Debate contribution: Ambulance Waiting Times

Debate contribution by Mr Mike Nesbitt on 13 January 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

13 January 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Ambulance Waiting Times

Assembly identifier

Official Report component 4738619

Read the official Assembly record

Text

I thank the Member for his intervention. I will come on to that in a moment, and I will also touch on something that Mr Dickson talked about when he mentioned double diagnosis. That is when one goes to a GP and then to an ED. Is that second diagnosis really necessary? To repeat, the moral injury that staff are feeling is not what they signed up for, it is not what they trained for and it is not what they turn up for, shift after shift. Some Members of the House want to add to the pressures on those individuals by placing on them a statutory duty of candour as individuals, with criminal sanctions attached. I respectfully say this to Members: please, please, please think about the consequences of what you are proposing and about how staff may react. Although there are difficult and unacceptable challenges, my Department has taken action to increase Ambulance Service capacity and address workforce challenges. There is a broader trend in healthcare whereby paramedics play an increasingly versatile role not only in emergency response but in primary, secondary and community care. I remember being with my dear mother on a Monday morning when a paramedic came out to examine her and said that he was not prepared to risk not admitting her to the Ulster Hospital emergency department, and he was right. Are we fiddling while Rome burns? No, we are not. My Department has provided funding to train 50 paramedics every year since 2021. That means that people from Northern Ireland who wish to graduate with a BSc honours in paramedic science no longer need to travel outside of the Province to complete their studies. As a direct result of that funding, 41 paramedics graduated from Ulster University in 2024. They have already taken up paramedic roles with the Northern Ireland Ambulance Service. I am glad to say that I was in Derry to see them graduate, and I was delighted to hear that there were local jobs for each and every one of them. In addition to paramedic training, my Department is actively engaged in developing a 10-year workforce plan with NIAS to further develop capacity, capability and utilisation of skills mix. That will allow the Ambulance Service to better meet the needs of our communities by developing the enhanced paramedic role, new care pathways and even better coordination across the health system. NIAS has a targeted programme for 2024-25 that has addressed long-term staff absence and increased available workforce. In addition to workforce, we have funded a number of initiatives in the Ambulance Service, including the development of an integrated care hub. The hub places clinicians, paramedics, nurses and mental health professionals in NIAS's control centre to triage patients and direct them to the most appropriate care pathway or service. Mental health practitioners play an important role in providing support to those in mental health crisis, and early indications are that that has reduced conveyances to emergency departments by around 40% for those in crisis. I repeat: 40%. That, of course, is leading to better outcomes. The integrated care hub has enabled NIAS to enhance its See and Treat and Hear and Treat capabilities in line with best practice as part of its reform agenda to reduce the number of patients needing conveyance to EDs. The integrated care hub has been invaluable to NIAS this winter, ensuring that emergency ambulances are prioritised for people who need them and that patients are directed to appropriate alternatives, which may include Hospital at Home, fall services and community teams. Investments associated with the urgent and emergency care review have resulted in Phone First and urgent care services being established across all geographic trusts, and this is an alternative to patients calling 999. Over 160,000 people accessed these services in the financial year 2023-24. Of those, almost 85% finished their care without attending a type-1 ED. More, of course, remains to be done. My Department also has a programme of work to provide access to same-day emergency care for patients without the need for an overnight admission to hospital. I want trusts to afford the Ambulance Service with direct access to these pathways. We are also working with trusts to create pathways that avoid ED. If your GP says that you need to go to the hospital, do you need a second assessment in an ED or can the GP refer you directly elsewhere: for example, to an urgent care department at the hospital, an ambulatory unit, a dedicated respiratory or cardiac unit? These things are happening. We are reforming the HSC system. Last month, I visited a new service, the regional coordination centre (RCC). This is a trust-owned initiative to provide a coordinated response on a daily basis to regional pressures. All five geographic trusts discuss their ED pressures and how they can help each other. It is new; it needs time, and they need to build trust in the system, but I believe that it will work, and it is part of that reform. I accept the need and requirement for further and more urgent reform. I have only two years left, but I aspire to take a big bite out of that problem. For those who are disappointed in that, I simply direct you to the fact that the Secretary of State for Health and Social Care in London has a 10-year plan. That is beyond my term of office. Importantly, however, there is also a palpable decision, from across the Cabinet, to prioritise the health of patients, whereas, despite some rhetoric here, actions are not matching words. I believe that I can only make some difficult decisions, some unpopular decisions and, hopefully, set a direction of travel that the next Minister feels compelled to follow. I accept that there is an urgent need for reform, including the development of community-based services enabling patients to stay well, remain in their homes and avoid the need for NIAS to convey them to hospital for admission. However, that requires financial support. Let me reiterate this point. In negotiating a return to Stormont, we made a collective argument to London that our block grant should be based on assessed need rather than a crude headcount. That argument was successful and resulted in the current 124% Barnett calculation. Yet, when it comes to the Health budget, assessed need has been overlooked and replaced by another crude statement that Health gets more than half of the block grant. That statistic is quoted like an incantation as if it proves, by itself, that Health does not need additional resources. I accept that we need to be more productive and efficient; I get that. However, I stress — I stressed it to the leadership of the HSC — that I also acknowledge that no amount of efficiency or productivity will close the gap between demand and capacity. The independent Fiscal Council said that to deliver the same service here as NHS England manages, we need £104 to £107 for every £100 that NHS England spends. The same Fiscal Council said that we used to get £109, but today, it is £101·50. Members, do the maths. I want to express my deepest gratitude for the remarkable commitment and dedication shown by the staff in the Ambulance Service and across the HSC. They work tirelessly to provide essential services during some of the most challenging of times. On behalf of our 70,000-plus workers, I say this to Members: do not suggest that the Bengoa report has been gathering dust on a shelf for nine years; it is happening, but the pace and the impact is dictated by our ability to fund change. If you are told that the budget is entirely inadequate to meet the needs of the HSC service, and yet vote for it, despite the warning, and then complain about the consequences of your decision, are you comfortable taking that position? When I say comfortable, I do not mean politically; I mean morally. I thank Members for their contributions. I do not have time to go into them too much, but Members accept that it is about the flow and that highly-skilled individuals are not delivering the service that they want to deliver and are suffering moral damage because of that.

I repeat: patients expect to retain dignity and privacy when they attend hospital and are being denied that, sometimes not just for hours but for days. That is not right. I get it.

1,415 words. Text as published by the Northern Ireland Assembly.

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