Causeway Hospital

Adjournment – in the Northern Ireland Assembly at 4:00 pm on 21 April 2015.

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Photo of Roy Beggs Roy Beggs UUP 4:00, 21 April 2015

The proposer of the topic will have 15 minutes, and all other Members will have approximately five minutes.

Photo of John Dallat John Dallat Social Democratic and Labour Party

It is my privilege and honour to lead on the debate on services at the Causeway Hospital, Coleraine, and to avail myself of the opportunity to comment on Sir Liam Donaldson's report. It is also an opportunity for me, on behalf of the people whom I serve, to pay tribute to the doctors, nurses and all the staff, past and present, who have dedicated their life to striving to bring about and maintain a level of health care at the Causeway Hospital that has the capacity to be second to none and unequalled anywhere in the health service.

Last weekend, a visitor to our home took ill suddenly and had to be rushed by ambulance to the Causeway Hospital, where he received a level of care in A&E and subsequently in medical ward 2 of the hospital that is, I believe, unequalled anywhere in the world. No words could ever describe the life-saving medical treatment and care that our visitor received. During those anxious hours in A&E, while a dedicated team of doctors and nurses worked with our visitor to stabilise him, took X-rays and carried out complex tests, I had the opportunity to see the drama, certainly in my eyes, of the working of a fully functional emergency department. I was amazed at what I saw and came to the conclusion that we must redouble our efforts to ensure that this wonderful facility, which people turn to in times of crisis, is secure for future generations. There is no time to dwell, but I want every man, woman and child to know that, on their doorstep, there are the most wonderful people who are driven not by money or reward but by a vocation unique to the health service.

I also acknowledge recent decisions by the Northern Trust to make significant appointments at the Causeway Hospital that have helped to reduce anxiety about its future. I just hope and pray that the Minister does not accept the one-size-fits-all approach that is based on a cost-cutting agenda and is perhaps more relevant to the health-care problems of large English cities. My arguments are in no small way based on the work of the Causeway Hospital campaign group, which is made up of some of the most dedicated, skilled and experienced people associated with community issues and, in particular, health care.

The Donaldson report, which I referred to in my introduction, acknowledges that we are dealing with an ever-increasing ageing population, but it must be said that it has serious inconsistencies and contradictions that, I feel sure, the Minister must be and needs to be aware of. Perhaps the worst of these is that Donaldson supports all acute services being provided by centrally located hospitals. Only 10% to 15% of acute admissions require rapid or planned transfer to regional units, and there is universal agreement here that patients who need regionally based specialist services should be transferred, as they currently are, using the existing clinical networks, joint protocols and guidelines. In that, there is no problem, disagreement or challenge and certainly no need to propose huge hikes in the salaries of senior and middle management, as suggested in the Donaldson report. In the real-life case involving my visitor, I could see that clearly, as A&E handed over the patient to another team of specialists who followed through the care that was needed to ensure a short stay in the hospital. This is the only sensible way to ensure that A&E is a seamless part of the hospital function. The 85% to 90% who do not require transfer to specialist hospitals should be treated locally, and it is here that we must ensure that the Causeway Hospital remains an acute centre of medical excellence for the vast majority of patients who have no need to be transferred to other hospitals or undertake long journeys, adding to stress, inconvenience and the cost of travelling to Belfast through a heavily congested city with poor public transport and parking.

There is much more to the fatally flawed report by Donaldson, and a lot of it is already obvious. The potential swamping of centre facilities that should be kept for their speciality role must be avoided, but it is already happening with headline news all too often. The unnecessary and intolerable strain placed on the Ambulance Service is already well established, with 96% of paramedic staff reporting stress and other health problems relating to work.

In the case of the Causeway Hospital, if such a daft proposal were to be followed through, it would mean the deskilling and erosion of the confidence of local medical and nursing staff, and that would be a tragedy because I know of no staff more dedicated, more committed and more representative of a health service that puts patients at the centre of its work.

I plead with the Minister not to accept the recommendations of consultants hook, line and sinker, particularly when those recommendations are plucked out of another area which is quite unlike and unrepresentative of our own. Remember, this is the man — I am talking about Donaldson — who was called on to resign by the British Medical Association when he was Chief Medical Officer in England after producing a highly controversial report on modernising medical careers. His record is not without blemish. In our case, he has produced a one-dimensional, management-centred, financially driven report that completely ignores patient-centred local factors.

The Assembly had a difficult birth and its adolescence has not been without trouble, but surely the one thing that we must agree on is our ability to make decisions that suit our people present and future, particularly when there is universal agreement on what should happen for the best reasons.

The arguments for ensuring that the Causeway Hospital remains an acute hospital have been well made by people locally who have worked in the service and dedicated their life to it and by those who have experienced the highest standards of care while they have been patients in that hospital. We all know that nothing remains the same and that change is inevitable, but change must be for the better and must be based on sound judgement and not on the back of a report from an author who does not share the experience of those who have worked in the hospital for a lifetime and know much better what works and what would be a disaster not just for the Causeway Hospital but for the health service as a whole.

In bringing about change, I welcome the increased collaboration between the Causeway Hospital and Altnagelvin Area Hospital. It is something that the previous Minister of Health, Edwin Poots, advocated, and I was pleased to see the current Minister, Jim Wells, in Altnagelvin this week. This is not a one-way street but a genuine exercise in sending patients in both directions to bring about higher levels of specialisation not just for the Causeway Hospital but for the Derry-based hospital, which has important links with Letterkenny General Hospital. Surely, that is good practice that protects the accident and emergency service. We must not allow our accident and emergency service to become simply a shopfront for patients who would be transferred to Belfast hospitals.

Time and again, we are told about problems with the recruitment of senior and middle-grade medical staff over the last five years. That could be corrected by clear investment in the future. Recent appointments and the apparent drive to create new partnerships can remove the uncertainty and will, with little doubt, stimulate interest in applying for posts in the Causeway Hospital and in Altnagelvin. I saw evidence of that at first hand when people from different parts of the world worked in harmony as a team to deliver a health service that is, without doubt, fit for purpose.

It is interesting to note that, since its official opening in 2001, the Causeway Hospital has had no capital investment, while Antrim has had very heavy investment. It is now time to reassess that strategy and to recognise that previous attempts to centralise services 30 miles away were flawed. Perhaps the recent appointments that I referred to are the first visible signs of intent to reverse that policy. I hope so. That needs to be underlined.

In accepting it is time for change, let us make sure that we put the present and the future needs of the community that the Causeway Hospital serves at the top of our agenda. In doing so, let us remember that easy and rapid access to local hospital services is essential, providing as a minimum the services that currently exist at that hospital. That is key.

Let us be reminded that Transforming Your Care has emphasised the need for closer working cooperation between hospitals and community services, with more care to be delivered outside the hospital. The Causeway is ideally suited to develop that concept in view of the already effective links, with GP practices and specialist nurses crossing the hospital/community interface and with the presence of two GP-run community hospitals. Let us learn from the blunders made in other areas, such as Mid Staffordshire, where the disintegration of the health service led to a renewed focus on the basics of general medical and nursing care. The recent report 'Future Hospital' emphasises the need for generalists, rather than super-specialists, to take responsibility for inpatient care and to respond in particular to the increasing prevalence of elderly patients with multi-morbidity. The Causeway is well placed to respond to that.

I emphasised the need for partnership and integration with other providers, but that must be on the basis that the Causeway is not in any way diminished in its core values as an acute hospital not only in name but in practice. The Causeway serves a population of at least 150,000, rising intermittently to 200,000, and caters for a mobile student population. I suggest that it would be utter madness to allow a situation to develop where people would have to travel 40 miles to Antrim or a similar distance to Altnagelvin, leaving a huge area isolated. In that respect, we must use our influence as a local Assembly to rise above those consultants' reports and to do what is best for our people. We should not leave it to a future generation to undo the harm that would be done if a report such as Donaldson's were implemented in its entirety. We need to question those reports and ask who is writing them and what superior knowledge they have over local medical doctors who have spent their entire lifetime working in this area.

Please do not let the hospitals become another railway story. Do not let Donaldson become like the Beeching blunder of the 60s, when thousands of miles of railways were closed down on the back of an ill-informed report that almost destroyed the railway system. Indeed, since that, many of those railways have had to be reopened.

We need to go for it and tackle all the factors that made the Causeway less attractive for recruitment and training. I mentioned collaboration with other hospitals, but in-house training is also vital and demands immediate plans to gain recognition and re-accreditation for a wonderful hospital that deserves to be the flagship of health care covering the entire north-west and beyond.

The Causeway can and will move with the times. It has already demonstrated that it can deliver acute hospital services that are safe, of high quality, sustainable and effective. The challenge to the Assembly and to our Minister of Health, Social Services and Public Safety is this: will you rise above Donaldson? Will you back a winner and give direction to those who are responsible for the long-term planning of health care in the Causeway area? Will you tell them that you believe passionately in the people who make the Causeway the hospital what it is and can be in the future? Will you ensure that there is capital investment and local leadership in planning the future? Will you avoid the blunders of past consultants who had no mandate and little knowledge of the areas that they reported on? Will you prevent them causing a future train wreck of a different type, involving the health and well-being of our people?

In drawing to a conclusion, I know that there are many issues that I have not dealt with, such as the ongoing management of palliative care, midwifery and the relationship with the Ulster University. Hopefully, others will pick up on those and other important issues. I look forward to other MLAs' contributions, because this is a task that we must do together. I particularly want to hear the Minister's response, whom I have confidence in, to the most important issues facing the people whom I and others represent now and in the future.

The Causeway Hospital has not let us down, the people who serve in it have not let us down, and God forbid that the Assembly lets the Causeway down.

Photo of Gregory Campbell Gregory Campbell DUP 4:15, 21 April 2015

I join in acknowledging Mr Dallat's getting the Adjournment debate on the Causeway Hospital and his concluding remarks about the need for a consensus in dealing with this issue, which has been the case ever since the Causeway Hospital opened. I am quite certain that it will continue to be the case as we move on.

There were a number of us who, before the present Minister became the Minister of Health, had either the foresight or the advanced knowledge that he would become the Minister of Health. We invited him to the Causeway Hospital anyway, to ensure that he would see at first hand the great facilities that there were and that he would be able to speak to the staff and the officials there and indicate his support not just for its retention but its development as a first-class facility. I think that it was a good move to get the Minister-to-be to come to the hospital and to get him signed up to the future of the Causeway Hospital. We are glad that he was able to do that.

Mr Dallat referred to a number of issues, and I may refer to one or two of them along with other issues. One of the things that sets the Causeway Hospital apart from other acute hospitals is the fact that, between now and September, the catchment population for the Causeway Hospital increases by about 70%, which is not applicable to any of the other acute hospitals across Northern Ireland. Of course, that is because of the coastal resorts, the thousands upon thousands of caravans that are located on the Causeway Coast and the holiday homes and the second homes that are based on the coast. It has the capacity to deal with many, many more minor injuries, and it has to do that over a five-month period that other hospitals do not have to deal with.

There has been a continuing concern, since within two or three years of the Causeway Hospital opening, about its future. About four or five years ago, for a prolonged period of time, possibly about 12 months, there was a concern that the hospital's future as an acute hospital at all was in considerable doubt. Campaigns were launched to ensure the retention of the hospital, and, of course, that moment passed. After that, again for a prolonged period, there was a concern and a fear in the locality that, while the hospital's future was secure, the A&E in the hospital also might be under threat. Over a period of time, thankfully, with work done on that, that concern has receded, although not disappeared entirely. I know that a number of us have been in regular contact with the trust and the Health Minister to try to ensure that this hospital is not just retained in the services that it currently provides but builds for the future.

On this occasion, I concur again with Mr Dallat — I will make sure that this will not be a repeated offence in that I will concur all the time with Mr Dallat — about the need to build the relationship between Altnagelvin and Causeway. So much can be done about that, whether it is maternity services or other services that I know they are looking to develop between the two sites. This is good and is positive for the future. The staff at the hospital are magnificent, as they are in each and every unit across Northern Ireland, and we need to offer them our unstinting support. I look forward to hearing from the Minister what his reaction and response is to the debate and to keep repeating the assurances of the commitment to the site and to develop it. Of course, as health provision changes into the future, the hospital's staff, the Department, the current Minister and subsequent Ministers will have to adapt to the changing needs.

Photo of Roy Beggs Roy Beggs UUP

Will the Member draw his remarks to a close?

Photo of Gregory Campbell Gregory Campbell DUP

I recommend the Adjournment debate to the Minister, and hopefully he will be able to respond positively to it.

Photo of Cathal Ó hOisín Cathal Ó hOisín Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I thank the Member who secured today's Adjournment debate. It is a very important topic.

I visited the Causeway Hospital last Friday, where I met senior clinicians and staff about their concerns, as I have done many times before. Many of those concerns remain the same today as they were previously; namely, the apparent lack of security of tenure, morale issues, and the perception that the Causeway Hospital has not been developed and resourced in the manner in which it should. The Causeway Hospital is an excellent hospital with outstanding staff, but it could be better utilised, funded and equipped. Indeed, for my part, coming from an area that is equidistant between Coleraine and Derry — that is, the Limavady and Dungiven area — I can say that Altnagelvin is better equipped and more easily accessed due to the better roads infrastructure. The Causeway Hospital remains the choice of many for access and treatment due to the positive experience of the patients there. Those people have voted with their feet, and that is why they are acknowledged by the clinicians and staff there.

A wide range of services and departments is available, including an emergency department; a children's ward; a day procedure unit; dermatology services; a fracture and pain clinic; gynaecology services; a minor injury unit; three outpatient departments; an X-ray department; an ICU; a maternity unit; medical photography; two medical wards; two surgical wards; a rehabilitation ward; theatres; and the Ross Thompson psychiatry unit. That is a fairly extensive guide to the services provided at the Causeway, but if we drill down into the form and nature of the service provision, we will see a different story. One of the clinicians I was talking to last Friday was Mr Barry Marshall, who is one of the chief obstetricians there. He told me that, even in the maternity unit, staff are not able to take expectant mothers for the birth of their babies if they are, for example, diabetic or have an above-average body mass index, even though they would be well capable of delivering the babies in the unit in such cases. The mothers have to go elsewhere — to Antrim or Altnagelvin. Those are not isolated circumstances. A less-than-holistic delivery service is available at the Causeway, and that is very much to be regretted.

Those matters have led to a degree of frustration among staff there. There is more than a perception that it has led to difficulties in recruiting and attracting staff to the Causeway. I am not sure what can be done to address that inability directly, but we must look at the underlying issues. The location of the Causeway Hospital is also critical, owing to its essential place in the delivery of health provision, both geographically and physically. For example, the glens of Antrim are a large and isolated area served by the Causeway. Furthermore, the entire Causeway Coast attracts hundreds and thousands of visitors during the summer months. That alone would justify the provision of adequate services at the hospital.

Historically, it might have been better to have had an acute hospital somewhere halfway between the two current hospitals at the Causeway and in Antrim, but we are where we are, so we must address the issue. I was recently informed that the urology department is to be moved, and that too is to be regretted.

I fully support fully the Causeway Hospital, the retention and expansion of its services, and the adequate and proper resourcing of those services.

Photo of Robin Swann Robin Swann UUP

I start by congratulating Mr Dallat on securing this Adjournment debate, because it was near enough three years ago to the day — 29 May 2012 — that he brought the same topic to the House. Having reflected on the contributions in Hansard from then, I can say that progress is being made at the Causeway Hospital. At that time, the tenor of the debate was very much around the future of accident and emergency services.

As has already been referred to, it is the large geographical area and the populace that the Causeway Hospital services that makes it unique among our hospitals, as well as the fact that the new council area — Causeway Coast and Glens Borough Council — has one of the highest levels of elderly and retired people living in it. Mr Campbell referred to the 70% increase in people to be serviced by the hospital as a result of the influx during the summer months. As Mr McQuillan said in the debate two years ago, that hospital is vital for the sustainability of the air show and the North West 200, two highly dangerous sporting events, which could be put in jeopardy should that level of service and support not be there. That is seasonal, but it is not as if everybody disappears during the winter months because that is when the large student population comes into the area, and they need looking after as well.

The basis for Mr Dallat bringing this Adjournment debate are the concerns that are being raised locally by staff, hospital users and the general populous. What is coming down the road, and what is the future of the Causeway Hospital through Transforming Your Care or the Donaldson report? That is what is adding to the local disquiet. Encapsulated in that is the Northern Trust's model of service, which seems to be based on an acute service in Coleraine, with A&E solely facilitated there, and the threat that would pose to the Causeway.

I welcome the recent appointments of senior clinicians to the Causeway, which have started to give a little bit of reassurance and security to the rest of the staff. I would like reassurance from the Minister that that is a continual path of development, involving the retention and expansion of the services that are already there. We see a contradiction in some of the Northern Trust's policies, which is why we are looking for that reassurance. Dalriada Hospital, which is used as a step-down facility to the Causeway, being under threat adds to the general unease in the local area. We really need that reassurance.

I have heard Members comment on the great service we get from the staff but, from the user's point of view, there still seem to be increasing pressures on A&E at times, when it has to close and patients are diverted. So, I would really like reassurance from the Minister that there can be some kind of review of provision to make sure that A&E is adequately provided for, as well as other departments in the hospital. What the Causeway needs at this time is certainty, and it is the Minister who can provide that certainty and give the staff of the Causeway, people who use it and the general populous around area that reassurance. I hope the Minister can provide that certainty in his summing up today.

Photo of Mervyn Storey Mervyn Storey DUP

I welcome this opportunity to discuss again what I believe is, as other Members have said, a vital service in our local community. I speak on a personal basis, given that my father has had to avail himself of the services of the Causeway Hospital for the last three weeks, following a small heart attack. I know that I speak with my father's endorsement when I say that the care that he has received, not only in the Causeway, but in Altnagelvin for a short time — Mr Dallat made reference to the working relationship between the two hospitals — was exemplary. Certainly, on a personal basis, as a family, we have nothing but the highest praise for the provision in the Causeway Hospital.

Comment has been made about where we were and concerns and fears. Let us be quite blunt and honest: some of those concerns were hyped up by politicians, who, for their own ends, wanted to use an issue such as the Causeway Hospital for cheap political point scoring. I am glad that what we have heard so far has been not been in that vein, having heard scare stories in the past that the hospital was closing and coming to an end.

Let us remember that I come from a town that knows what it is like to lose a hospital. The Causeway Hospital came into existence as a result of the closure of the Route. It took a long time for the people in my part of the North Antrim constituency to become accustomed to the fact that the new hospital was down the road in Coleraine, but they now look upon it as their local hospital and have bought into it. Just the other day, I called into see Dr John Robb, someone we all have known for many years.

He expressed his appreciation of the fact that, after all the years of transition from the Route to the Causeway, people have bought into the Causeway Hospital as their local service. We need to give Fred Mullan and his staff credit; some comments were made about the staff. Fred Mullan has done an exceptional job since taking up his post and needs to be given all possible support.

The Minister will probably have something to say about this, but let us remember that Simon Stevens, who took up the position of chief executive of the NHS in England in April, said that small hospitals were vital in meeting the needs of an ageing population and would provide focus for the community services that have become "too complicated and too fragmented". In many respects, that is a reflection of what we see being provided at the Causeway.

The trust has a responsibility to ensure that its sets out its vision for services in the entire area. Despite all that we can say that is positive — there is a lot to be said that is positive — there is still a concern about what happens between the Causeway and the Antrim Area Hospital sites. There is a tension there, and you only have to speak to staff to realise that there is sometimes that concern.

I look forward to the trust setting out its vision in what I trust will be a very short time. Politicians can then collectively give their support to ensuring that we continue to see the provision of services such as A&E. I have been lobbying the trust for some time to provide dialysis services in the Causeway, and I welcome the fact that it is now considering the provision of those services very seriously. That will bring its own challenges and opportunities. We have to look a bit wider at what a service can bring to an area and the implications that it could have, and I am well aware that the provision of dialysis services would raise concerns about the number of medical beds.

I had a very productive meeting with Dr Tony Stevens and with Valerie Watts. We need to keep our focus very clearly on the provision of services. At the heart of it is the community that the hospital serves.

I commend the Member for securing the debate. Let us collectively, as politicians, work with the Minister, the trust and the board to ensure that the Causeway Hospital continues to provide for our community in the way that it has done.

Photo of George Robinson George Robinson DUP 4:30, 21 April 2015

I am pleased to speak in the Adjournment debate, and I congratulate the SDLP Member Mr Dallat for securing it. I congratulate all the staff at the Causeway Hospital, who have proven that they are professional, friendly and caring. I have heard those words used many times by patients and relatives alike. I also want to be positive in my contribution, as recruitment and the hospital's future are being positively addressed.

I have spoken to representatives of the Northern Trust and have learned that five consultants have been appointed in surgery, gastroenterology, respiratory medicine, obstetrics/gynaecology and internal medicine. I have also learned that a consultant cardiologist is being recruited for a joint post between the Causeway and Altnagelvin hospitals. Specialist doctors in general surgery, obstetrics and anaesthetics have also been appointed. That is fantastic news and will ensure continuing and permanent services at the Causeway Hospital.

I want to outline my support for the Causeway Hospital and express my relief that the chief executive has stated his commitment to it. That has been reflected in the appointments that have been made, which will, hopefully, ensure that the other posts are filled soon. All those positive changes add great confidence and boost morale among the Causeway Hospital's staff and, indeed, the wider community in the causeway area. The list of appointments does not show a hospital that is earmarked for closure. Indeed, I welcome the fact that those new appointments will secure the Causeway Hospital in line with the commitments from the trust's chief executive, Dr Stevens, Dr Fred Mullan and others.

At some stage, a great boost to the hospital and staff would be a programme of separation and independence for the Causeway and Antrim hospitals. I also welcome the trust's developing a service for elective surgery that will further secure the future of the Causeway Hospital and the vital role that it plays for the local community and visitors to the area.

Indeed, the tourist sector benefits greatly from the presence of the Causeway Hospital. The North West 200, the air show and Portrush raft race are just some of the major attractions that we look forward to in the north-west. We may have the Open golf tournament, perhaps as early as 2019, when the Causeway Hospital will play a vital role for dozens of tourists and visitors to our beautiful north coast as well as our student population.

There is also a close working relationship between the trust, the unions and the voluntary and community sectors that, I hope, can be extended in future to serve the entire population of the Causeway area. Despite scaremongering from some quarters, I have always believed that the Causeway Hospital can be maintained as a viable facility, and I have not changed my belief. The most important people of all in achieving this are the staff, who form a remarkable unit of professionalism.

In conclusion, I quote the Northern Trust:

"The Northern Trust is well placed to deliver real and effective integration of hospital, community and social care services. In the Causeway and Glens area, this would be based around an acute hospital in Coleraine with an emergency department and supporting clinical services."

Those words bring me reassurance, as I hope they do to all the staff and residents of the area. The Causeway Hospital has a positive and important future in health provision for the north-west of Northern Ireland. I and my colleagues, including the Health Minister, will always be available to support the chief executive, staff and others in their endeavours to keep a world-class health facility at the Causeway Hospital.

Photo of Adrian McQuillan Adrian McQuillan DUP

As a Member for East Londonderry, I welcome the debate on the future of the Causeway Hospital, and I want to make it clear at the outset that I fully support its retention as an acute hospital and nothing less.

There has been much speculation about the future of the Causeway Hospital over the last number of years that has caused fear and distress among all in the area and for staff and users of the facility. There is no denying that that scaremongering added to the difficulty of recruiting and retaining clinical staff, which itself added to the question of the hospital's future. However, the recent filling of a number of permanent consultant posts, with more in progress, has given the hospital the much needed morale boost that it has been longing for.

There is no doubt that there is a need for a hospital; otherwise such appointments would not have been made. The hospital is a key asset in delivering integrated services to a very large catchment area. Let us not forget that the population rises on the north coast over the holiday period at times of significant sporting and leisure events, such as the North West 200, which attracts over 100,000 visitors, and the air show, which, last year, attracted around 200,000 visitors to the area. There are many more that I could add.

A large proportion of the East Londonderry constituency is rural and isolated, and for constituents in those areas it is vital that acute services and a 24-hour emergency department remain fully functioning. The hospital has borne the brunt of some seriously negative press in the last year, but there have also been some very positive aspects that did not attract as much media attention. It has had excellent results in achieving improved waiting times through initiatives such as changes to work patterns for senior medical, nursing, allied health and managerial staff and the introduction of the community rapid response service. The staff must be commended for this because they worked extremely hard at all levels to achieve that improvement when many other hospitals were experiencing an increase in their waiting times.

The Causeway Hospital continues to provide a significant range of services, including an accident and emergency department. I believe that morale at the hospital will continue to improve with the Minister's reassurance of his commitment to retaining these services in future. That can only add to the continuing improvement of the services received by and care provided to this extensive area, including the north coast and further afield.

We are all very aware of the hard times facing all Departments. However, I am sure that the Minister will continue to support the retention of the Causeway Hospital and will make his spending cuts in other areas with less impact on front-line services to the area. I also urge the Minister and the Causeway Hospital management to continue to be proactive in advising and informing staff, users and campaigners at the hospital to reduce the risk of any further rumours escalating and to keep morale up in all areas of service from front-line services such as domestic and caring staff up to consultant and senior management level. Historically, mistrust between senior management and staff has added to the low morale. Thankfully, the new chief executive has so far demonstrated a very hands-on approach and worked closely with staff and elected representatives to build relationships, which can only be welcome.

The Minister has also been very proactive in his involvement with staff and user groups, which is reassuring to them and the wider public. I have always been vocal in pledging my support for the retention of the Causeway Hospital. I have no fear and continue to state my categorical support for the hospital and its services. I will continue to support the staff, users and campaigners in the best way I can to ensure that those services and that hospital have a future for many years to come.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

I commend Mr Dallat for securing the debate and join in the warm tribute that he paid to the staff and personnel of the Causeway Hospital, which provides that vital service not just to East Londonderry but to much of North Antrim. I welcome the fact that there is, at present, the appearance of more stability attached to the future of the Causeway Hospital. I am a little surprised by the attack by Mr Storey on his colleague the outgoing MP for North Antrim, who spoke about the threat of closure to the Causeway Hospital, but I welcome the fact that, with recent appointments etc, it looks a little more stable.

I want to draw the Minister's attention to one particular issue, because it is important that we nail down some matters in the debate. The Minister said in a recent answer to me — he may well have said it to others — that he is:

"committed to retaining Causeway Hospital as a small acute hospital. The model for services ... will be based around an acute hospital in Coleraine with an emergency department and supporting clinical services".

The same Minister — here is the area that I seek clarification on — has embraced with great enthusiasm the Donaldson report, which sets its face against small acute hospitals. It sets its face in favour of centralising acute services. Indeed, it is so audacious in its first recommendation, which the Minister has, it seems, accepted, that there should be an international panel and that we should all blindfold ourselves in advance and commit to accepting the outcome. I certainly will not do that, and I trust that the Minister will not do so.

I would like the Minister to explain where the future lies between his commitment to the retention of Causeway and his embracing of Donaldson, with his agenda against such hospitals. I do not think that you could read the Donaldson report and conclude otherwise than that the Causeway would be one of the hospitals within his target range for the closure or reduction of acute services. The Minister needs to be very emphatic and very clear with the House tonight about what he means. What will he emphatically stand by in regard to the retention of the Causeway as an acute hospital, or does the equivocation that might arise rest in the use of the word "small"? Is he in fact trying to marry the audacious attempts of Donaldson and his commitment to the Causeway Hospital with some sort of agenda to diminish facilities? Will the Minister be absolutely clear? How does he square his embracing of the anti-small acute hospital agenda of Donaldson with his embracing, which is welcome, of sustaining the small acute services such as we have? I trust that that will be faced up to and made very clear.

Will the Minister also be clear to the House about what he sees as the future of the maternity unit in the Causeway? That is the other area of considerable concern that the Minister needs to address. He needs to put the matter beyond doubt so that the outgoing MP for North Antrim might not again be concerned about the potential closure of the Causeway Hospital.

[Interruption.]

Photo of Roy Beggs Roy Beggs UUP 4:45, 21 April 2015

Order. I remind Members not to make remarks from a sedentary position.

Photo of Claire Sugden Claire Sugden Independent

Like other Members who have contributed so far, I thank my constituency colleague Mr Dallat for tabling the Adjournment debate. Whether it is unfounded or not, there remains significant concern about the future of Causeway Hospital in its entirety or in the services it provides. I also welcome the positive contributions by Members in the House thus far, particularly by the Minister's party colleagues, because they are in a really unique position to encourage and ensure the future of the Causeway Hospital. I hope that they will continue to support it in the way in which they have shown today.

I suppose that I want to follow on from Mr Allister's point about the Donaldson report, because it is one of the points that makes me understand the uncertainty around Causeway. Yes, the Minister has shown his commitment to Causeway being an acute hospital with an A&E supporting clinical services. That is fantastic, but the devil is always in the detail. I would like the Minister to give more information about the way in which it will move forward as an acute hospital. Will it have a 24-hour A&E service, and what clinical services will it provide? To be fair to the Minister; up until now, the problem with the uncertainty about Causeway has been the investment it has had. Until recently, there have not been any clinical appointments or capital investment. There has been no development. Is that part of the Minister's future plans to ensure that Causeway will remain part of all this?

To come back to the Donaldson report; it is not a terrible report. I take issue with parts of it. At the end of the day, we are not England; we are Northern Ireland. We do not have the same infrastructure. We are a rural constituency. Perhaps, if the Minister's Executive colleague had seen fit to extend the A26 through to Coleraine, there might be more of an argument to reduce the services at Causeway, but he did not do so. Right now, in the position in which we find ourselves, the Donaldson report is not quite applicable to Northern Ireland.

I agree with Mr Allister that the Minister, up to this point, seems quite enthusiastic about it. That does give me concern for Causeway, particularly when the Minister was asked about Causeway and his response was that, with a population of 1·8 million, 10 hospitals was not appropriate for Northern Ireland. That was in response to a question about Causeway, so that makes me think that forefront in the Minister's mind is that the Causeway Hospital is one too many for Northern Ireland. I hope that the Minister does follow through on his commitment and is not paying lip service to the people in the Public Gallery and to the fact that we have an election in a few weeks' time. I hope that he really does put substance behind the fact —

Photo of Gregory Campbell Gregory Campbell DUP

I thank the Member for giving way. I understand what she is referring to. However, with regard to certainty or uncertainty about the future of the hospital, would she agree that the recent very welcome clinical appointments to the hospital — and, as I understand it, further appointments to be made in the forthcoming weeks and months — are hardly an indication of a lack of commitment to the hospital, but rather the reverse?

Photo of Roy Beggs Roy Beggs UUP

The Member has an extra minute.

Photo of Claire Sugden Claire Sugden Independent

Thank you. I thank the Member for that question. Yes, Mr Campbell, I agree that that does perhaps suggest that there is some sort of investment in Causeway, but that investment is a long time coming. We need to ensure that it remains in Causeway. I understand that these appointments, whilst they are at the Causeway Hospital, are within the Northern Trust. That means that they can be shifted about to other hospitals. I hope that the Minister will give his commitment in other ways as well the recent appointments, but I do take that fair point.

To conclude my contribution to the debate, I ask the Minister to clarify and, again, to reiterate his commitment to the Causeway Hospital with a wee bit more detail. Will the A&E be open 24 hours or will it be part time? That was referred to me earlier and I think it is cause for concern.

Photo of Claire Sugden Claire Sugden Independent

Yes. Please, go ahead.

Photo of John Dallat John Dallat Social Democratic and Labour Party

Is the Member aware that the A&E department in Coleraine hospital is, on many occasions, much busier during the night than during the daytime?

Photo of Claire Sugden Claire Sugden Independent

Yes. I thank the Member for that. I am aware of that, but other Members in the House have also brought up the fact that our population increases significantly in the summer holidays, which would also need to be taken into account during the daytime. I am somewhat sceptical about making it a part-time A&E service, but if this debate comes down to that, and if that is what Causeway is going to be, I would rather we get it out now so that we can start preparing for it and so that the people in the Public Gallery can find out what is going on beyond the simple commitment to Causeway Hospital and its A&E.

Photo of Jim Wells Jim Wells DUP

First of all, I thank Mr Dallat for his patience. This debate was due to have been held last week, but because I was witnessing first-rate care in the Royal for my wife, I simply could not make it. I am glad that the Assembly Business Office and, indeed, the Business Committee were able to facilitate his request to have the debate moved on a week.

As the Member for East Londonderry Mr Campbell said, I visited the Causeway Hospital at his request. I have to say that that was in my capacity as Deputy Chairman of the Health Committee. I was impressed by the large number of staff who arrived at the door to meet me and by the very detailed tour of the hospital that I had. I was due to go back to the Causeway quite recently, but, again, because of the problems with my wife's health, I was not able to make it. However, I commit to visiting the Causeway as soon as possible and to discuss some of the issues raised.

I know Fred Mullan very well. He went to Queen's with me many years ago, and I have kept in touch with him about this issue. I have found his input and that of all the Northern Trust's senior staff very helpful. I thank Mr Dallat for raising the issue, and I take this opportunity to thank all the staff at the Causeway Hospital for their service to the local community and for their commitment to deliver high-quality health services. I think that every Member who rose to speak during the debate made exactly the same point, which is that there is absolutely no problem with the standard of service that the people of the north coast are getting from that team.

The hospital is in one of the most beautiful scenic areas of Northern Ireland. In fact, it is almost as scenic as south Down. That was a joke, by the way, in case 'The Coleraine Chronicle' should happen to raise it in next week's edition. The hospital provides services to the local population and the many visitors who come to enjoy the north coast's beaches, attractions and, of course, its world-class golf courses. Such an area needs a vibrant hospital, and I am, therefore, committed to retaining the Causeway Hospital as a local acute hospital. I hope that that allays Mr Allister's fears.

The model for services in the Causeway and the glens area will be based around an acute hospital in Coleraine, with an emergency Department, supporting clinical services, a well-developed intermediate care service and community teams evenly distributed across the area. Of course, it is a very wide area. Perhaps one of the most fortuitous aspects of local government reorganisation is that the new council area more or less fits very neatly the area the Causeway Hospital covers, going right out to Limavady at one extreme and right over to Moyle in the other.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

I am obliged to the Minister. Can I take it, then, that the Minister is repudiating the Donaldson philosophy in the case of the Causeway Hospital? Is the Causeway proofed against the Donaldson philosophy? Is the Minister prepared to say that to the House?

Photo of Jim Wells Jim Wells DUP

It is worth saying that Donaldson did not make any reference whatsoever to the Causeway Hospital.

Photo of Jim Wells Jim Wells DUP

Yes. He made a statement. I am going to come back to it, because the Member raised a very crucial point about recommendation 1 of Donaldson. I wish to deal with that, because several Members, including Claire Sugden, raised it, and I want to deal with it.

What I can say to you is that that is our position on the Causeway Hospital. Donaldson is out to consultation, which ends on 22 May. I am not going to pre-empt the public response to Donaldson on a whole range of issues. Let me remind you that there was more than one recommendation in the Donaldson report. Everybody has homed in on recommendation 1, to some extent ignoring the other nine recommendations, which are equally important. I will come back to that, and I am sure that the Member will remind me if I do not.

There are partnership arrangements for the community and voluntary sector within the Causeway area. That supports the integrated model of service. The commitment to maintain acute services at the Causeway Hospital was clearly demonstrated in January this year, when the Northern Trust made new clinical appointments to the hospital. Many people raised that issue. Those are permanent appointments.

I want to come back to the concern about the lack of continuity of tenure. I do not know where that is coming from; these are permanent salaried posts in the Causeway Hospital, including consultants in surgery, respiratory, obstetrics and gynaecology and a consultant physician in internal medicine. They have been appointed and funded, and they are there on a permanent basis.

Photo of Jim Wells Jim Wells DUP

Certainly.

Photo of Claire Sugden Claire Sugden Independent

Although those appointments are currently based in Causeway, they are trust appointments as opposed to Causeway Hospital appointments. The Northern Trust also encompasses Antrim hospital and others, so could it, in the future, be that those appointments are moved elsewhere?

Photo of Jim Wells Jim Wells DUP

All appointments made in Northern Ireland are made to a trust rather than a specific hospital. These posts were advertised, and it was made very clear to the applicants that they were for the Causeway. They were in response to demands from many MLAs and the MP for the area for new permanent staff. It is a huge commitment by the board and the trust to the Causeway that those have been made. We are also making a joint appointment to a post with Altnagelvin hospital for a consultant cardiologist; that person is in the process of being recruited. That gives us an indication. On top of that, as Mr Campbell said, the trust is recruiting three further posts: a consultant in emergency medicine, a consultant physician in general medicine and care of the elderly and a consultant physician with an interest in respiratory medicine. Those are very highly qualified and highly paid clinicians. If you add up all those appointments, it is a very significant revenue investment in the future of the Causeway Hospital.

I have to be honest — many people have mentioned this — that there were difficulties and uncertainty about the future of the Causeway Hospital, and it was difficult to recruit consultants as a result of that. As a result of the new management team that we have in the Northern Trust, there is a much brighter future and a certainty. There is a commitment from the chief executive to the Causeway that has encouraged senior clinicians to apply for positions in the Causeway. Much of the praise for the turnaround in that situation has to go to the new chief executive and his team, who have done a lot of work to transform the future of the Northern Trust from one that was shrouded in doubt to one where there is a very bright future. That augurs very well for the future of the Northern Trust. Equally, public representatives tell me that there is an open-door policy; Members of the Assembly and MPs who have problems and difficulties are getting their voices heard by the new management team. That has to be a good thing.

Causeway Hospital, like several other smaller acute hospitals across Northern Ireland, has, in the past, experienced difficulties. However, these appointments are good news for the people who use the Causeway Hospital. It is expected that these permanent — I emphasise that word — postings will enhance the continuity and quality of care for patients. I do not know where the problem that Oisin — sorry, I will say "Oisin" because I cannot pronounce his second name — identified about the lack of continuity is coming from.

Photo of Jim Wells Jim Wells DUP

I certainly will.

Photo of Cathal Ó hOisín Cathal Ó hOisín Sinn Féin

I accept that the Minister has confirmed the degree of permanence of a number of the positions, but the issue about continuity is referenced in the service provision itself, as well as by some of the individuals. As I said, I believe that the urology department is moving to Altnagelvin as of now. That is where the uncertainty comes from.

Photo of Jim Wells Jim Wells DUP

That is a valid point. Urology is a particularly difficult area throughout Northern Ireland. Every trust is finding it difficult to recruit consultants in that field. Indeed, yesterday, in response to a question about cancer waiting lists, I quoted urology as causing 35% of the delays. However, that is a specific issue that is related not so much to the Causeway but to that specialism, where we really cannot appoint people at all when vacancies arise. I would like to think that all the other issues that I have quoted indicate that there is a commitment to the Causeway.

In capital investment, remember that the Causeway opened only in 2001. I very clearly remember it being built. A friend of mine designed the roundabout at the hospital; I remember chatting to him about it. It is a very modern hospital. You would not expect a huge degree of capital investment in a hospital of that age because it is still relatively modern. That having been said, we spent £2·3 million and £1 million in the last two years, so there is £3·3 million that has been invested in that hospital.

That is entirely normal. Current projects under consideration for the Causeway Hospital include the installation of a wind turbine generator at an estimated cost of £1·2 million. There is already one at the Ulster University and one at Antrim Area Hospital. Again, the fact that we are prepared to spend such a large amount of money on renewable energy indicates a commitment to the site and to hospital. As Members will be aware, Transforming Your Care recommended three options for the future management of the Causeway Hospital.

[Interruption.]

Photo of Roy Beggs Roy Beggs UUP

Order, Members.

Photo of Jim Wells Jim Wells DUP 5:00, 21 April 2015

My predecessor indicated that an appraisal of the future management options for the Causeway Hospital should be informed by the work of the turnaround and support team that was appointed to the Northern Trust in 2013. A key element of that team's work was a series of service reviews, including the networking of clinical services and the development of a new model for medical leadership and management.

I remind Members that I was up in Londonderry last week, where I inspected the new cath labs that have been installed. They are absolutely state of the art — the most modern on the island of Ireland and in the United Kingdom. The people of the Causeway area have access to those. Indeed, while I was there, there was a patient from Coleraine and a patient from Castlerock, both in the Northern Trust area, being treated by that outstanding technology. That shows the advantage of sharing services with Altnagelvin. In both cases, within the hour, the patient had been transported from the scene of their cardiac arrest to the cath labs and treated in a very effective way. That shows that the new links with Altnagelvin are bearing fruit. Now, it would not be possible to have a cath lab at the Causeway in Coleraine or, indeed, at any smaller hospital in Northern Ireland, but it is good that we have hypothecated that service for not only the Western Trust but a very large section of the Northern Trust.

It is important that the work of the turnaround and support team be substantially implemented before further work is carried out on the options appraisal on future management arrangements. When the recommendations from the team have been implemented, the focus can once again turn to the appraisal of the management options recommended by Transforming Your Care.

Donaldson is out for consultation. The points that have been made today should be made to Donaldson. Mr Storey has just made a point of handing me 'Causeway's Future: Proposals for the Way Forward for Causeway Hospital', which was prepared by the Causeway Hospital Campaign group. Those are all the sorts of points that the Donaldson review wants to hear. We are not wedded to any particular recommendation of Donaldson, but I was enthusiastic, because Donaldson has caused us to stop and think on many issues about where we are going in Northern Ireland and how, in many ways, we can configure our services. It has prompted the debate that we need to have. There are MLAs and MPs who see a very bright future for the Causeway Hospital through documents such as this. It is important that the review team has that information and can take it on board.

People who might cast aspersions on Liam Donaldson's track record have to remember that we are talking about the Sir Alex Ferguson of health. This is an individual who was the Chief Medical Officer for England and has vast experience and an impeccable track record in this field. When he makes recommendations, we should sit up and take note. That does not mean that we slavishly follow everything that he says, but we have to give it due and careful consideration. I think that Mr Allister is slightly wrong to say that —

Photo of Jim Wells Jim Wells DUP

He is entirely wrong to suggest that we should bin the Donaldson review or not take it into account.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

I do not think that I said to bin the Donaldson review. I invited the Minister to square the circle between Donaldson, which states that 10 hospitals is too many and therefore —

[Interruption.]

This may be a matter of disinterest to Mr Storey, but it is a matter of great interest to his constituents. Donaldson said that we should bin the 10 acute hospitals and centralise resources: you cannot do that and allow the Causeway Hospital to escape. Therefore, I ask the Minister to reject any Donaldson consequential as far as it affects the Causeway and to make that abundantly clear.

Photo of Roy Beggs Roy Beggs UUP

I invite the Minister to draw his remarks to a close.

Photo of Jim Wells Jim Wells DUP

All that I can say in reply is that there is not much sense in me calling a consultation on Donaldson and then issuing an edict as to what I think it should agree. When the consultation is closed, we will have a chance to sit down and analyse what has been said alongside documents such as this and the Hansard report of this debate. We can then have an intelligent debate on the best way in which to configure hospital services in Northern Ireland.

That is as far as I am prepared to go at this stage, but I hope that the huge investment we are making in the Causeway Hospital in staffing at the moment indicates how important a role we see it having in the north coast area.

Adjourned at 5.05 pm.