Debate contribution: Cross-border Healthcare

Debate contribution by Mr Mark Durkan on 18 June 2024.

MLA

Mr Mark Durkan

Party at the time

Social Democratic and Labour Party

Date

18 June 2024

Type

Debate contribution

Business

Opposition Business

Heading

Cross-border Healthcare

Assembly identifier

Official Report component 4497224

Read the official Assembly record

Text

Go raibh maith agat, a Phríomh-Leas-Cheann Comhairle.

We have a health system whose prognosis is critical, where "urgent" no longer means "urgent", and "red flag" has lost its urgency. Patients face prolonged waits and uncertainty at the expense of their health. The erosion of those categorisations reflects a system under immense strain where timely access to care not only is compromised but, in some cases, seems to be a pipe dream. Practically every health service waiting list in the North is breaking records: bad ones. Half of the people waiting to access mental health services wait longer than nine weeks. Over 17,000 people are on a waiting list for occupational therapy and have been stripped of their dignity. Almost 25,000 people await orthopaedic surgery, with some, crippled by pain, being told they will wait seven years to access a knee replacement. How is that acceptable? Patients across the spectrum of health services are being referred for treatment for conditions that were once manageable but have become unbearable as a result of the unconscionable delays. The failure to deliver timely healthcare not only costs the public purse dearly but costs lives. We stand at a critical juncture, facing formidable health challenges that were not created overnight. In fact, pre-pandemic, our waiting lists were 100 times bigger than those in England, a region with 30 times the population of here. The festering wounds of the health service went unsalved during political collapse. Past Health Ministers have failed to invest in health, and that saw our workforce driven to the picket lines not just to demand fair pay but to fight for the safety of the patients whom they care for. There was little attempt to resolve the situation. As a result, health has paid the heaviest price after more than a decade of mismanagement of, albeit, a shrinking public purse by the two big parties and a refusal to implement transformation as per the Bengoa report. The Executive had the key to reforming the health system but did not bother to turn the lock. Embracing cross-border healthcare is born of necessity but also practicality. It is an imperative response to our growing waiting lists and healthcare disparities. As has been highlighted, collaboration with the South will allow the maximisation of available healthcare resources, provide opportunities for medical professionals through shared expertise and offer the potential for cost savings and better allocation of healthcare funds.

I am sorry. I will come to you at the end, if I have time, Patsy. The success of the ROI reimbursement scheme is testament to the need to drive cross-border solutions. During its last iteration in 2022, over 2,000 patients availed themselves of the provision in just 14 months. People are contacting my office and, I am sure, those of others by the dozen, desperately seeking updates on the return of the scheme. Painful time frames prove devastating for patients and their families. People are living in agony, their lives turned upside down in a health system that no longer catches people when they fall. Patients are turning to their credit union books, dipping into their life savings or, even worse, borrowing money from God knows who and God knows where to access healthcare. That is becoming an all-too-familiar story. While the scheme was not perfect, as Mrs Dodds was eager to point out, it offered a glimmer of hope. The current system is ridiculous. We have patients criss-crossing the border weekly in their busloads for procedures in the North, such as cataract surgery; meanwhile, patients here cannot access the same treatment in a timely manner. That said, the North West Cancer Centre stands as a shining example of successful cross-border collaboration. Its success underscores the power of partnership and regional cooperation in delivering specialised healthcare services where they are needed most. I am conscious that it was the Speaker who was Health Minister at that time, as he often reminds us. Sadly, the pragmatism and vision that he demonstrated in that role seems to be lacking in his colleagues today. Despite the state-of-the-art cancer services in the north-west, widening health inequalities have hit hard in that highly deprived region. The fact that a child in Derry has a life expectancy that is 11 to 15 years shorter than that of a child in a more affluent area is harrowing. The expected lifespan of a man in Derry is lower than one in countries such as Lebanon and Cuba, according to research conducted by the Department of Health. The state of health here is not like Beirut: it is worse. It is incredible that, in a place as small as Northern Ireland, there are such disparities across and within council areas. The largest inequality gap in the Western Trust and other trust areas was in deaths due to drug misuse. We see the impact of drug misuse and addiction: the bereaved parents whose lives have been shattered and the individuals feeling that they have nowhere else to turn. The escalation both in the severity and volume of cases is heartbreaking. At the moment, far too many vulnerable people fall through the gaps of addiction and mental health support services, and many cross the permeable border daily. It is no coincidence that drug-related deaths have trebled in a decade. It is a direct consequence of Tory austerity and failed leadership here. On the motion, the harmonisation of pay, especially in border regions, is of particular importance to prevent our specialist staff leaving in their droves. It used to be the case that nurses, doctors and allied health professionals (AHPs) had to take a plane across the water or across the world for better-paid opportunities. Now, they just have to hop into their car and drive a few minutes down the road. Recently, I spoke to one health specialist who is paid two thirds more for her expertise across the border, as are several of her ex- and now new colleagues, who have headed South for more reward. Who would blame them? The failure to pay health service staff what they are worth is an embarrassment; worse than that, it is draining the lifeblood of the health system, and any savings that it achieves are false. Look at the spending on locums and agency staff and at the failure to deliver services. That is something that I implore the Minister to consider with regard to the capitation formula for trusts. He spoke of Agenda for Change and the need for pay parity. There has to be a weighting in border areas to prevent that haemorrhaging of staff across the border. The Health budget is stretched to breaking point like a threadbare blanket, unable to cover all the needs. Inevitably, vulnerable people will fall through the gaps. However, we are no clearer on how the Government plan to address the crisis in health, and where are we with transformation? It is all well and good pumping money into a system — I wish that we could pump even more into it — but that system is crying out for reform. We need to do things differently to ensure maximum impact of the money that is spent. We should explore or do more than explore all-island collaboration on bespoke specialist areas such as tier 2 obesity services, cross-border enhancements in social work services in safeguarding and data sharing, as well as perinatal and paediatric pathology services. That is vital. It is unacceptable that, since 2019, post-mortem examinations have had to be carried out in England due to a lack of specialist staff, adding further distress to grieving parents. Five years ago, I received assurances from the permanent secretary that work was under way to seek a cross-border solution. It is unforgivable that, to date, there has been no progress. The DUP's position on this and its rationale for opposing the motion are typical of its approach to nasal amputation: it cuts off its nose to spite its face, an approach that continues to cost people dear. It is no wonder that our health service is in such a state when you look at the approach of our two biggest parties. They say that health is a priority when, clearly, politics always comes first. Sinn Féin has had only one Member in the Chamber for the majority of the debate. I am glad to see that she has now been joined by a few more. I was worried that abstentionism had extended — sorry, been reapplied — to Stormont as well. I agree with Ms Kimmins's view, however, that getting into a car and driving, even for a couple of hours, is preferable for families to having to get on a plane on that most awful of journeys. We must build a healthcare system that is responsive, resilient and compassionate —

— a system that leaves no patient behind and values our heroic health service staff, who carry out Herculean tasks daily.

1,490 words. Text as published by the Northern Ireland Assembly.

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