Debate contribution: Altnagelvin Hospital: Access to Accident and Emergency

Debate contribution by Mr Mike Nesbitt on 21 January 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

21 January 2025

Type

Debate contribution (made as a minister)

Business

Adjournment

Heading

Altnagelvin Hospital: Access to Accident and Emergency

Assembly identifier

Official Report component 4750017

Read the official Assembly record

Text

Thank you, Mr Deputy Speaker. I thank Pádraig Delargy for securing the Adjournment debate. It is an important issue, and I very much accept that. Let me start with a very important positive. I am fully supportive — fully supportive — of the need for a new emergency department at Altnagelvin Hospital. I am aware of the depth of concern and feeling that surrounds the issue. I was there recently. I have been to six EDs since Christmas. I will be in the South West Acute Hospital — the SWAH — tomorrow. While they are all different — Altnagelvin, as we have acknowledged, is the oldest, which presents its own infrastructure problems — there is a commonality that I have picked up from all six. Patients who check in are not just asked for their health and care number: far too many of them are also asked to surrender their dignity and their right to privacy. When I was in Altnagelvin, I talked to the wife of a patient. The two of them had been in chairs for four days. Four days. That is not right, and it is not fair on the staff — the nurses and doctors — who are suffering moral injury, because they know what they can do. That is not just the case in Altnagelvin; it is happening in the six EDs that I have recently visited. Generally, in the resuscitation area — the resus area — of an ED, there will be clinicians and nurses. However, if the resus area has five bays and there are six or seven patients who need resus, how do you square that circle? How do you riddle that? What you have to do is make a decision, not on the best option but on the least worst option. You are going to have to move a patient out of resus who is not ready to be moved because there is a patient who is worse off and needs in. We talk about winter pressures, but I have stopped talking about them. I now talk about "additional winter pressures" in recognition of the fact that the pressures on EDs are now happening 365 days a year. I will say to the House what I have said in all those EDs to members of staff: I understand that we cannot continue endlessly to try to run healthcare, and particularly emergency departments, on goodwill, because goodwill is finite. It will run out at a certain point. That point will be different for different people, but everybody has a limit to their goodwill. Returning to the specific issue of Altnagelvin, the current space is not adequate to support current or future numbers. As Mr Delargy said, it was built to support approximately 35,000 patients per annum. It is probably receiving double or just over double that number. We will get a new ED at Altnagelvin. If I am being realistic, I think that five years is the quickest time in which it could be done. Mr Durkan mentioned the fact that we have been at this for a while. The first business case was for multiple facilities, and the decision of the Department was that it would be more realistic, practical and achievable to break it up into single units. That is why there has been a second outline business case, specifically for an emergency department. I have been told not to suggest that getting it through to final business case and then to construction will be done in fewer than five years.

My decision?

Any Minister. Yes, OK.

I do not want people to think that nothing is happening. A couple of Members mentioned the relatively new minor injuries unit, which opened on 25 March 2024. The direction of travel here is that it is often not required. If you go to the GP, get a diagnosis and are told by the GP, "You need to go to an acute hospital", you go and sit for those 300-plus minutes, waiting for a second assessment. The second assessment is redundant — it is not required — in some cases. Therefore, a referral directly to a minor injuries unit would take some pressure off. It is also a much better pathway for the patient. Some settings have dedicated areas, such as respiratory and cardiac units. Again, we are moving to the point where GPs make the direct referral, so that second, unnecessary assessment, which comes at the cost of sitting for hours or, perhaps, days in chairs or standing in the ED, is done away with. There is a respiratory hub at Altnagelvin — it was established in September 2021. I have been in it. It is a really good facility. There is also a cardiology assessment hub. That was initiated as a result of COVID-19. Patients are triaged there and assessed by an experienced cardiac nurse. Those things are happening. It is important to ensure that the proposed solution for the new ED delivers the benefits that are needed and represents value for money. Nuala McAllister made the point about what has been happening in Belfast. I do not think that anybody can stand over that. We certainly do not want to see it repeated. Nuala also talked about not doing these things piecemeal. That is why, in October 2024, I launched the consultation, 'Hospitals — Creating a Network for Better Outcomes'. We have to view Altnagelvin and all the hospitals, including SWAH, in the other geographic trusts, as an network. Not every hospital will do everything. The result should be that we develop hospitals that have specialisms. I want to see best practice rolled out across Northern Ireland. That does not mean in every hospital, but every service should be best practice. As well as that consultation, I published the three-year strategic plan, in December. It sets out a path for the future, based on three pillars: stabilisation; reform; and delivery. By April 2027, subject to additional funding, which is a big question, we will further reform urgent and emergency care through exploring and, subject to analysis, developing a regional 111 urgent care service. Through investment in Hospital at Home and immediate care services, we will offer better and more appropriate alternatives, where appropriate, to emergency departments. I turn now to some of the remarks that were made by Members. I very much welcome Mr Delargy saying that he and, I believe, everybody in the Chamber wants to work with me and the Department. However, with respect, we need some common agreements. Mr Delargy suggests that faster processing times would help ambulances. I agree, but: it is a, "Yes, but", from me, because, even if you doubled the size of the ED at Altnagelvin, with the appropriate staff, you would not cure the problem. The problem emerges and is evident in EDs, but the problem is not the EDs. It is the flow. Over this winter, the biggest block has been at the back door, not the front door. It has been the lack of community capacity by way of domiciliary or home care packages and care home beds. Those issues cannot be fixed very readily, but I am determined to work on them. Mr Delargy acknowledged that I have decided to give the real living wage to people who work in domiciliary care. It is important to make that sector more attractive. The salaries and the daily rate simply are not attractive at the moment. At one point, I think that Mr Delargy compared staffing levels at Altnagelvin with the levels in the Belfast Trust. With respect, that is not really comparing like with like. We can compare the Western Trust, which has more than one hospital, with the Belfast Trust, which has more than one hospital, but comparing one hospital with a whole trust does not really do it for me.

Yes.

I accept that. Sinéad McLaughlin mentioned equity and regional balance. I am very keen on that. She will be aware of the fact that my Live Better initiative to tackle health inequalities has two demonstration areas, which are coming soon, and one of those is the Moor district electoral area in her city. I am very optimistic that it will start a process. One of our measures has to be healthy life expectancy. Since devolution came back in 1998, we have not shifted the dial in the right direction. Thank you for the debate. It has been very helpful for me. Let us be aware of and absolutely honest about the issues. Let us address them urgently, but let us not use language that might have the effect of putting people off visiting EDs when that is where they really need to be in order to get the healthcare that they require.

1,465 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 11:48 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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