHA.  The audits have 3 elements - Patient Experience, Patient Stories and Observations.  The audit results are presented to GMB every quarter.  (Copies of these reports have already been forwarded).

• Patient Experience – a range of mechanisms are in place to gain feedback from users and carers on service experience and on development proposals. These include a long-standing Older People’s panel, which contribute to strategic development and to service specific change debate, including the development of the Older Persons’ pathway. There is well-developed user involvement in Cancer services, Endoscopy services and a range of other services.    

Yours sincerely



Dr P Flanagan

Medical Director

 

 

Encs.

Recent Media Activity Surrounding Northern Health & Social Care Trust

http://www.bbc.co.uk/news/uk-northern-ireland-18160556 - Leaked reports critical of Antrim Area hospital. The reports were commissioned in January after criticism over patient waiting times .Two reports, critical of practices at Antrim Area hospital were leaked on Tuesday afternoon

http://www.antrimguardian.co.uk/articles/news/27258/antrim-hospital-could-be-closed  - Thursday, 17 May 2012 Antrim Area Hospital: closure threat.Antrim Hospital is fighting for its very survival this week and, according to a secret internal Trust paper, the outlook may be grim.

http://www.colerainetimes.co.uk/community/listen-to-doctor-s-cuts-warning-trust-urged-1-3868591 - Published on Wednesday 23 May 2012 08:37 HEALTH chiefs must listen to a warning by a senior doctor over possible plans to cut A&E services at the Causeway Hospital, it has been claimed

May 2012 Last updated at 13:26  Northern Trust accepts Antrim Area hospital criticism The reports criticised the hospital's bureaucratic culture Continue reading the main story Related Stories. Antrim hospital faces criticism  .The Northern Health Trust has said it accepts fully the recommendations of two reports which criticised practices at Antrim Area hospital.

Amalgamation at hospital 'is mind-boggling' Tuesday, 29 May 2012 .Aiming to downgrade, or close, a small hospital, school, or post office in a small, local community results in losses difficult to define as well as the obvious material ones. Read more: http://www.belfasttelegraph.co.uk/opinion/letters/amalgamation-at-hospital-is-mindboggling-16165165.html#ixzz1wRv6schP http://www.bbc.co.uk/news/uk-northern-ireland-18244905 Edwin Poots says A&E services will be based on facts and figures. "But I make it clear, I will not be making the same mistake as was made over the closure of the Mid Ulster and Whiteabbey hospitals."

Sean Donaghy Should Step Down - he has overseen the worst performance that any health trust has seen in Northern Ireland, although he inherited these problems from his brother and current CEO of the Belfast Health Trust Colm Donaghy, he has failed to deliver and fix the failures that Colm left behind him.

Save The Mid like many Mid Ulster residents are not shocked by the content of the Rutter & Hinds review, indeed the information released to the public is neither new or something that both the Government and Northern Health & Social Care Trust (NHSCT) already did not know. This report is not just a scathing indictment on the governance of the NHSCT but also the Health Minister and Mid Ulster MLA's as they have been for two years been made fully aware of the concerns contained within this report, yet failed to act in a manner that would be creative of patient safety. Indeed neither Magherafelt nor Cookstown Councils made a written submission to the Compton Report.

Save The Mid submitted 3 different reports to the Compton review which are supported in part by this new information, three reports that were also sent to the Government for their consideration yet no reply was given. http://savethemid.weebly.com/research-documents.html

However concerns have been raised by the report, Dr Rutter in his review only spent 1 day in Antrim Hospital as stated by CEO NHSCT Sean Donaghy, later revelations are stating that Mrs Hinds has omitted staff concerns about bulling and harassment. Concerns that Save The Mid also brought to the Health Minister regarding a top A&E Consultant in Antrim in bullying and harassing nurses and doctors we left unanswered. Other concerns are also contained in NHSCT Exe member Valarie Jackson, head of Acute service, saying these human needs are only specific to patients waiting and not the entire emergency care pathway, what about patients who are admitted do they not count.

When we look at recommendations like the Trust should have more specific A&E information Save The Mid fully agree with this as waiting times do not include time spent in clinical decision and short stay wards and the corridor ward. We see other recommendations in terms of targets and waiting times which are the exact same recommendations that have been made over a two year period yet no action has been taken.

We believe that the NHSCT does not have the capacity to implement these recommendations, we can create different pathways for direct admissions from GP's and other health services, however all the NHSCT are going to do is create different entries into the same crowed hospital, 90% of all delays at Antrim are because there are no beds.

Save The Mid totally reject the recommendation for another Senior Executive to be appointed within the NHSCT, there are already enough highly paid mangers for managers.

What the reports does not contain is how the Trust have got into such difficulties, they why are we seeing these problems, Save The Mid fully believe this is a direct consequence of the removal of services at the Mid Ulster Hospital site, it was stated in a risk assessment 5 years ago that Antrim would not be able to cope if they shut the mid down and this is what we have seen. This was a decision made by government and thus the government should be held accountable for. This report shows that lack of capacity in all areas and a breakdown of communication, these are simple risk assessments that any business like the Trust should be able to plan and manage. These are routine failures of routine procedures; if the NHSCT cannot plan for the future then they should not be there.

Already in the space of a year the NHSCT has passed a new A&E at Antrim  that is not big enough yet will help, a new mental health ward that is too small to meet their own projections and a new neonatal unit that is 5 years late in making and already to small by health and safety standards, where else in the UK would such bad forward planners get away with, this is why we are seeing these problems that Rutter & Hinds have published.

As with NI Water, when the detriment of a service led to a public Health & Safety concern, the CEO stepped down, Save The Mid believe that the same should happen within the NHSCT and Sean Donaghy should either step down or be removed from his position. In conjunction with this John Compton position AS CEO of the HSCB and his current review should be halted in the NHSCT until such time that management and services are stabilised to bring about any more reconfigurations.

Hugh McCloy - statement "The Mid Ulster Hospital must now be considered to have services returned to it, and have this supported by Mid Ulster MLA's & the district councils, they have sat behind the fence long enough, Mid Ulster patients have travelled too far to be treated worse than they would of been if Mid Ulster Hospital was still open, these changes that were made in the name of patient safety have been proved wrong again. How many reports, deaths and instances of breaches of human dignity will it take until someone is held accountable for the mess they have left our health service in? if our MLA's who include the Deputy First Minister cannot hold them accountable the serious question has to be asked , Who Will??"

If you can highlight these recommendations this is what people need to know, the government were already advise and asked to do this, these were submitted to the health minister, Compton, health committee and mla's they didn’t respond

Recommendations;
1.     Mid Ulster hospital to have its statues of 9am to 11pm A&E restored, with ambulance bypass protocols from 2006 brought into effectiveness.
2.     Minor Injury status to be introduced from the hours of 11pm to 9am, a bypass protocol will need to be developed with the NHSCT and NIAS.
3.     Doctor on call based in Moneymore to provide backup cover for the A&E and Minor Injury Unit.
4.     The High Dependency Unit to be bedded and re-staffed in order to receive, if any, patients admitted from A&E.
5.     The decision to remove the High Dependency Unit to be question by the Health Committee as the risk assessment in 2006 specifically states this unit to remain as part of the critical care network.
6.     Ward 2 to be restored, this will alleviate bed pressures at other network hospital’s & also provide beds for those admitted from A&E.
7.     Ward 3 to be restored, the current plan to close Thompson house will leave a major bed shortage across the each Health Trust, Ward 3 to be reopened for these patients. Having these patients in Ward 3 will also combat the pressure on services such as NIAS to deliver patients for Xray scans.
8.     Thompson house to gain several consultant based clinics that are ear marked to be placed in the main hospital building, with the consultants also being rotated as cover for the A&E and High Dependency Unit.
9.     That Dr Maurice Hayes is made available for questioning by the Health Committee on Developing Better Services.
10.    For every manager or director involved in the rundown of services to be prevented from taking part in any further review into health in Northern Ireland.

Adjournment

The Causeway Hospital, Coleraine

Mr Deputy Speaker: The proposer of the topic will have 15 minutes. The Minister will have 10 minutes to respond. There has been considerable interest in this debate, so we have had to cut down to four minutes the time that is available to all other Members who wish to speak.

Mr Dallat: I thank my party colleagues, and I thank the Business Committee for selecting this topic for the Adjournment debate. As always, there are competing issues in every constituency, but, in this case, there was no dissent from selecting the Causeway Hospital as an issue that is worthy of debate. Indeed, the fact that so many Members are present and so many individuals are in the Public Gallery is an indication of how seriously the issue is being taken.

The concern felt due to the uncertainty that arose following the Compton report has sent shockwaves throughout the North, well beyond the catchment area of the Causeway Hospital. For decades, people like John Robb, who is in the Public Gallery, and other distinguished members of the medical profession campaigned for a new hospital. When the foundation stone was laid by the late Mo Mowlam, the then Secretary of State for Northern Ireland, we all believed that we had a facility that would serve the people of that area for decades to come.

We could leave behind the appalling deception and indecision of the 50s and 60s and the false dawns and piecemeal thinking of the old regime, which thought that it could fool all the people all the time. We could forget the appalling neglect of the 70s, 80s and 90s, when local people had no say and were at the beck and call of non-elected direct rule Ministers. Lord Melchett, the chap in the blue jeans, with neither a vote in Ireland or Britain, was in charge of the health service and contributed to the non-decisions in the north-east.

How wrong we were to believe that we had left the past behind. No sooner had the spanking new hospital opened its doors than the rumours began. Promised services that were to be provided in the Causeway were not commissioned and other services were downgraded. It came, therefore, as no surprise that the Compton report has re-energised those with a death wish for the Causeway. The plotting is well under way, and options are doing the rounds. One option is to do nothing. How stupid, how condescending, how patronising — indeed, how humiliating — to the intelligence of those who live in the catchment area of this wonderful hospital. Doing nothing is not an option for any hospital.

The rationalisation of acute hospitals and the provision of accident and emergency services in the Belfast area may be appropriate, but we do not have four hospitals on our doorstep. It is not appropriate, sensible or wise to be applying the same rationale when deciding to deprive a whole catchment area, which runs from Limavady and beyond to the glens of Antrim. That suggestion is crazy and misguided, and it should be binned immediately.

The Causeway is a new hospital that is still settling down, and it could do without the uncertainty that is currently prevailing. Where are the rights of the citizen? What is this doing to the collective community morale? Has anyone calculated the social cost, the hidden economy?

Minister, you said on radio this morning that you would make your decision based on population figures. I suggest that population figures are not the only criterion that you need to consider. There are other critical factors that you, as a politician, need to take seriously, which were well articulated by a local GP, Pamela Logue, who was also on radio this morning. If the decision is based on population figures alone, the bureaucrats and the clinicians would win and have their way. However, that is not democracy, because it disregards the right of people to have a decent acute hospital and A&E services in their area and compels them to make a tortuous 45-mile journey to the nearest acute hospital with an A&E department.

I have the hospital services configuration options paper, which has been circulating since 11 April. Quite frankly, that is a discredited document, poorly camouflaged to achieve an object that would be a stab in the back to the people served by the new Causeway Hospital. Here is the preferred option:

“Causeway Hospital … delivering a reduced range of unscheduled hospital services, with extended in-patient elective surgical services achieved through directly additional elective work being directed from Antrim Hospital and Altnagelvin provided under a Trust/secondary care lead model of delivery.”

I do not expect everyone to understand that. I am sorry Minister, but intelligent people will not buy that sweetener, because even the authors do not believe that elective surgery from other hospitals, even if it were to happen, is any kind of substitute for a fully functioning hospital that caters for the needs of people when they need it.

Antrim Area Hospital was designed to accommodate 35,000 A&E patients; it is now dealing with double that number and is failing badly, because it does not have the capacity to deal with that kind of unplanned expansion.

4.15 pm

Local doctors have their backs against the wall and could not, with the best will in the world, replace doctors at the Causeway Hospital, who are constantly training in, updating and specialising in the skills that must be available when that ambulance arrives with its blue light flashing, with precious little time to find a solution to a crisis that in many cases is the difference between life and death.

We are told that this kind of rationalisation has taken place in England, Scotland and Wales, where large hospitals with huge capacity are within easy reach by motorway. Neither applies in the case of the Causeway, because Antrim Area Hospital is relatively small, with no possibility of absorbing additional pressure, and the network of roads is not of a standard to accommodate high-speed blue-light ambulances.

We are told that Coleraine cannot attract the type of clinician needed to work there, but I have evidence to the contrary. Malcolm Brown, brilliantly trained in Australia in vascular surgery, was not allowed to work in the Causeway Hospital.

For years, I have asked the Northern Trust and the Western Trust to encourage the Causeway Hospital and Altnagelvin Hospital to work in partnership to achieve increased economies of scale and a better service for patients in both areas. That has happened but not to the extent that it should have, and further development in that area now appears to be ruled out. Simply to downgrade A&E services does the very opposite. It erodes the mainstream medical and surgical departments, which are essential for the proper functioning of a modern hospital. It sets in motion the next stage in the demise of a hospital built at enormous cost just over a decade ago. What shame, what disgrace, what nonsense.

Just a week ago, a petition with more than 28,000 signatures was handed over that calls on the Minister to save the hospital’s A&E department. I assure him that that is only a tiny fraction of those outraged, appalled and disgusted by a review that is designed for only one thing: to downgrade and dilute the A&E department at the Causeway Hospital. I repeat that this is not on, any more than is doing nothing.

I look forward to what other Members have to say on the subject, and I am delighted that so many are present. I am particularly interested in the Minister’s response, and, unlike his predecessors during the distant past, I want to hear a political mind. On that point, I suggest that there are still people in the Department and in the trust who would feel more comfortable with Lord Melchett in blue jeans than with our own Minister in a suit, elected to listen to the needs of ordinary people let down so badly in the past but now hoping that the Assembly will make a difference.

It is well known that if you create enough doubt about a project, you will eventually bring it down. Unfortunately, that works, and I fear that if the green light is not given to the Causeway to stabilise, expand and develop its services in a way in which it was prevented from doing from the beginning, a whole community of people, numbering many thousands, will be deprived of a service to which they are entitled, not in Antrim or Belfast but in the heart of the catchment area, stretching from Greysteel to Ballycastle and beyond.

Minister, you are long enough in the tooth to realise that your judgement in this case is best, because it is more likely to represent the wishes and needs of people. You know that your fingers have already been burnt by the stupidity of other health trusts that have stretched your endurance to the limit. You can avoid further embarrassment, further anger, additional hurt and unnecessary anxiety by defusing this ticking time bomb.

My plea is primarily for those who will need the A&E department and aftercare, but it is also in the interests of the staff, who have given years of loyal service to making the Causeway Hospital a sanctuary for people when they are at their lowest, critically ill and in need of urgent medical and surgical care.

Minister, a wise old man once told me that it is much better to be remembered for what you built rather than to be forgotten for what you knocked down. I have never forgotten that, and although you and I have had our differences, I would not want you to be remembered, or indeed forgotten, as the Minister who knocked down the A&E services at the Causeway Hospital.

The bureaucrats in the Northern Trust, fuelled by so-called advice from the clinicians, will tell us on 22 June 2012 that they have plans for the Causeway Hospital, Coleraine. That will fuel the anger that is felt, and only you can stop it. You can end the disgraceful history that I talked about, and you can certainly ensure that it does not repeat itself.

Minister, I will take a chance and say that I have confidence. I listened to you on the radio this morning, but you need to go further this evening. I am delighted that you turned up for the Adjournment debate. You could have chosen not to be here, but you are. I hope that you will send many people home this evening reassured that the long and turbulent history of getting a hospital in Coleraine will not be undone by those who do not have to go to the electorate for a vote, who do not have to publish a manifesto and who base their decisions purely on considerations that do not represent the people who matter the most: the people of that catchment area.

Mr Deputy Speaker: I have not presided over an Adjournment debate for which there has been such considerable interest. I am very conscious that, given that the issue affects Members’ constituents, if we are to allow everyone who wishes to speak the time to do so, we could be strapped for time. On this occasion, I do not intend to allow an extra minute for interventions. However, Members may allow interventions at their discretion if they wish.

Mr Campbell: As so many Members want to get in, I will keep my remarks brief.

Last year, when the issue of the possible winding down of the Causeway Hospital began to surface, a number of colleagues and I arranged to meet the Minister, who kindly agreed to see us in his departmental offices. We met during the Milk Cup. As we met that morning, the daily newspapers were in front of us, and some of their front pages recorded an incident that occurred at the Milk Cup the previous night, when a young footballer had taken seriously ill on the field of play and was rushed to the Causeway Hospital. Of course, had an effective service not been provided at the Causeway Hospital, we may have been met with a front-page headline of a much starker disposition. That was purely coincidental, but, in a particularly stark and individualistic way, it painted the picture of the issue of the services to the north coast.

I will endeavour to summarise those issues as briefly as possible. Over the next few years, the Northern Trust will serve a population of about half a million, which will make it the largest trust in Northern Ireland in population terms. The Causeway Hospital is sometimes described as a smaller hospital, yet last year it delivered 35% of total live births in the maternity units at the Causeway Hospital and the Antrim Area Hospital, both of which are in the trust area, and it carried out 37% of all elective and non-elective surgery.

The Compton report and other health service reports that assessed changes in services indicated that a withdrawal of emergency services should result in 80% of an acute hospital’s work continuing as before. However, professionals in the Causeway Hospital and elsewhere have indicated to my colleagues and me that that is not the case anywhere else in the United Kingdom. That simply has not happened before, and there is no reason to believe that it would happen at the Causeway Hospital.

My colleagues and I had a series of meetings with the Northern Trust, as it has grappled with the issues that came out of the Compton report. My colleagues and I met Mr Donaghy and the Minister on a series of occasions. Each time we met Mr Donaghy, however, he indicated that — if I were to simplify the problem, as alluded to by Mr Dallat — the issue is the difficulty in attracting surgeons and other senior staff in sufficient numbers to maintain the services required.

Mr Deputy Speaker: Will the Member draw his remarks to a close, please?

Mr Campbell: My understanding is that there is a gap of about 18 months that can be bridged by overseas and other qualified personnel being brought into the Causeway Hospital --

Mr Deputy Speaker: The Member’s time is up.

Mr Campbell: — to maintain 24/7 elective surgery and A&E, which needs to be maintained.

Mr Ó hOisín: Go raibh maith agat, a LeasCheann Comhairle. I welcome the Member’s bringing this debate forward. I hope that the Minister will provide some clarity so that the debate is not self-defeating. There is, I believe, a serious lack of confidence among the staff and nurses at the Causeway, which has sometimes been contributed to by the attitude of the trust in dealing with this. Like others, we, too, met on many occasions the trust and Mr Donaghy, and in the case of the Causeway we really should have been doing it all together and singing off the one hymn sheet.

Mr Campbell referred to the population issue. Of course, that is the issue we looked at. We have figures of some 458,000 being alluded to within the trust area with additional visitor numbers of upwards on half a million over the three- to four-month summer period. That is already well through the upper threshold and glass ceiling of the provision of two acute hospitals.

We all know the historical reasons why the Antrim Area Hospital went where it did. If it was being done today, of course, it would not have gone there but perhaps somewhere more central. But that is history and we now have to look at how best to deal with what we have. The Causeway Hospital deals with not only the boroughs and council districts of Coleraine, Ballymoney, Moyle, Larne, Ballymena, Antrim and Magherafelt but areas such as the other half of my constituency in the Limavady borough, where people will attend the Causeway.

Admittedly, we have a reasonably good road from the likes of Dungiven to Derry, and people will go on the relatively minor mountain road to the Causeway because of the time factor but also because of the treatment factor. So, it is the hospital of choice for many people in the Limavady Borough Council area. A neighbour of mine’s wee lassie got a fractured wrist at a camogie game the other evening and they had her down at the Causeway and were in and out within an hour, which in itself stands as a testament because elsewhere that could be increased manyfold.

There are quite a number of Members wishing to speak but I think we will be saying virtually the same thing: that we believe that there should be no diminution in the provision of service at the Causeway Hospital, particularly in relation to the A&E and surgery cases. What is needed, perhaps, is a proactive pushing of the Causeway, and there seems not to have been that. Some sort of skewed weighting seems to have been applied to the Antrim Area Hospital, and that has resulted in a differential between the two hospitals which goes into the pay structures and recruitment. That has left very much a feeling of inequality at the Causeway.

Five of the area’s six MLAs met the consultants and local GPs at an emergency meeting last night. They reinforced yet again the uncertainty that exists.

Mr Deputy Speaker: Would the Member draw his remarks to a close, please?

Mr Ó hOisín: So, there has to be a radical review of the management of the Causeway, but it is an essential hospital delivery within the area.

4.30 pm

Mr G Robinson: I am glad to be able to speak in the Adjournment debate on the future of the Causeway Hospital, Coleraine. First and foremost, I congratulate and commend all the health service staff for their dedication and service to the health service. I also commend the Unison union personnel who gathered in the region of 26,000 signatures to support the retention of all services at Causeway, including the critical A&E facility.

My colleagues and I have attended meetings with trust officials in the past few months, and we have been reassured at each meeting that all facilities at Causeway are safe. All those facilities must equate to those available at Antrim Area Hospital. The commitment by the trust to the parity of services on a long-term basis at Causeway and parity with Antrim Area Hospital on a 24/7 basis will enable the trust to recruit the appropriate staff to fill the current vacancies. It will also have the positive side effect of boosting morale among the existing staff.

Many have welcomed the news that the Irish Open golf tournament is coming to the north coast and have pointed to the number of visitors that we expect to be attracted to that great event. That is just one event to add to those that annually benefit the north coast, which is in the Causeway Hospital catchment area. We have the North West 200 road race, the raft race and the air show. Sadly, we saw at this year’s North West 200 why the first-class A&E services that Causeway provides are required. In forthcoming years, I believe we will have more sporting events. We must have A&E facilities and the infrastructure to cope with them, as well as with the local communities that stretch from Ballycastle to Limavady. A fully functional, 24/7, quality hospital, namely the Causeway, is absolutely critical to the needs and welfare of a large community, plus the needs of the large influx of visitors to the north coast.

Mr McQuillan: I thank the Member for bringing this debate today. I had the pleasure of handing in a petition to the House last week on behalf of the Causeway branch of Unison. The petition had some 26,182 signatures and was the largest petition ever presented to the House. I believe that that extremely high figure speaks for itself in demonstrating the strength of need in the coastal area for this hospital in its current status. I also believe that any change to its current status would only have a detrimental effect on the provision of health services in the area and to the economy.

Events such as the North West 200, which is one of the best attended events in Northern Ireland’s sporting calendar with over 100,000 spectators, the international air show and the Milk Cup would not be able to meet the very stringent risk assessment criteria to enable them to continue at their current location. Tourism would suffer, jobs would be lost and businesses would fail. That would have a serious, long-term, damaging effect on the area, and the economic revenue would fall. Unemployment figures would rise, social deprivation would increase, education would suffer and skills would be lost. The list is endless.

The coastal area has an ever-increasing elderly population, as it is one of the most popular retirement locations in Northern Ireland. It is proven that elderly patients are more likely to present with an emergency need than they are to have an elective appointment.

Regionally, by population, the Northern Trust is the largest trust in Northern Ireland by over 100,000. It currently serves a population of 458,750, which is ever increasing and predicted to rise to over 500,000 in the next 10 years. The current guidelines recommend that there should be one acute hospital for every 250,000 population, and, with those figures, the Northern Trust justifies the need for two acute hospitals.

The north coast has a very large caravan and holiday let population and a high rise in weekend visitors. The population figures in the Causeway Coast area fluctuate to up to three times the normal residential level, which is well above the recommended figure to require and sustain an accident and emergency department. I sincerely hope that that fluctuation is given serious consideration.

The Causeway Hospital currently handles approximately half the work of Antrim Area Hospital on approximately one third of the budget. Understandably, seasonal variations impact on the Causeway Hospital more than on any other hospital in Northern Ireland, due to its location. When you look at the Northern Trust figures for theatre operations for 2011, you will see that Causeway Hospital carried out 11,402 operations, which is 37·6% of the total of the Northern Trust, compared with Antrim, which carried out 9,636 operations, or 31%. Those operations at the Causeway were carried out with fewer surgeons and fewer consultants and with a significantly lower budget.

I will look now at emergency medicine. Causeway Hospital handled 37·8% of the total new and unplanned attendances for the Northern Trust in 2011. Those figures more than prove that there is a significant requirement for two acute hospitals in the Northern Trust area. There needs to be an improvement in the network across the two acute sites to provide continuity of service, more efficiency, enhanced budget management and the quality primary care of patients. There needs to be an improvement in the sharing of services and resources, and that can be done through the networking of skilled consultants, surgeons and specialists between the two sites.

I do not disagree that, in some cases, the merging of two hospitals or services can be a viable and sustainable option, provided that the sites are located in relative proximity. However, that is not the case with the Causeway and Antrim Area hospitals. There is not the significant infrastructure to meet the golden hour delivery service that the Compton report recommends. Given the vast rural and remote areas in the Northern Trust area, the distances to be travelled would have a major detrimental impact on the patient. It has become clear that, unless services are delivered as closely as possible to the patient’s home, within the constraints of safety, there is a considerable danger that medical care will become economically inaccessible to a significant proportion of the population.

Mr Deputy Speaker: The Member’s time is almost up.

Mr McQuillan: There needs to be a clear vision for the sustainability of both acute hospitals in the Northern Trust area. Any change to the status quo will have a damaging impact on the levels of service and care provided.

Mr McClarty: I thank John Dallat for securing the debate. No other subject in the constituency is concentrating minds more.

Many of the arguments have been rehearsed, and I will not go over them again. We all recognise that the Causeway Hospital is suffering from challenges, and staffing lies at the heart of them. The European working time directive set the maximum working week at 48 hours, which led to a significant reliance on locum doctors. Furthermore, middle grade doctors are apparently not attracted to work at Causeway. It is thought that training is of a lower standard because of the lower population. However, from talking to clinicians in Causeway, it seems that this is absolute nonsense. There is no more attractive area for doctors to come to than the Causeway area. How can you attract any clinician when there is a threat of closure hanging over the Causeway Hospital?

I have every confidence that the problems can be resolved through the better management of rotas, the rotation of doctors throughout the trust and a determined effort to recruit staff. Perhaps it is not as simple as I make it sound, but that is certainly the preferred option to safeguard an essential service and employment.

Since the publication of Mr Compton’s report, the Minister has seemed very enamoured of it. In an ideal world, the report would certainly be fitting, but there is one problem — we do not live in an ideal world. We live in a world where, when a child falls over and cuts its head badly, the concerned parents take him or her to the nearest A&E. They do not think about which facility will best provide for the child. They simply want to get the child treated as quickly and safely as possible. I suggest that the Minister looks outside the box of black-and-white bureaucracy and considers realistically what A&E means for the public. Ultimately, A&E is an accessible, on-demand and known service. People know where the nearest A&E is. They know that it is available 24/7, 365 days a year and that they will be treated for whatever ailment they are suffering from. A&E contributes greatly to addressing the inequalities of access to other healthcare, particularly by marginalised and excluded groups, because it is universally accessible — A&E is simple. Of course, other services, such as the GP out-of-hours service and even pharmacies, are more appropriate for many ailments, but knowing where to go and what service to approach is complicated. For most people making decisions while panicking about injury or illness, A&E will be the first service that springs to mind.

Minister, I appeal to you: listen to the 26,000 people who signed the petition against closure and listen to the clinicians at the Causeway Hospital.

I will conclude by quoting Dr Owen Finnegan, who is a respected and long experienced senior consultant at the Causeway Hospital. He said:

“Without these services in the Causeway, the local population would be put at significant health risk and the services in Antrim Hospital would be unable to cope, leading to significant deterioration in the delivery and the standard health care model for the whole trust area.”

Mr Deputy Speaker: Other Members who wish to speak will have three and a half minutes. I call Daithí McKay.

Mr McKay: I was going to say thank you, a LeasCheann Comhairle, but I do not think I will. I will try not to repeat what other Members said. I think everyone here is singing from the same hymn sheet, and I hope that the Minister is also singing from the same hymn sheet. It is unusual to have 16 Members from seven different constituencies present for an Adjournment debate, so credit should be given not only to the Member for East Derry who brought this issue to the Floor, but to those who campaigned and protested and to the 26,000 people who signed the petition.

For me, it is quite simple: this is a good service. You hear of all the horror stories coming from some of our other accident and emergency units, but there are no problems in the Causeway Hospital. The Member for East Antrim, who is to my right, and I visited the A&E one Thursday night, along with a number of council colleagues, and the staff there were doing sterling work. There were no issues of any great concern. The only problem was staff morale. Staff morale has been severely damaged since the Compton report came out, and the only threat that I can see is coming from the trust and from all this discussion. That can lead to a self-fulfilling prophesy.

The Member who brought this issue to the Floor is right that what we have here is a good health product. It is valued greatly by the people of the Causeway area and my constituency of North Antrim, and we need to build on that and make it a more successful hospital. It is a rural area; it is not Belfast. It is not an urban area with a big population; therefore, it needs to be treated differently.

A lot of discussion in the local press has been about what would happen if the Causeway Hospital were to close. People in Ballycastle would have to travel 40 minutes in an ambulance, as opposed to 25 or 26 minutes to Coleraine. That would be longer again if there were an emergency on Rathlin Island, and we need to take the islanders’ health concerns on board as well.

Antrim hospital has a capacity of 45,000, and Causeway Hospital has a capacity of 30,000. Antrim hospital is due to have an upgrade, which will increase that to 90,000. However, the combined demand of Causeway and Antrim at the moment is 114,000, and as some Members said, given the fact that there is a growing population that will reach nearly half a million by 2020, there is no way that Antrim hospital is going to cope, never mind Altnagelvin to the west. So, we should not rush into any decisions. I urge the Minister to consider the great value that the Causeway Hospital brings to the health service. It is one of our only A&Es that has a clean sheet and a good service record.

The Hinds and Rutter reports that came out last week were quite shocking in what they outlined. There is clearly a need to reflect on decisions that have gone before in respect of Belfast.

Mr Deputy Speaker: Could the Member draw his remarks to a close, please?

Mr McKay: I urge the Minister to take those on board because what we need now is an assurance from the Minister that the Causeway Hospital is not going to follow in the wake of Whiteabbey or Mid-Ulster Hospitals.

Mr Kinahan: I am extremely pleased to be speaking here instead of my colleague Robin Swann, who cannot be here today and would also liked to have been speaking. I am concerned that a little bit of this debate is caused by the politics of rumour and panic that have been set about by comments elsewhere. However, the Ulster Unionist Party recognises that cuts are needed. I reiterate that one of our Minister’s key points all the way through was not to cut hospitals. People should remember that.

What puzzles me is why we have to tie ourselves to Compton’s ideas at all times. If we follow them, it looks like the Causeway Hospital and Antrim hospital could be closed in years to come, and then what will happen? I wonder if Paisley Jnr was right when he said that the Causeway Hospital was going to be closed. I would like the Minister to clarify that matter.

4.45 pm

Compton thinks we should be closing hospitals because he is comparing 1·8 million people in four acute hospitals in England. Where is he comparing? Is this greater London? Is it the west of England? We should be judging and making those calls on our own merits. If I can borrow from Windsor Park, “We’re not Brazil, we’re Northern Ireland”. We should be making those decisions on our own merits.

However, I will focus on the Causeway Hospital. I talked to Mr Donaghy last week, and the only cut that is coming at the moment, so we are told, is the blue-light service between midnight and 7.00 am, yet that means that somewhere between 340 and 440 cases every month will be moved to Antrim. We know that Antrim is struggling to cope at the moment. While I am taking about Antrim, I suggest that someone needs to go in there and talk to staff and take the stress away from them. We have fantastic staff there working under very, very difficult circumstances.

If we are going to cut those hours, what publicity will be put in place to ensure that the public know what is going on? What ambulance cover will be put there? What paramedic cover will there be and what cover will there be from the doctors? If even those little cuts are happening, the public must know what is going on.

Yet, running all the way through this is the concern, hidden at the back, that there is going to have to be a cut to Antrim Area Hospital — even a closure, some have said, and I hope that that is completely wrong. However, it will cost more than £250 million to build a new hospital. Surely, we can get our health service running better so that the right people are going to the hospitals or to GPs and pharmacies. Surely, we can get a system where the health service is running at its very best so that we do not have to cut anywhere and we can keep all our excellent hospitals and keep everyone in their job and, particularly, keep the Causeway.

Mr McMullan: Go raibh maith agat, a LeasCheann Comhairle. I, too, agree with everything that has been said by everybody here today. I would like to take the line that, instead of looking at closing the Causeway Hospital, we should ask whether we have got the best out of Antrim Area Hospital. I believe that bad management has led that hospital to where it is today. If you look at efficiency and the way that the Causeway Hospital is working, that lesson is not in the Compton report. I ask the Minister to look at that and try to get the two hospitals working closer together to get Antrim up to its maximum potential. We have not seen that yet.

We have seen what the trust did for years. It hid the fact that there were trolley waits; it hid trolleys in rooms when people went to visit the hospital; it told lies until it had to come out and tell the truth. I do not think that we have seen the best of Antrim. If we close --

Mr Deputy Speaker: Could I ask Members to be moderate with their language?

Mr McMullan: Sorry, Chairman, it is a very emotive subject. We have to get to the core of the matter.

We talked about not being able to get staff for the Coleraine hospital. When the Mid-Ulster Hospital closed, where did all the staff go? They went to Antrim. It seems to me that Coleraine was penalised for its efficiencies. It met its targets, and it did everything that it was supposed to do. The targets for Antrim were not met. I thank the Minister for answering my question in a letter. However, we talk about people saying things. The rumour mill is out there. The rumour mill started when a statement was made in a council meeting. It is the kind of thing that will close, and I do not think that we need that.

I come from the glens, and we find the Causeway Hospital vital. One thing that has not been mentioned is that, if the Causeway is to close, it will put the Ambulance Service at breaking point. At present, we have one ambulance unit in Ballycastle to cover everywhere. You could end up with an ambulance coming from anywhere to take you to hospital. More times than enough, people from the glens are referred to the Causeway Hospital and, at times, to Altnagelvin. We need that hospital there as much as the people in the Causeway area need it there. It is vital.

I can remember when the whole argument started about building the hospital in Ballymena or where it is today. Some people seem to be bringing that argument back again, and I do not think that it is relevant. We must look at keeping the services that we have. We have an excellent service in Coleraine, we have an excellent working staff, and we have an excellent everything there.

Another thing is that the Causeway Hospital is one of the main places for special needs children, and, when they are statemented, they go there for their yearly reviews and everything.

The consistency of special needs provision has been overlooked.

One of the things that the trust is peddling to councils is community plans. Minister, I would like you to tell the Assembly tonight when those community plans will come out. It is my belief that there will not be legislation for community plans until 2015, which is well --

Mr Deputy Speaker: Will the Member draw his remarks to a close, please?

Mr McMullan: — which is well after the plan that the trust is peddling to councils.

I support everything that has been said here. We should retain the hospital.

Mr D McIlveen: I am conscious of time, so I will try to get straight to the point and not labour it unnecessarily. One thing that I have learned quite quickly in my short time in the Assembly is that civil servants have a remarkable ability to get a spreadsheet to say what they want it to say. I mean no disrespect to them when I say that. I would be devastated — I think that that is probably the only word that I can use — if that were allowed to happen in discussions on the Causeway Hospital.

In addition to the permanent population base around the Causeway Hospital, 750,000 people a year come to north Antrim to visit two of our tourist attractions: the Giant’s Causeway and Carrick-a-Rede. Tens of thousands of people also holiday there. So, I think that we have to be careful that we do not base our consideration of the Causeway Hospital just on the static population around it. Doing so would tell only a very small part of the story of what the Causeway Hospital does and of the large amount of people that it serves. Tribute has been paid to the staff, and I think that we have to echo that. I am not suggesting that we do not listen to civil servants, but I am suggesting that we listen to the medics, doctors and people on the ground at the Causeway Hospital who know exactly what is going on with that hospital’s needs.

Dr John Robb, a retired surgeon, said:

“Getting rid of the A&E at the Causeway Hospital would be catastrophic”.

Dr Owen Finnegan, a retired consultant, said:

“Without these services in Causeway, the local population would be put at significant health risk and the service in Antrim Hospital would be unable to cope”.

I think that we have to take note of those statements.

I have spoken to medics. One accident and emergency doctor I spoke to said that if a patient were transferred from the Causeway Hospital to Antrim Area Hospital in a blue-light ambulance, which happens from time to time, it would be difficult and a challenge for even the most gifted of our doctors to keep that patient alive under the circumstances, given the state of the road between Ballymoney and Ballymena. I saw the Minister for Regional Development in here a few moments ago. I am sorry that he has left, because I would like him to give some indication of whether a conversation has even taken place about that infrastructure. I fear that if it remains as it is and if we realise Sean Donaghy’s ambition of moving A&E to Antrim Area Hospital between midnight and 7.00 am, people’s taking ill will be like playing a game of Russian roulette. I do not believe that we can afford to do that with the health of the people whom we represent. If you get sick before midnight, you are safe.

Mr Deputy Speaker: The Member’s time is almost up.

Mr D McIlveen: If you get sick after midnight, you are playing a very dangerous game, given the current infrastructure. I commend the Adjournment topic.

Mr Storey: I agree with most of the sentiments discussed. However, I dispute what the Member for South Antrim said about the previous Health Minister where local hospitals are concerned. I remind him that the previous Health Minister said: “We can’t sustain local hospitals with acute services in situations where it is virtually impossible to recruit.”

Turning to the issue that is before us, I think that we need to remember what Bill Tweed, the former chief executive of the Northern Trust, said when the Causeway Hospital was opened in 2001. He said:

“I am confident that this hospital will serve the Causeway residents and its many visitors well into the next millennium.”

As someone who has lived in north Antrim all my life and lives in the town of Ballymoney, let me say this: we heard all these arguments before in relation to the closure of the Route Hospital and the Mary Rankin Hospital. The Civil Service gave us all the same arguments and all the same rhetoric. Now, we are back in the same position. In fact, we are almost in a worse position. Here we have a trust telling us, “By the way, we will give you a golden apple. We will tell you that what you need is a brand new hospital in Ballymena costing £500 million.” I have to ask the Minister and the other Executive Ministers whether we really have control over senior civil servants who come out with that sort of nonsense. In times when we are being challenged in relation to the economy, they put out an options paper and then go round councils in north Antrim and try to sell that paper, saying, “Here is what you could have. You could have a brand new hospital but the cost is £500 million”.

Let me make it clear that the people of Ballymoney reluctantly gave up the Route Hospital, and I pay tribute to Dr John Robb who is with us today and who coined the phrase “democratisation of the health service”. Men such as John Robb, Owen Finnegan and others have given us a service in Ballymoney and subsequently in the Causeway Hospital, which we have bought into and look upon as our local service. It is our local hospital. This is not a campaign of sentimentality; it is about securing a service that provides for the people of north Antrim, east Londonderry, and further afield.

I congratulate the Minister on the stance that he has taken. I congratulate him on the correspondence that he sent to me in October 2011 in which he said that the Causeway is here to stay. Let us be very clear that that will happen, because the message needs to go out to the Civil Service.

In my closing remarks, I want to pay tribute to the clinicians and consultants who are currently at the Causeway Hospital. It is because of them that we still have a service there. It is because of them and the dedication that they have shown, and many of us have spoken to those who are currently there and those who have retired.

Mr Deputy Speaker: The Member’s time is almost up.

Mr Storey: My message to the Northern Health and Social Care Trust is this: do the same as the Southern Health and Social Care Trust. Go on a recruitment campaign, not a rationalisation campaign, and that will ultimately mean the preservation of the Causeway Hospital.

Mr Allister: One need only look at the unremitting chaos in Antrim Area Hospital over the past winter and on previous occasions to see why it would be the height of utter folly to consider adding to that chaos by closing the Causeway Hospital. Within the Northern Trust area there are two acute hospitals. Antrim Area Hospital cannot cope with what it has got — pure and simple. The Hinds report and the Rutter report add to the devastating picture in Antrim. Yet, there are those within the trust who say that the answer, nonetheless, is to take the one acute hospital that is functioning, meeting its targets, and in which you do not have to lie on a trolley or wait for interminable hours, and close its acute services and put them elsewhere, where they already cannot cope. That is absolute madness.

For a Minister to have allowed it to get to that point is, I think, very regrettable. To have a trust that has run away with itself with plans of that nature shows that it is out of control. This morning, there were indications from some of the things that the Minister said that perhaps he is back-pedalling from his wholesale commitment to Compton. It is Compton that has put us in this position. The Minister needs to do more than back-pedal. He needs to say — I trust that he will take the opportunity to do so today before the trust meets on 22 June — that there will be no closure of acute services in Coleraine. It is not enough to say that Coleraine hospital is here to stay; it must be that Coleraine hospital with acute services and accident and emergency has to be here to stay. It is up to the Minister to say so, and I trust that he will take the opportunity today to say to the board that whatever it comes up with on 22 June, it cannot be the running down of A&E at Causeway.

If that is what he is saying, he will have a welcome from all sides of the House.

5.00 pm

I think it is quite appalling that, from within the trust and from others, there has been a rolling campaign to talk down the Causeway, to badmouth it and to say that you cannot get staff. The one way to make sure that you will not get staff is to talk it down. That is a strategy of closure by stealth, and that is what I fear we are seeing: those with an agenda to try to get to the point where they would say that they are terribly sorry, they did not want it to end up like this, but they have no option. We saw that in the City Hospital in terms of its A&E and the supposed temporary closure. Now I see the same trend in relation to the Causeway Hospital. I want to say on behalf of my constituents in the upper part of North Antrim that they cannot and will not put up with that. We have a hospital that is valued and necessary and that must be retained.

Mr Deputy Speaker: Will the Member draw his remarks to a close, please?

Mr Allister: The message to the trust and to the Minister is: hands off the A&E in the Causeway.

Mr Poots (The Minister of Health, Social Services and Public Safety): I welcome the opportunity to respond to the debate today, and thank Members for their contributions. Most have been very sensible and rational, and most have been non-political, with the odd exception, but we will learn to excuse those people. I know that the subject of the Causeway Hospital has been a matter of some concern and media speculation of late, and, in particular, the issue of the emergency department has been raised recently in the House. I will try to respond to as many points as I can.

I want to start by commending the work of all of the staff at the Causeway Hospital. I am very much aware of the pressures on our health and social care services and the dedication and diligence of the workforce in the Causeway Hospital in ensuring that the treatment and care of patients is of the highest order. The review of health and social care services in Northern Ireland and the subsequent ‘Transforming Your Care’ report have made it clear that significant changes will be required to the HSC in Northern Ireland. I support the vast majority of the recommendations in the ‘Transforming Your Care’ report. It is too soon to say exactly what those changes will mean for the future configuration of services, or the implications for individual hospitals, but our aim must be, as I have said many times, to have safe, resilient and sustainable services with the focus on the individual and not the institution.

A key driver for the HSC review was the very real concern that the system as it currently stands was not sustainable and that, without change, we could not continue to meet the growing demands on health and social care, with potential consequences for quality of care and, more importantly, patient safety. Those concerns have been borne out by the review, and what we must now do is ensure that we address those issues in a focused, far-sighted and thoughtful way. I have said before that a whole-systems approach is necessary if we are to provide safe and sustainable services in the longer term, not just for the people in the Causeway area but for the entire population of Northern Ireland.

Designing and delivering a new model for health and social care services, one that is built around patient needs, will require engagement with patients. Front line providers and local commissioning groups will play a key role in that by identifying and determining local health needs and ensuring that those are provided for in the most efficient and effective manner. We have recently had a petition handed to the Assembly and the Speaker through Mr McQuillan, gathered by the Unite union. That is certainly a very clear demonstration of where local people’s views are about the service that is required in the Causeway Hospital. It is not something that one would lightly ignore.

A key proposal within Transforming Your Care was the development of population plans to identify the projected needs in an area and how best to meet those needs, consistent with the principles of the ‘Transforming Your Care’ report. The population plans that are currently being worked up by the trusts and the commissioning bodies are an essential first step in identifying what our services should look like for the future, and it is particularly important that they consider what is sustainable in the longer term. The HSC review is not prescriptive about the service configuration in hospital facilities. However, it sets out expectations of what should be included and what a major acute hospital must be capable of sustaining. In implementing Transforming Your Care, my priorities are safety and quality of service provision.

I am aware that Members have concerns about the continuation of acute services including an emergency department at the Causeway Hospital. It is important to emphasise at this point that no decisions have been made. It is not helpful for speculation to precede the proper process that I have approved to ensure that the future configuration of acute hospital care services is safe, sustainable and resilient. We have to see what the population plans tell us about the provision of health and social care services in the Northern local commissioning group (LCG) area and what current and, importantly, future needs will look like.

As the process of identifying and assessing options has not been completed, no one can yet say what the full range of options that will be assessed in any part of Northern Ireland will be. However, there will be proper, open and formal consultation on the way ahead that I will propose when I have assessed all the population plans. No decision on major service reconfiguration will be made before that process has been completed.

A key feature in service configuration will be the need to ensure a staffing profile with the necessary and appropriate skills base to deal with the eventualities that will arise. We cannot, for example, support a service where junior doctors deal with life-critical issues. We need to make sure that we have doctors who have the requisite skills to deal with the particular problems that come to an emergency department. Conversely, we cannot overload other emergency departments with large numbers of patients, as that could lead to unacceptable levels of service and staff working under extreme pressure.

It is important that there is engagement at local level in any consideration of services. I want to ensure that people are fully informed and have the opportunity to contribute to the future delivery of services in their areas. I have stressed this point to local representatives to ensure that they participate in the process that is under way to develop a population plan for the Northern LCG area.

I want to see services becoming more accessible to people in their communities and closer to their homes. This will mean changes to how health professionals work together to break down the barriers and blockages that can adversely affect how health and social care are provided. I also want to make sure that, by moving services closer to home where it is safe and appropriate to do so, we ensure that our hospitals are configured to deal with those who need them most, while those who can be safely cared for in the community are discharged as soon as their health and social care needs permit.

The configuration of our hospital system must reflect and be responsive to the needs of our population. That is why population plans are so important and why we have to get them right. I will be quite happy to challenge the proposals where I do not think that they will meet the needs of the population covered by the Northern Trust. That is why it is crucial that any redesign of the service is done not through a top-down approach but one that involves local populations and professionals working within clear parameters.

As part of the development of a population plan in the Northern Trust area, a number of professional advisory groups comprising local consultants, GPs, nurses and allied health professional staff from across the Northern LCG area have been established to work through the issues and identify possible solutions. These groups have identified a number of options, including a reconfiguration of hospital services in the Northern area, which may have implications for the Causeway Hospital. I expect that, as they evolve, the forthcoming population plans will provide further proposals and details on what TYC will mean for local areas.

As I said, however, no decisions have yet been made about future hospital services in the Northern area. A range of engagement activities is under way with councils and community groups across the area, and discussion of the options and the future role of the Causeway Hospital is part of the debate in the workshops and meetings. Difficult decisions may have to be made in the future, but our aim at all times will be to ensure that patients are put first and that we have in place a safe and sustainable service that meets the needs of the population it serves.

To that end, the future services of the Causeway Hospital are very much in the hands of the local management and clinicians. The proposals that they produce need to be safe, sustainable, resilient and, dare I say, innovative. I have, at no point, expressed any desire to remove services from the Causeway Hospital. If I do not receive a safe, sustainable and resilient proposal, there is a serious risk of the withdrawal of services in an unplanned way by the Royal Colleges, which will not allow their members to be compromised by delivering an unsafe service.

We will have the formal consultation processes, which will recognise the significant changes across the system to the services. Key stakeholders and the wider public will have their say. I encourage the local community to engage fully, as it and many of the local MLAs and MPs have been doing, with the development of the population plan. I trust that, as we reach a conclusion on the matter in due course, after giving it all the appropriate attention, detail and thought, we will arrive at the right decision for the Northern Ireland health service and for the people who live in the catchment area of the Causeway Hospital. To that end, we will have to wait until we hear all the relevant information before can make those decisions. Thank you for giving me the opportunity to speak.

Adjourned at 5.11 pm. 

Northern Ireland Patients have waited the equivalent of 2,006 days In Northern Ireland A&E's Jan-Mar 2012

According to the most recent data released by the Department of Heath Safety & Social Services at total of 4,011 patients had to wait over 12 hours in an A&E before being treated, admitted, transferred or discharged home.

As the DHSSPS do not provide the statistical information for waiting times above 12 hours, using the 12 hour base line of patients waiting 12 hours or more a total of 48,132 hours were spent waiting in A&E’s, this is equivalent to a minimum of 2006 days.

This shocking figure is also equivalent to 5.5 years. And does not contain waiting times for patients waiting 4-8 hours or under 4 hours.

For table click here: http://savethemid.weebly.com/uploads/7/4/7/7/7477841/ae_waiting_2012.pdf

Since the implementation of the Hayes report/Developing Better services in 2005 the performance of front line acute care has seriously fell into detriment. The removal of acute service from Omagh, Whiteabbey and Mid Ulster hospitals have had a huge impact upon the capacity of the health service, this coupled with the recent downgrading of Lagan valley, Belfast City and the newly Downe Hospital and proposal of John Compton to downgrade 5 more acute hospitals, Northern Ireland could soon be seeing an “Armageddon” in front line acute care.

The performance of the health service in Northern Ireland is the worst in the UK and potentially the developed world, recent figures show thousands of patients waiting for treatment.

Over the next 5 years a recent review intends to further reduce the capacity of Northern Ireland Hospitals, a move that is said to be in the name of patient safety?

Over the past 2 years several hospitals in northern Ireland have been downgraded, one in particular the Mid Ulster Hospital in Magherafelt was stripped of its acute services despite a risk assessment stating that it was the most dangerous move health chiefs could of made. See Save The Mid Campaign's blog for full breakdown http://savethemid.weebly.com/blog.html

There is an Armageddon of health services in Northern Ireland, it will not be long until tourists are given a health warning when they enter Northern Ireland.

The Department of Health, Social Services and Public Safety today published the March 2012 Northern Ireland Waiting List Statistics Releases.
~ Thursday, 24 May 2012

The Waiting List Statistics Releases show detailed information on the number of people waiting for a first outpatient appointment, a diagnostic test or inpatient treatment at hospitals in Northern Ireland.

Key facts and figures for NI Waiting Times at end of March 2012

Waiting Times for a First Outpatient Appointment

The 2011/12 Ministerial target relating to outpatient waiting times states that from April 2011, at least 50% of patients should wait no longer than nine weeks for a first outpatient appointment, and no patients should wait longer than 21 weeks.

Overall

The total number of people waiting for a first outpatient appointment at the end of March 2012 was 103,007.
This represented a decrease of 21,093 (-17.0%) on the number waiting at the end of December 2011 (124,100) and was down 3,199 (-3.0%) on the number waiting at the same time last year (106,206).

Proportion waiting over nine weeks

At the end of March 2012, 27.5% (28,277) of the total number waiting were waiting more than nine weeks for a first outpatient appointment, a decrease from both the 47.8% (59,378 out of 124,100 total patients) waiting more than nine weeks at the end of December 2011, and the 30.0% (31,909 out of 106,206 total patients waiting) waiting at the end of March 2011.

Patients waiting longer than 21 weeks

The number of people waiting more than 21 weeks for a first outpatient appointment at the end of March 2012 was 5,903, 5.7% of the total number waiting. This compared with 24,720 waiting more than 21 weeks at the end of December 2011, 19.9% of the total waiting.

Completed Outpatient Waits for a First Appointment

A total of 145,562 patients attended a first outpatient appointment during the March 2012 quarter, an increase of 21,917 (+17.7%) on the quarter ending December 2011 (123,645) and up 9,550 (+7.0%) on the quarter ending March 2011 (136,012). These figures include all activity commissioned by the Health Service in Health and Social Care hospitals and also include outpatient activity, commissioned by the Health Service, which is undertaken by the independent sector at locations other than Health and Social Care hospitals.

Waiting Times for First Appointment at an Integrated Clinical Assessment and Treatment Service (ICATS)

Overall

The total number of people waiting for a first ICATS appointment at the end of March 2012 was 6,476. This represents an increase of 33 (+0.5%) from the previous quarter (6,443), and an increase of 497 (+8.3%) from the end of March 2011 (5,979).

Proportion waiting over nine weeks

At the end of March 2012, 10.7% of patients were waiting more than nine weeks for a first ICATS appointment (693 out of 6,476 total patients waiting), compared to 17.7% of patients (1,141 out of 6,443 total patients waiting) waiting at the end of December 2011, and 6.4% (381 out of 5,979 total patients waiting) at the end of the same quarter the previous year.

Patients waiting longer than 21 weeks

There were 76 (1.2%) patients waiting longer than 21 weeks for a first appointment at ICATS, compared with 280 patients (4.3%) waiting longer than 21 weeks at the end of December 2011.

Waiting Times for a Diagnostic Service

The total number of patients waiting at the end of March 2012 for a diagnostic service was 60,912, a decrease of 4,518 (-6.9%) on the previous quarter (65,430), and a decrease of 1,193 (-1.9%) on the number waiting at the end of March 2011 (62,105).

Patients waiting over nine weeks

At the end of March 2012, there were 6,718 (13.7%) patients waiting over nine weeks for a diagnostic service. This represented a decrease of 2,967 (-30.6%) on the number waiting more than nine weeks at the end of December 2011 (9,685), but was up 866 (+14.8%) on the number waiting more than nine weeks at the end of March 2011 (5,852).

Patients waiting over 13 weeks for a day case endoscopy

At the end of March 2012, there were 1,928 (16.4%) patients waiting over 13 weeks for a day case endoscopy. This represented a decrease of 3,445 (-64.1%) on the number waiting more than 13 weeks at the end of December 2011 (5,373), and a decrease of 4,263 (-68.9%) on the number waiting more than 13 weeks at the end of March 2011 (6,191).

Diagnostic Reporting Turnaround Times

The Ministerial target for diagnostic reporting times states that, from April 2011, all routine diagnostic tests should be reported on within four weeks.

Overall

The total number of completed diagnostic reports verified and dispatched to the referring clinician during the quarter ending 31 March 2012 was 118,551, an increase of 5,907 (+5.2%) on the previous quarter (112,644), and an increase of 14,347 (+13.8%) on the same quarter in the previous year (104,204).

Completed Routine Reports

99.4% of routine diagnostic tests were reported, verified and dispatched within four weeks (with 97.4% of routine diagnostic tests reported, verified and dispatched within two weeks). Although the target that 100% of all routine tests should be reported within four weeks was not met, each Trust managed to report on over 98% of all routine tests within four weeks.

Completed Urgent Reports

91.6% of urgent diagnostic tests in Northern Ireland were reported, verified and dispatched within two days, with each Trust reporting on over 88% of all urgent diagnostic tests within two days.

Waiting Times for Inpatient Admission

The Ministerial target, for inpatient waiting times, states that from April 2011, at least 50% of patients should wait no longer than 13 weeks for inpatient or day case treatment, and no patient should wait longer than 36 weeks.

Overall

The total number of patients waiting for treatment at the end of March 2012 was 50,828.
This total has decreased by 5,642 (-10.0%) compared with the previous quarter (56,470), and also fell by 2,052 (-3.9%) compared with the same quarter in the previous year (52,880).

Patients waiting over 13 weeks

At the end of March 2012, there were 18,109 (35.6%) patients waiting more than 13 weeks for inpatient treatment. This number represented a decrease of 6,059 on the figure for the previous quarter (24,168), but was up 479 on the number waiting over 13 weeks at the end of March 2011 (17,630).
The proportion of people waiting more than 13 weeks for inpatient admission was 35.6% (18,109 out of 50,828 total patients waiting), compared to 42.8% at the end of December 2011 (24,168 out of 56,470 total patients waiting) and 33.3% at the end of March 2011 (17,630 out of 52,880 total patients waiting).

Patients waiting over 36 weeks

There were 775 patients waiting longer than 36 weeks for inpatient admission at the end of March 2012, a decrease of 4,238 on the previous quarter (5,013), and down 486 on the number waiting over 36 weeks at the same time last year (1,261).

Completed Inpatient Waits

A total of 55,194 inpatients were admitted to hospital, following an inpatient wait, during the March 2012 quarter. This was an increase of 4,131 (+8.1%) on the quarter ending December 2011 (51,063) and was up 7,808 (+16.5%) on the quarter ending March 2011 (47,386). These figures include all activity commissioned by the Health Service in Health and Social Care hospitals and also include inpatient activity, commissioned by the Health Service, which is undertaken by the independent sector at locations other than Health and Social Care hospitals.

One year since the election and nearly 2 years since the Mid Ulster has lost its A&E Save The Mid look at what questions were asked by Mid Ulster MLA's regarding the Mid Ulster Hospital.

You can judge for yourself if they work for you? In all 6 newly elected MLA's full of promises about health delivered 7 questions about Mid Ulster Hospital, not one question was put to the Minister about returning acute services to Mid Ulster Hospital.

It is good however insulting it may be to hear them speak about Mid Ulster Hospital, it would be more of a comfort to residents in Mid Ulster to see them fight for Mid Ulster Hospital.

Already in the light of Causeway Hospital being under threat, MLA's in the Coleraine area have inuddated the health minster for answers, what has changed in Mid Ulst
Mr Patsy McGlone
(SDLP - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety for an update on the plans for additional beds at Antrim Area Hospital to meet the demand resulting from the changes to services at the Mid-Ulster Hospital, Magherafelt.     23/05/2011

Mr Francie Molloy
(SF - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety how many patients have presented at the Minor Injuries Clinic at the Mid Ulster Hospital since it was established in May 2010; and how many of these patients were able to receive the necessary treatment at the clinic. [Priority Written]    01/06/2011

Mr Patsy McGlone
(SDLP - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety what additional services were provided by the Ambulance Service in the Mid Ulster area as a result of the £875,000 additional funding which was provided following the reduction in services at the Mid Ulster Hospital, Magherafelt.     08/06/2011

Mrs Sandra Overend
(UUP - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety (i) whether any internal structural changes have been made to the Mid-Ulster Hospital in the last 12 months; (ii) whether he has any plans to change the internal structure of the hospital in the next 12 months; and (ii) why this information was not provided in his response dated 6 September 2011.     14/09/2011

Mr Ian McCrea
(DUP - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety to detail the number and type of day procedure operations carried out at the Mid-Ulster Hospital in (i) 2010; and (ii) 2011.    Display answer 21/09/2011

Mr Ian McCrea
(DUP - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety to detail the current, and future, plans for the Mid-Ulster Hospital site.    Display answer 22/09/2011

Mr Patsy McGlone
(SDLP - Mid Ulster) To ask the Minister of Health, Social Services and Public Safety, in relation to the salaried dental service at the Mid-Ulster Hospital, Magherafelt, to detail (i) the number of adult and child patients currently registered; (ii) the costs, including building and capital costs, incurred in the set-up of this service; (iii) the total running costs incurred by the service in the last 12 months, including staff, maintenance, laboratory and materials; and (iv) the gross Health Service item of service fees generated by the service, including the patient contribution to Health Service charges, between 1 February 2011 and 31 January 2012.    Display answer 28/03/2012 Answered

In October 2011 Save The Mid submitted several documents to the Compton Review, contained with these reports were several recommendations based on fact based evidence.

In light of the current information being submitted about Antrim Area Hospital, Save The Mid will be calling for the Health Minister to recommend that the Northern Health & Social Care Trust assess these recommendations with the  view of implementing them.

The state of acute emergency care has floundered since the removal of acute services at the Mid Ulster Hospital, yet this is no surprise at this was pre-warned. Each and every local MLA also knew of these dangers, it is time they fought for Mid Ulster and the services that were once in place to save our lives.

Save The Mid 2011: ref stm/00/1002

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Recommendations;

1.     Mid Ulster hospital to have its statues of 9am to 11pm A&E restored, with ambulance bypass protocols from 2006 brought into effectiveness.

2.     Minor Injury status to be introduced from the hours of 11pm to 9am, a bypass protocol will need to be developed with the NHSCT and NIAS.

3.     Doctor on call based in Moneymore to provide backup cover for the A&E and Minor Injury Unit.

4.     The High Dependency Unit to be bedded and re-staffed in order to receive, if any, patients admitted from A&E.

5.     The decision to remove the High Dependency Unit to be question by the Health Committee as the risk assessment in 2006 specifically states this unit to remain as part of the critical care network.

6.     Ward 2 to be restored, this will alleviate bed pressures at other network hospital’s & also provide beds for those admitted from A&E.

7.     Ward 3 to be restored, the current plan to close Thompson house will leave a major bed shortage across the each Health Trust, Ward 3 to be reopened for these patients. Having these patients in Ward 3 will also combat the pressure on services such as NIAS to deliver patients for Xray scans.

8.     Thompson house to gain several consultant based clinics that are ear marked to be placed in the main hospital building, with the consultants also being rotated as cover for the A&E and High Dependency Unit.

9.     That Dr Maurice Hayes is made available for questioning by the Health Committee on Developing Better Services.

10.                        For every manager or director involved in the rundown of services to be prevented from taking part in any further review into health in Northern Ireland.

See below document for full report that was submitted to John Compton, Edwin Poots and the Northern health 7 Social care Turst

Northern Health & Social Care Trust's mental health performance is in the red