Debate contribution: Reconfiguration Framework: Consultation

Debate contribution by Mr Mike Nesbitt on 1 October 2024.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

1 October 2024

Type

Debate contribution (made as a minister)

Business

Ministerial Statements

Heading

Reconfiguration Framework: Consultation

Assembly identifier

Official Report component 4562355

Read the official Assembly record

Text

I thank the Member of the Opposition for his comments and his question. I can say to him that this will not lie on the shelf and gather dust. Indeed, some Members have suggested that the Bengoa report from 2016 has, over the past eight years, sat on the shelf gathering dust, and that is not the case. There have been some movements on foot of that Bengoa report. I think of day procedures and elective care and how we are trying to separate elective care from emergency operations. That is a sensible way forward. In my closing remark, I asked Members to think about this as one of a series of statements that are coming. Professor Bengoa will be back next week to, as I put it, reboot that report, not to write a new one, because the challenges remain as they were in 2016. I intend to publish in the forthcoming weeks a three-year plan that will cover the rest of my time as Health Minister, if I am spared to work through to May 2027. I have made it clear that I want to see a regional attitude towards breast screening services. We will continue to deliver that at pace. I have talked about my initiative, which I am calling "Live Better", to tackle health inequalities. That is due to be launched in the forthcoming weeks. In association with that, I will look at some of the social determinants of health inequalities. I think of, for example, tobacco and vaping. We will be hand in glove with the UK legislation on that front. I am considering minimum unit pricing for alcohol, because it is clear that, if you go into the most deprived areas, you see the worst impacts of alcohol abuse. I say to the Member that a lot is happening. I cannot give you a step-by-step time frame, but I am moving at pace to deliver better outcomes for patients, service users and the staff who deliver healthcare.

I thank the Chair of the Committee for her welcome and her comments. I am, of course, not a clinician; I have no medical or clinical qualifications. As Minister, I see myself as an enabler of change. Recently, I was in both the Causeway Hospital and the Antrim Area Hospital. As the Member knows, the Northern Health and Social Care Trust is consulting on the future of general emergency surgery provision and the potential that it may move from the Causeway Hospital down to Antrim. In its consultation document, the trust has made clear its preferred option, which is the one that I have just articulated. However, when I met the clinicians at Antrim Area Hospital, they made it clear that it was an imperative for patient safety and delivering better outcomes. So, yes, I will be guided by clinicians, surgeons, allied health professionals (AHPs) and nurses. There is also a need to consult the local community, because all healthcare is not just personal but local. For example, for most of my adult life, my nearest hospital has been the Ulster Hospital. Of course, I feel an affinity for the Ulster more than I would for the South West Acute Hospital (SWAH), Altnagelvin Area Hospital or Daisy Hill Hospital. I have to get over that affinity and wishing for every service that I need to be delivered at Dundonald and recognise that it is in my best interests, once we have the areas of specialty, to travel a little further for a procedure. Having said that, I know that people who are prepared to travel for a procedure want the aftercare as close to home as possible. That is the principle underlying my thinking.

I thank the Member for her comments. No acute hospital is, in any way, in danger; in fact, some of the proposals, such as the one to separate emergency from elective surgery, will secure their future. On the first point about attracting workforce, interestingly — well, you will be the judge of that, but I found it interesting — I went up to Altnagelvin a few weeks ago to visit some of our international colleagues who have come here. They go into the centre at Altnagelvin to learn about the processes and procedures that we use in hospitals that may be different from what they are used to in India, Afghanistan or wherever their country of origin is. The interesting thing for me was asking them whether they preferred to be at Altnagelvin in Derry/Londonderry or at the South West Acute Hospital in Enniskillen. There was a variety of answers. Those who came from big cities in India tended to say that they preferred Altnagelvin because it is in the city of Derry/Londonderry, whereas others whose origins were, perhaps, more rural preferred Enniskillen. It is possible to think about imaginative ways in which to tackle those workforce challenges and not just simply buy into a narrative that a rural hospital will not attract a workforce. It may be more challenging, but I accept and rise to that challenge. The Member made a very important point about transport. It is all very well for me to say that I am prepared to travel to Antrim, Londonderry or Enniskillen for my procedure when I have many family members with cars who would be more than willing to take me there and bring me back. I have been working with other Ministers — the Minister for Infrastructure and the Minister of Agriculture, Environment and Rural Affairs — to look at community transport arrangements and how to provide transport for those who do not have ready access to it. I am also thinking about the Northern Ireland Ambulance Service (NIAS), which has a voluntary driver scheme. That scheme took a bad hit to its numbers because of COVID. The NIAS is working hard to get the pool of drivers back up. We need to be imaginative. For example, I think of church networks: it strikes me that people who regularly go to church may be the sort of people who have the kind of community interest that might lead them to think about becoming community drivers. The issues that the Member raised are very much on my radar. They are valid and need to be addressed.

In headline terms, that sequence starts with the announcement in the Chamber today. Professor Bengoa will be at a half-day conference in Belfast next Wednesday afternoon. I will be interested to hear the detail of his remarks on whether he feels that his report from 2016 is still valid — I believe that it is. He will also reference some developments that have taken place globally over the past eight years and perhaps encourage us to take the next steps. After that, as I said, I will publish the three-year plan that will cover the rest of the mandate. Out of that, we will have to get down into the weeds of what we mean when we talk about which hospitals deliver which services. I assure Members that we will go out to public consultation on every one of the potential moves, because that is the right thing to do. That is why it will not be possible to do it in a year or in the remainder of the mandate, and that is why I am talking about a five-year plan. We have to bring people with us, and I do not mean just the clinicians and everybody who works in healthcare, important as they are. We also want the community to come with us. Sometimes, when we say that we will change services, people think that they are losing a service from their local facility without being reassured that something better will come in its place. For example, you may separate emergency and elective surgery in one hospital in order to make that hospital a centre for excellence in elective surgery, which would be a bit better for securing its future. Sorry, I wandered off topic a bit. There will be a series of announcements, and, while they might not please the Member, they will certainly give her the opportunity to respond.

An increased focus on centres of excellence for elective care will mean that some patients will be asked to travel further for non-emergency procedures. I refer to the 2023-24 health survey for Northern Ireland, in which approximately 80% of respondents indicated that they would be prepared to travel within Northern Ireland for a routine procedure or operation, if that meant that the waiting time would be reduced. Similar questions were asked by the Age Sector Platform, and over 80% said that they would be willing to travel further if there were benefits such as reduced waiting or procedure times and a lower risk of cancellation. As the Member suggests and as Mrs Erskine made clear, there needs to be accessible and reliable public transport for patients who do not have access to private vehicles, particularly the elderly and the vulnerable. In that regard, flexible appointments, especially for those who are travelling a greater distance, would also be important.

I do not want to be prescriptive or overly prescriptive at this point in the process. I will stick with what I have said. There is huge logic in trying to separate emergency surgery from elective surgery, because, if you are on a waiting list for planned or elective surgery, the length of the list does not really matter. If you have been given the appointment, it is frustrating to get a phone call early that morning to say, "I am sorry. The theatre is in use for an emergency procedure. The anaesthetist, the surgeon and the theatre nurses have all been taken up, and your surgery is cancelled". Those are the sorts of things that I am talking about. We need a logical redistribution that means that we are more productive and more efficient in what we do. You asked about Craigavon Area Hospital. My goodness. I was there a couple of weeks ago, and the last area that I visited was the emergency department. It was not edifying to see so many people in the corridors outside the emergency department being fed. When you want to access healthcare, dignity is really important. Far too many patients feel that they lose their dignity because of overcrowding, particularly in emergency departments. That was late August, by the way. One of the emergency department consultants said, "I think this is the start of the winter pressures". We have to box clever and use the whole of the estate. I am not the expert, I am not a clinician, and I am not a medical professional who can say how we should do that, but we need to look at the network. It is important to get people thinking of networks. People tend to think of the local hospital as being "it". Once we can do that, we can have a good, mature debate about who does what.

1,837 words. Text as published by the Northern Ireland Assembly.

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