Debate contribution: Ambulance Handovers

Debate contribution by Mr Mike Nesbitt on 24 March 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

24 March 2025

Type

Debate contribution (made as a minister)

Business

Opposition Business

Heading

Ambulance Handovers

Assembly identifier

Official Report component 4864678

Read the official Assembly record

Text

Thank you, Madam Principal Deputy Speaker. I must say that I am heartened to note the near-universal acceptance of the fact that the issue is not just about the Ambulance Service but about a whole-system response to the pressures faced and about the flow through our hospitals. If I have time, I hope to return to some of the comments that the Member who moved the motion and the Members who moved the two amendments made. When we were here in January to discuss ambulance waiting times, I commended the hard-working and dedicated staff of the Northern Ireland Ambulance Service, and I make no apology for my doing so again. The staff — those working on the front line and those working in support of them— are, like all staff across Health and Social Care, the lifeblood of the system. They have worked too hard for too long in a system that does not deliver the type of care that their commitment and resolve deserve. I suggest that, as political representatives, we owe it to them to do better and to relieve them of that moral distress. That is why I welcome the Northern Ireland Audit Office report on ambulance handovers. As we know, it was published on 11 March, and it underlines the seriousness and scale of the pressures facing HSC services. Alongside key officials, I will carefully consider the report's recommendations. I have already noted the recognition of the fact that the root cause of delayed ambulance handovers is wider severe HSC whole-system pressure and hospital discharge delays. Patients are waiting for far too long in ambulances outside our EDs, and that is a direct consequence of poor flow in our hospitals and social care constraints, as Members noted. I also recognise the risk of harm to patients who are delayed at handover on arrival at EDs and the impact of that delay on NIAS's capacity to respond to the next emergency call in the community. Reducing ambulance handover delays has been and remains one of my key areas of focus, but it is important to reiterate that, while pressures manifest at the emergency department, flow through the system and getting people medically fit for discharge into the community remain significant issues. It has been widely referenced in recent weeks and months that hospital flow is hampered by delays in discharging individuals who are deemed to be medically fit. My Department is taking a number of steps to minimise the challenges in coordinating those delays. To support the adult social care reform programme, we have established a social care collaborative forum. That provides vision and strategic advice and guidance on the delivery of social care. The forum will take forward agreed action across a number of work streams to support improvement and transformation in adult social care. That work will include a comprehensive review of the regional care home contract and specification, with a revised contract expected to be in place by June of this year. It also means taking forward my commitment to end minimum wage jobs in social care, ensuring that all staff are paid at least the real living wage. The work involves the extension of the early review team pilot model, which reviews needs and ultimately allows additional capacity to be recycled into the system. It also involves digital interventions, such as CareLineLive and the care home availability app, using technology to help ease pressures. The work involves direct payments and emergency direct payments to enable packages of care to be provided through the employment of a personal assistant. That will improve flow and discharge transitions. The work also involves the extension of the trusted adviser model to a seven-day model across all hospital sites, promoting safe and timely discharges from hospitals.

I thank the Member for her comment. I have absolutely no difficulty in agreeing to that meeting. Work to address the wider system pressures has to be prioritised. That does not mean that NIAS has been sitting idle, waiting for issues to be resolved elsewhere. Flow and discharge issues are key aggravating factors, but there is much that NIAS can do and, indeed, is already doing. My Department is actively engaged in developing a 10-year workforce plan with NIAS to further develop capacity, capability and the utilisation of the right skills mix. That will allow the Ambulance Service to better meet the needs of our communities by developing the enhanced paramedic role, innovative care pathways and strategic collaborations across the health system. In 2023-24, NIAS established a new integrated clinical hub, which incorporates senior clinicians. NIAS subsequently changed clinical practices in the integrated clinical hub team to support the management of patients in the community where possible, thus reducing conveyances to EDs while ensuring that patient safety is maintained during extended response times. The integrated clinical hub's highly skilled senior clinicians can identify alternative pathways for patients through the increased use of Hear and Treat and See and Treat pathways, which can be managed through an urgent care liaison desk. That enhanced clinical team provides increasing numbers of patients with advice in order to reduce conveyances to our emergency departments. It also provides advice to support crews, enabling referrals to a range of other pathways, including Hospital at Home and the falls, epilepsy and diabetes pathways.

Learning from the Scottish Ambulance Service, which has integrated mental health professionals into its control room, the integrated clinical hub contains mental health professionals from the South Eastern Health and Social Care Trust who work at weekends to provide expertise that supports patients in accessing alternative pathways for mental health issues. The service currently operates Friday to Sunday from 6.00 pm to 2.00 am. Early data from NIAS shows a 40% reduction in conveyance to emergency departments among patients who are experiencing mental health crises. That has led to much-improved patient experiences. Western Health and Social Care Trust staff are finalising training to work with the NIAS control room, which will enhance their service even further. Funding for the scheme is being provided until the end of March 2026. This year, an external evaluation will be carried out by the Public Health Agency to inform plans for further expansion of the service. I have previously rehearsed my concerns about the pressure on NIAS staff, who must deal with the welfare and distress of their patients and their carers on a daily basis. Those concerns remain with me. Nevertheless, NIAS is making great strides in supporting staff back to work, improving their long-term absence rates and increasing the available workforce. It is right that the improved absence rate was acknowledged in the Audit Office report, and I hope to see that trend continue. I remain determined to find better ways for the system to work to tackle the complex issues that we face. That is why I initiated a series of winter planning workshops aimed at identifying new, innovative solutions to the system-flow issues that we face collectively. I attended the first of those events on 4 March and was encouraged by the engagement and enthusiasm from HSC leaders from across the system. The workshop was attended by a wide range of stakeholders from across HSC, including the royal colleges, clinicians and other front-line services. Our system leaders are all involved. There will be three more workshops over the coming months, with the final workshop in June. That will inform a sharper, more focused plan for next year. I expect to see better outcomes in advance of winter, including improvements to ambulance handover times. Improving those times and response times in the community is a key focus, and, as part of work to explore new methods of working, my officials and the trusts have engaged with the London Ambulance Service to understand better its scheme for releasing ambulances no later than 45 minutes after arrival. We know that that scheme has resulted in significant improvements in handover times across the London area. My officials, alongside clinicians and management from trusts, visited the King George Hospital in London with the London Ambulance Service on 10 March to discuss the adoption of a robust protocol for the escalation of ambulance handovers that exceed the 15-minute target. Those discussions continue at pace with trusts on how the learning can be used to improve handover at our hospitals. One of the key messages from the visit was that, for the protocol to work, there is a need for a whole-system approach and that emergency departments and the Ambulance Service, on their own, cannot bring about the changes without the support of the rest of the system. It will require leadership, ownership and cultural change, which are at the heart of the planning workshops that I have been facilitating with leaders across HSC. I am pleased that everybody seems to be up for the challenge. More broadly, my vision remains to keep emergency departments for emergency cases. That is why I have continued to implement the recommendations set out in the urgent and emergency care review. Like elsewhere in the United Kingdom, the pressures across our system are immense, meaning that the long-term vision that I have articulated — improving services and the service that you experience by making it easier to access the most appropriate services at the right time — remains essential. We published the urgent and emergency care review in 2022 with strategic priorities, including the roll-out of urgent care centres across all trusts, greater use of rapid-access clinics and ambulatory care, the introduction of local and, ultimately, regional Phone First services and improving intermediate care to treat patients in their home as an alternative to hospital admission. An additional recommendation from the review was the initiation of the Getting It Right First Time — GIRFT — review of emergency medicine. Following the completion of that report, commissioned by Robin Swann, my Department considered its recommendations and produced an improvement plan. My Department has also worked with trusts to address specific issues highlighted in that report. I know that there is interest among some in the House in having sight of the GIRFT report on emergency medicine and the associated implementation plan. That is why I will publish both on my Department's website tomorrow. I am pleased to be able to assure Members that the GIRFT implementation plan is on track for delivery. Since the completion of that review, the GIRFT team has continued to work with my officials and the trusts on their improvement plans and played a key role in the development of the trusts' local winter plans for 2024-25. The GIRFT team has also been involved as external advisers on work to improve and standardise same-day emergency care (SDEC) services, which were commissioned and expanded through the No More Silos programme. I welcome the ongoing support and challenge provided by the team. Although some progress has been made in delivering changes to services to meet the needs of patients and service users, I am afraid that there is no quick fix, and addressing the current situation will require sustained, long-term effort, additional recurrent funding and support across the political spectrum. The Audit Office report was clear on the need for urgent action — I hear that call — but I stress yet again that we will be limited in the impact that we can make without additional budgetary support, and that impact will be much less again when I am being asked to make additional baseline reductions. I have accepted the challenge to transform the system, as outlined in my recently consulted on 'Hospitals — Creating a Network for Better Outcomes' document, but the long-term, meaningful change that is required to see results must have cross-party support in the Executive, and that must be backed by adequate resources. Mr Durkan moved the motion. He made just one comment that I take issue with. He talked about the workforce making "highly risky decisions": I do not recognise that phrase. On my visits to the EDs post Christmas, many of the workforce talked about having to make decisions that were the "least worst option", but I gently suggest that that is substantially different from making "highly risky decisions". Mr Robinson moved amendment No 1. He clearly gets it: a whole-system solution is required. It is about the flow, and I absolutely agree with him that, while we have five separate geographic health trusts, we need standardised regional protocols and to have the five trusts operating as though they were one. Mrs Dillon talked about looking elsewhere. When I was in Washington earlier this month, I visited a brand new $800-million facility, an enormous emergency department in which corridor care was a thing. Every day, corridors filled with patients to the extent that they had specific corridor care teams. In the other ED that I visited, they said that their ambulances queued up daily to hand over. Therefore, it is not just a problem in Northern Ireland. The motion calls for money. Sinn Féin's amendment calls for investment. My final message is a simple one. This is planet earth calling the Northern Ireland Assembly. There is a £400 million gap in the projected budget for the Health Department. We cannot commission new services.

2,204 words. Text as published by the Northern Ireland Assembly.

Assessment

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Assessed 21 October 2026 at 12:11 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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