Health Provision: Armagh City and District
Cathal Boylan (Sinn Féin)
Go raibh maith agat, a Phríomh-LeasCheann Comhairle. Cuirim fáilte roimh an deis an díospóireacht thábhachtach seo a chur os comhair an Tionóil inniu. I am grateful for the opportunity to debate this important topic in the Chamber today. I thank the Minister for taking the time out to attend, and I look forward to his response and the contributions of other Members, who are well aware of the issues around the health sector in Armagh city and district.
I remind those in the Chamber of the significant impact of the reduction in health service provision in the Armagh city and district area over the past years. As many people know, Armagh has not had the major private investment that other areas of the North have had. It is not an industrial hub. It has been known primarily for its public sector jobs, its array of niche shops and its tourism product, with its cathedrals, Emain Macha, which is Navan Fort, the observatory and its links to St Patrick, to name but a few.
Ceantar agus cathair Ard Mhacha. Armagh city and district has long been recognised as a centre for public sector jobs, be it in the administration of the local government authority, education, the Department of Agriculture and Rural Development, and health, especially as it includes the St Luke's Hospital site, which contains the Mullinure and Longstone hospital facilities. Over the years, that led to the building-up of a highly skilled pool of workers in the health sector. Unfortunately, a review of health and social care has seen the services provided decimated, which has had the knock-on effect of employees being relocated, job losses and service contracts being made void. That has had an impact on the local economy.
I will briefly outline some issues that have arisen in this sector over the past four or five years. The St Luke's hospital complex is one of the oldest in Ireland, and has provided psychiatric care for many years.
Mickey Brady (Sinn Féin)
Does the Member agree that when we had meetings with the trust and the Department about the scaling down and eventual closure of St Luke's as a psychiatric hospital, we were told that the new Bluestone unit at Craigavon Area Hospital would cater for approximately 80 patients, which would solve the problems? I know, because of the number of people in Newry with queries, that that has not been the case. That unit has not been able to cope with the number of cases. St Luke's was always a mainstay in the constituency, particularly for those from the Newry area. It was recognised as a very good facility, and, unfortunately, that was taken away, without any rationale given.
Cathal Boylan (Sinn Féin)
Also on this site, Longstone Hospital provided long-term care and an assessment and treatment unit for adults with a learning disability. Thirdly, Mullinure Health and Wellbeing Centre provided patient care for people with dementia in the Gillis Centre and a one-stop elderly assessment clinic.
As far back as April 2008, I asked questions of the previous Minister about the complex. Given the proposals under the Bamford Review of Mental Health and Learning Disability, concerns had been raised about the long-term care for those in the hospitals and about the staff. So after care had been provided at the complex for years, the then Minister implemented changes that included ward closures and left only skeleton services, mostly administration, at St Luke's, Longstone and Mullinure. Services and patients were relocated to Craigavon, and vulnerable patients were placed on the care in the community programme. Since 2008, services have been moving out of the city and district. All this took place despite thousands of people in the Armagh city and district, supported by all parties in the local council, all the MLAs, the constituency MP and the trade unions opposing each and every proposal and putting forward suggestions that would have had the desired efficiency savings. This was all to no avail. Changes were forced through, and the people of Armagh city and district had to endure the changes that they were united in opposing.
The next major overhaul of the health system was the relocation of the minor injuries unit at Mullinure Hospital to Armagh Community Hospital, which, in itself, was not a major bone of contention. What shocked people was the reduction in the service provided. Health provision in the area — a mixture of GP, Armagh Community Hospital and out-of-hours at Mullinure — reduced from a 24/7 service to one available to 7.00 pm, five days a week. Now, people in the Armagh area who find that they need health provision that is deemed non-emergency but is severe enough to require urgent attention must travel to the closest A&E, which is at Craigavon Area Hospital, a location that requires patients to have a car because, as we all know, the transport system in Armagh city and district does not exist in the evening.
Once again, this review was opposed by all the political parties, unions and the public, 9,000 of whom signed a petition. However, once again, the views of the majority were ignored. At that point, the people of Armagh city and district really believed that they had become second-class citizens in the eyes of the health service. Now, we are in the midst of another review; this time of the GP out-of-hours service that was transferred from Mullinure to Armagh Community Hospital at Tower Hill. Although assurances have been given, you cannot blame the people of Armagh for being sceptical and thinking that, once again, a service will be hit in a way that will be of no benefit to the local community.
I welcome the Minister being here, and, on behalf of the citizens of Armagh city and district, I appeal to him to personally look at the minor injuries unit in Armagh. Look at the proposals put forward by the local council as a corporate body, which would have extended the unit's opening hours to midnight, with services such as X-rays and diagnostics provided, while still making efficiency services. Those proposals would give an effective service to Armagh city and district, while relieving the burden on an already overstretched Craigavon A&E department. I also urge him to ensure that the current GP out-of-hours service is retained and personally prove to the good people of Armagh city and district that they are not second-class citizens and that they are entitled to the same standard of healthcare that befits other areas throughout the North.
Before I conclude, I want to talk a wee bit about the consultation process for GP out-of-hours services. I hope that the Minister will give us an assurance that the consultation will be a proper participatory process in which all the people affected by the changes can get involved and that any suggestions that they bring forward will not just sit on the shelf but will be deemed appropriate for change if necessary.
I will also put on record that Mairead McAlinden from the Southern Health and Social Care Trust has offered to meet me, and I will take up that opportunity.
In closing, I ask the Minister to outline plans for future healthcare provision in Armagh city and district and give some reassurance to the public and the workers that all will be done to provide the best care for the community and that resources will be given to the staff to provide it.
William Irwin (DUP)
Healthcare provision in the Armagh city and district area has been a topic for discussion in the Assembly and, critically, at local council level. I am a member of Armagh City and District Council, and I have been actively involved in the council's collective efforts to maximise the potential for services in the city and district area and to try to consolidate the services that are provided there.
That has not been without its difficulties, as representatives from the area can testify. However, our current Health Minister, with his forthright views, his extremely hands-on attitude to his departmental duties and his focus on getting things done, has meant that we have a clearer picture of the vision for services in the city and district area. I am sure that the Minister will mention that in his response.
I am also pleased that a local council-led campaign to ensure that Armagh remains a hub for public sector employment, including health sector jobs, remains on track. Indeed, the Minister announced recently that a human resources centre for the sector in Armagh has been secured, which is a welcome boost not only for the people directly employed in the service but for the local economy.
There has been some concern locally about the changes to the minor injuries provision in the city and district area. I know that the Southern Trust fully briefed our local council about its future plans and was rigorously questioned by elected representatives. Not all the recommendations have been met with approval from local representatives, but any service decisions have to be based on solid facts. Although some concerned people expressed great anger in the local press at the changes, some pointed to statistics that illustrated that only one patient every three hours was using the service at Mullinure Hospital.
The extension of operating hours at Armagh Community Hospital at Tower Hill from 9.00 am to 7.00 pm can be viewed either as a cut in services or as a consolidation of existing services. Obviously, people are concerned about out-of-hours provision and the distance from Armagh city to Craigavon or Dungannon. However, I feel that the distances are not beyond acceptable in the majority of circumstances. Make no mistake, this is an emotive issue, and the people in the district have responded to it. I will be keen to see how the service copes after bedding in, and I will be interested to see performance reports to gauge how well the changes have been received and the statistics on the use of the service at Tower Hill following the extension of the opening times.
The Assembly, and the entire community, is better off with a Minister who is prepared to roll up his sleeves and tackle difficult issues. That is a very welcome change from what went before. I will continue my efforts to ensure that Armagh remains a location for healthcare services and public sector employment, and I urge all parties to do likewise.
Healthcare provision across the Province is changing, and we need not only to prepare for change but to ensure that any such changes meet the needs of a changing population. No major decisions have yet been taken about overall future provision in the Southern Trust area, but I know that consultations will be carried out on any proposed changes, and I have no doubt that people will fully engage with those consultations.
Indeed, I feel that the response and engagement of Armagh people has been tremendous to date and shows exactly how seriously people in the area view their health services. Coupled with a very proactive local council in Armagh, I know that future proposals will be scrutinised at a very high level. The lion's share of the Budget in Northern Ireland is spent on healthcare. Therefore, the greatest consideration must be given to how that money is spent in order to achieve the maximum benefit for the patient.
Danny Kennedy (UUP)
I am grateful for the opportunity to contribute to the debate. I thank its sponsor and acknowledge the attendance of Minister Poots in the Chamber. Many of the points have already been covered, including the historic position of Armagh as an important location not only in that region but in Northern Ireland generally.
Armagh does not have a lot of what might be called heavy industry. It is very reliant on the public sector. Over the years, the significant number of jobs in local government, education and particularly health have been so welcome and necessary. Historically, health provision in Armagh has been excellent at the various locations through the medical services and dedication of staff. I want to place on record my appreciation for the quality of healthcare in Armagh in all its respects and responsibilities. We have been very well-served as a community.
It is regrettable that the trust did not respond to the petition that was signed by 9,000 local people seeking to save the 24-hour service. Out-of-hours services play a crucial role as the first point of contact and provide urgent care and treatment at times when other services are closed. Instead of the provision that was previously available all day, every day, seven days a week, the trust has now moved to a pilot scheme that offers the service on a more limited basis of 9.00 am to 7.00 pm, five days a week.
Of course, that decision can be traced to the backdrop of reduced resources in the face of, it might be said, growing demand. The Member who introduced the Adjournment debate might want to reflect on and detail what action his party colleagues in the previous Executive took to support the former Health Minster to secure additional resources at a very critical time. I recognise the challenges that are faced by Minister Poots, other Ministers and, indeed, the trust. However, it is regrettable that anyone who requires the services of a minor injuries unit outside the hours that are now provided for will have a considerable distance to travel, either to South Tyrone Hospital in Dungannon or to the A&E in Craigavon.
We are a fairly diverse and far-flung constituency, much of which is rural. This will put a strain on the service provided to that rural population. I ask the Health Minister to give an undertaking that there will be no further dilution of the remaining services, such as the out-of-hours service; that he will look closely at the results of the pilot study and the ongoing service that is being provided; and that he will ensure that the trust has carried out all necessary procedures in arriving at this decision. I have no doubt that —
Mickey Brady (Sinn Féin)
I thank the Member for giving way. I did not want to interrupt Mr Irwin while he was eulogising the Minister; he was in full flow. I absolutely agree with Mr Kennedy, but one of the points that my colleague Cathal Boylan made was that, after closing time in the minor injuries unit, people have to travel to Craigavon. More so than most of us, you are in a position to realise the public transport difficulties. I am not trying to be facetious, but would that be factored in to any long-tem planning? Under Transforming Your Care, there may be other changes about which we do not know. Is that in your vision and on your radar? People who do not have access to cars have a genuine difficulty.
Danny Kennedy (UUP)
I am grateful for the advice from the Principal speaker is in charge of proceedings of the House of Commons in..." class="glossary">Deputy Speaker. The Member has put his views on the record. Clearly, I have other responsibilities outside this debate, and, if a thing is to be called joined-up government, I can accept the Member's point. However, what he is talking about is not without its problems or its challenges either. We are all in a challenging situation, but I think that it is essential that the maximum amount of healthcare is available at the point of need to our constituents in Newry and Armagh, and, particularly in this case, Armagh city and the surrounding district. I very much hope that the Minister will listen closely to the points that were made and to the concerns about ongoing support and service to those people who want to make sure that their representatives are speaking for them in a debate of this nature.
Go raibh míle maith agat, a Phríomh-LeasCheann Comhairle, agus tá áthas orm páirt a ghlacadh sa díospóireacht thábhachtach seo faoi chúrsaí soláthar leighis i gceantar agus i gcathair Ard Mhacha. Go deimhin, do thugais féin rún chuig an Tionól sa bhliain 2009. Ar an drochuair, níor éistíodh liom an lá sin; tá súil agam go bhfuighidh mé éisteacht níos fearr sa lá atá inniu ann.
Thank you very much, Mr Principal speaker is in charge of proceedings of the House of Commons in..." class="glossary">Deputy Speaker. I welcome the opportunity to take part in this important debate, and I thank Mr Boylan for securing the time in the Chamber. Indeed, we debated this topic previously when I secured an Adjournment debate back in 2009. Unfortunately, on that day our pleas were not listened to, nor were the pleas of the people of Armagh. The Minister's predecessor decided to close and relocate services out of Mullinure Hospital to Dungannon and Lurgan. I hope that today's time will be spent more fruitfully with the present Minister.
As Mr Boylan said, there have been more changes to the services with the relocation of the minor injuries unit from the Mullinure site to the community hospital at Tower Hill. In itself, relocation of services is not an issue. Co-locating the minor injuries unit, the GP out-of-hours services and community hospital services on the one site makes very good sense. However, it does not make sense in my mind, nor in the minds of the people of Armagh and district, to reduce hours in, for example, the minor injuries unit in Armagh. In March, I attended the Southern Trust's board meeting to try to persuade it against its decision that has meant that Armagh city and district is left with no evening or weekend cover. If local residents need access to a minor injuries unit after 7.00 pm or at the weekend, they will have to travel, as was said earlier, to Dungannon or to one of the emergency departments in Dungannon or Newry. That does not make sense because our emergency departments are already under pressure, and we should not further pressurise them with minor injuries.
Health provision does not begin or end at the community hospital or minor injuries unit. I rise to express concerns about the condition of the health estate across the greater Armagh area. Armagh goes beyond the primate's wall, and that is the crux of the matter in my view. Beyond Armagh, there are rural communities in Clady, Granemore, Derrynoose, Madden, Middletown, Killylea, Tullysaran and in many other hamlets and villages in between. It is a very rural part of Northern Ireland, and the view of the community in those areas is that health services do not stretch beyond Craigavon. Indeed, at one time, Armagh had numerous hospitals such as St Luke's, Mullinure, Tower Hill and the City Hospital. However, in recent years, those hospitals have been closed, one by one, and with their closure came the withdrawal of services.
In time of need, our first point of contact is quite often the local GP surgery. However, if you look at the GP accommodation at Willowbank in Keady or at the Richhill health centre, you will see excellent GPs offering an excellent service in what can only be described as substandard, cramped conditions and out-of-date accommodation, yet a £300,000 centre for adults with learning difficulties remains unused and empty in Keady five years after it was completed. Is that a good use of resources for Armagh?
Today, I take the opportunity to ask the Minister to review health provision in the Armagh area. We need a strategic view and a plan for the future that will build on and invest in the services offered at Armagh Community Hospital and support the services at Daisy Hill in Craigavon. As I said earlier, we need investment in the GP surgeries in Keady and Richhill and increased hours at the minor injuries unit in Armagh to recognise the rural hinterland that that unit serves. As Mr Boylan pointed out, we also need maintenance of the GP out-of-hours service.
I have already indicated the feelings of the community, and several Members have referenced the well-supported petition on health. Many people in the Armagh area believe that their services are not funded to the extent that is needed. They have witnessed those services crumble in recent years at a time when the population of the Southern Trust is growing. It has both the youngest and oldest population in Northern Ireland, yet the Southern Trust is underfunded by the Department's capitation formula. I appeal to the Minister to protect the services that are left in Armagh, keep them close to the community and bring forward proposals to address the very serious inadequacies in health provision in the greater Armagh area. Sin a bhfuil le rá agam anois. Go raibh céad maith agat as an deis cainte.
Edwin Poots (DUP)
I am grateful for the opportunity to hear the views of Members on this issue. As Health Minister, my vision is to ensure that services provided by health and social care providers meet the needs of patients, clients and local communities, and my aim is to continue to support the development of high quality integrated and responsive primary and community care services that will benefit all those who live in Northern Ireland. The people who work in health and social care services — the doctors, nurses, therapists, administrators, ancillary staff and managers — are the true determinant of high quality services. It is they who deliver the high-quality service for patients and clients. I am strongly committed to the principle that health and social care services should be driven by, and be responsive to, the needs of patients, clients and their carers, and I believe that truly high-quality health and social care services can only be delivered when they are resourced and designed around the needs of people who use them.
I realise that some people are anxious and concerned about the future of our services, especially in the present financial climate. I understand and share their concern, but with strong leadership involving people and effective planning, I believe that the challenges we face can be met.
The vision that I have for health and social care is one that will drive up the quality of services and outcomes for patients, improve outcomes and enhance the patient experience. I want to ensure that service users are at the heart of everything we do. Patients are entitled to receive the right care in the right place at the right time. They are at the centre of our policy developments and our planning assumptions. The design and delivery of services that meet needs and expectations is what really matters to patients.
One of my key objectives, which I frequently refer to, is the development of an enhanced role for primary care, working hand in hand with healthcare providers and patients in designing and delivering consistently high-quality safe and needs-based care in community settings.
In relation to the minor injuries unit, the Southern Trust has recently made changes to services in Armagh with the centralisation of services at Armagh Community Hospital. The service at Armagh Community Hospital had its opening hours extended to 7.00 pm. The minor injuries unit at the Mullinure site, which provided a service overnight at weekends, has closed. Unfortunately, that service was not well utilised, with one patient attending every three hours. In times of financial constraint, we cannot afford to spend money on staff waiting for patients to come to a facility. We need to have the patients to justify it.
Decisions relating to the provision of local minor injuries services are matters for the local health and social care trust to determine in consultation with local people. Indeed, I understand that the pilot scheme, extending the opening hours of Armagh Community Hospital to 7.00 pm, was the result of discussion with the local council, prior to public consultation. I know that the Mullinure minor injuries unit was greatly valued by some of the local population; however, it is essential that we make the appropriate use of health service resources. Mr Kennedy indicated that the previous Minister struggled somewhat with resources, and the truth is that we have to take decisions like this to properly utilise the resources that we have, otherwise somewhere else suffers. We simply cannot afford to spend money on a service that the public are not using, for whatever reason.
I understand, too, that some people are fearful that Armagh is losing a safety net of sorts by not having access to the unit overnight and at weekends for minor conditions. There is no question of Armagh being left without access to urgent and emergency care because of the closure of Mullinure. Emergency care is available from Craigavon Area Hospital, and the 999 service is available for serious emergencies. The GP out-of-hours service will provide urgent care, and the South Tyrone Hospital MIU provides minor injuries services seven days a week.
The Health and Social Care Board launched a public consultation in the strategic framework for GP out-of-hours services in June. The purpose of the framework is to facilitate the development of future provision of GP out-of-hours services across Northern Ireland. The framework focuses on how access to GP out-of-hours services can be simplified and where opportunities to align those services with other healthcare services can be maximised and made efficient. At the same time, it also ensures that safe and effective GP out-of-hours services are available to all our population.
GP out-of-hours services are a vital component of the health and social care system. As a first point of contact for the public, they provide urgent advice, care and treatment at a time when GP surgeries are closed. The consultation on the strategic framework reflects the need for GP out-of-hours services to evolve and develop in order to accommodate the changing healthcare system in Northern Ireland. The recently published report 'Transforming Your Care' (TYC) proposes changes to the way in which health services are delivered in local communities. The need to provide the right care in the right place at the right time is a key principle of that change, and the development of GP out-of-hours services across Northern Ireland will be an essential component.
The public consultation will enable Health and Social Care staff and public and key stakeholders to contribute their views to the future design and configuration of GP out-of-hours services. The consultation period will run for 13 weeks from June 2012 until Friday 20 September.
TYC implementation will mean bringing health and social care services closer to people in their home and their community — moving services out of hospitals where it is safe and appropriate to do so. That shift left will include a more personalised approach to care and an emphasis on moving resources towards prevention and health promotion. As part of the process, draft population plans were produced by local commissioning groups in liaison with the health and social care trusts and others. The population plans provide a basis for taking forward a number of TYC proposals, particularly in respect of the service configuration and the shift left of services from secondary care into primary and community care and the configuration of acute services.
The population plans have been based on criteria and guidance to ensure that the proposals put forward meet our needs for safe and resilient services and quality outcomes. The draft plans have been subject to quality assurance work over the summer period. The quality assurance work on the draft is being concluded. It is a critical process, involving input from a range of stakeholders. It will ensure that the population plans and the strategic implementation plan provide a sound basis for how our health and social care services are delivered in the future.
No decisions have been made on the final shape of services in the southern area. However, it should be said that I cannot undo decisions that were taken in 2008 and 2009 on St Luke's and other facilities. Those decisions are long past the post and are not something that I can change at this point.
Reference was made to transportation issues. Again, that is not in my bailiwick. Perhaps Members may wish to have a debate on that on another occasion.
Cathal Boylan (Sinn Féin)
I thank the Minister for giving way. I had an opportunity to attend the presentation on GP out-of-hours services. Although all of us in the House recognise that there is a reliance on cars, especially in rural areas, that matter came up in discussions about how the consultation would go forward. The discussion said exactly that: there is a requirement for cars in the countryside. Part of the process is that there will be access to services. However, I want to see a proper service provided, and that should be the starting point as opposed to the notion that it is OK because people in rural areas have cars and, therefore, they will be able to access services. If you take the district itself and the people out at the Derrynoose end, which is right on the border, who have to access services in Craigavon or 999, that is a long way away. I am sure that the Minister will take on board the fact that it is about the provision of service, and the tools to deliver that service are key.
Edwin Poots (DUP)
I am very well aware that public transport is not great in the Armagh area. When we looked at relocating office jobs in the health service to Armagh, one of the objections that came from members of staff was the poor public transportation linkages. However, that is not something that I have any control over. It should be noted that, as regards business services, we have put 80 jobs towards Armagh, and that will be happening quite soon. We decided to have those jobs in Armagh and utilise the vacant facilities left in the health estate by previous decisions.
A consultation document is being prepared to assist the consultation process that will issue with the revised draft strategic implementation plan and population plans. The consultation process should be launched within the next month. The consultation will be supported by a wide range of engagement events that will allow patients, service users and the wider public to have their say. Any decisions on the future configuration and provision of services will be informed by the consultation. Any major service changes will be the subject of a separate consultation. As outlined earlier, my aim is to bring about change in our health and social care system to deliver better prevention and early intervention, so that that care is more patient-centred, closer to home, resilient and safe, and delivers the best possible outcomes well into the future to meet the needs of citizens in Northern Ireland.
Adjourned at 6.40 pm.