Debate contribution: Altnagelvin Hospital: Access to Accident and Emergency

Debate contribution by Mr Pádraig Delargy on 21 January 2025.

MLA

Mr Pádraig Delargy

Party at the time

Sinn Féin

Date

21 January 2025

Type

Debate contribution

Business

Adjournment

Heading

Altnagelvin Hospital: Access to Accident and Emergency

Assembly identifier

Official Report component 4749958

Read the official Assembly record

Text

Go raibh maith agat, a Leas-Cheann Comhairle.

We have heard much in the media and in our constituency offices about winter pressures. Addressing those pressures requires a coordinated response involving the Department, trusts, community organisations and others to ensure that the emergency services remain effective during the challenging winter months. That involves expanding access to primary care and community health services in order to manage non-emergency cases outside emergency departments, which can help to alleviate the pressures. In Altnagelvin, those pressures are faced all year round. There is a clear and demonstrable need for a new fit-for-purpose emergency department at Altnagelvin. Our role is to highlight issues that our constituents are facing and to be the voice of our community and every single person whom we represent.

The focus of the debate is on highlighting the transformative impact that a new, adequately sized and adequately resourced emergency department would have on the people of Derry and the north-west. Today, I will focus on the voices and experiences of our healthcare staff, ambulance crews and patients. I will focus on two strands: the need for a new department and for immediate solutions.

Altnagelvin Hospital has the oldest emergency department in the North. It was built to see 40,000 patients a year, and it now sees between 70,000 and 80,000. Derry is the heart of the north-west region. We have seen what can be achieved when we deliver healthcare on a joined-up, all-Ireland basis. We have seen the change that the North West Cancer Centre (NWCC) and coronary care services deliver when we look at provision in that context. It has significantly enhanced the lives of people in our area and, as the evidence shows, delivers more effective health outcomes. Recent changes in circumstances have added to Altnagelvin's workload. They include the removal of general and emergency services and general emergency surgery at the South West Acute Hospital (SWAH); the reduction in orthopaedic and neurology consultancy at Antrim Hospital; and no max-facs care in Sligo. In addition, Altnagelvin has been the trauma centre for the north-west and the point for coastguard referrals. We need an adequately sized and adequately resourced emergency department. Altnagelvin has reported the longest waiting times of any emergency department in the North. From arrival to admission, Derry's accident and emergency waiting time was 19 hours and 52 minutes in 2021, while it was 19 hours and 58 minutes in 2023. Those figures do not accurately reflect the reality, because some coronary care incidents, strokes and accidents are admitted straight away or referred to Belfast, which distorts the figures. In achieving a new emergency department at Altnagelvin, we need to future-proof it to ensure that we do not face the same problems in years to come. We need a flexible plan to cope with population growth and increased demand. It is about the impact that that has on individuals, however. It is about those in mental health crisis, children, older people, those with chronic conditions and those with dementia. We have received dozens of testimonies from staff and patients in Altnagelvin. We have been contacted by scores of people who have been there themselves or with a loved one in extreme despair or distress but have no separate facility to go to. They often feel stigma when sitting in A&E, sometimes accompanied by police officers, and are afraid of knowing someone there and of the judgement that comes with that. There is one consultation room for patients who are undergoing a mental health assessment. Staff have told us that they need at least three. There is another side to that. A lack of consultation rooms also means a lack of privacy to deliver bad news to families or a loved one or to inform patients who have a terminal or life-changing illness. We have heard from the mother of a child aged seven with a broken arm who, because of the lack of beds in the paediatric ward, waited for eight hours until her child passed out from the pain. There are two beds in what needs to be a five-bed department. Dozens of older people have contacted us to tell us that they feel afraid in A&E. We have also heard numerous times about the lack of physical infrastructure. There is one toilet in a waiting room. That is one toilet for upwards of 100 sick people; one toilet for people suffering with Crohn's, kidney stones or many other issues; one toilet in which there have been multiple reports of drug-taking; one toilet for clinically unwell patients. Where is the infection control? Where is the dignity and safety for patients? We have heard from Ambulance Service staff, who have told us that they are tied up, sometimes for 16 hours, at A&E, preventing them from getting to other emergencies. Faster processing times at A&E would mean that ambulances could return to service much more quickly. All the staff we spoke to mentioned feeling burnt out and having extremely low morale that has been exacerbated by an inadequately resourced A&E. They mentioned assaults — verbal and physical — and leaving due to the lack of consistency and training. I thank the Minister for his recent visit to the A&E at Altnagelvin, during which he thanked the medical staff for the:

"incredible dedication and high quality care they provide to patients especially under such difficult circumstances."

We in the Chamber have the power to begin to change things in Altnagelvin. We can upgrade support for healthcare staff to reduce burnout and introduce flexible staffing solutions and incentives, along with targeted recruitment drives, to increase workforce numbers. None of that will happen overnight, but getting a business case signed off and fast-tracked would be a good start. There are immediate solutions that the Health Minister could implement today. He could commission inpatient beds in Altnagelvin; look at the number of consultants and junior doctors who serve their placements in Altnagelvin and work in Altnagelvin; and increase the number of nursing home beds and access to domiciliary care. On the issue of commissioning inpatient beds, it is difficult to get a bed in the emergency department, but it is also difficult to get beds across our hospital. We heard from a patient who was triaged at 7.00 pm. They were on an IV drip and had to sit on a plastic chair in a corridor overnight. Inpatient beds can be commissioned for Altnagelvin today. I would love to hear from the Department on whether it has looked at demand and capacity, whether there has been an assessment of how appropriate the bed numbers are for the population and what metrics are used to do that assessment. When it comes to staff training and consultants, Altnagelvin's numbers reflect neither the local population nor the need. The Belfast Health and Social Care Trust has 2·8 times as many consultants as Altnagelvin. In addition, while Altnagelvin does between 60% and 70% of the cardiology work that Belfast does, we have two cardiology registrars when Belfast has 14. That accentuates the higher poverty and deprivation stats as well as the health inequalities, which the Department of Health has acknowledged. This is not a zero-sum game. It is not about removing staff from other areas. I acknowledge that specialist services are reserved for certain hospitals to ensure that patients receive the best life-saving treatment, but a 7:1 staffing ratio does not stack up. That is significantly higher, even with an allowance for specialist provision. Our objective today is about equity and adherence to the Department of Health's commitments to regional balance, tackling health inequalities and removing barriers to healthcare. People in my constituency are as entitled to that as anyone in any other part of the North. The number of doctors trained in Altnagelvin is also lower. Why does that matter? It matters because fewer trainee staff get experience in Altnagelvin, fewer get experience outside Belfast and fewer get experience in the areas in which, we know, they are needed. We need to bring in more locum staff at junior and middle levels, because that would have a positive impact on the number who stay and train here before they become consultants. We spoke to numerous junior doctors during their strike who mentioned friends in Belfast, talent leaving our area and never getting the chance to gain employment in our trust area. Why would they work in Altnagelvin when they would have to work every three or four weekends, while their friends in other trust areas and other specialities sometimes have to work only two weekends per year? As with strand 1, what metrics does the Department use to allocate junior doctors across trust areas. On nursing home beds and domiciliary care, a colleague mentioned in the Chamber yesterday that there are hundreds waiting to get into hospital and hundreds waiting to get out. Last weekend, 532 people across the trust areas were fit to be discharged. Implementing a more efficient triage process and patient management system to ensure faster assessments and healthcare would help to tackle that. We know that nursing home beds and domiciliary care are scarce in all areas, but it is particularly pertinent and most acute in the Western Health and Social Care Trust. Patients face prolonged stays due to insufficient community care options. A lack of sufficient capacity in domiciliary care means that beds are used for longer, even though patients have been deemed medically fit to leave hospital. I ask the Minister to press ahead at pace to pay domiciliary care staff and social care staff adequately — I acknowledge the fact that he is already working to do so — and to implement a specific recruitment strategy in the broader social care sector. I say this to the staff in Altnagelvin A&E: "We have your backs. We will be your voice in Stormont and in every other political Chamber to ensure that a fit-for-purpose emergency department is delivered for Altnagelvin." To the patients who have shared their experiences with us I say, "Thank you. Thank you for putting your trust in us to represent you. We will stand with you and with every person in Derry and across the north-west to demand equality in access to healthcare." Building a new emergency department in Altnagelvin will not happen overnight, but we need to work together to get the business case agreed and fast-tracked. We cannot stand still until that happens. Today, I ask the Health Minister to commission more inpatient beds in Altnagelvin; to look at a recruitment strategy that mirrors the demographic trends and meets the guidelines for tackling health inequality that the Department of Health has published; and to ensure that there are clear pathways for patients who need nursing home and domiciliary care packages. I thank the Minister for being here today and sincerely hope that we can work together to deliver.

1,814 words. Text as published by the Northern Ireland Assembly.

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