Debate contribution: Bangor and Newtownards Minor Injury Units: Closure

Debate contribution by Mr Robin Swann on 30 April 2024.

MLA

Mr Robin Swann

Party at the time

Ulster Unionist Party

Date

30 April 2024

Type

Debate contribution (made as a minister)

Business

Adjournment

Heading

Bangor and Newtownards Minor Injury Units: Closure

Assembly identifier

Official Report component 4487812

Read the official Assembly record

Text

Thank you very much, Mr Deputy Speaker. Before I get into my substantive response, I will pick up on some of the comments made by Members, because it is important to provide clarification before I respond to the debate. Miss McIlveen and Mr Chambers used quotations attributed to me from press releases or other documents, I can assure them and the House that I stand by what I have said in the past. I do not change my mind or perform U-turns just because something may be popular or seen to be the right thing to do. I will address a wider comment, which I am attributing not just to Ms Egan or Mr Muir in today's debate, in order to dispel the easy line that is often used that, in Northern Ireland, we spend more per head on health than any other country. Compared with England, Scotland and Wales, that statistic proves to be right, but, in 2022, the Northern Ireland Fiscal Council stated that we spend:

"broadly the same as in the North West and North East of England."

When spend is broken down regionally, there is therefore not the disparity that some try to portray when they say that our system is overfunded. On where we stand on that matter, the Northern Ireland Fiscal Council also stated in 2022:

"health spending in NI has previously been broadly in line with relative need."

I thank the Member for securing the Adjournment debate and providing an opportunity to address an issue that concerns a key change and improvement to unscheduled care in the South Eastern Health and Social Care Trust. The consolidation of minor injury services on the Ulster Hospital site represents what I have been told is an improved service for the residents of the Ards and North Down Borough Council area. At the Ulster Hospital, patients have immediate access to a service that is open longer hours, with a wider range of diagnostics. More importantly, the minor injury service has been secured for the long term, with the appropriate skills in place and training for staff. In addition, the unit is now consultant-led, whereas the smaller units were led by specialist emergency care nurses. I will expand on that later. Although the decision was taken by the permanent secretary, under the Northern Ireland (Executive Formation etc) Act 2022 — Members have highlighted the fact that the decision was made in the absence of Ministers, when this place was not functioning — I have been assured that the correct processes were followed in making that decision. I have been informed by the South Eastern Trust that the main drivers for implementing the new model included increased demand for unscheduled care, staffing challenges, substandard facilities and the need to optimise staff skills and expertise. Above all, the trust was facing a strong risk that it would have to react suddenly to the inability to provide minor injury services on the two sites in the very near future. To mitigate that risk, the trust's decision to transfer those services to one site was aimed at ensuring that unscheduled care services for the population of Ards and North Down remained safe and sustainable for the long term.

I have been informed that, in the consultation document, the trust cited difficulties in the recruitment and retention of staff at the minor injury units. Officials in my Department and the Public Health Agency sought additional information from the trust about its position and were advised that there had been ongoing recruitment drives for emergency nurse practitioners (ENPs). Prior to the consultation exercise, the most recent recruitment drive had been in autumn 2022. While that was successful in appointing a number of candidates to the trust, none of the successful applicants was interested in taking up a permanent position at the Ards minor injury unit. That is most likely because working as part of a multidisciplinary team, as would be the case in emergency departments, is an attractive proposition for emergency nurse practitioners because of the extended scope of practice and greater opportunities for nursing management experience that it offers. At the close of the consultation period, 40% of the posts were outstanding in the emergency nurse practitioner workforce. Two of the posts were filled by other trusts' ENPs on a supplementary basis. The trust has advised that, on average, since 2018, 20% of the ENP workforce has been unfilled at the Bangor and Ards MIUs. As I mentioned, the trust reported that ENPs had a reduced scope of practice at a stand-alone unit and that that was a contributory factor in its recruitment difficulties. In recent years, bank ENPs have supported the operational rota at Ards MIU. However, the six retired bank ENPs who had been available in previous years to secure the service have been reduced to two, meaning that the historical reliance on bank staff was no longer possible. A further major issue for the trust that, I was informed, was affecting services at Ards minor injury unit was the condition of the estate in which the service operated. The building needed major investment or replacement to continue providing the service. In the absence of any immediate capital funding, the trust was faced with the prospect of temporarily closing or relocating in the short term, while awaiting capital investment, in order to effectively manage the risks that were present. Even if the facilities at Ards Hospital were renovated, the volume of demand versus the available space would also be likely to present challenges on the current site. Likewise, the facility in Bangor is limited in space and would struggle to meet further demand if that were the operational alternative. The public consultation on the future of urgent and emergency care in Northern Ireland, which was mentioned, was launched in March 2022, and the consultation findings report was published in October 2022. The report concluded that there was broad support for the proposals outlined in the public consultation, which included three strategic priorities: creating an integrated urgent and emergency care service; capacity, coordination and performance; and a regionalised approach to immediate care. The move to consolidated minor injuries services on the Ulster Hospital site met priority 1, which was to create that integrated urgent care service. My Department, along with the South Eastern Trust, is still committed to providing better urgent and emergency care services and recognises the need for reform to address the many challenges in the healthcare system, which that move seeks to do. I have confirmed that all the relevant procedures were followed in making the decision. Having identified significant challenges and the need to make a service change, the chief executive of the South Eastern Trust notified my Department in December 2022 of the trust's intent to change the model of care that it provides to residents of Ards and North Down. That, like all significant service change, is a requirement under the Department of Health's policy guidance on roles and responsibilities. In January 2023, the trust received approval from the Department to commence a public consultation on the matter. The consultation outlined nine options, with a preference to move the minor injuries service units to the Ulster Hospital site. The consultation commenced in February 2023 with trust board approval for the statutory 12 weeks, and it ended in May 2023. I have noted Members' concerns about the consultation period, but I was advised that, during the consultation period, the trust held three public events: two online and one in person. The events had 121 attendees, 388 responses were received, and 642 local groups and 460 organisations were informed. As has been mentioned, a petition of over 19,000 signatures against the move was also received. The trust's findings and associated mitigations were publicly presented in a feedback report released in June. During the summer period, the trust's board approved the preferred option, and the trust's chief executive wrote to the Department requesting approval to transfer the services. A number of clarifications and queries were addressed by my officials in the Department and the Public Health Agency before the findings were submitted to the permanent secretary. Having carefully considered the proposal and the consultation outcome, the permanent secretary, in the absence of an Executive, wrote to the trust's chief executive at the end of August to approve the changes under the Northern Ireland (Executive Formation etc) Act 2022. As a result, the minor injuries services transferred to the Ulster Hospital site on 6 September 2023. Mr Deputy Speaker, that is the update that I have.

1,426 words. Text as published by the Northern Ireland Assembly.

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