Health: Transforming Your Care
Ministerial Statements
11:15 am
Edwin Poots (DUP)
I wish to make a statement to the Assembly on progress on the implementation of ‘Transforming Your Care’ (TYC), the report of the review of health and social care services in Northern Ireland. ‘Transforming Your Care’ was presented to the Assembly on 13 December 2011. It provides a compelling case for major and long overdue reform of our health and social care services to ensure that we have a system that is safe, resilient and sustainable into the future. In January, I initiated a take-note debate on the report in the Assembly. At that time, Members from across the Assembly broadly welcomed the report, and there was recognition of the need to reform our health and social care system.
It is crucial that we take steps now to build a health and social care system that is fit for the future, by improving the quality of care, ensuring better outcomes for patients and clients, and enhancing the experience of health and social care for all our service users. We need to improve services for our population and have an effective system for doing so, and we need to do that in a way that secures improved productivity and value for money. Those factors must drive all of us to create a better, person-centred health and social care system, built around the individual, not the institution.
We know that Northern Ireland has the fastest-growing population in the UK and that it is continuing to grow. The TYC report states that the number of people over 75 is expected to increase by 40% by 2020. The over-85 population is to increase by around 20% by 2014 and by 58% by 2020, compared with the figure for 2009.
The Institute of Public Health in Ireland published the report ‘Making Chronic Conditions Count’, which forecasts the population prevalence of a number of chronic conditions, namely hypertension, coronary heart disease, stroke and diabetes. Between 2007 and 2020, the prevalence of those long-term conditions amongst adults in Northern Ireland is expected to increase by 30%. Those are not new figures, but they are still startling. The increasing numbers of people with those conditions will undoubtedly put pressure on the health and social care system and have implications for the sustainability of services.
We need to recognise fully the demands and pressures that those demographic changes will bring now and into the future. ‘Transforming Your Care’ indicated that demand for services could grow by around 4% a year by 2015, noting that that would mean 23,000 extra hospital admissions; 48,000 extra outpatient appointments; 8,000 extra nursing home weeks; and 40,000 extra 999 ambulance responses. We need to plan strategically to meet patient and client needs in light of such projections.
In recognising those pressures and the need for change, ‘Transforming Your Care’ recommended a new model for the delivery of integrated health and social care services in Northern Ireland, containing 99 proposals covering 10 areas of care. It set out a strategic road map into the future and has the potential to make a huge difference to how we plan and deliver health and social care services in the medium and long term. It will bring care closer to people’s homes, improve patient outcomes, ensure better use of our resources, and ensure that we maximise the use of our skill bases, particularly in prevention and early intervention.
In making this statement today, I want to inform Members of the progress that has been made and outline the next steps. A key early objective in the delivery of the reform was the development of population plans for each of the five local commissioning groups (LCGs) and trust areas by the end of June. The local commissioning groups are committees of the Health and Social Care Board, with statutory responsibilities for the planning and resourcing of health and social care services to meet the needs of their local populations. The population plans are to identify the strategic needs of the local population, based on demographics and population health trends and to identify how those needs should be met in future. They should provide the basis for making the significant changes required in our health and social care system, particularly in respect of shifting services from secondary care into primary and community care, where it is safe and appropriate to do so, and the reconfiguration of acute services.
The population planning process has been the focus of intensive work over the past few months. Local commissioning groups have worked closely with the trusts and other stakeholders to carry out a detailed assessment of the services required to meet the future needs of patients and clients in their respective areas in a safe, resilient and sustainable way over the next three years and beyond. A focus of the population plans has been to identify key initiatives that would support the delivery of Transforming Your Care and the changes required to effect that.
In developing population plans, local commissioning groups and trusts have engaged actively with clinicians and health professionals, community and political representatives. The production deadline for the draft plans was challenging, but we need to ensure that there is a momentum to the work so that people using our health and social care services, as well as those who provide them, can see and feel improvements as quickly as possible. I acknowledge and pay tribute to those involved in the efforts that have been made to produce the plans in this challenging timescale. We need to sustain that momentum. The development of the population plans has been an intensive exercise, but I believe that it is an example of how local commissioning groups and Health and Social Care trusts can work collaboratively in a focused way towards a common goal of improving patient and client care.
The five population plans are complemented by an overarching strategic implementation plan produced by the Health and Social Care Board to draw together the key elements of the population plans including cross-cutting regional aspects. The strategic plan is intended to set out a coherent framework for the delivery, over the next three years, of the major changes that would drive transformation, supported by the details for local areas contained in the population plans.
The population plans include a number of recurring key themes that are drawn together in the overall strategic implementation plan. I want to outline some of them. A fundamental principle in Transforming Your Care is the shift of service provision, moving treatment and care out of the hospital sector and into the community, closer to people’s homes. A key vehicle for facilitating that is the development of integrated care partnerships, which bring together health and social care professionals to work together to deliver better services for local populations and enabling targeted care in the community and, if appropriate, in people’s homes. Integrated care partnerships will focus initially on delivering the transformation of care set out in Transforming Your Care, in particular by supporting older people and people with long-term conditions to maintain their independence in their homes or in assisted housing through a stronger emphasis on primary and secondary disease prevention, reablement and focused programmes of therapeutic care and support interventions. The longer-term model for integrated care partnerships will need to be developed so that they become a core part of our system to deliver quality and sustainable health and social care.
The implementation of Transforming Your Care would support older people and those with long-term conditions to maintain their independence. The strategic implementation plan envisages a range of changes and benefits over the next three years that include the provision of social inclusion programmes for older people; a reduction in hospital admissions resulting from falls; and a reduction in acute hospital bed days and emergency department attendances for older people. There should also be a reduction in unplanned admissions by implementing telehealth solutions and increasing the way in which services can be provided, particularly for people with long-term conditions, as well as the further development of reablement and intermediate care.
I want a reduction in the number of people in institutional care, the development of self-directed support and individual budgets and the supported-living model for learning and physical disability services. There is a need to realign learning disability services to focus more on resettlement, with a commitment to the closure of long-stay institutions.
Transforming Your Care will also mean addressing how services are provided for people with physical disabilities, again with the emphasis on care closer to home. The strategic implementation plan includes, for example, a review of day-care provision and the further development of multiagency and multidisciplinary collaboration to increase choice and service provision.
The implementation of Transforming Your Care will also address the need to bring the care of mental health service users back into the community when that is appropriate and support more people to remain in their homes where possible.
There will be a focus on resettling into the community those living in long-stay hospitals through working closely with the voluntary sector as appropriate. The dementia strategy will be implemented, with integrated care partnerships helping the proactive management of people with dementia in primary and community care settings.
Population health and well-being are crucial elements of Transforming Your Care. The implementation of the A Fitter Future for All framework to address obesity and the tobacco strategy are just two ways in which Transforming Your Care will help people to improve their health and well-being with the support of health and social care.
On maternity and child health, I believe that keeping pregnancy and labour normal to reduce interventions and promote normalisation of birth, while increasing the percentage of women accessing antenatal care in the community, is essential. Transforming Your Care will seek to support healthy pregnancies and promote good parent/child relationships in the crucial early years. It is also important that children be given the best possible start in life. Transforming Your Care will support that through a focus on early intervention and a multi-agency approach to family care and childcare, preventing children from having to be separated from their family and enabling some children to remain safely with their family.
Transforming Your Care also seeks to ensure that people are afforded choice and high-quality care at the end of life, reducing the number of people admitted to hospital inappropriately during their end-of-life phase and ensuring that people are given the choice to die at home. There should be provision for specialist palliative and end-of-life support out of hours, as well as enhanced links between specialist and generalist services, with more staff competent in the core principles of palliative and end-of-life care.
Carers play a critical role in the overall care and well-being of the people whom they care for. I remain committed to improving the quality of life and support for carers. There will be new models of respite and short breaks, focused support for carers through assessment of needs and a range of community-based support, including working closely with voluntary organisations.
I am of course aware of the concerns that many have about the reconfiguration of hospital services. The HSC review team concluded that it is likely to be possible to sustain only five to seven major acute hospital networks. Creating hospital networks and reorganising acute services would mean hospitals not working in isolation but contributing to the provision of services to the population in the area and, where appropriate, in adjacent areas. The strategic implementation plan highlights the need to guarantee the sustainability of our hospitals by ensuring that all acute services adhere to best practice in quality outcomes, infrastructure and staffing. Fragility in hospital services needs to be addressed by ensuring that roles are sufficient to support best outcomes and staffing levels in line with best practice. The role of some hospitals would be expected to change as they became part of a network, working with partners to provide services to their local population.
Many Transforming Your Care recommendations will be progressed through the population plans. Work is also being progressed on other recommendations from Transforming Your Care to ensure a coherent approach to change. For example, Transforming Your Care recommended the introduction of an electronic care record (ECR) in Northern Ireland. In May, I announced the signing of a £9 million contract for an ECR system that will transform how patients’ records are managed throughout the HSC and directly benefit everyone who uses the health service in Northern Ireland, joining up records to give better, safer, faster care. The ECR system will improve the safety and quality of care by ensuring that the right information is available in the right place, thus reducing the need for people to repeat their details needlessly. In February, I announced a Northern Ireland physical and sensory disability strategy and action plan setting out the strategic direction for the further development of services and support for disabled people over the next three years. The action plan contains the key actions and associated timescales for the delivery of those services and support.
To support the reform and modernisation of services for people with long-term conditions, I launched in April my Department’s policy framework document, ‘Living with Long Term Conditions’. It provides a framework within which commissioners and providers can improve services, share and extend good practice, and develop systems and practices that deliver best outcomes for patients, clients and carers.
Yesterday, I launched the new maternity strategy, which will provide a clear pathway for maternity care in Northern Ireland from pre-conceptual care through to postnatal care. What I hope those examples show is that we are taking steps to ensure that the vision of TYC is realised and that people will see a very positive change in how services are designed and delivered — changes that are focused on people.
I want to emphasise how crucial it is that we get the reforms right. I have only just received the draft strategic implementation plan and population plans, and I have not had an opportunity to consider the details. It is important that the documents are given careful consideration. They are important documents, and I wish to study them carefully. I encourage Members to do the same. Not to do so would be failing in our responsibilities. The summer period is not an ideal time for consultation, particularly on issues as important as this. I therefore intend that, before consultation on the plans is formally launched, there should be a period of further quality assurance work on the plans. That would also provide an opportunity for engagement with clinical leaders in advance of formal comprehensive consultation and stakeholder engagement being launched in September, once the draft plans have been agreed by me. In effect, that will mean that the draft plans may continue to be subject to refinement until the quality assurance and engagement processes have been completed. The plans would then be finalised after the autumn consultation exercise, and further public consultation would be undertaken on any significant service changes being proposed in light of conclusions on the implementation plan and population plans.
In the spirit of openness and transparency, I have asked that the draft population plans and the strategic implementation plan are made publicly available today and ahead of the formal consultation in the autumn. The plans will be available from today on my Department’s website at www.dhsspsni.gov.uk. I ask Members, health and social care staff and the public to familiarise themselves with the documents. I stress again, though, that the consultation exercise will not be launched until September.
Since taking up office as Minister of Health, Social Services and Public Safety, my overriding aim has been to ensure that the safety of patients and clients is paramount and that the quality of care provided is improved. That is, I believe, an aim shared by people who deliver services daily throughout our health and social care system. It is vital that we continue to make the decisions and take the actions that are needed to improve our health and social care services. I am pleased that progress is being made across a number of areas of care in line with the timelines envisaged in the ‘Transforming Your Care’ report, and that today I can announce that we have taken another step forward with the production of draft population plans and the strategic implementation plan. We have made a good start. We need to continue to build on that so that the public and the HSC workforce start to see and experience the transformation of services that they deserve. I commend the statement to the House.
Sue Ramsey (Sinn Féin)
Go raibh maith agat, a LeasCheann Comhairle. I welcome the statement and the further update from the Minister on ‘Transforming Your Care’. I also thank the Minister for briefing the Deputy Chair and me earlier on the contents of the statement.
Minister, the view in the community is that, although people hear about ‘Transforming Your Care’ regularly, not many people know the details. It is important that, at every opportunity, we give as much information as possible to the people who are going to be affected by the change in the way health and social care is delivered, including the workforce, which you rightly mentioned.
TYC is about taking people out of the acute sector and into the community. Community pharmacy needs to play an important role in that, and the uncertainty around community pharmacy is not helping. Will the Minister update us on what is happening with community pharmacy? In the June monitoring round, the Minister bid for £18 million to implement TYC, and the bid was not met. Is the lack of funding going to present the Minister with problems in moving forward with the implementation of TYC?
Edwin Poots (DUP)
There were a number of issues raised. First, I think it is absolutely critical that we establish the views of the public on these issues. Often, a report such as this will be produced and will almost pass the public by, but whenever you get to the raw implementation of it, when a residential home is being closed that is in your area or that serves a member of your family, it will stir the public up. Transforming Your Care is about so much more than that. We need to engage with the public in a very meaningful way to ensure that they have a good understanding of where we intend to go and to hear what their views are. Do more people want to receive more care in their own home? I suspect that they do, but I want to know whether that is the case with the public. Do more people want to receive more care in the primary care settings as opposed to in hospitals? I suspect that they do, but we need to establish that. I accept that we need a robust system of engagement during the process of public consultation and that it needs to be meaningful.
I regret that there is uncertainty in pharmacies, but I accept that it exists within that sector. One course of work that is being done is the margin survey. It is absolutely critical that that is completed; that we have a good grip on the profitability of pharmacy; that we look at how we can include pharmacy in the stronger delivery of services to people on the ground in the future; and that we ensure pharmacists receive remuneration for the work that they do.
The final part of the question was on the bid for £18 million that was required to deliver this review. The Department of Finance and Personnel made it clear to us, and we accept, that we first need to identify all the potential savings within the Department that we can put towards this, and that is what we are doing. There is an invest-to-save budget of around £30 million and we are entitled to bid for that where we cannot identify those savings. I hope that we would receive some of that funding, but it is our task and our duty to ensure that, where there are savings to be made within the Department, we continue to carry that out before we bid for further funding.
Jim Wells (DUP)
The Minister has identified the fact that there has been remarkably little public engagement in this process up to now. I think that debate will only really start when names are attached to the reduction or increase of services. What is his view on the Patient and Client Council’s suggestion that a leaflet be distributed to every household in Northern Ireland to explain why he felt that Transforming Your Care was necessary and why we need to implement the policies that John Compton outlined in his report?
Edwin Poots (DUP)
I am happy to discuss any proposals around engagement with the public with the Patient and Client Council given its role, the work that it does and the expertise that it has developed. It is important that we seek to ascertain the views of the public for significant change in a very meaningful way, given that we have a budget that represents well over 40% of the public spend here in Northern Ireland, we have 725,000 going through our emergency departments each year and that everybody in Northern Ireland needs this service at some point in their life. I will be very happy to work with others, including the Patient and Client Council, which has a key role to play in this, to ensure that we get meaningful feedback from the public.
John McCallister (UUP)
I welcome the Minister’s statement. I think that the refusal of the £18 million funding in the June monitoring round is a setback to driving this agenda forward, and I hope that the Minister will make a commitment that, if he does have to make any further cuts to meet that demand, they will not be from front line services or a failure to fill staff vacancies.
John McCallister (UUP)
The Minister talked at length about looking after people at home, particularly the elderly and people with learning disabilities or dementia. Will he give a commitment that he will also support the carers of those people with adequate respite services?
Edwin Poots (DUP)
I very much welcome the fact that a number of bids were met, including £10 million to deal with outstanding surgery and the backlog that has existed for a considerable period. I am delighted that we have made huge progress in the past year in some areas concerning outpatients, such as endoscopies, for example. We have made fantastic progress in reducing the backlogs that existed there, and we want to work very hard on doing likewise in surgery and in ensuring that people receive prompt responses to their care. I am very glad that that has happened.
I think that the Finance Department’s case is reasonable. It has established £30 million funding for an invest-to-save initiative. We, along with other Departments, are entitled to bid for that, but we are entitled to do so only when we have ensured that we have made the savings that need to be made in our Department. That is a course of work that I will continue to engage in. It is not about cutting front line services. In fact, last year, we had more nurses employed than we had in the previous year. So we have not been running about, cutting front line services. Let us dismiss that; let us deal with that myth. We have been working every hard on ensuring that waste that exists within the £4·5 billion budget is reduced, and I think it would be morally wrong for us in the Department of Health to continue to say that we want more money but not deal with the waste where it exists. Anybody who says that waste does not exist within a budget of £4·5 billion is living in a world of delusion. Waste is still taking place in the health service. We have not got to it all, and we need to continue to work on it. I look to Members to assist us in identifying that waste, and I will certainly respond to it where it is identified.
One of the fears or, perhaps, unintended potential consequences, of the necessary reform of services away from centres and towards the community and the patients could be the accidental privatisation of many community services in the years ahead. In other jurisdictions, they have legislated around their reform programme in order to protect and defend against unintended privatisation. Will the Minister give a commitment that he will legislate here in Northern Ireland to do the same and ensure the NHS remains the people’s property and not some private enterprise’s property?
Edwin Poots (DUP)
Absolutely not; that would be providing legislation not to deliver value for money. In my role as Minister, I have a responsibility to deliver value for money. The concept of the NHS is to provide healthcare to all who need it, free at the point of need. That is the important concept of the health service. In respect of domiciliary care and residential care, Mr McDevitt perhaps wants to go back to the days of the long wards in the Royal where people were kept for many years in geriatrics. I much prefer the nursing home model. Although none of us would look forward to entering a nursing home, it is considerably better than the geriatric beds, for example.
Many people with a learning disability have been taken out of such places as Muckamore and Downshire and been rehabilitated in other much better facilities, which are run by the private sector. This nonsense that the private sector is bad and wrong and that those who are involved are only in it for money, and that we should take absolutely nothing to do with it, is exactly that — nonsense. I want to ensure that we provide the best quality of services at the best value for money, and I will ensure that that is the case, no matter who is providing it.
Kieran McCarthy (Alliance)
I thank the Minister for his statement. Paragraph 5 acknowledges the increase in senior citizens that there will be in the years ahead. Can the Minister indicate how those population plans will improve the services for those senior citizens and carers and ensure sufficient respite facilities? There has been an increase in such chronic conditions as heart disease, strokes, diabetes, etc, and, already, concern has been expressed at the shortage or cutback in resources to tackle those conditions. Can the Minister assure the House that adequate funding will be provided for those chronic conditions?
Edwin Poots (DUP)
Well, in terms of chronic conditions, it is about adequate care as opposed to adequate funding. Of course you need the funding to support the care, but we need to use our funding more wisely. Our budget is set to rise to £4·65 billion by 2015, but were we not to change anything, the actual requirement would be £5·2 billion. So, really, Transforming Your Care is an absolute necessity. Imagine if I was to come to this Assembly and say, “I actually need £5·2 billion just to maintain what we have, given the rising needs, so I want other Departments to surrender £550 million to enable us just to keep the thing going”. Yesterday, DRD was looking for more money for that Department; DEL wants more money to employ to help employ people; and so forth. I suspect that I would have great difficulties achieving £550 million over the next three years, so it is absolutely critical that we do things differently. That is why we have invested money in telemonitoring, for example. People say, “Why are you investing £18 million in something like that?” The difference that it will make is that it will keep people who have COPD, diabetes, asthma or other chronic conditions out of hospital, which will reduce our costs. It will keep people out of your emergency departments, which will reduce our costs, and it will provide a better service and better care for those individuals, because if their condition can be managed and we can respond to them more quickly, before that condition deteriorates to the point where they need hospital care, that is a win-win both for the individual and for us financially.
The Member raised the issue of respite care, and I think someone else raised it. It is a very important issue. Respite care, in my view, is fundamental to how we do things. As individuals, carers do a course of work that we could never hope to pay for and that we could never hope to replicate within the system. So, if we do not support carers, including the provision of respite care so that carers themselves do not fall into ill health, that will be completely negative and completely backward and will have serious implications for the services that Health and Social Care delivers. So, I am absolutely committed to providing respite care for carers and for the people that they care for.
Paula Bradley (DUP)
I, too, thank the Minister for his update on Transforming Your Care. Minister, in your statement you said that it was essential that children be given the best start in life. Can you possibly tell us what plans there are to enhance early years provision with a view to improving long-term outcomes?
Edwin Poots (DUP)
I thank the Member for the question. In terms of early years, I think that parenting is critical. We in Northern Ireland have a growing problem: a growing problem in our justice system, and a growing problem with young people starting families who are ill-prepared to start families and do not have the support to do it. Therefore, we require more intervention. Now, I come from a background of not believing in state intervention unless it is absolutely necessary. In this instance, it is absolutely necessary. We have too many children who are brought up and not provided with the proper nurturing, the proper educational support, the proper nutrition or the correct boundaries within life. The parents who are bringing those children into the world need help and support, and we will roll out and extend services such as family nurse partnerships to assist, because the investment that is made in those early years will bring significant and tangible benefits in later years.
All the evidence indicates that investing in early years and early intervention will deliver far more. For example, a child who ends up in a care home costs us around £1,500 per week. We can avoid those situations. We can help parents. If we can actually ensure that children get a better start in life, where they do not have those serious adverse incidents happening in their homes, we will avoid suicides and children ending up in the justice system, and we will reduce the vicious circle that is continuing to grow. That is something that we are committed to doing, and we believe that the family nurse partnerships are of significant benefit, and we intend to extend them further.
Francie Molloy (Sinn Féin)
I thank the Minister for his statement. How will Transforming Your Care impact on children with palliative care needs? What safeguards will be put in place to ensure that end-of-life decisions are taken in full consultation with families so that everyone understands the procedures?
Edwin Poots (DUP)
Palliative care is critical. The role that the families of children with palliative care needs play in decision-making is crucial. There is nothing worse than having a child who has a terminal illness. Therefore, it is wholly appropriate that the parents have every opportunity to understand all the issues, what is available to them, including the clinical procedures and the drugs that might be available, and the potential benefits and negatives. Negatives can often be associated with some of the treatments. Parents and the families of loved ones or, in the case of older people, those people themselves should be allowed to make the choices that are best for them.
It is important that we can offer more palliative care in the home and community setting, away from the hospital. It is important that when people reach the point at which they know that the end of their life is coming quite soon, they can make the appropriate choices and die with a degree of dignity.
I do not see any dignity when a person who is in his or her own home or a nursing home is taken into hospital, goes through the admissions process, goes into a hospital bed and dies within 48 hours. That is not a dignified way to die. There is no dignity in removing people from their own facility, moving them in an ambulance and putting them through all the processes, diagnostics and tests for them to die only a short time later. We have to look at these things again. There is an opportunity to do that, working closely with our GPs and the community to ensure that people have the most dignified death possible.
Gordon Dunne (DUP)
I thank the Minister for his statement and the work on Transforming Your Care to date. Will the Minister advise on any plans to improve access to the most up-to-date treatments for heart attacks?
Edwin Poots (DUP)
We are delivering better results in respect of heart attacks, but we can do better again. The draft strategic implementation plan intended investment to ensure that everyone has 24-hour access to safe, sustainable cardiac catheterisation laboratory services. That includes the introduction of an emergency primary percutaneous coronary intervention (PCI) service, as required by the Programme for Government, with an associated investment of £8 million over the next three years.
With cardiac catheterisation, a very thin plastic catheter is passed into the heart chambers or coronary arteries. A coronary angiography is the most common test using a cardiac catheter. The procedure shows up the structure of the coronary arteries and detects any narrowing. The catheter can also be used to perform operations in the heart, including the insertion of balloons to widen narrowed coronary arteries, which is known as angioplasty. PCI, which is often referred to as primary angioplasty, is a treatment for heart attack patients that unblocks an artery carrying blood to the heart. The real benefits of that, as opposed to just injecting people with thrombolysis drugs, is that it reduces the muscle damage to an individual. The evidence is that if you had to wait for six hours as opposed to having this treatment within the first hour, it would take six years off your life as opposed to one year. So, having 24/7 availability across Northern Ireland for the 1,000 people who require such a service will save lives and also extend considerably the lives of those who recover from a heart attack.
That we intend to make that investment and deliver those services 24/7 is a very positive story coming out of Transforming Your Care today. It is good news for people who suffer a coronary incident.
Samuel Gardiner (UUP)
I thank the Minister for his statement and welcome it. When does he intend to go public with this so that the public can have a view on his statement and voice their opinion, which he can report back to the Department if necessary?
Edwin Poots (DUP)
Obviously, we will not go through the process in July and August, because we would be criticised, and rightly so, for engaging in a consultation process over that period. However, the documents will be made available at that point so that people can have their early considerations heard. We will quality-proof the documents before opening the public consultation in September.
As I indicated, it is critical that the consultation be meaningful and that we hear meaningful responses from the public. It would be unfortunate if we were to get caught up in discussion about this residential home or that one. Those are issues, and we certainly must listen to opinions, but there are far wider issues in the document that we need to listen to the public on, such as the creation of integrated care partnerships; the role of those integrated care partnerships; the role of GPs, in association with allied health professionals, in preventing people from moving into the secondary care sector; and the shift of budget from the hospital sector to the community and primary care sector. Those are all issues on which we need to hear from the public. Therefore, I want the process to be meaningful.
Minister, I join you in commending the staff and commissioners involved in meeting the tight deadlines for the population plans.
You referred to mental health services and population health and well-being, saying that they are crucial elements of Transforming Your Care. In the past two weeks, there have been four deaths through suicide in my constituency. The youngest person to die was 14 years old. Therefore, Minister, will you expand on how suicide will be tackled under Transforming Your Care, recognising that a collaborative approach will be needed to support families bereaved through suicide?
Edwin Poots (DUP)
Suicide is one of the more significant causes of death in Northern Ireland. Sadly, almost 300 people took their own life last year. There was a reasonable reduction on the previous year’s number. Nonetheless, far, far too many people are still choosing to take their own life, for whatever reasons. Around 75% of those who commit suicide are men, a lot of whom belong to the younger generations.
I referred earlier to parenting. For example, where youngsters have three or four severe adverse incidents in the first few years of their life, they are 10 times more likely to self-harm or attempt suicide in their teenage years. Those are all things that we need to look at in the long term, but there are measures that we need to take in the short term to highlight the fact to people that there are better options. We are looking at creating places of safety. Those will not be in hospital emergency departments, because we do not think that emergency departments are the most appropriate places to treat people who have mental health issues and suicide ideation. We want to do a series of things. For example, we want to look at how we might use sportspeople to get messages across. Sportspeople are not immune to mental health issues. In fact, we saw that recently with the death of a young football manager in England. We need to use people who have a high profile and who can reach out and speak to young people in particular about other options.
I appreciate the support that I am getting from Ministers in other Departments. We met last week to discuss the issue. I have met all the Ministers on a one-to-one basis about the issue. This is certainly a course that we need to continue on. Minister McCausland, for example, is assisting us with the minimum pricing of alcohol. I heard what the ‘Belfast Telegraph’, for example, said about many people not agreeing with us on a minimum price for alcohol. However, all the evidence from psychiatrists indicates that alcohol makes a major contribution to suicide. So, in our efforts to reduce this awful thing called suicide, which has taken so many of our young people’s lives, we need to listen to all the evidence that is available and to work very closely together.
Pam Lewis (DUP)
Thank you, Mr speaker is in charge of proceedings of the House of Commons in..." class="glossary">Deputy Speaker, and I also thank the Minister for his update on Transforming Your Care. Obviously, changes will be required throughout the health service, and I assume that that would include the likes of the Ambulance Service. How are ambulance services anticipated to change in the years ahead?
Edwin Poots (DUP)
In the statement, I identified that there was the potential for 40,000 additional responses to 999 calls. That would put huge pressure on the Ambulance Service, which is delivering better in reaching its eight-minute response time, and so on.
The draft strategic implementation plan outlines proposals for the way in which our Ambulance Service would continue to develop new protocols that support the right care in the right place at the right time and with the right outcome. Our focus will be on ensuring that patients have access to services that meet their emergency and urgent care needs. All parts of our health and social care system, including the Ambulance Service, will have to work together to achieve that goal. Protocols need to be outcome driven, reflect best practice and provide alternatives to hospital attendance that support and enable people to manage their health safely in their home when appropriate. They will also mean that, when necessary, patients can be taken without delay to the most clinically appropriate destination. So, an ambulance will very often drive past one hospital to get to another that is the most appropriate for the delivery of that care. We just talked about PCI. Those interventions will not be available in every hospital, but it is critical that we get people to the right facility so that such a situation can be dealt with and the best outcomes delivered.
We need to work closely with the Ambulance Service on ambulance care and support where matters such as people waiting for handover times, and so on, are concerned. I do not think that it is a good use of the Ambulance Service for ambulances to wait for hours before an emergency department can take a patient off their hands. To ensure that the ambulance care that is provided is the most efficient possible, we can do so much more and we can do so much better.
Gregory Campbell (DUP)
I welcome the report. In the Minister’s statement, he outlined the 23,000 extra hospital admissions, the 48,000 extra outpatient appointments and the 40,000 extra ambulance responses to 999 calls that there would be over the next two years. Does he accept and understand that his population plans indicate that, on the Causeway Coast, an additional pressure is created by the tens of thousands of visitors over the summer period? Rather than speculation that the service at the Causeway Hospital will be reduced, will he take that into account and ensure that the hospital has an improved service?
Edwin Poots (DUP)
In spite of all the speculation, the report states that there is no intention of closing the facility at the Causeway Hospital. As far as the future configuration of services is concerned, there will be implications for individual hospitals, but our aim is to provide safe, resilient and sustainable services that can focus on an individual rather than on institutions. We have identified the need — the Northern Trust proposes this — for the trust to manage Antrim Area Hospital and the Causeway Hospital as one hospital on two sites, ensuring that there is 24/7 cover and that doctors are always available at both sites. So, given the speculation that arose some time ago, I think that that is positive.
However, I make it very clear that it is critical and essential that the services that are provided at Antrim Area Hospital and the Causeway Hospital are safe, resilient and sustainable. That puts a huge onus on clinicians in those hospitals to ensure that that is always the case. I do not want the royal colleges deciding at some stage that they are not prepared to support that service. Those decisions should remain in the hands of the Northern Ireland public, through the Assembly, the Health Committee and this Minister or whoever holds the office. Therefore, it is incumbent on those who manage the system and the clinicians who provide that service to ensure that the system is always robust. Those who access services in the Northern Trust do not deserve anything less than a robust, safe, sustainable and resilient service. I will seek to ensure that that continues to be the case.
Edwin Poots (DUP)
I have had the privilege of visiting Mourne Stimulus. The Member is absolutely right: it provides a fantastic service. Great work is done there by the local community and great fundraising work is also done by the local community to further develop that service. We need to support those people. They raised the issue that many in the south Down area have to travel to Dungannon, for example, for respite care. That is an issue. We recognise the nature of the problem and need to look at how that can be addressed.
Given the location of Mourne Stimulus, the South Eastern Trust and the Southern Trust may need to work together to seek to address that issue. Newcastle falls into the South Eastern Trust area, and it may be appropriate for both trusts to work together to try to deliver a solution for people in the south Down area so that they do not have to travel such long distances for respite care. It is a particular problem if someone goes into respite care and something goes wrong. Someone may have just travelled an hour to Dungannon and an hour back, and a couple of hours later they get a phone call to be told that something has happened and they need to go back and collect their family member. They then have to make that trip again. We recognise that that is a problem and need to continue to try to address it.
Jim Allister (Traditional Unionist Voice)
I return the Minister to the subject of the Causeway Hospital. He just said that there is no threat to the facility, and I want to tease out what exactly he meant by that. Did he mean that there is no threat at all to the A&E acute facility at the Causeway Hospital, either in the hours that it is open or the range of facilities that it covers? Is that his assurance? Is there no such threat to those services now or in the future?
Edwin Poots (DUP)
In a previous statement I made in response to the Member for doom and gloom, I encouraged the people in the Causeway area to take some hope after Mr Allister had made particular predictions because he has a very strong track record of getting his predictions wrong.
Edwin Poots (DUP)
He has also got this prediction wrong. The Causeway A&E is not closing. I have made that very clear, and it is in the report and the document around the population plans. For the long-term future, the Causeway Hospital and every facility in Northern Ireland have to be safe, sustainable, resilient and robust. It is for the clinicians in those areas to ensure that that is always the case. I can reflect and look back to when services were withdrawn, for example, in Dungannon, and no Minister or public representative had any say in that whatsoever. It is incumbent on clinicians, wherever they are, to ensure that they identify the system that is right for that area and that deals with the issues in that area.
Mr Campbell, rightly, pointed out that there is a huge influx of people into the Causeway area in the summer. On Friday, I travelled back home from the successful golf event in Portrush, and it took 45 minutes of driving at the speed limit — I was not driving, by the way — to get to Antrim Hospital. In the instance of someone who is quite ill and bleeding in an ambulance that is restricted to 55 miles per hour, such a journey can be very significant and last for over an hour. It is always important to get people to the right place, but there is also the issue of supporting quality services in an area where an already large population is enhanced during the summer. It is incumbent on the Northern Trust management, with local clinicians, to ensure that that service is sustained. There is no political will or desire whatsoever to reduce that service; it is in the hands of the local people who manage and run the Causeway Hospital.
Mickey Brady (Sinn Féin)
Go raibh maith agat, a LeasCheann Comhairle. I welcome the statement, in which you said, Minister, that you: “remain committed to improving the quality of life and support for carers”.
As you know, carers save the health service huge amounts of money every year. Have you had any engagement with fellow Ministers, particularly Minister McCausland, to ensure that carers get access to the available meagre benefits to which they are entitled?
Edwin Poots (DUP)
Clearly, benefits are the responsibility of DSD. Various measures are out there to better inform the public of what benefits are available. I tend to agree that you will never be rich on the benefits that are around. Many people who are providing care are doing no more than scraping through, so it is important for DSD in particular to ensure that people have all relevant information. We in the Health Department are happy to distribute such information through GP surgeries and so forth, and to have it readily available for carers, who often have enough stress without worrying about financial stresses at times.
I, too, thank the Minister for his statement. I am sure that he will feel irritated if I momentarily go back to the Causeway Hospital issue. I am sure that the Minister will agree that someone such as him, in perfect health and travelling in a top of the range Superb car, will have no difficulty getting from Coleraine to Antrim. However, for somebody who has just suffered a stroke or heart attack, any degree of consultation will not shorten the long and tortuous journey between the furthest extremes of the Causeway area and Antrim hospital, which I understand to be the preferred choice of the health trust. Will the Minister please put a stop to the speculation about which he complains by telling the people of that area that the 24-hour A&E department in the Causeway Hospital is safe and that we, as politicians, will have the say on behalf of the population of 150,000, rather than the bureaucrats or the clinicians making the decision?
Edwin Poots (DUP)
I assure the Member that I am neither grumpy nor irritable today, and I am not going to become so now. I am, in fact, in fine fettle. There is no intention whatsoever of closing the emergency department at the Causeway Hospital. It has also been made clear that every hospital in Northern Ireland has to ensure that the services that they provide are safe, sustainable, resilient and robust. That is something that the royal colleges will expect; they will not put their staff into or allow their members to engage in a service that they do not believe meets those standards. It is incumbent on everyone to ensure that that is the case, but there is no political will to reduce services at the Causeway Hospital.
On his example of a person with a heart attack; they, more than likely, will not go to the Causeway or a whole series of other hospitals in Northern Ireland. That is because the PCCI services to which I referred will not be available in the Causeway Hospital. They will more than likely be travelling to Altnagelvin Hospital. As a consequence, they will have a better chance of having their life saved, and, if they get treatment, they have a better chance of having their life extended because they are getting the appropriate treatment. I have often referred to the individual from Ardglass who was taken past the Downpatrick hospital and treated at the Ulster Hospital for a stroke. That person walked out of the Ulster Hospital a week later, because they got the appropriate treatment in that facility. It was much better for that person to have travelled the extra 40 minutes to receive the appropriate treatment than to have come out of the Downe Hospital three months later having suffered the full impact of a stroke because the thrombolysis was not available. It will be the same with heart attacks. So, it is about having the appropriate services at the appropriate hospitals to meet the needs of the population of 1·8 million in Northern Ireland.